bluuebunny/crossref_metadata_2025 huggingface dataset:
The emergency medical system
Authors: Sabbe Marc , Bronselaer K , Hoogmartens O
Published: April 2015

The mission of the emergency medical services is to promote and support a system that provides timely, professional, and state-of-the art emergency medical care, including ambulance services, to anyone who is victim of a sudden injury or illness, at any time or location and at any phase of the emergency incident. These phases include lay people’s prevention and preparedness, occurrence of the problem, its detection, alarming of trained responders, help provided by bystanders and trained pre-hospital providers, transport to the appropriate hospital, and, if necessary, admission or transfer to a more appropriate hospital. In order to meet the goal outlined, emergency medical services must work closely with local and state officials—fire and rescue departments, other ambulance providers, hospitals, and other agencies—to foster a smooth functioning network. The term emergency medical services evolved to reflect a change from a simple system of ambulances, providing only transportation, to a system in which actual medical care is given at the scene and during transport. Medical supervision and/or participation of emergency medicine physicians in the emergency medical services systems contribute to the quality of medical care. This emergency medical services network must be capable of responding instantly and reliably around the clock, with well-trained, well-equipped personnel linked, as needed, through a strong communication system. Research plays an important role in conserving resources and improving the delivery of health care. This chapter gives an overview of the different aspects of emergency medical services and calls for high-quality research in pre-hospital emergency care in a true partnership between cardiologists and emergency physicians.
Ethical issues in cardiac arrest and acute cardiac care: a European perspective
Authors: Vincent Jean-Louis
Published: April 2015

The respiratory system is key to the management of patients with respiratory, as well as haemodynamic, compromise and should be monitored. The ventilator is more than just a machine that delivers gas; it is a true respiratory system monitoring device, allowing the measurement of airway pressures and intrinsic positive end-expiratory pressure and the plotting of pressure/volume curves. For effective and reliable monitoring, it is necessary to keep in mind the physiology, such as the alveolar gas equation, heart-lung interactions, the equation of movement, etc. Monitoring the respiratory system enables adaptation of not only respiratory management, but also haemodynamic management.
Blood gas analysis: acid–base, fluid, and electrolyte disorders
Authors: Paul Richard , Myrianthefs Pavlos , Baltopoulos George , McMaster Shaun
Published: April 2015

Acid-base homeostasis is vital for the maintenance of normal tissue and organ function, as both acidosis and alkalosis can have harmful and potentially life-threatening effects. Arterial blood gas analysis, combined with routine clinical history and examination, can provide useful information for the management of the critically ill cardiac patient. Most acid-base derangements are reversed by treatment of the underlying disease process, rather than simple correction of the abnormal pH, and prognosis is determined by the nature of the underlying disease, rather than the extent of pH value deviation. Within this chapter, a six-step approach is presented for prompt and accurate acid-base interpretation. Water and electrolyte disorders are common in the intensive cardiac care unit, particularly in patients with cardiac failure. Prompt recognition and treatment is required to prevent cardiovascular and neurological compromise. Therapeutic strategies range from simple electrolyte substitution and fluid management to extracorporeal filtration of excess fluid and electrolytes. These are discussed within this chapter.
Mechanical ventilation
Authors: Abuella Gihan , Rhodes Andrew
Published: April 2015

Mechanical ventilation is used to assist or replace spontaneous respiration. Gas flow can be generated by negative pressure techniques, but it is positive pressure ventilation that is the most efficacious in intensive care. There are numerous pulmonary and extrapulmonary indications for mechanical ventilation, and it is the underlying pathology that will determine the duration of ventilation required. Ventilation modes can broadly be classified as volume- or pressure-controlled, but modern ventilators combine the characteristics of both in order to complement the diverse requirements of individual patients. To avoid confusion, it is important to appreciate that there is no international consensus on the classification of ventilation modes. Ventilator manufacturers can use terms that are similar to those used by others that describe very different modes or have completely different names for similar modes. It is well established that ventilation in itself can cause or exacerbate lung injury, so the evidence-based lung-protective strategies should be adhered to. The term acute lung injury has been abolished, whilst a new definition and classification for the acute respiratory distress syndrome has been defined.
Pericardiocentesis
Authors: Aguasca Gerard Martí , Blanco Bruno Garcia del , Sauleda Jaume Sagristà
Published: April 2015

Cardiac tamponade is a life-threatening condition that may require the urgent removal of pericardial fluid. Therefore, the pericardiocentesis procedure should be part of the skills of physicians treating critically ill patients. The pericardiocentesis technique has evolved from a blind and unguided procedure, prone to complications, to a safer and more effective guided technique by using echocardiography or fluoroscopy. However, as in any invasive procedure, complications still occur. Therefore, indications should be restricted to patients with cardiac tamponade or a high suspicion of specific aetiologies when performed for diagnostic purposes. Accurate indications, optimal imaging assessment, knowledge of materials required, familiarization with different techniques, and rapid recognition of complications are key for a successful procedure.
Nutrition support in acute cardiac care
Authors: Casaer Michael P , Van den Berghe Greet
Published: April 2015

Malnutrition in cardiac and critical illness is associated with a compromised clinical outcome. The aim of nutrition therapy is to prevent these complications and particularly to attenuate lean tissue wasting and the loss of muscle force and of physical function. During the last decade, several well-powered randomized controlled nutrition trials have been performed. Their results challenge the existing nutrition practices in critically ill patients. Enhancing the nutritional intake and the administration of specialized formulations failed to evoke clinical benefit. Some interventions even provoked an increased mortality or a delayed recovery. These unexpected new findings might be, in part, caused by an important leap forward in the methodological quality in the recent trials. Perhaps reversing early catabolism in the critically ill patient by nutrition or anabolic interventions is impossible or even inappropriate. Nutrients effectively suppress the catabolic intracellular autophagy pathway. But autophagy is crucial for cellular integrity and function during metabolic stress, and consequently its inhibition early in critical illness might be deleterious. Evidence from large nutrition trials, particularly in acute cardiac illness, is scarce. Nutrition therapy is therefore focused on avoiding iatrogenic harm. Some enteral nutrition is administered if possible and eventually temporary hypocaloric feeding is tolerated. Above all, the refeeding syndrome and other nutrition-related complications should be prevented. There is no indication for early parenteral nutrition, increased protein doses, specific amino acids, or modified lipids in critical illness.
Physiotherapy in critically ill patients
Authors: Gosselink R , Roeseler J
Published: April 2015

Physiotherapists are involved in the management of patients with critical illness. Physiotherapy assessment of critically ill patients is less driven by medical diagnosis; instead, there is a strong focus on deficiencies at a pathophysiological and functional level. An accurate and valid assessment of respiratory conditions (retained airway secretions, atelectasis, and respiratory muscle weakness), physical deconditioning, and related problems (muscle weakness, joint stiffness, impaired functional exercise capacity, physical inactivity, and emotional function) allows the identifying of targets for physiotherapy. Evidence-based targets for physiotherapy are deconditioning, impaired airway clearance, atelectasis, (re-)intubation avoidance, and weaning failure. Early physical activity and mobility are key in the prevention, attenuation, or reversion of physical deconditioning related to critical illness. A variety of modalities for exercise training and early mobility are evidence-based and are implemented, depending on the stage of critical illness, comorbid conditions, and cooperation of the patient. The physiotherapist should be responsible for implementing mobilization plans and exercise prescription and make recommendations for their progression, jointly with medical and nursing staff.
The use of biomarkers for acute cardiovascular disease
Authors: Jaffe Allan S
Published: April 2015

Understanding the proper use of biomarkers requires clinicians to appreciate some critical pre-analytic and analytic issues, as well as how to use the markers properly. The bene?ts of such an approach will not only facilitate the care of patients today, but will also prepare clinicians to understand and embrace the new generation of markers that is coming and that will continue to make this area transformational for cardiology. Two fundamental concepts underlie the clinical use of biomarkers: First, biomarkers should always be used in conjunction with all other clinical information. Second, in order to maximize their diagnostic and prognostic use, biomarkers should be interpreted as quantitative variables. For example, a cardiac troponin level which is 50 times the upper limit of normal has a much higher positive predictive value for the presence of an acute myocardial infarction, compared to a level just above the upper limit of normal.
Biomarkers of coagulation and thrombosis
Authors: Hvas Anne-Mette , Grove Erik L , Kristensen Steen Dalby
Published: April 2015

Coagulation is evaluated by conventional coagulation analyses, often supplemented by point-of-care tests. Recently, a number of point-of-care tests for evaluation of platelet function and the efficacy of antiplatelet therapy has been investigated. Thrombophilia contributes to the risk of thrombosis, and a battery of complex assays is required to identify all thrombophilias. Disseminated intravascular coagulation is characterized by microthrombosis and clinical bleeding. A scoring system for overt disseminated intravascular coagulation provides a five-step diagnostic algorithm. The cornerstone of the management of disseminated intravascular coagulation is treatment of the underlying triggering condition. Heparin-induced thrombocytopenia is an adverse immunological effect of heparin therapy. Besides thrombocytopenia, the major clinical consequence of heparin-induced thrombocytopenia is an increased risk of thrombosis. The diagnosis is based on clinical symptoms and detection of platelet-activating heparin-induced thrombocytopenia antibodies. When heparin-induced thrombocytopenia is strongly suspected, it is recommended to stop heparin treatment, investigate for heparin-induced thrombocytopenia antibodies, and initiate non-heparin anticoagulant treatment.
ST-segment elevation myocardial infarction
Authors: Cheong Adrian , Steg Gabriel , James Stefan K
Published: April 2015

Acute myocardial infarction with ST-segment elevation is a common and dramatic manifestation of coronary artery disease. It is caused by the rupture of an atherosclerotic plaque in a coronary artery, leading to its total thrombotic occlusion and resultant ischaemia and necrosis of downstream myocardium. The diagnosis of ST-segment elevation myocardial infarction is based on a syndrome of ischaemic chest pain symptoms, associated with typical ST-segment elevation on the electrocardiogram and an eventual rise in biomarkers of myocardial necrosis. The treatment of ST-segment elevation myocardial infarction is focused on re-establishing blood flow in the coronary artery involved, preferably by percutaneous coronary intervention, or by pharmacological thrombolysis in the case of expected lengthy time delays or lack of availability of facilities. Early mortality from ST-segment elevation myocardial infarction can be attributed to the sequelae or complications of myocardial ischaemia, or complications related to therapy. The former include arrhythmias (such as ventricular tachycardia or fibrillation), mechanical complications (such as ventricular free wall, septal, and mitral chordal rupture), and pump failure leading to cardiogenic shock. The latter includes haemorrhagic complications and coronary stent thrombosis. Given that myocardial necrosis is a critically time-dependent process, the organization of an ST-segment elevation myocardial infarction care system and adherence to the latest clinical trial evidence and guidelines are crucial to ensure that patients are treated in an optimal manner.
Cardiogenic shock in patients with acute coronary syndromes
Authors: Thiele Holger , Zeymer Uwe
Published: April 2015

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
Acute heart failure: early pharmacological therapy
Authors: Dalzell Jonathan R , Jackson Colette E , Gardner Roy , McMurray John JV
Published: April 2015

Acute heart failure syndromes consist of a spectrum of clinical presentations due to an impairment of some aspect of the cardiac function. They represent a final common pathway for a vast array of pathologies and may be either a de novo presentation or, more commonly, a decompensation of pre-existing chronic heart failure. Despite being one of the most common medical presentations, there are no definitively proven prognosis-modifying treatments. The mainstay of current therapy is oxygen and intravenous diuretics. However, within this spectrum of presentations, there is a crucial dichotomy which governs the ultimate treatment approach, i.e. the presence, or absence, of cardiogenic shock. Patients without cardiogenic shock may receive vasodilators, whilst shocked patients should be considered for treatment with inotropic therapy or mechanical circulatory support, when appropriate and where available.
Atrial fibrillation and supraventricular arrhythmias
Authors: Katritsis Demosthenes , Camm A John
Published: April 2015

This chapter discusses the acute management of patients presenting with tachyarrhythmias suggestive of regular supraventricular tachycardias (SVT) and/or atrial fibrillation (AF). A classification of narrow- and wide-QRS tachycardias is presented, and the differential diagnosis of narrow- and wide-QRS tachycardias is discussed. Principles of acute therapy are presented either in the context of acute therapy before establishing a definitive diagnosis or for particular arrhythmia entities with an established diagnosis of a regular SVT or AF.
Congenital heart disease in adults
Authors: Price Susanna , Keogh Brian F , Swan Lorna
Published: April 2015

The number of patients with congenital heart disease surviving to adulthood is increasing, with many requiring ongoing medical attention. Although recommendations are that these patients should be cared for in specialist centres, the clinical state of the acutely unwell patient may preclude transfer prior to the instigation of lifesaving treatment. Although the principles of resuscitation in this patient population differ little from those with acquired heart disease, the acutely unwell adult congenital heart disease patient presents a challenge, with potential pitfalls in examination, assessment/monitoring, and intervention. Keys to avoiding errors include: knowledge of the primary pathophysiology, any interventions that have been undertaken, residual lesions present (static or dynamic), and the normal physiological status for that patient-to determine the precise cause for the acute deterioration and to appreciate the effects (detrimental or otherwise) that any supportive and/or therapeutic interventions might have. Expert advice should be sought at the earliest opportunity.
Pulmonary hypertension
Authors: Galiè Nazzareno , Manes Alessandra , Palazzini Massimiliano
Published: April 2015

Pulmonary hypertension is a haemodynamic and pathophysiological condition defined as an increase in the mean pulmonary arterial pressure of ≥25 mmHg at rest, as assessed by right heart catheterization. In fact, while transthoracic echocardiography may provide clues on the presence of pulmonary hypertension, the haemodynamic evaluation offers a more precise and comprehensive assessment. Pulmonary hypertension is heterogeneous from a pathophysiological point of view, and the diversity is reflected in the haemodynamic definitions. The different haemodynamic forms of pulmonary hypertension can be found in multiple clinical conditions which have been classified into six main groups and at least twenty-six subgroups. Each main clinical group shows specific pathological changes in the lung distal arteries, capillaries, and small veins. If we combine the haemodynamic and clinical heterogeneity, we understand the complexity of an accurate diagnosis in the individual patient which is crucial for the prognostic assessment and treatment strategy. In addition, the concomitant presence of different haemodynamic and clinical mechanisms cannot be excluded in individual cases (e.g. in patients with congestive heart failure and associated lung diseases). The presence of pulmonary hypertension, as defined above, is always an ominous prognostic sign, even if the severity may differ according to the haemodynamic changes and underlying clinical condition. The therapeutic approach also is markedly different, according to the clinical group, and symptomatic and haemodynamic severity. For these reasons, the four more frequent clinical groups are discussed individually, while the classifications are described in the Introduction section.
Pulmonary embolism
Authors: Torbicki Adam , Kurzyna Marcin , Konstantinides Stavros
Published: April 2015

Pulmonary embolism is usually a consequence of deep vein thrombosis, and together the two conditions are known as venous thromboembolism. Non-thromboembolic causes of pulmonary embolism are rare. Pulmonary thromboembolism is a potentially life-threatening disease, if left untreated. This is due to a natural tendency towards early recurrence of pulmonary emboli which may lead to fatal right ventricular failure. In more severe cases, secondary right ventricular failure may result from myocardial ischaemia and injury caused by systemic hypotension and adrenergic overstimulation. Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, haemoptysis, syncope, hypotension, and shock. Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. Computerized tomographic angiography has become the mainstay of diagnosis. However, depending on the clinical presentation, treatment decisions may also be made based on results from other tests. In particular, in high-risk patients with persistent hypotension or shock, bedside echocardiography may be the only available test to identify patients in need of primary thrombolysis, surgical embolectomy, or percutaneous intervention which will stabilize the systemic cardiac output. For most normotensive patients, anticoagulation is sufficient as initial treatment. However, in the presence of signs of right ventricular dysfunction and myocardial injury monitoring is recommended to allow prompt rescue reperfusion therapy in case of haemodynamic decompensation.
Acute pain in the intensive cardiac care unit
Authors: Jaggar Siân , Laycock Helen
Published: April 2015

◆ Cardiac intensive care units admit a heterogeneous patient group

◆ Pain is common, occurring in up to 70% of medical and surgical patients

◆ Effective analgesia is important

◆ Pain is under-recognized and inadequately treated, particularly in medical patients

◆ Consequences of pain are widespread, involving multisystem physiological changes

◆ Pain causes significant psychological sequelae for patients, and ethical implications for physicians

◆ Pain management should utilize a systematic approach. Ensuring optimal patient comfort requires:

○ Understanding of the potential causes of pain in cardiac intensive care

○ Using validated pain assessment tools to identify the presence of pain and evaluate treatment effects

○ Employing a multimodal, multidisciplinary management strategy
Palliative care in the intensive cardiac care unit
Authors: Wood Jayne , Carruthers Maureen
Published: April 2015

Specialist palliative care services originally focused on improving the quality of life for patients with a diagnosis of cancer in the terminal phase of their illness. However, organizations, such as the World Health Organization, supported by recent national strategies, such as the End of Life Care Strategy (United Kingdom, 2008), promote the early integration of specialist palliative care into the management of patients with incurable disease, irrespective of the diagnosis. The primary goal of the intensive cardiac care unit is to help patients survive acute threats to their lives. However, the suddenness and severity of illness, particularly when associated with an underlying cardiological diagnosis, often means that the provision of optimal specialist palliative care is challenging. This chapter addresses key issues relating to the provision of specialist palliative care in the challenging and complex environment of the intensive cardiac care unit, including symptom control, end of life care, decision making, and communication. The benefits of multidisciplinary working for effective quality improvement in patient care and best support for patients, families/carers, and staff are also addressed. The importance of interdisciplinary working is highlighted, and, by embedding the principles of holistic care into daily practice, the intensive cardiac care unit can ensure that patients and their families/carers receive the support they need in a timely manner from individuals who are well supported in what is often considered to be one of the most challenging medical environments.
Ophthalmoplegia
Authors: Shaibani Aziz
Published: April 2015

Ophthalmoplegia is usually chronic and therefore diplopia is not a feature. There is enough time for the brain to suppress one image. It is amazing how much impairment of eye movement has to occur before the patient becomes concerned or considers it as abnormal. Neglected myasthenia gravis may be confused with mitochondrial ophthalmoplegia or oculopharyngeal muscular dystrophy or even congenital myasthenic syndrome. Central cause of ophthalmoplegia should be ruled out first by performing doll’s eye movement. Detailed family history looking in particular for ptosis, ophthalmoplegia, and dysphagia is diagnostically very useful. Non neurological causes of ophthalmoplegia such as severe exophthalmus, and retroorbital pathology should be considered.
Facial Weakness
Authors: Shaibani Aziz
Published: April 2015

Unilateral or bilateral facial weakness is an important manifestation of many neuromuscular disorders; some of them are as simple as Bell’s palsy while others are as serious as Guillain-Barrésyndrome. Facial weakness can be easily mimicked, and therefore psychogenic etiology should always be borne in mind. Peripheral facial weakness affects all functions and parts, while central weakness may save the upper face and may affect emotional and voluntary functions differentially. There are several causes of bilateral facial palsy but statistically, Bell’s palsy is still the most common. Long term complications of facial palsy can be devastating and facial rejuvination surgery is usually only modestly effective.
Tongue Signs
Authors: Shaibani Aziz
Published: April 2015

The tongue is heavily innervated and plays a central role in articulation, swallowing, and tasting. Unilateral weakness is usually well tolerated. Intermittent weakness of the tongue is highly suspicious of myasthenia gravis, while progressive weakness and atrophy are typical for amyotrophic lateral sclerosis(ALS). Tongue weakness without atrophy or fasciculations is a sign of upper motor neuron or cerebellar involvement. Lingual dysarthria should be differentiated from other types of dysarthria. Tongue tremor is common and may be confused with fasciculations. Inspection of the tongue is often diagnostically useful in neuromuscular patients. Fasciculations, myokymia, grooving with pressure, and trigrooved tongue are examples.
Muscle Twitching
Authors: Shaibani Aziz
Published: April 2015

Muscle twitching is a pianless involuntary movement of muscles, usually focal short lived. Patients may confuse it with restlessness of the legs and jerking of extremities unless specifically asked. Tremor,especially of the tongue, is also commonly confused with twitching, but its regular nature should be noticed. Fasciculations and rippling are the most important neuromuscular causes of twitching. Reproduction of the symptoms in the clinic, if possible, is very useful for the diagnosis. Otherwise, a video taken by the patient or family members showing these twitchings is equally good. Fasciculations may be enhanced by tapping the affected muscle group and hyperventilation. Surprisingly, EMG evidence of fasciculations may be scarce despite their clinical predominance.
SDSS J013127.34–032100.1: a candidate blazar with an 11 billion solar mass black hole at z = 5.18
Authors: Ghisellini G. , Tagliaferri G. , Sbarrato T. , Gehrels N.
Published: April 2015

The radio-loud quasar SDSS J013127.34–032100.1 at a redshift z = 5.18 is one of the most distant radio-loud objects. The radio to optical flux ratio (i.e. the radio-loudness) of the source is large, making it a promising blazar candidate. Its overall spectral energy distribution, completed by the X-ray flux and spectral slope derived through Target of Opportunity Swift/X-ray Telescope observations, is interpreted by a non-thermal jet plus an accretion disc and molecular torus model. We estimate that its black hole mass is (1.1 ± 0.2) × 1010 M⊙ for an accretion efficiency η = 0.08, scaling roughly linearly with η. Although there is a factor ≳2 of systematic uncertainty, this black hole mass is the largest found at these redshifts. We derive a viewing angle between 3 and 5 deg. This implies that there must be other (hundreds) sources with the same black hole mass of SDSS J013127.34–032100.1, but whose jets are pointing away from Earth. We discuss the problems posed by the existence of such large black hole masses at such redshifts, especially in jetted quasars. In fact, if they are associated with rapidly spinning black holes, the accretion efficiency is high, implying a slower pace of black hole growth with respect to radio-quiet quasars.
Kinetic scale turbulence and dissipation in the solar wind: key observational results and future outlook
Authors: Goldstein M. L. , Wicks R. T. , Perri S. , Sahraoui F.
Published: April 2015

Turbulence is ubiquitous in the solar wind. Turbulence causes kinetic and magnetic energy to cascade to small scales where they are eventually dissipated, adding heat to the plasma. The details of how this occurs are not well understood. This article reviews the evidence for turbulent dissipation and examines various diagnostics for identifying solar wind regions where dissipation is occurring. We also discuss how future missions will further enhance our understanding of the importance of turbulence to solar wind dynamics.
Intermittency, nonlinear dynamics and dissipation in the solar wind and astrophysical plasmas
Authors: Matthaeus W. H. , Wan Minping , Servidio S. , Greco A. , Osman K. T. , Oughton S. , Dmitruk P.
Published: April 2015

An overview is given of important properties of spatial and temporal intermittency, including evidence of its appearance in fluids, magnetofluids and plasmas, and its implications for understanding of heliospheric plasmas. Spatial intermittency is generally associated with formation of sharp gradients and coherent structures. The basic physics of structure generation is ideal, but when dissipation is present it is usually concentrated in regions of strong gradients. This essential feature of spatial intermittency in fluids has been shown recently to carry over to the realm of kinetic plasma, where the dissipation function is not known from first principles. Spatial structures produced in intermittent plasma influence dissipation, heating, and transport and acceleration of charged particles. Temporal intermittency can give rise to very long time correlations or a delayed approach to steady-state conditions, and has been associated with inverse cascade or quasi-inverse cascade systems, with possible implications for heliospheric prediction.
Performance optimization of a bendable parabolic cylinder collimating X-ray mirror for the ALS micro-XAS beamline 10.3.2
Authors: Yashchuk Valeriy V. , Morrison Gregory Y. , Marcus Matthew A. , Domning Edward E. , Merthe Daniel J. , Salmassi Farhad , Smith Brian V.
Published: April 2015

The Advanced Light Source (ALS) beamline (BL) 10.3.2 is an apparatus for X-ray microprobe spectroscopy and diffraction experiments, operating in the energy range 2.4–17 keV. The performance of the beamline, namely the spatial and energy resolutions of the measurements, depends significantly on the collimation quality of light incident on the monochromator. In the BL 10.3.2 end-station, the synchrotron source is imaged 1:1 onto a set of roll slits which form a virtual source. The light from this source is collimated in the vertical direction by a bendable parabolic cylinder mirror. Details are presented of the mirror design, which allows for precision assembly, alignment and shaping of the mirror, as well as for extending of the mirror operating lifetime by a factor of ∼10. Assembly, mirror optimal shaping and preliminary alignment were performedex situin the ALS X-ray Optics Laboratory (XROL). Using an original method for optimalex situcharacterization and setting of bendable X-ray optics developed at the XROL, a root-mean-square (RMS) residual surface slope error of 0.31 µrad with respect to the desired parabola, and an RMS residual height error of less than 3 nm were achieved. Once in place at the beamline, deviations from the designed optical geometry (e.g.due to the tolerances for setting the distance to the virtual source, the grazing incidence angle, the transverse position) and/or mirror shape (e.g.due to a heat load deformation) may appear. Due to the errors, on installation the energy spread from the monochromator is typically a few electron-volts. Here, a new technique developed and successfully implemented for at-wavelength (in situ) fine optimal tuning of the mirror, enabling us to reduce the collimation-induced energy spread to ∼0.05 eV, is described.
EIS: the scattering beamline at FERMI
Authors: Masciovecchio Claudio , Battistoni Andrea , Giangrisostomi Erika , Bencivenga Filippo , Principi Emiliano , Mincigrucci Riccardo , Cucini Riccardo , Gessini Alessandro , D'Amico Francesco , Borghes Roberto , Prica Milan , Chenda Valentina , Scarcia Martin , Gaio Giulio , Kurdi Gabor , Demidovich Alexander , Danailov Miltcho B. , Di Cicco Andrea , Filipponi Adriano , Gunnella Roberto , Hatada Keisuke , Mahne Nicola , Raimondi Lorenzo , Svetina Cristian , Godnig Roberto , Abrami Alessandro , Zangrando Marco
Published: April 2015

The Elastic and Inelastic Scattering (EIS) beamline at the free-electron laser FERMI is presented. It consists of two separate end-stations: EIS-TIMEX, dedicated to ultrafast time-resolved studies of matter under extreme and metastable conditions, and EIS-TIMER, dedicated to time-resolved spectroscopy of mesoscopic dynamics in condensed matter. The scientific objectives are discussed and the instrument layout illustrated, together with the results from first exemplifying experiments.
A dispenser–reactor apparatus applied forin situXAS monitoring of Pt nanoparticle formation
Authors: Boita Jocenir , Vinicius Castegnaro Marcus , Martins Alves Maria do Carmo , Morais Jonder
Published: April 2015

In situtime-resolved X-ray absorption spectroscopy (XAS) measurements collected at the PtL3-edge during the synthesis of Pt nanoparticles (NPs) in aqueous solution are reported. A specially designed dispenser–reactor apparatus allowed for monitoring changes in the XAS spectra from the earliest moments of Pt ions in solution until the formation of metallic nanoparticles with a mean diameter of 4.9 ± 1.1 nm. By monitoring the changes in the local chemical environment of the Pt atoms in real time, it was possible to observe that the NPs formation kinetics involved two stages: a reduction-nucleation burst followed by a slow growth and stabilization of NPs. Subsequently, the synthesized Pt NPs were supported on activated carbon and characterized by synchrotron-radiation-excited X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD) and extended X-ray absorption fine structure (EXAFS). The supported Pt NPs remained in the metallic chemical state and with a reduced size, presenting slight lattice parameter contraction in comparison with the bulk Pt values.
Should social care staff be Facebook friends with the people they support?
Authors: Bates Peter , Smith Sam , Nisbet Robert
Published: April 2015

Purpose

– Local policies often prohibit care staff from online contact with the people they support. The purpose of this paper is to review the reasons put forward for this ban and seek explanations.

Design/methodology/approach

– The paper examines relevant literature on the use of social networking by disabled and nondisabled people. This paper offers a critique of common policies and justifications and poses a challenge to those who impose such regulations.

Findings

– The paper finds no support for current policies.

Research limitations/implications

– The authors found only a limited amount of research in this area, and research findings were not commonly utilised by policy makers.

Practical implications

– Policy makers and regulators need to take a more rigorous and person-centred approach to rule making in respect of social media.

Social implications

– A widespread ban on the use of social media in communications between staff and the people they support is exposed as paternalistic and exacerbating infantilisation and exclusion rather than seeing disabled people as digital citizens. Regulators and those with responsibilities for safeguarding need to adopt a more empowering and person-centred approach.

Originality/value

– This paper will only make a difference if regulators and those with responsibilities for safeguarding adopt a more empowering and person-centred approach rather than the fear-based blanket prohibitions that have applied to date.
Development of a culture sensitive prevalence study on older adults violence: qualitative methods contribution
Authors: Gil Ana Paula , Santos Ana João , Kislaya Irina
Published: April 2015

Purpose

– The purpose of this paper is to reflect on how qualitative approaches can improve a prevalence study on older adults’ violence. The paper describes how qualitative data can help frame a complex and multidimensional problem, such as older adults’ violence, within the culture where it happens and therefore prevent two risks present in prevalence studies: underestimation and overestimation.

Design/methodology/approach

– To adequately measure violence and violent behaviours the authors first conducted four focus groups with the target population – older adults aged 60 and over – and 13 in-depth interviews with older adult victims of violence. Through content analysis of focus groups and in-depth interviews the authors sought to understand how violence is perceived, defined and limited by the general population and by victims.

Findings

– By employing qualitative methods the authors were able to operationalise violence, decide upon and select specific behaviours to measure, rephrase questions and develop strategies to approach the general population through telephone interviews.

Research limitations/implications

– The qualitative approaches helped reduce participants bias in the prevalence study and therefore to minimise the risks of underestimation and overestimation.

Originality/value

– The study exemplifies how assessing quantitatively to a sensitive subject requires taking into account the perspective of the target population through a qualitative approach.
Finding the win-win
Authors: Wilson Liz
Published: April 2015

Purpose

– The purpose of this paper is to consider critical improvements that need to be made to the volunteer tourism industry with regard to risks to both service users and volunteers. Following an exploration of why these issues are so hard to resolve, recommendations are made for next steps forward.

Design/methodology/approach

– The paper uses a case example of the project from which the author is a Director: Supporting Kids In Peru and draws on her additional practice experience as a child protection social worker.

Findings

– The paper provides a summary of observations to encourage and support practice improvements within the volunteer tourism industry to better safeguard both volunteers and vulnerable people they may be working with.

Practical implications

– A number of clear recommendations are made, including sharing information, improving communication and setting minimum standards, to improve the overall professionalism of the industry.

Originality/value

– The paper provides an insightful practitioner perspective to an aspect of the tourism industry that bridges directly into social services, something which it has had little time to prepare for and has seen dramatic growth in the past few years.
Wildlife and conservation volunteering
Authors: Lynch Peter
Published: April 2015

Purpose

– The purpose of this paper is to outline the stages involved in developing an audit to determine the best wildlife and conservation organization to volunteer with.

Design/methodology/approach

– The paper outlines details of the analysis and assessment of 53 organizations based on nine core criteria. The framework developed for this purpose also provides a tool that could be used to assess other organizations.

Findings

– Publication of the Wildlife and Conservation Volunteering Guide has given volunteers a resource that enables them to make informed decisions about which organization to volunteer with and to enable the featured organizations to reflect on their own relative attractiveness to volunteers.

Originality/value

– The viewpoint highlights several unintended consequences of an audit and demonstrates that published audit criteria prompt organizations to instigate changes.
Is certification the answer to creating a more sustainable volunteer tourism sector?
Authors: Rattan Jasveen K
Published: April 2015

Purpose

– The aim of this paper is to provide a background and offer insights of the use of ecolabels and certifications within the tourism industry and their applicability within the volunteer tourism sector.

Design/methodology/approach

– This study utilizes a comprehensive literature review on tourism ecolabels and certification and presents a discussion about volunteer tourism certification.

Findings

– The paper finds that it is apparent that changes need to be made in the overall practices of operators within the volunteer tourism sector. Guidelines and evaluation techniques are useful, but are not guaranteed in their applicability. However, neither is certification, unless it is monitored and accountable to its stakeholders. Creating a certification that has real world and tangible aspects for its consumers and subscribers would be more useful than one that is very theoretically dense. It is evident that certification can be used as a powerful tool in the quest to attain sustainability, and should not be ignored as a possible solution for the volunteer tourism sector.

Originality/value

– This paper provides a comprehensive discussion on volunteer tourism certification and the extent to which a certification scheme would aid in alleviating current criticisms of the volunteer tourism sector and increase its social responsibility.
INITIAT‐E.D.: Impact of timing of INITIation of Antibiotic Therapy on mortality of patients presenting to an Emergency Department with sepsis
Authors: Wisdom Alice , Eaton Vaughn , Gordon David , Daniel Santhosh , Woodman Richard , Phillips Cameron
Published: April 2015

Objectives

To analyse the association between time from triage to administration of initial antibiotics and mortality in all patients presenting with sepsis to a tertiary hospital ED.

Methods

A retrospective review of patients presenting to the ED with sepsis from January to December 2012 was conducted at Flinders Medical Centre, South Australia. Outcome measures were: time elapsed from triage to administration of initial antibiotic therapy and in‐hospital mortality.

Results

A total of 220 patients presented with sepsis, comprising 102 cases of uncomplicated sepsis and 118 severe sepsis. The median time to antibiotic administration was 3.5 h (interquartile range [IQR] 1.7–6.6) and in‐hospital mortality was 28.6% (95% CI 22.6–34.6%). There was no association observed between delays to antibiotics and mortality in the total patient population. When stratified by presenting severity, patients with severe sepsis demonstrated a trend towards increased mortality when delays to antibiotics exceeded 6 h from triage (HR = 2.25, 95% CI 0.91–5.59, P = 0.08) in comparison with <1 h. Significant delays to antibiotic administration occurred when initial agents were charted as a ‘regular medicine’ (9.4 h, IQR 5.1–16.6) in comparison with a ‘once only order’ (3.4 h, IQR 1.7–6.7), P < 0.001.

Conclusions

Early administration of antibiotics specifically in patients with severe sepsis might be beneficial. Further studies within the ED are warranted to establish the effect of delayed antibiotics in a generalised sepsis cohort.
Prediabetes, diagnosed and undiagnosed diabetes, their risk factors and association with knowledge of diabetes in rural Bangladesh: The Bangladesh Population‐based Diabetes and Eye Study
Authors: Islam Fakir M. Amirul , Chakrabarti Rahul , Islam M. Tauhidul , Wahab Mohammad , Lamoureux Ecosse , Finger Robert P. , Shaw Jonathan E.
Published: April 2015

Background

The aim of the present study was to determine the prevalence and risk factors of prediabetes and diagnosed and undiagnosed diabetes mellitus (DM) in rural Bangladesh.

Methods

Using a population‐based cluster random sampling strategy, 3104 adults aged ≥30 years were recruited. Fasting capillary blood glucose, blood pressure, height, weight, waist circumference, and knowledge, attitudes, and practice related to diabetes were recorded. Diabetes was defined as fasting glucose (FG) ≥7.0 mmol/L or a self‐reported diagnosis of diabetes; impaired FG (IFG) was defined as FG ≥ 6.1 and <7.0 mmol/L.

Results

The overall crude prevalence of DM was 7.2% (95% confidence interval [CI] 6.3%–8.1%; n = 222), of which 55% (n = 123) was previously undiagnosed (UDM). The prevalence of IFG was 5.3% (95% CI 4.5%–6.1%; n = 163). The age‐standardized prevalence of DM and IFG was 6.6% and 5.0%, respectively. The prevalence of UDM was higher in people of lower socioeconomic status (59% vs 31%; P < 0.001). Of those with known DM, 56% had poor glycemic control (FG ≥ 7.0 mmol/L) and 37% were not on medication. Overall knowledge of DM was poor; only 16.3%, 17.8%, and 13.4% of those with UDM, IFG, and normal FG knew that diabetes causes eye disease, compared with 55.6% of those with known DM (Ptrend < 0.001).

Conclusions

In this rural Bangladeshi community, UDM was high. Lower socioeconomic status was associated with a higher risk of UDM. Overall knowledge of DM was poor. Public health programmes should target those of low socioeconomic status and aim to increase knowledge of DM in rural Bangladesh.
Vitamin D Versus Placebo in Improvement of Endothelial Dysfunction: A Meta‐Analysis of Randomized Clinical Trials
Authors: Stojanović Marko , Radenković Miroslav
Published: April 2015

Aims

The possible effect of vitamin D administration in humans on endothelial dysfunction (ED) still remains undetermined. The current meta‐analysis was performed to evaluate if vitamin D could improve ED.

Methods

Randomized, double‐blind, and placebo‐controlled clinical trials were identified by systematic search of the PubMed, the Cochrane Library, the Web of Science and the Scopus data bases, as well as different reviews and clinical trials articles. A random effects model was used to calculate the pooled overall effect on flow‐mediated dilation (FMD) linked to the vitamin D administration. Meta‐regression and subgroup analyses were performed to evaluate the impact of study characteristics on the effect of vitamin D administration on FMD.

Results

A total of eight studies with nine relevant study arms were identified. The obtained results of pooled analysis showed that vitamin D administration did not improve FMD (eight studies, 529 subjects; weighted mean difference (WMD): 0.96%, 95% CI: −1.24% to 2.06%; P = 0.09). This was probably due to significant heterogeneity in between included trials (I2 = 84%, P < 0.00001). On the other hand, subgroup analysis demonstrated that vitamin D improved FMD in trials that lasted <16 weeks; if systolic blood pressure (SBP) was higher than 140 mmHg and in trials where diastolic blood pressure (DBP) was <80 mmHg.

Conclusion

Although the current evidence clearly demonstrates that in certain conditions vitamin D can improve ED, a larger number of clinical trials are needed to confirm this assumption to confirm or reject the final statement on this topic.