bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Imaging (MRI)and Electroencephalographic (EEG) Findings in a Cohort of Normal Children With Newly Diagnosed Seizures
Authors: Doescher Jason S. , deGrauw Ton J. , Musick Beverly S. , Dunn David W. , Kalnin Andrew J. , Egelhoff John C. , Byars Anna Weber , Mathews Vincent P. , Austin Joan K.
Published: January 2017

In the initial assessment of children with new-onset seizures, the suggestion that electroencephalography (EEG) should be standard and that magnetic resonance imaging (MRI) should be optional has been questioned. The purposes of this study were to (1) describe the frequency of EEG and MRI abnormalities and (2) explore relationships between MRI and EEG findings to determine their relevance in the assessment of children with new-onset seizures who are otherwise developing normally. As part of an ongoing, prospective study of children with new-onset seizures, we studied 181 children (90 girls and 91 boys). Children were entered into the study within 3 months of their first-recognized seizure. The association between EEG and MRI abnormalities was explored using a chi-square test. Abnormal MRI findings were found in 32.6% ( n = 59) of the sample. The EEG and MRI results agreed with respect to classification into normal or abnormal in 37% ( n = 67). Of the 50 children with a normal EEG, however, 21 (42%) were found to have an abnormal MRI. We found an unexpectedly high frequency of imaging abnormalities in our sample of otherwise normal children, although the significance of these findings is not clear. Follow-up of these patients will help us interpret the importance of the abnormalities. Despite our relatively small sample, however, our findings indicate that a normal EEG does not reliably predict a normal MRI in children with first seizures. ( J Child Neurol 2006;21:490—495; DOI 10.2310/7010.2006.00127).
High Levels of Alzheimer Beta-Amyloid Precursor Protein (APP) in Children With Severely Autistic Behavior and Aggression
Authors: Sokol Deborah K. , Demao Chen  , Farlow Martin R. , Dunn David W. , Maloney Bryan , Zimmer Jennifer A. , Lahiri Debomoy K.
Published: January 2017

Autism is characterized by restricted, repetitive behaviors and impairment in socialization and communication. Although no neuropathologic substrate underlying autism has been found, the findings of brain overgrowth via neuroimaging studies and increased levels of brain-derived neurotrophic factor (BDNF) in neuropathologic and blood studies favor an anabolic state. We examined acetylcholinesterase, plasma neuronal proteins, secreted beta-amyloid precursor protein (APP), and amyloid-beta 40 and amyloid-beta 42 peptides in children with and without autism. Children with severe autism and aggression expressed secreted beta-amyloid precursor protein at two or more times the levels of children without autism and up to four times more than children with mild autism. There was a trend for children with autism to show higher levels of secreted beta-amyloid precursor protein and nonamyloidogenic secreted beta-amyloid precursor protein and lower levels of amyloid-beta 40 compared with controls. This favors an increased α-secretase pathway in autism (anabolic), opposite to what is seen in Alzheimer disease. Additionally, a complex relationship between age, acetylcholinesterase, and plasma neuronal markers was found. ( J Child Neurol 2006;21:444—449; DOI 10.2310/7010.2006.00130).
Sequence Analysis of the Structural Nuclear Encoded Subunits and Assembly Genes of Cytochrome c Oxidase in a Cohort of 10 Isolated Complex IV—Deficient Patients Revealed Five Mutations
Authors: Coenen Marieke J.H. , Smeitink Jan A.M. , Pots Jeanette M. , van Kaauwen Edwin , Trijbels Frans J.M. , Hol Frans A. , van den Heuvel Lambert P.
Published: January 2017

The mitochondrial oxidative phosphorylation system is composed of five multiprotein complexes. The fourth complex of this system, cytochrome c oxidase (complex IV), consists of 13 subunits: 3 encoded by mitochondrial DNA and 10 encoded by the nuclear genome. Patients with an isolated complex IV deficiency frequently harbor mutations in nuclear genes encoding for proteins necessary for the assembly of the complex. Strikingly, until now, no mutations have been detected in the nuclear encoded structural subunits of complex IV in these patients. We report the results of a mutational analysis study in patients with isolated complex IV deficiency screened for mutations in all structural genes as well as assembly genes known to cause complex IV deficiency. Four patients carried mutations in the complex IV assembly gene SURF1. One patient harbored a mutation in the COX10 gene involved in heme A synthesis. Mutations in the 10 nuclear encoded structural genes were not present. ( J Child Neurol 2006;21:508—511; DOI 10.2310/7010.2006.00136).
Longitudinal Assessment of Neuropsychologic and Language Function in Children with Benign Rolandic Epilepsy
Authors: Northcott Ellen , Connolly Anne M. , McIntyre Jenny , Christie Jane , Berroya Anna , Taylor Alan , Batchelor Jennifer , Aaron Galia , Soe Samantha , Bleasel Andrew F. , Lawson John A. , Bye Ann M.E.
Published: January 2017

Previous studies of benign rolandic epilepsy have reported improvement in cognitive functioning over time. Their focus was the impact of paroxysmal electroencephalographic (EEG) activity on neuropsychologic function. Comprehensive longitudinal language assessment has not previously been undertaken. In a cross-sectional study, we demonstrated that some children with benign rolandic epilepsy have difficulties in verbal and visual memory and phonologic awareness. The current study evaluated a subgroup longitudinally to determine if difficulties improved. Twenty-eight patients underwent comprehensive longitudinal neuropsychologic and language assessments. The clinical features evaluated included seizure frequency, absolute age, medications, and a follow-up EEG. Differences in performance were analyzed using t-tests. Improvement in cognitive functioning, particularly in the areas of verbal memory, receptive language ability, and phonemic manipulation, was demonstrated. Visual memory and aspects of phonologic awareness showed no change. The improvements were not related to the clinical variables. It is important to recognize cognitive difficulties in children with benign rolandic epilepsy. Some difficulties can resolve; however, continued monitoring, particularly in areas of visual memory and phonologic awareness, is required. ( J Child Neurol 2006;21:518—522; DOI 10.2310/7010.2006.00138).
In Vitro Evaluation of Poly-(ε-Caprolactone-Co-L-Lactide) Implants Containing Trypanocidal Drugs
Authors: Lemmouchi Yahia , Schacht Etienne
Published: January 2017

Poly(e-caprolactone-co-L-lactide) copolyesters with different compositions were synthesized by bulk polymerization. The copolymers were characterized by NMR, GPC, and DSC analyses. Slow release devices were obtained as rods by extrusing polymer/drug mixtures (75/25, w/w) prepared by solution casting. The rods were coated by dipping in a methylene chloride solution of the core polymer. The in vitro release of isometamidium chloride (IMM) and ethidium bromide (EtBr), from these rods was carried out in phosphate buffer (PB) pH 7.4 at 3700. The release of IMM is faster than for EtBr. Initial IMM release is governed by osmotic pressure, whereas EtBr release is mainly diffusion controlled. The in vitro release of these drugs is governed by polymer matrix degradation at the later stage of the release process. The in vitro release of IMM from these copolymers depends on polymer composition and coating thickness. The in vitro release of EtBr may be controlled by polymer composition, polymer molecular weight, coating thickness, and device geometry.
Permeation of Proteins through a Biodegradable Hydrogel
Authors: Škarda Vaclav , Rypáček František
Published: January 2017

The permeation of proteins of different molecular weights into a biodegradable hydrogel, a model system for controlled release of biologically active macromolecules, was investigated. The hydrogels were prepared by a crosslinking copolymerization from a biodegradable synthetic polypeptide, poly[N5-(2-hydroxyethyl)-L-glutamine] (PHEG) with methacryloylated side chains and acrylamide. The permeation of sodium azide, trypsin-kallikrein inhibitor (TKI), trypsin, and albumin into the gels with network densities between 0.04 and 0.226 mmol/mL were determined.

The permeation of sodium azide was not influenced by the gel network density. The permeability of T[and trypsin was controlled by gels with permeability coefficients ranging from 2.8 x 10−9 to 4.0 x 10−10 mmol/mL. Gels with different network densities controlled the diffusion of peptides and proteins with molecular weights between 6,000 and 60,000. The combined effect of diffusion and biodegradation of the gel on the permeation rate of macromolecules was determined for poly-α,β-[N-(2-hydroxyethyl)-DL-aspartamide]. A decrease in the gel cross-linking density due to the degradation efficiently increased the permeability to the model macromolecule.
Branched and Linear Poly(Ethylene Glycol): Influence of the Polymer Structure on Enzymological, Pharmacokinetic, and Immunological Properties of Protein Conjugates
Authors: Veronese Francesco M. , Caliceti Paolo , Schiavon Oddone
Published: January 2017

Linear and branched poly(ethylene glycol)s, with similar molecular weights, were conjugated with uricase and asparaginase, and an investigation of enzymological, immunological, and pharmacokinetic properties of the conjugates was carried out. It was found that the steric hindrance of the branched polymer has a relevant role in determining the biological properties of the conjugates. Conjugations with branched polymers inactivate the enzyme less than the linear ones. Compared to the native and the linear polymer conjugate counterparts the branched polymer derivatives: (1) are more stable to proteolysis by elastase, pronase, and trypsin, (2) stay longer in the blood with increased systemic availability after intravenous administration in mice, and (3) give rise to lower levels of antinative enzyme antibodies after immunization. These data are consistent with a greater surface area of protein covered by the branched PEG.
Fluorescence and Turbidimetry Study of Complexation of Human Serum Albumin with Polycations
Authors: Güney Orhan , Saraq A. Sezai , Mustafaev Mamed I.
Published: January 2017

Complexation of poly(N-ethyl-4-vinylpyridinium bromide) (PEVP) and poly(N-ethyl/cethyl-4-vinylpyridinium bromide) (PECVP) with human serum albumin (HSA) was studied by fluorescence spectroscopy and turbidimetric titration in dilute aqueous solutions. Solubility of polycation-HSA complexes depends on the initial concentrations and ratios of the components, pH, hydrophobic-hydrophilic balance of the macromolecules, and existence of low molecular salt (NaCl). A soluble interpolymer complex which is formed at low concentrations of polycation is insoluble at high polycation concentrations. The average fluorescence quantum yield of HSA decreases as polycation binds to the protein. The maximum reduction in emission intensity of HSA indicates the number of the HSA molecules bound per polymer chain. Quenching of HSA fluorescence by PECVP is decreased in the presence of NaCl at pH 7.0 but not at pH 4.3.
Fate of Biodegradable DL-Lactic Acid Oligomer Microspheres in the Articulus
Authors: Nishide Masato , Kamei Shigeru , Takakura Yoshinori , Tamai Susumu , Tabata Yasuhiko , Ikada Yoshito
Published: January 2017

The objective of the present study was to investigate the biodegradation and tissue responses of dl-lactic acid oligomer microspheres in the knee articulus. Different-sized microspheres containing a fluorescent dye were prepared from oligomers with different molecular weights (Mw) by a solvent evaporation method. Following intra-articular injection into the kneejoint of rabbits, the microspheres were localized at the popliteal fat tissue, irrespective of the microsphere size and oligomer Mw. When degradation of the microspheres injected intra-articularly was evaluated based on the decrease in the fluorescent intensity of microspheres remaining, the microspheres were degraded with time to finally disappear in the articular cavity. The degradation periods of microsphere prepared from 3,000, 5,600, and 7,000 Mw oligomers were 5, 10, and 17 days, respectively, whereas no size dependence on microsphere degradation was observed. No inflammatory response to the microspheres by the synovial tissue was observed; however, there was a temporary increase in the number of white blood cells in the articular cavity, irrespective of the microsphere size.
Cell Growth on Poly(EGDMA/HEMA) Based Microbeads
Authors: Ayhan H. , Piskin E. , Gürhan I.
Published: January 2017

Poly(EGDMA/HEMA) copolymeric microbeads were prepared by suspension polymerization. A comonomer, i.e., HEMA, was included in the formula in order to provide functional hydroxyl groups on the microbead surfaces. Toluene was used in the polymerization formulations to introduce porosity into the matrix. Hydroxyl groups were first oxidized with NaIO4, and then two biological molecules, namely collagen and fibronectin were immobilized by using glutaraldehyde. A spacer-arm, i.e., hexamethylene diamine, was also used in some cases. More protein molecules were immobilized onto more swellable microbeads using spacer-arm. Higher amounts of collagen were immobilized, more than fibronectin immobilization. Growth of two cell lines, 3T3 and MDBK, on these microbeads with a wide variety of surface properties was studied in vitro culture media. Growths of both cells even onto the plain microbeads were significant. More cell proliferation occurred with the more swellable microbeads. More cells proliferated on the microbeads carrying fibronectin covalently attached onto the microbeads through spacer-arm molecules. Fibronectin was better than collagen for promoting high proliferation. The mathematical model proposed successfully simulated the growth kinetics.
Metastatic Pulmonary Angiosarcoma Presenting With Bilateral Secondary Spontaneous Pneumothoraces
Authors: Jimenez Daniel , Antaki James , Kamangar Nader
Published: January 2017

Background:

Spontaneous pneumothorax (SP) is uncommon and can present as a primary disease process or as a result of underlying lung pathology. Several parenchymal lung diseases, such as malignancy, are known to cause SP. One such malignancy, angiosarcoma, has a high propensity to metastasize to the lung and present as cavitary and cystic lesions.

Case:

We present a case of a 76-year-old male diagnosed with angiosarcoma of the scalp that was found to have extensive cystic pulmonary metastatic lesions. Soon after his initial diagnosis, he presented with severe respiratory distress secondary to a spontaneous left-sided pneumothorax. After intubation and left-sided chest tube placement, the patient developed a right-sided tension pneumothorax requiring emergent chest tube placement.

Conclusion:

Cutaneous angiosarcoma is a rare malignancy that frequently metastasizes the lung. Spontaneous pneumothorax can be the presenting manifestation of the disease and often results in respiratory failure.
Effects of Reinstitution of Prolonged Mechanical Ventilation on the Outcomes of 370 Patients in a Long-Term Acute Care Hospital
Authors: Sansone Giorgio R. , Frengley J. Dermot , Horland Allan , Vecchione John J. , Kaner Robert J.
Published: January 2017

Objective:

To investigate the effects of the reinstitution of continuous mechanical ventilator support of >21 days in 370 prolonged mechanical ventilation (PMV) patients, all free from ventilator support for ≥5 days.

Methods:

Four groups were formed based on the time and number of PMV reinstitutions and compared (group A: reinstitutions within 28 days, n = 51; group B: a single reinstitution after 28 days, n = 53; group C: multiple reinstitutions after 28 days, n = 52; and group D: no known reinstitutions, n = 214).

Results:

Of the 370 patients, 156 (42%) required PMV reinstitutions. Most reinstitutions occurred within 7 months: 51 (33%) of the 156 patients within 28 days and 49 (31%) within the next 6 months. Group comparisons revealed a progression of outcomes from group A, the worst, to group D, the best, with groups B and C having intermediate but significantly different values. Decannulation was associated with an 88% decreased risk of PMV reinstitution and a 43% lower risk of death (all P < .001).

Conclusion:

Prolonged mechanical ventilation reinstitution rates were high, with most occurring within 7 months of freedom from MV. In general, the longer the period of ventilator freedom, the less the likelihood of a PMV reinstitution. The identification of 4 distinct PMV groups of patients by time and number of reinstitutions added useful prognostic information. Since PMV reinstitutions within 28 days lead to permanent MV support, >28 days of ventilator freedom provided an optimal cut point for assessing the likelihood of again requiring PMV.
N-Terminal Pro-Brain Natriuretic Peptide Concentrations After Hypertensive Intracerebral Hemorrhage: Relationship With Hematoma Size, Hyponatremia, and Intracranial Pressure
Authors: Li Fei , Chen Qian-Xue , Xiang Shou-Gui , Yuan Shi-Zhun , Xu Xi-Zhen
Published: January 2017

Introduction:

The role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with hypertensive intracerebral hemorrhage (HICH) is poorly understood. This study aimed to investigate the secretion pattern of NT-proBNP in patients with HICH and to assess its relationship with hematoma size, hyponatremia, and intracranial pressure (ICP).

Methods:

This prospective study enrolled 147 isolated patients with HICH. Blood samples were obtained from each patient, and values of serum NT-proBNP, hematoma size, blood sodium, and ICP were collected for each patient.

Results:

The peak-to-mean concentration of NT-proBNP was 666.8 ± 355.1 pg/mL observed on day 4. The NT-proBNP levels in patients with hematoma volume >30 mL were significantly higher than those in patients with hematoma volume <30 mL ( P < .05). In patients with severe HICH, the mean concentration of NT-proBNP was statistically higher than that in patients with mild–moderate HICH ( P < .05), and the mean level of NT-proBNP in hyponatremia group was significantly higher than that in normonatremic group ( P < .05). In addition, the linear regression analysis indicated that serum NT-proBNP concentrations were positively correlated with ICP ( r = .703, P < .05) but negatively with blood sodium levels only in patients with severe HICH ( r = −.704, P < .05). The serum NT-proBNP levels on day 4 after admission were positively correlated with hematoma size ( r = .702, P < .05).

Conclusion:

The NT-proBNP concentrations were elevated progressively and markedly at least in the first 4 days after HICH and reached a peak level on the fourth day. The NT-proBNP levels on day 4 were positively correlated with hematoma size. There was a notable positive correlation between plasma NT-proBNP levels and ICP in patients with severe HICH. Furthermore, only in patients with severe HICH, the plasma NT-proBNP levels presented a significant correlation with hyponatremia, which did not occur in patients with mild–moderate HICH.
Correlation of Lactic Acid and Base Deficit Values Obtained From Arterial and Peripheral Venous Samples in a Pediatric Population During Intraoperative Care
Authors: Bordes Brianne M. , Walia Hina , Sebastian Roby , Martin David , Tumin Dmitry , Tobias Joseph D.
Published: January 2017

Lactic acid and base deficit (BD) values are frequently monitored in the intensive care unit and operating room setting to evaluate oxygenation, ventilation, cardiac output, and peripheral perfusion. Although generally obtained from an arterial cannula, such access may not always be available. The current study prospectively investigates the correlation of arterial and peripheral venous values of BD and lactic acid. The study cohort included 48 patients. Arterial BD values ranged from −8 to 4 mEq/L and peripheral venous BD values ranged from −8 to 4 mEq/L. Arterial lactic acid values ranged from 0.36 to 2.45 μmol/L and peripheral venous lactic acid values ranged from 0.38 to 4 μmol/L. The arterial BD (−0.4 ± 2.2 mEq/L) was not significantly different from the peripheral venous BD (−0.6 ± 2.2 mEq/L). The arterial lactic acid (1.0 ± 0.5 μmol/L) was not significantly different from the peripheral venous lactic acid (1.1 ± 0.6 μmol/L). Pearson correlation coefficients demonstrated a very high correlation between arterial and peripheral venous BD ( r = .88, P < .001) and between arterial and peripheral venous lactic acid ( r = .67, P < .001). Bland-Altman plots of both pairs of measures showed that the majority of observations fell within the 95% limits of agreement. Least-squares regression indicated that a 1-unit increase in arterial BD corresponded to a 0.9-unit increase in peripheral venous BD (95% confidence interval [CI]: 0.7-1.0; P < .001) and a 1-unit increase in arterial lactic acid corresponded to a 0.9-unit increase in peripheral venous lactic acid (95% CI: 0.6-1.2; P < .001). These data demonstrate that there is a clinically useful correlation between arterial and peripheral venous lactic acid and BD values.
Predictive Value of Serum Albumin Level for the Prognosis of Severe Sepsis Without Exogenous Human Albumin Administration: A Prospective Cohort Study
Authors: Yin Mei , Si Lei , Qin Weidong , Li Chen , Zhang Jianning , Yang Hongna , Han Hui , Zhang Fan , Ding Shifang , Zhou Min , Wu Dawei , Chen Xiaomei , Wang Hao
Published: January 2017

Background:

The prognostic significance of serum albumin levels in patients with sepsis has previously been reported; however, these studies have not excluded the potential confounding effect of exogenous albumin administration. In this study, we investigate the predictive value of serum albumin for the prognosis of severe sepsis without the interference of exogenous albumin administration.

Methods:

A prospective cohort study was conducted from April to November 2014 in the internal and surgical intensive care units of a tertiary care hospital. During the study period, due to a supply shortage, patients were not treated with human albumin. Serum albumin levels were measured, and laboratory and clinical data were collected at the onset of severe sepsis. Prognostic factors were analyzed using receiver operating characteristic curve and multivariate Cox proportional hazard regression analysis. Survival was assessed by Kaplan-Meier method.

Results:

One hundred sixteen patients were included in the study. The overall 28-day mortality was 26.7%. The most common infection sources were lower respiratory tract, abdomen/pelvis, and bloodstream. Compared to patients who survived, those who died had lower serum albumin levels and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores. Receiver operating characteristic curves demonstrate that albumin level is a strong predictor of 28-day mortality, and the optimal cutoff value maximizing sensitivity and specificity is 29.2 g/L. Through multivariate Cox regression analysis, low serum albumin levels (<29.2 g/L) and APACHE II scores are identified as independent risk factors for mortality. Patients with lower serum albumin levels more often had abdominal/pelvic sources of infection, acute kidney or liver injury, septic shock, and higher APACHE II and SOFA scores. The 28-day survival rate was lower for patients with serum albumin below 29.2 g/L than for patients with serum albumin at or above this level.

Conclusion:

Having excluded potential confounding effect of exogenous albumin administration, low serum albumin levels are associated with an increased risk of death in patients with severe sepsis.
Effect of Etomidate on Pneumonia Development in Critically Ill, Nontrauma Patients
Authors: Hammond Drayton A. , Vines Claire E. , McPhee Ashley L. , Bhandari Naleen Raj , Jones Kendrea M. , Meena Nikhil , Painter Jacob T.
Published: January 2017

Purpose:

To determine whether etomidate use before intubation increased development of hospital-acquired pneumonia (HAP) in critically ill, nontrauma patients.

Materials and Methods:

A single-center, retrospective, cohort study of critically ill, nontrauma patients admitted to the medical intensive care unit (ICU) from 2012 to 2015 and intubated with or without etomidate was conducted. Demographics, comorbidities, primary diagnosis, critical illness scores, concomitant medications, and outcomes were obtained from medical records. Student t, chi-square, and Fisher exact tests were performed as appropriate. Relevant characteristics were modeled using logistic regression techniques to determine whether any predicted HAP independently.

Results:

Of the 174 patients, 94 (54%) received etomidate and 80 (46%) did not. There was no difference in HAP between etomidate and no etomidate groups (13.8% vs 23.7%, P = .092). Duration of mechanical ventilation (4.4 vs 4.6 days, P = .845), ICU length of stay (7.4 vs 6.9 days, P = .547), ICU mortality (14.9% vs 12.5%, P = .648), and hospital mortality (17% vs 16.2%, P = .892) were similar between the groups. For each 1-day increase in mechanical ventilation duration, the likelihood of HAP development increased by 21%. Patients who received etomidate but no neuromuscular-blocking drug were 80% less likely to develop HAP than those who did not receive etomidate or a neuromuscular-blocking drug (odds ratio: 0.202, 95% confidence interval: 0.045-0.908).

Conclusion:

Etomidate use was not associated with a difference in HAP development in critically ill, nontrauma patients.
Out-of-Hospital ICU Transfers to an Oncological Referral Center
Authors: Gutierrez Cristina , Cárdenas Yenny R. , Bratcher Kristie , Melancon Judd , Myers Jason , Campbell Jeannee Y. , Feng Lei , Price Kristen J. , Nates Joseph L.
Published: January 2017

Objective:

To determine resource utilization and outcomes of out-of-hospital transfer patients admitted to the intensive care unit (ICU) of a cancer referral center.

Design:

Single-center cohort.

Setting:

A tertiary oncological center.

Patients:

Patients older than 18 years transferred to our ICU from an outside hospital between January 2013 and December 2015.

Measurements and Main Results:

A total of 2127 (90.3%) were emergency department (ED) ICU admissions and 228 (9.7%) out-of-hospital transfers. The ICU length of stay (LOS) was longer in the out-of-hospital transfers when compared to all other ED ICU admissions ( P = .001); however, ICU and hospital mortality were similar between both groups. The majority of patients were transferred for a higher level of care (77.2%); there was no difference in the amount of interventions performed, ICU LOS, and ICU mortality between nonhigher level-of-care and higher level-of-care patients. Factors associated with an ICU LOS ≥10days were a higher Sequential Organ Failure Assessment (SOFA) score, weekend admissions, presence of shock, need for mechanical ventilation, and acute kidney injury on admission or during ICU stay ( P < .008). The ICU mortality of transferred patients was 17.5% and associated risk factors were older age, higher SOFA score on admission, use of mechanical ventilation and vasopressors during ICU stay, and renal failure on admission ( P < .0001). Data related to the transfer such as LOS at the outside facility, time of transfer, delay in transfer, and longer distance traveled were not associated with increased LOS or mortality in our study.

Conclusion:

Organ failure severity on admission, and not transfer-related factors, continues to be the best predictor of outcomes of critically ill patients with cancer when transferred from other facilities to the ICU. Our data suggest that transferring critically ill patients with cancer to a specialized center does not lead to worse outcomes or increased resource utilization when compared to patients admitted from the ED.
Impact of an Antipsychotic Discontinuation Bundle During Transitions of Care in Critically Ill Patients
Authors: D’Angelo Ryan G. , Rincavage Molly , Tata Asha L. , Millstein Leah S. , Gulati Mangla S. , Flurie Rachel W. , Gonzales Jeffrey P.
Published: January 2017

Introduction:

Delirium affects a large proportion of patients admitted to the intensive care unit (ICU) and is associated with increased morbidity and mortality. Antipsychotics have become frequently used agents for the treatment of delirium; however, they are often continued at transitions of care. This has potential negative short- and long-term health consequences that are preventable. We investigated the antipsychotic tapering bundle’s impact on the rate of antipsychotic continuation at transitions from the medical intensive care unit (MICU).

Methods:

This was a preretrospective and postretrospective chart review that included adult patients in the MICU initiated on antipsychotic therapy for ICU delirium. A bundled multidisciplinary education program and antipsychotic discontinuation algorithm were implemented in the MICU to provide recommendations for safe and effective use of antipsychotics for ICU delirium and minimize continuation of therapy at transitions of care. Rates of antipsychotic continuation at transition from the MICU were compared between the preintervention and postintervention groups with the χ2 test.

Results:

A total of 140 patients in the prebundle group and 141 patients in the postbundle group were enrolled. Overall, baseline characteristics were similar. After implementation of the discontinuation bundle, antipsychotic continuation at MICU discharge decreased (27.9% in the prebundle group vs 17.7% in the postbundle group; P < .05). In the multivariate analysis, patients were less likely to be continued on antipsychotic therapy at MICU discharge after implementation of the bundle (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.26-0.86). There were also lower rates of overall antipsychotic continuation at hospital discharge (OR: 0.4; 95% CI: 0.18-0.89).

Conclusion:

This is the first study to demonstrate a reduction in antipsychotic continuation at transition from the MICU after implementation of an antipsychotic discontinuation bundle in ICU patients. We believe this bundle allows for safer transitions of care from the MICU and decreases unnecessary antipsychotic therapy.
External Validation of Two Classification and Regression Tree Models to Predict the Outcome of Inpatient Cardiopulmonary Resuscitation
Authors: Guilbault Ryan W. R. , Ohlsson Marcus Andreas , Afonso Anna M. , Ebell Mark H.
Published: January 2017

Objective:

To prospectively validate a previously developed classification and regression tree (CART) model that predicts the likelihood of a good outcome among patients undergoing inpatient cardiopulmonary resuscitation.

Design:

Prospective validation of a clinical decision rule.

Setting:

Skåne University Hospital in Malmo, Sweden.

Patients:

All adult patients (N = 287) experiencing in-hospital cardiopulmonary arrest and undergoing cardiopulmonary resuscitation between 2007 and 2010.

Interventions:

Patients from Skåne University Hospital who underwent CPR (N = 287) were classified using the CART models to predict their likelihood of survival neurologically intact or with minimal deficits, based on a cerebral performance category score of 1. Discrimination and classification accuracy of the score in the Swedish population was compared to that in the original (derivation and internal validation) populations.

Measurements and Main Results:

For model 1, the area under the receiver–operating characteristic curve (AUROCC) was 0.77, compared with 0.76 and 0.73 in the original derivation and validation populations, respectively. Model 1 classified 71 (2.8%) of 287 patients as being at a very low risk of a good neurologic outcome compared with 157 (26.1%) of 287 patients predicted to be at an above average risk of a good neurologic outcome. Model 2 had a similar AUROCC as the original validation population of 0.71 but lower than the original derivation population. Model 2 performed similarly to Model 1 with regards to its ability to correctly classify patients as very low or higher than average likelihood of a good neurologic outcome.

Conclusion:

Two CART models validated well in a different population, displaying similar discrimination and classification accuracy compared to the original population. Although additional validation in larger populations is desirable before widespread adoption, these results are very encouraging.
Polymers of 1-Vinyl-2-Pyrrolidinone as Potential Vitreous Substitutes: Physical Selection
Authors: Hong Ye , Chirila Traian V. , Cuypers Maximiliaan J. H. , Constable Ian J.
Published: January 2017

More than 300 polymers of 1-vinyl-2-pyrrolidinone (VP) were synthesized, subjected to hydration, and characterized with the aim to select the most suitable materials as potential artificial substitutes for the vitreous body of the eye. The materials include cross-linked homopolymers, uncross-linked copolymers of VP with 2-hydroxyethyl methacrylate (HEMA), and cross-linked copolymers VP/HEMA. Five different cross-linking agents, both hydrophobic and hydrophilic, were used in this study. The resulting hydrogels, with equilibrium water contents ranging between 66.5 and 99.1%, were first subjected to a selection based on their physical behavior during manipulation, after which only the transparent, viscoelastic gels were further considered. Subsequent injectability and visual acuity tests, as well as the evaluation of light transmission characteristics, reduced further the number of potential candidates for vitreous substitution to only thirteen hydrogels. An eliminatory strategy based on physical properties of the potential vitreous substitutes is essential in order to avoid unnecessary sacrifice of experimental animals for in vivo assessment.
Biodegradable Polyurethanes: Biodegradable Low Adherence Films for the Prevention of Adhesions after Surgery
Authors: Rehman Ihtesham Ur
Published: January 2017

Adhesions commonly occur after internal disease or surgery. The natural healing response leads to the formation of vascular and avascular adhesions after inflammatory diseases and surgical interventions. A barrier film could be incorporated during surgery between layers of tissues that must not adhere to one another. The film would be biodegradable so that it disappears over a period of time, and would ideally be two sided, allowing relative movement at that interface, while being firmly anchored on the opposite side to prevent displacement. Polyesterurethane-polydimethylsiloxane graft polymers are synthesised. Chemical characterization of the polymer is performed by using Fourier Transform Infrared Spectroscopy and Gel Permeation Chromatography. In vitro hydrolytic degradation is carried out in which films are immersed at 37°C in alkaline solution. Degradation is assessed by tensile testing as a function of time to determine the degradation of mechanical strength, infrared spectroscopy, and mass loss. A titration method is also used to determine quantitatively the hydrolytic degradation. In order to study the adhesions of films, an in-vitro model based on a gelatine test, which is simple and rapid, is described.

Suitable candidate films investigated from the in-vitro work are subjected to in vivo tests for both biodegradation and their ability to prevent adhesion.
In Vitro Thermomechanical Ageing of Ni-Ti Alloys
Authors: Gil F. J. , Planell J. A.
Published: January 2017

NiTi alloy is used as a biomaterial due to its pseudoelastic behaviour. It exhibits a great potential in dental and orthopedic applications where constant correcting loads are required. In order to use such materials, it is necessary to investigate the effect of the cyclic straining upon the transformation stresses and temperatures of the material, the effect of thermal cycling and the ageing at different temperatures and times of heat treatment. The aim of this work is to study the load and thermal cycling and the ageing with the temperature of a superelastic NiTi shape memory alloy.
Empathy Works, Obedience Doesn't
Authors: Pepinsky Hal
Published: January 2017

This is an elaboration of a theory of how to make peace instead of making war on crime and personal violence. From a warmaking perspective safety from crime and personal violence lies essentially in making individuals obedient to commands from the proper authorities. From a peacemaking perspective as proposed here, safety from personal violence lies essentially in building empathy rather than in commanding obedience. Signs of obedience like remorse are inherently unreliable indicators that people are safe company. When it comes to safety from personal violence, empathy works, obedience doesn't.
Competence Development and Appraisal in Organizations
Authors: Stoker J.I. , Van der Heijden B.I.J.M.
Published: January 2017

This contribution focuses on the way in which employees and managers perceive themselves and each other. Based on two PhD-projects, one in which differences between self-ratings and supervisor ratings have been studied, and one in which the focus was the differences between team leaders' self-perception and the team members' perception, it was concluded that supervisors and employees have a different view on the competencies and behavior of one another. Some explanations for these results are given. Also, implications for competence development and appraisal of employees and managers will be described.
Career Development Tasks of Mexican American Adolescents: An Exploratory Study
Authors: Bullington Robin L. , Arbona Consuelo
Published: January 2017

This interview-based study explored the extent to which four academically successful Mexican American adolescents were engaged in age appropriate career development tasks as suggested by Super's (1957, 1984) theory. It also explored the adolescent's understanding of the role that ethnicity played in their career related behaviors. Findings suggest that these Hispanic adolescents were engaged in age appropriate tasks according to Super's theory and that both family and ethnic related factors were relevant to their career development.
Straight Talking: The Nature of Effective Career Discussion at Work
Authors: Kidd Jennifer M. , Hirsh Wendy , Jackson Charles
Published: January 2017

Many employees need help from others in managing their careers, and it is likely that much of this help will be given in the context of a face-to-face discussion, either in a formal setting or more informally. Drawing on the accounts of 104 UK employees who had participated in helpful career discussions, this paper examines with whom and in what settings effective career discussions took place, and the skills and personal qualities displayed by givers and receivers of support. A wide range of individuals provided this form of support. The most important skills and qualities shown by givers of support were: the personal qualities of interest, commitment and trustworthiness; challenging and facilitative skills; giving honest feedback; and providing information.
Examining the Process and Outcome of Career Counseling for Different Types of Career Counseling Clients
Authors: Rochlen Aaron B. , Milburn Lynne , Hill Clara E.
Published: January 2017

Using cluster analysis, we identified two types of career counseling clients: (a) Clients with moderate levels of career-related distress, discomfort, and uncertainty and (b) clients with high levels of career concerns, personal distress, and stigma about career counseling. The more distressed group expressed lower evaluations of a career counseling session and perceived their counselors as providing fewer action-oriented counseling skills than the less distressed group. No differences emerged in terms of client's perceptions of the therapeutic relationship. The practical implications and limitations of these results are discussed.
Glaxo's links with higher education
Authors: Derx Donald J.
Published: January 2017

Glaxo's UK companies have extensive and long-standing links with educational establishments and take a keen interest in the educational system as a whole. This article explains Glaxo's interest in higher education, describes its involvement in general terms and details its relationships through contract and collaborative research.
York University Enterprise
Authors: Final Sue
Published: January 2017

In the academic year 1988–9, York University's silver jubilee year, the university decided to improve its links with industry. Concentrating on local business, the university promoted the idea of the university as a regional resource. This report details the success of their enterprise.
The Academic Research Centre
Authors: Steiner Karl V. , Kukich Diane S.
Published: January 2017

The authors argue that the academic research centre can perform an invaluable function in coordinating the flow of information and knowledge between academic departments in a university and between the university and industry. To illustrate their argument, they offer a case analysis of the Center for Composite Materials at the University of Delaware and show that the Center not only opens up new sources of funding and collaborative research opportunities, but also enhances the skills of the students who collaborate in its programmes. They also describe new federal funding initiatives and point out that recent US government programmes are continuing to integrate research centres to solve real-world problems in close cooperation with industry.
A University—Industry Partnership in US Undergraduate Education
Authors: Demetry Chrysanthe
Published: January 2017

The WPI–Norton Company Project Center, in operation since 1973, is a partnership designed to enhance undergraduate engineering education at Worcester Polytechnic Institute(WPI) and to solve problems of direct relevance to Norton Company Student teams complete year-long projects on topics proposed by Norton Company and are advised both by WPI faculty and Norton employees. This arrangement differs from cooperative education in that the projects satisfy a WPI degree requirement, and the students are not paid by the company. This paper describes some logistical details of the Center's operation and highlights successes and challenges revealed by a recent evaluation of the partnership.
Out of the Ivory Tower and into the Real World
Authors: Hughey Aaron W. , Mussnug Kenneth J.
Published: January 2017

Colleges and universities are becoming more involved in providing training to companies in their regional service areas. Faculty who are proficient in a traditional classroom, however, do not always excel as corporate trainers. Instructional strategies that are inherently effective in academe seldom yield comparable results in an industrial setting. Employee training programmes generally demand a more applications-oriented approach and tend to focus succinctly on immediate outcomes. Furthermore, training initiatives often encounter considerable resistance from session participants. This can precipitate serious difficulties for professors who are accustomed to maintaining absolute control via the grading process. Corporate trainees want to know precisely how the information presented will assist them in the performance of their current job responsibilities or how it will help prepare them for future assignments. This paper explains how faculty members can adapt their academic teaching styles to meet the unique needs of company employees. Included in the discussion are explicit recommendations for preparing for a specific training assignment, developing a customized training plan, dealing with critical logistical considerations, and ultimately facilitating a successful training experience. Several problems that can occur are also described along with suggestions for resolving them as efficiently as possible. Finally, the importance of following-up after the training has been completed is addressed.
Top Management Culture and Performance in Canadian, UK and US Hospitals
Authors: Gerowitz M. B. , Lemieux-Charles L. , Heginbothan C. , Johnson B.
Published: January 2017

This study examines the role of top management team culture in hospitals located in Canada, the UK and the USA. Clan, developmental, empirical and rational cultures were identified using the competing values framework. This study was organized around three basic questions. The first question asked whether hospital management teams in the USA, Canada and the UK have different management cultures given the differences in their political economies. The second question asked whether management culture was associated with differences in performance? The third question addressed the issue of the legitimacy of culture type as an independent variable. If culture type has legitimacy, other organizational variables such as structure, conflict resolution style, market strategy and stakeholder priorities should be manifested differently in each culture type. The findings support the legitimacy of the culture variable and the premise that the political economy influences the distribution of culture types. The dominant cultures of the hospital management teams studied were positively and significantly related to organizational performance for clan, rational and developmental cultures. The implications for management theory, professional practice and public policy are discussed.
Clinical Audit: Integrating the Management of Quality
Authors: Packwood T.
Published: January 2017

The recent implementation of clinical audit by the Department of Health seeks to both integrate existing professional audit activities, and to integrate the resulting multi-professional audit more closely with other quality-assurance activities developed by corporate management and purchasers.

This paper, which is based on studies of medical and clinical audit undertaken over the past 3 years, examines the potential for integration in the light of, first, the history and characteristics of the different forms of quality assurance initiative and, second, a comparison of their different properties. In many ways clinical audit appears to stand between domination by both professional and managerial influences, which may enhance its potential for integrating different approaches. If, however, clinical audit is to succeed it is suggested that it requires a strong managerial infrastructure; with clearly delineated responsibilities related to the different modes of quality assurance.
Communication Audits and the Management of Change: A Case Study from an NHS Unit of Management
Authors: Tourish D. , Hargie O.
Published: January 2017

This article explores the importance of high quality communication between managers and staff for the effective management of change within the National Health Service (NHS). In particular, a methodology termed communication audit is outlined. Such audits enable managers to gather accurate information about communication practices within organizations and allows them to assess the nature, quantity and quality of internal communications. This, in turn, facilitates the identification and resolution of potential problems and helps to provide a clearly focused agenda for action and change. A case study is offered which illustrates how such an audit was applied to a Unit of Management within the NHS. The implications for managers throughout the organization are then considered.