bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship Between Blood Pressure Variability and Cognitive Function in Elderly Patients With Good Blood Pressure Control
Authors: Cho Natsuki , Hoshide Satoshi , Nishizawa Masafumi , Fujiwara Takeshi , Kario Kazuomi
Published: August 2017

BACKGROUND

Although higher blood pressure (BP) levels and BP variability have been associated with cognitive impairment, data are sparse regarding the relationship between BP variability and cognitive function in elderly patients with well BP control.

METHODS

We analyzed 232 ambulatory patients with one or more cardiovascular risk factors. All patients underwent ambulatory BP monitoring and the Japanese version of the Montreal Cognitive Assessment (MoCA-J).

RESULTS

The mean age was 77.7 ± 8.3 years; 33.6% were male, and 85.3% were taking antihypertensive drugs. The average 24-hour BP level was 118.7 ± 10.0/68.3 ± 6.4 mm Hg. When we divided the weighted SD of systolic BP (SBP) as a measure of BP variability into quartiles, the top quartile group (≥19.6 mm Hg) had a significantly lower total MoCA-J score (15.4 [95% confidence interval 14.2–16.7] vs. 17.9 [17.2–18.6], P = 0.001) and lower scores on several domains, visuoexecutive (2.2 [1.9–2.6] vs. 2.8 [2.6–2.9], P = 0.012), abstraction (1.0 [0.7–1.2] vs. 1.3 [1.1–1.4], P = 0.015), attention (2.8 [2.4–3.1] vs. 3.6 [3.4–3.8], P = 0.001), and naming (2.1 [1.9–2.3] vs. 2.5 [2.4–2.6], P = 0.001) than quartiles 1 through 3 combined, after adjustment for age and 24-hour SBP. These associations were not found in the quartiles of 24-hour SBP.

CONCLUSIONS

In elderly patients with well ambulatory BP control, higher BP variability but not average ambulatory BP level was associated with cognitive impairment.
Inhibitory effect of indole analogs against Paenibacillus larvae, the causal agent of American foulbrood disease
Authors: Alvarado Israel , Margotta Joseph W , Aoki Mai M , Flores Fernando , Agudelo Fresia , Michel Guillermo , Elekonich Michelle M , Abel-Santos Ernesto
Published: August 2017

Paenibacillus larvae, a Gram-positive bacterium, causes American foulbrood (AFB) in honey bee larvae (Apis mellifera Linnaeus [Hymenoptera: Apidae]). P. larvae spores exit dormancy in the gut of bee larvae, the germinated cells proliferate, and ultimately bacteremia kills the host. Hence, spore germination is a required step for establishing AFB disease. We previously found that P. larvae spores germinate in response to l-tyrosine plus uric acid in vitro. Additionally, we determined that indole and phenol blocked spore germination. In this work, we evaluated the antagonistic effect of 35 indole and phenol analogs and identified strong inhibitors of P. larvae spore germination in vitro. We further tested the most promising candidate, 5-chloroindole, and found that it significantly reduced bacterial proliferation. Finally, feeding artificial worker jelly containing anti-germination compounds to AFB-exposed larvae significantly decreased AFB infection in laboratory-reared honey bee larvae. Together, these results suggest that inhibitors of P. larvae spore germination could provide another method to control AFB.
Advanced Perioperative Crisis Management
Authors: McEvoy Matthew D. , Furse Cory M.
Published: August 2017

This book has grown out of decades of practicing simulation and teaching concepts of perioperative crisis resource management at our institutions, at national meetings, and in our residency and fellowship training programs. The purpose is to fill a gap between two areas of valuable work that exist in the perioperative emergency space; namely, between books that consist largely of steps of diagnosing a problem followed by a list of treatment steps and those reference books or articles that form the compendium works. As such, the goal of this volume is to be an up-to-date, high-yield, clinically relevant resource for understanding the epidemiology, pathophysiology, and proper assessment and management of a wide variety of perioperative emergencies. Our target audience is anesthesiologists, nurse anesthetists, surgeons, recovery and critical care nurses, and anyone else practicing within the perioperative arena.
A Critical Thinking Approach to the Unstable Patient
Authors: Nunnally Mark E. , Banerjee Arna , McEvoy Matthew D.
Published: August 2017

Several factors unfairly shape the medical community’s approach to crisis. Almost all assertions about adequacy of care are influenced by hindsight bias rather than evidence. Additionally, there is a common misperception that choices are obvious in real time, and that there are simple routes to success and failure. Such factors underscore the truth that clinicians do not think enough about how to think about crises. However, prior to moving toward the specifics of managing any specific perioperative crisis, a framework for how to approach any crisis is needed. Accordingly, this chapter introduces a conceptual map for a critical thinking approach to the unstable patient.
Cardiac Dysrhythmias
Authors: Henry Mark , Deegan Robert J.
Published: August 2017

This chapter presents a systematic approach to the diagnosis and acute management of hemodynamically significant dysrhythmias and pulseless arrest states. An overall approach to the unstable patient is reviewed with a specific focus on cardiac conduction and the effects of hemodynamics. By undertaking assessment of the pulse and clinical stability of the patient, the rate and regularity of the rhythm, and the QRS morphology, the clinician can make rational assessments to guide evidence-based therapeutic interventions and avoid the risks of inappropriate treatments. Furthermore, this chapter discusses the transition from stable to unstable to pulseless rhythms and the appropriate treatment for each.
Hypoxia During Anesthesia
Authors: Zamor Natacha
Published: August 2017

In the modern anesthesia machine, there are various safety checks in place to help prevent the delivery of a hypoxic gas mixture to the patient. They include the pin index safety system (PISS), diameter index safety system (DISS), failsafe valve, oxygen-nitrous oxide proportioning system, oxygen supply failure alarm, flowmeter sequence, and, most distally, the oxygen analyzer. The PISS is a feature in the high-pressure system. The DISS, failsafe valve, and oxygen failure alarm are in the intermediate-pressure system. The flowmeters, proportioning system, and oxygen analyzer are in the low-pressure system. This chapter undertakes a discussion of the distinct role of each feature and their limitations.
Airway Fire
Authors: Ng Ju-Mei
Published: August 2017

Airway fires during tracheotomy are rare but potentially fatal events, which are preventable. There are many surgical procedures that place the patient at a higher risk for airway fires, identification of those procedures and the associated risk is the first step towards avoiding this deadly complication. In this chapter the fire triad, of which each of the three components is independently necessary for fire to occur is described. Operating room fire safety measures are reviewed, with emphasis on the management of airway fires. The immediate interventions during an airway fire are discussed, together with the dilemma of which method should be used to secure the airway after the endotracheal tube catches fire.
Undiagnosed Pheochromocytoma
Authors: Stasic Andrew F.
Published: August 2017

Pheochromocytomas are neuroendocrine tumors that secrete large amounts of vasoactive catecholamines resulting in excessive tachycardia and hypertension. These rapid physiologic perturbations can be especially dangerous in patients at risk for stroke and myocardial infarction. Pharmacologic preparation of patients with known pheochromocytomas preoperatively can take many days of advance notice, but doing so successfully will significantly reduce the likelihood of intraoperative hemodynamic complications. Patients who present intraoperatively with undiagnosed pheochromocytomas pose unusual challenges for the anesthesiologist. Prompt recognition of the possibility of an undiagnosed pheochromocytoma and rapid treatment with the appropriate vasoactive drugs may be life saving.
Thyrotoxicosis
Authors: Horn Nicole D.
Published: August 2017

Thyrotoxicosis is a severe form of hyperthyroidism that can lead to a life-threatening episode of thyroid storm. The onset of hyperthyroidism can be gradual and unrecognized. Triggers such as infection and surgery can result in large releases of thyroid hormone, causing a hypermetabolic condition called thyroid storm that produces tachycardia, dysrhythmias, and hypotension. Because of the elevated heart rate and increased myocardial contractility, patients with hyperthyroidism have a decreased cardiac reserve and are at increased risk for adverse cardiac events during the perioperative period. Thyroid storm must be considered in the differential diagnosis of patients with this presentation so that prompt treatment with beta-adrenergic blockers and antithyroid drugs can be given.
Hypomagnesemia/Hypermagnesemia
Authors: Shah Aali
Published: August 2017

Hypomagnesemia is a relatively common electrolyte abnormality that may produce little to no significant clinical manifestations in patients. Commonly used medications such as proton-pump inhibitors and antidepressants can cause magnesium deficiency. The primary cardiac effect of hypomagnesemia is a prolongation of the Q-T interval. It is exposure to other drugs in the perioperative period and physiologic changes caused by anesthesia and surgery that can further alter cardiac electrophysiology and lead to serious ventricular dysrhythmias. Hypermagnesemia is generally iatrogenic from excessive ingestion, renal failure, or therapeutic administration for preeclampsia. Adverse effects of hypermagnesemia include somnolence, muscle weakness, and slowing of cardiac conduction.
Perimortem Cesarean Delivery for Maternal Cardiac Arrest
Authors: Cobb Benjamin , Lipman Steven
Published: August 2017

In the absence of a return of spontaneous circulation during maternal cardiac arrest, a perimortem cesarean section should be strongly considered as an integral component of maternal resuscitation. Uterine compression of the great vessels in the second–third trimesters may contribute to ineffective resuscitative measures. In addition, in the setting of ongoing maternal compromise, fetal outcome may be optimized by delivery. The rarity of maternal cardiac arrest poses a multitude of challenges in the effective application of a perimortem cesarean delivery. Nevertheless, perimortem cesarean delivery remains an essential rescue maneuver for women with periviable fetuses who do not respond to initial resuscitative maneuvers.
Vessels
Authors: Kotsis Eleni , Zorn Jamie M. , Lim Grace
Published: August 2017

Acute coronary syndrome (ACS) in pregnancy is generally considered a rare but potentially life-threatening occurrence. Recent societal trends, including improvements in infertility treatments and professional demands, have contributed to many women delaying pregnancy. The rise in average maternal age means that risks for coronary artery disease and subsequent ACS events in pregnancy are likely to be more frequently encountered by the obstetric clinician. A thorough understanding of the risks, pathophysiology, management, and treatment of ACS and its ramifications in the pregnant patient is required knowledge for all anesthesiologists and other anesthesia providers. This chapter provides a structured approach to the assessment and management of ACS in the parturient.
Difficult Airway: Special Considerations in Pregnancy
Authors: Elkhateb Rania , Mhyre Jill M.
Published: August 2017

Pregnant patients are at increased risk of difficult airway management due to both anatomic and physiologic changes that occur with pregnancy and during the process of labor. While the majority of surgical procedures on labor and delivery are performed with neuraxial anesthesia, general anesthesia may be required at any time. As such, all anesthesia professionals must be prepared at all times for unplanned and emergent obstetric airway management, including management of the difficult airway in the parturient. Strategies include assessment of patient risk early in labor, maintaining difficult airway equipment in the labor and delivery suites, conducting simulation scenarios of difficult and failed airway management, and following difficult airway management algorithms.
Post–Dural Puncture Headache
Authors: Rubin Philip
Published: August 2017

Post–dural puncture headache (PDPH) is a benign but debilitating condition that may occur as a consequence of any dural puncture, whether intentional (as with spinal anesthesia or lumbar puncture) or inadvertent (as with epidural anesthesia). The headache is characteristically unique, as it is postural in nature—worsened when sitting or standing, and markedly improved in the recumbent position. After the puncture, passage of cerebrospinal fluid (CSF) across the dura mater from a pressurized environment (subarachnoid space) to the epidural space, is the initial culprit behind the headache. Noninvasive conservative measures including hydration, analgesics, and caffeine intake are typically offered as initial treatments, but if those measures fail, the “gold standard” epidural blood patch is commonly offered. This procedure entails injection of autologous blood into the epidural space to both halt continued CSF “loss,” and to increase CSF pressure, both of which aid in headache resolution.
Postoperative Visual Loss
Authors: Lee Lorri A.
Published: August 2017

Postoperative visual loss (POVL) has multiple diagnoses and contributory causes including emboli, direct globe compression, prolonged elevation of venous pressure in the head with associated large fluid shifts, prolonged hypotension, periorbital trauma, preexisting ophthalmologic anatomic risk factors, and many other associated factors. It frequently results in permanent injury and severe disability. Though any loss of vision postoperatively should prompt an emergent or urgent ophthalmologic consultation, some of the rarer causes of POVL are considered true medical or surgical emergencies. This chapter briefly discusses these rarer causes and primarily focuses on the more common POVL diagnoses, including the mechanism of injury, appropriate assessment, and initial management.
Acute Loss of Intraoperative Evoked Potential Signals
Authors: Jameson Leslie
Published: August 2017

Monitoring of somatosensory and motor evoked potentials has become the standard of care for a large proportion of spine surgeons. Understanding how anesthetic management may affect these evoked potentials is critical to optimizing the ability to detect impending spinal cord or peripheral nerve injury. Similarly, once a nerve injury is detected, knowledge of the various anesthetic and surgical maneuvers possible to avoid permanent injury is essential for the best patient outcomes. This chapter discusses the effects of various anesthetic agents on somatosensory and motor evoked potentials and potential critical interventions that can be made when a nerve injury is identified by this monitoring.
Autonomic Dysreflexia
Authors: Kla Koffi
Published: August 2017

Autonomic dysreflexia (AD), a potentially emergent clinical syndrome that can occur in patients with spinal cord injury, is characterized by a sudden rise in blood pressure caused by uncontrolled sympathetic activation of the autonomic system below the level of the lesion. When caring for spinal cord injury (SCI) patients, a pretreatment plan should be in place if an AD episode occurs. Physical manifestations of an AD episode can include headache, flushing, and diaphoresis above the lesion. Treatment should be aimed at identifying and eliminating the trigger stimulus and must be prompt to avoid serious complications of blood pressure elevation such as seizures, intracranial hemorrhage, myocardial infarction, or even death. When nonpharmacological measures fail, quick-onset, short-acting antihypertensive medications should be given to lower blood pressure.
Epiglottitis, Croup, and Stridor
Authors: Sabbagh Michel , Freely Jr. John J.
Published: August 2017

Stridor is a high-pitched sound representing partially obstructed or turbulent flow in the airway. Stridor can be part of the inspiratory or expiratory phase, depending on the origin of the flow disturbance. This chapter reviews the etiology of stridor and its subtypes. It also focuses on two important pediatric disease states where stridor is a defining characteristic: epiglottitis and croup. Epiglottitis has emerged as an uncommon cause of pediatric airway compromise, with the widespread use of Haemophilus influenza type b vaccination. Croup continues to be a significant cause of stridor, and is much more common, although less life-threatening. Current opinions on initial evaluation, anesthetic induction, intubation, and follow-up care for both diseases are discussed.
Seizures and Status Epilepticus
Authors: Taneja Pravin
Published: August 2017

Epilepsy is one of the most prevalent chronic neurological disorders both in the U.S. and worldwide, effecting ~1% of the world population. As a result, patients with a history of epilepsy frequently present for surgery. It is important to be aware of how to best characterize the severity of the disease, and treat seizures should they be encountered. In this chapter, we review the epidemiology and pathophysiology of epilepsy. We also discuss the most severe and life threatening form of the condition, status epilepticus. In this emergency situation it is critical that seizures be terminated, and supportive care given. We delineate initial treatment steps and medications, in addition to providing recommendations for refractory cases.
Pyloric Stenosis
Authors: Freely Jr John J. , Sabbagh Michel
Published: August 2017

Pyloric stenosis is one of the most common surgical conditions affecting neonates and young infants. Hypertrophy of the pyloric muscular layers results in gradual gastric outlet obstruction. Persistent episodic projectile vomiting and dehydration as well as hypochloremic, hypokalemic metabolic alkalosis are cardinal features. Definitive treatment is surgical pyloromyotomy, but it is not a surgical emergency. Emergency medical intervention is often required to correct intravascular volume depletion and electrolyte disturbances. Morbidity and mortality should be limited due to advancements in surgical and perioperative care. Morbidity can occur due to poor preoperative resuscitation, anesthetic management difficulties, or postoperative complications. The following manuscript is a review of current evidence-based perioperative care of infants with pyloric stenosis. It reviews the pathophysiology that results in metabolic disturbances and intravascular volume depletion. It focuses on preoperative assessment and correction of electrolyte abnormalities and anesthetic technique including airway management and postoperative analgesia.
Beta Blocker/Calcium Channel Blocker Overdose
Authors: Cropsey Christopher L. , Knight Patrick B.
Published: August 2017

Beta blocker and calcium channel blocker overdose is a rare perioperative complication that manifests with symptoms of altered mental status, hypotension, bradycardia, and cardiovascular collapse. Although the clinical presentation is often similar, the underlying pathophysiology can differ between either cardiogenic or vasodilatory shock. Standard therapies such as calcium administration or beta-adrenergic agonists may be effective but often require much higher doses than normal. The evidence for targeted therapies, such as high-dose insulin infusion and glucagon, is mixed, but these should be considered. Refractory toxicity may require advanced lifesaving measures such as intra-arterial balloon counterpulsation or extracorporeal membrane oxygenation. If prompt cardiovascular support can be achieved, patient outcomes are generally very positive.
Serotonin Toxicity
Authors: Britell Patrick E. , Andrews Charles M.
Published: August 2017

Serotonin toxicity is a potentially life-threatening and severe illness that results from excess serotonin activity. It can be due to prescription medications, drug interactions, and sometimes intentional poisonings. This illness is often iatrogenic and can be predicted by the amount of excess serotonin (5-HT) that activates serotonin receptors both centrally and peripherally. Serotonin toxicity produces a large range of symptoms and varies in cases from mild to severe and even lethal. This chapter reviews the mechanism of development of this illness, symptoms and criteria for diagnosis, appropriate assessment of the patient in the clinical setting, and an outline for timely treatment.
Insulin Overdose
Authors: Novak Richard J.
Published: August 2017

The most significant risk of hypoglycemia is damage to the central nervous system. Iatrogenic insulin overdose by healthcare professionals as well as self-administered overdoses are known to occur. Of particular concern to anesthesia care team members is that hypoglycemia under general anesthesia may be difficult to diagnose clinically, because general anesthesia masks the neuroglycopenic symptoms of stupor and coma. In fact, anesthesiologists are the physicians most at risk for administrating an insulin medication error. A structured system of monitoring and administering insulin promotes patient safety. This chapter will review the appropriate assessment and management of patients suffering from insulin overdose, with particular focus on perioperative challenges.
Introduction to clinical neuropsychiatry
Authors: Hodgkiss Andrew
Published: August 2017

This short introduction to clinical neuropsychiatry is intended for oncology and palliative medicine clinicians. The emphasis is on the clinical examination of higher function (bedside cognitive testing). Assessment of global cognitive function, then simple, lobe-by-lobe bedside tests, are described. Delirium and dementia are defined, and distinguished from one another. The chapter closes with simple examples of how various brain diseases—be they degenerative, infective, vascular, endocrine, or toxic—can manifest as psychopathology (neuropsychiatric disorders).
Psychiatric consequences of cancer treatments: conventional chemotherapy
Authors: Hodgkiss Andrew
Published: August 2017

The psychiatric consequences of a range of conventional chemotherapy agents are reviewed. Anti-folates can cause frank demyelination (methotrexate-induced leucoencephalopathy) or more subtle cognitive impairment. The latter is attributed to reduced hippocampal neurogenesis due to the excitotoxic effects of homocysteine. Low mood, due to reduced availability of SAM, is also found during anti-folate chemotherapy. Ifosfamide-induced encephalopathy is described. Depression and encephalopathies are found with mitotic spindle poisons. Procarbazine is considered as a monoamine oxidase inhibitor. Finally, the developing appreciation of the mixed neuropsychiatric actions of bexarotene, an RXR activator, is reviewed.
Psychiatric consequences of cancer treatments: ‘small molecule’ molecularly targeted agents
Authors: Hodgkiss Andrew
Published: August 2017

The psychiatric consequences of a range of small-molecule, molecularly targeted systemic treatments for cancer are reviewed. Psychopathology may arise from the endocrine complications of VEGFR/multiple TK inhibitors. The mechanisms by which PI3K/AKT inhibition and proteasome inhibition can provoke anxiety and depressive phenomena in animals and humans are discussed. PARP-1 inhibition impairs memory acquisition in animal models and is neuroprotective. PARP-2 inhibitors display anti-neuroinflammatory properties in mice. The cognitive enhancing, mood stabilizing, and neuroprotective effects of HDAC inhibitors are considered.
Non-invasive imaging
Authors: Thorne Sara , Bowater Sarah
Published: August 2017

Non-invasive imaging is used extensively in patients with congenital heart disease. It is an invaluable tool in both in the initial diagnosis and also with the serial assessment and monitoring of patients. As the technology and our knowledge continues to develop in this field, it has largely replaced the use of invasive techniques, such as cardiac catheterization, for diagnosis and assessment in many conditions. This chapter discusses chest X-ray (CXR), transthoracic echocardiography (TTE), transoesophageal echo (TOE), cardiovascular magnetic resonance (CMR) imaging, and computed tomography (CT).
Physiological testing
Authors: Thorne Sara , Bowater Sarah
Published: August 2017

Exercise testing provides objective evidence of functional performance in cardiac disease. There are several modalities available; the method used will depend on the clinical question to be addressed, the equipment available, and the functional ability of the subject being investigated. This chapter explores types of exercise tests and metabolic exercise testing.
Functionally univentricular hearts and Fontan circulation
Authors: Thorne Sara , Bowater Sarah
Published: August 2017

This chapter describes tetralogy of Fallot and pulmonary atresia with ventricular septal defect (VSD), including natural (unoperated) or shunt-palliated history, operated history, follow-up after radical repair, and pulmonary atresia with VSD.
Heart failure in ACHD
Authors: Thorne Sara , Bowater Sarah
Published: August 2017

Despite the advances in surgical techniques, very few ACHD patients have a truly curative procedure, with the majority being at lifelong risk of complications, including ventricular dysfunction, arrhythmias, and premature death. Ventricular dysfunction, leading to heart failure, remains a major cause of morbidity and mortality, with some studies showing that it accounts for up to 40% of deaths in adults with CHD. This chapter discusses drug therapy, transplantation, and end-of-life care in ACHD.
Lifestyle issues
Authors: Thorne Sara , Bowater Sarah
Published: August 2017

This chapter discusses lifestyle issues in adult congenital heart disease, including exercise, diving, travel, and insurance.
Left ventricular outflow tract obstruction
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: August 2017

Conditions that result in left ventricular outflow tract obstruction, i.e. valvular aortic stenosis, due to a bicuspid aortic valve, and subvalvular and supravalvular aortic stenosis are discussed.
Coarctation of the aorta
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: August 2017

Diagnosis and management of coarctation of the aorta are discussed in this chapter.
Primary (essential) hypertension
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: August 2017

Risk stratification and therapy of primary hypertention are discussed. The management of resistant hypertension, hypertensive crisis, and hypertension in pregnancy is presented.
Classification of cardiomyopathies
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: August 2017

The AHA and ESC classifications of cardiomyopathies are presented.
Catecholaminergic polymorphic ventricular tachycardia
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: August 2017

Diagnosis and therapy of catecholaminergic polymorphic ventricular tachycardia are discussed.
The cardiac conduction system
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: August 2017

The anatomy of cardiac conduction system and genetic mutations that have been associated with conduction disease are discussed.
Acute aortic syndromes
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: August 2017

Acute aortic syndromes comprise aortic dissection, intramural haematoma, and penetrating atherosclerotic ulcer. Classification, presentation, diagnosis, and management of these conditions are discussed.
Deep vein thrombosis
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: August 2017

Deep venous thrombosis and thromboembolism in pregnancy are discussed.
Rheumatic fever
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: August 2017

Diagnosis and management of pseudoaneurysms of the heart are discussed.
Religious Freedom and Human Rights in Kazakhstan
Authors: Podoprigora Roman , Apakhayev Nurlan , Zhatkanbayeva Aizhan , Baimakhanova Dina , Kim Elina P , Sartayeva Kaliya R
Published: August 2017

Many post-Soviet governments are still unable to identify the attitude to religious freedom and religious activity. The human rights trend adjoins with a very suspicious attitude to the religious phenomena as a relic of the Soviet regime of the state–church relationships. Moreover, the professional communities and society as a whole were not appropriately prepared for the religious diversity or the new role of religion in public and private life. This article discusses why the government is very careful in the regulation of religious processes. The article also explains the reasons of inattention by Kazakhstani lawyers to human rights and religious issues and analyses the situation regarding religious freedom within frames of existing legislation in Kazakhstan.
Cardiovascular involvement in myositis
Authors: Diederichsen Louise P.
Published: August 2017

Purpose of review

The purpose of this review is to provide an update on cardiovascular involvement in idiopathic inflammatory myopathy (IIM). Studies from the past 18 months are identified and reviewed. Finally, the clinical impact of these findings is discussed.

Recent findings

Epidemiological studies have revealed an increased risk of myocardial infraction and venous thromboembolism (VTE) – including deep venous thrombosis and pulmonary embolism – in adults with polymyositis or dermatomyositis compared to the general population, even after adjustment for potential confounders. This increased risk applies particularly within the initial year of diagnosis. In addition, cross-sectional studies have shown subclinical cardiac involvement in IIM effecting both heart function and rhythm, and conduction abnormalities, which in part might be because of myocarditis. The International Consensus Group on cardiac magnetic resonance (CMR) imaging suggests that CMR should be considered as a potentially viable diagnostic tool to evaluate the possibility of silent myocardial inflammation in IIM with normal routine noninvasive evaluation.

Updated literature on cardiovascular involvement in IIM has identified an increased risk for subclinical and clinical cardiovascular disease in these rare inflammatory muscle diseases.
The role of collective labor contracts and individual characteristics on job satisfaction in Tuscan nursing homes
Authors: Vainieri Milena , Smaldone Pierluigi , Rosa Antonella , Carroll Kathleen
Published: August 2017

Background:

The role played by remuneration strategies in motivating health care professionals is one of the most studied factors. Some studies of nursing home (NH) services, while considering wages and labor market characteristics, do not explicitly account for the influence of the contract itself.

Purpose:

This study investigates the relationship between the labor contracts applied in 62 Tuscan NHs and NH aides’ job satisfaction with two aims: to investigate the impact of European contracts on employee satisfaction in health care services and to determine possible limitations of research not incorporating these contracts.

Methodology:

We apply a multilevel model to data gathered from a staff survey administered in 2014 to all employees of 62 NHs to analyze two levels: individual and NH. Labor contracts were introduced into the model as a variable of NH.

Results:

Findings show that the factors influencing nursing aides’ satisfaction occur at both the individual and NH levels. Organizational characteristics explain 16% of the variation. For individual characteristics, foreign and temporary workers emerge as more satisfied than others. For NH variables, results indicate that the labor contract with the worst conditions is not associated with lower workers’ satisfaction.

Conclusion:

Although working conditions play a relevant role in the job satisfaction of aides, labor contracts do not seem to affect it. Interestingly, aides of the NHs with the contract having the best conditions register a significantly lower level of satisfaction compared to the NHs with the worst contract conditions. This suggests that organizational factors such as culture, team work, and other characteristics, which were not explicitly considered in this study, may be more powerful sources of worker satisfaction than labor contracts.

Practice Implications:

Our analysis has value as a management tool to consider alternative sources as well as the labor contract for employee incentives.
Social identity and the prison health worker: Implications for practitioner satisfaction and turnover intentions
Authors: Stephenson Amber L. , Bell Nicolette
Published: August 2017

Background:

Delivering health care within the prison walls poses distinct and arduous challenges to the practitioner. Correctional health workers regularly face issues of overcrowding, increased prevalence of infectious disease, advancing age, deteriorating conditions, and patients with an inclination for violence. Still, regardless of the sizeable workforce, costs, and impact on community well-being, correctional health is often overlooked in health services delivery research.

Purpose:

The aim of this study was to better understand the unique nature of delivering services in the prison context through the lens of social identity theory and further explore practitioner satisfaction and retention.

Methodology/Approach:

A survey design was used in this study, sampling clinicians in a state department of corrections in the United States. Using the data from 317 respondents, the study explored the relationship between professional identification and perceived organizational support as they impact job satisfaction and turnover intention and while controlling for burnout.

Results:

Using nested ordinary least squares regression and nested logistic regression, the results showed that professional identification and perceived organizational support were positively associated with job satisfaction. Perceived organizational support was negatively and significantly related to turnover intentions.

Conclusion:

This article adds originality and value to the literature by using social identity theory to address the occupational perceptions of a large, yet often underrepresented and underexplored, subsector of the health workforce.

Practice Implications:

The results highlight several areas where health care managers, whether from correctional or noncorrectional environments, could implement policy and procedure changes to further engage and retain the clinical workforce. To engage and retain the health worker population, managers must consider identification-reinforcing interventions that align with the self-concept and visibly display gestures of organizational support.
Human neutrophil elastase mediates fibrinolysis shutdown through competitive degradation of plasminogen and generation of angiostatin
Authors: Barrett Christopher D. , Moore Hunter B. , Banerjee Anirban , Silliman Christopher C. , Moore Ernest E. , Yaffe Michael B.
Published: August 2017

BACKGROUND

A subset of trauma patients undergo fibrinolysis shutdown rather than pathologic hyperfibrinolysis, contributing to organ failure. The molecular basis for fibrinolysis shutdown in trauma is incompletely understood. Elastase released from primed/activated human neutrophils (HNE) has historically been described as fibrin(ogen)olytic. However, HNE can also degrade plasminogen (PLG) to angiostatin (ANG), retaining the kringle domains but not the proteolytic function, and could thereby compete for generation of active plasmin by tissue plasminogen activator (tPA). We hypothesized that HNE can drive fibrinolysis shutdown rather than fibrinolysis.

METHODS

Turbidometry was performed using light scatter (λ = 620 nm) in a purified fibrinogen + PLG system and in healthy citrate plasma clotted with Ca2+/thrombin ± tPA, ±HNE, and ±ANG to evaluate HNE effects on fibrinolysis, quantified by time to transition midpoint (T
m). ΔT
m from control is reported as percent of control ±95% CI. Purified HNE coincubated with PLG or tPA was analyzed by western blot to identify cleavage products. Exogenous HNE was mixed ex vivo with healthy volunteer blood (n = 7) and used in TEG ± tPA to evaluate effects on fibrinolysis.

RESULTS

HNE did not cause measurable fibrinolysis on fibrin clots, clotted plasma, or whole blood as assessed by turbidometry or TEG in the absence of tPA. Upon tPA treatment, all three methods of evaluating fibrinolysis showed delays and decreases in fibrinolysis caused by HNE relative to control: fibrin clot turbidometry ΔT
m = 110.7% (CI 105.0–116.5%), clotted citrate plasma (n = 6 healthy volunteers) ΔT
m = 126.1% (CI 110.4–141.8%), and whole blood native TEG (n = 7 healthy volunteers) with ΔLY30 = 28% (p = 0.043). Western blot analysis of HNE–PLG co-incubation confirmed that HNE generates angiostatin K1–3, and plasma turbidity assays treated with angiostatin K1–3 delayed fibrinolysis.

CONCLUSION

HNE degrades PLG and generates angiostatin K1–3, which predominates over HNE cleavage of fibrin(ogen). These findings suggest that neutrophil release of elastase may underlie trauma-induced fibrinolytic shutdown.
Physiological Gaussian Process Priors for the Hemodynamics in fMRI Analysis
Authors: Wilzén Josef , Eklund Anders , Villani Mattias
Published: August 2017

Inference from fMRI data faces the challenge that the hemodynamic system, that relates the underlying neural activity to the observed BOLD fMRI signal, is not known. We propose a new Bayesian model for task fMRI data with the following features: (i) joint estimation of brain activity and the underlying hemodynamics, (ii) the hemodynamics is modeled nonparametrically with a Gaussian process (GP) prior guided by physiological information and (iii) the predicted BOLD is not necessarily generated by a linear time-invariant (LTI) system. We place a GP prior directly on the predicted BOLD time series, rather than on the hemodynamic response function as in previous literature. This allows us to incorporate physiological information via the GP prior mean in a flexible way. The prior mean function may be generated from a standard LTI system, based on a canonical hemodynamic response function, or a more elaborate physiological model such as the Balloon model. This gives us the nonparametric flexibility of the GP, but allows the posterior to fall back on the physiologically based prior when the data are weak. Results on simulated data show that even with an erroneous prior for the GP, the proposed model is still able to discriminate between active and non-active voxels in a satisfactory way. The proposed model is also applied to real fMRI data, where our Gaussian process model in several cases finds brain activity where previously proposed LTI models, parametric and nonparametric, does not.
NINJA-Associated ERF19 Negatively RegulatesArabidopsisPattern-Triggered Immunity
Authors: Huang Pin-Yao , Zhang Jingsong , Jiang Beier , Yu Jhong-He , Lu Yu-Ping , Chung KwiMi , Zimmerli Laurent
Published: August 2017

Recognition of microbe-associated molecular patterns (MAMPs) derived from invading pathogens by plant pattern recognition receptors (PRRs) initiates defense responses known as pattern-triggered immunity (PTI). Transcription factors (TFs) orchestrate the onset of PTI through complex signaling networks. Here, we characterize the function of ERF19, a member of theArabidopsis thalianaethylene response factor (ERF) family. ERF19 was found to act as a negative regulator of PTI againstBotrytis cinereaandPseudomonas syringaepv.tomatoDC3000 (Pst). Notably, overexpression ofERF19increased plant susceptibility to these pathogens and repressed MAMP-induced PTI outputs. In contrast, expression of the chimeric dominant repressorERF19-SRDXboosted PTI activation, conferred increased resistance toB. cinerea, and enhanced elf18-triggered immunity againstPst. Consistent with a negative role of ERF19 in PTI, MAMP-mediated growth inhibition was respectively weakened or augmented in lines overexpressingERF19or expressingERF19-SRDX. Moreover, we demonstrate that the transcriptional repressor Novel INteractor of JAZ (NINJA) associates with and represses the function of ERF19. Our work reveals ERF19 as a key player in a buffering mechanism to avoid defects imposed by over-activation of PTI and a potential role for NINJA in fine-tuning ERF19-mediated regulation.
Differential gene expression in chicken primary B cells infectedex vivowith attenuated and very virulent strains of infectious bursal disease virus (IBDV)
Authors: Dulwich Katherine L. , Giotis Efstathios S. , Gray Alice , Nair Venugopal , Skinner Michael A. , Broadbent Andrew J.
Published: August 2017

Infectious bursal disease virus (IBDV) belongs to the familyBirnaviridaeand is economically important to the poultry industry worldwide. IBDV infects B cells in the bursa of Fabricius (BF), causing immunosuppression and morbidity in young chickens. In addition to strains that cause classical Gumboro disease, the so-called ‘very virulent’ (vv) strain, also in circulation, causes more severe disease and increased mortality. IBDV has traditionally been controlled through the use of live attenuated vaccines, with attenuation resulting from serial passage in non-lymphoid cells. However, the factors that contribute to the vv or attenuated phenotypes are poorly understood. In order to address this, we aimed to investigate host cell-IBDV interactions using a recently described chicken primary B cell model, where chicken B cells are harvested from the BF and culturedex vivoin the presence of chicken CD40L. We demonstrated that these cells could support the replication of IBDV when infectedex vivoin the laboratory. Furthermore, we evaluated the gene expression profiles of B cells infected with an attenuated strain (D78) and a very virulent strain (UK661) by microarray. We found that key genes involved in B cell activation and signaling (TNFSF13B, CD72 and GRAP) were down-regulated following infection relative to mock, which we speculate could contribute to IBDV-mediated immunosuppression. Moreover, cells responded to infection by expressing antiviral type I IFNs and IFN-stimulated genes, but the induction was far less pronounced upon infection with UK661, which we speculate could contribute to its virulence.
A three-dimensional cadmium coordination polymer based on 1,4-bis(1,2,4-triazol-1-yl)but-2-ene and benzene-1,3,5-tricarboxylic acid
Authors: Zhou Qian-Kun , Li Ni-Ya
Published: August 2017

The CdII three-dimensional coordination poly[[[μ4-1,4-bis(1,2,4-triazol-1-yl)but-2-ene]bis(μ3-5-carboxybenzene-1,3-dicarboxylato)dicadmium(II)] dihydrate], {[Cd2(C9H4O6)2(C8H10N6)]·2H2O}
n
, (I), has been synthesized by the hydrothermal reaction of Cd(NO3)2·4H2O, benzene-1,3,5-tricarboxylic acid (1,3,5-H3BTC) and 1,4-bis(1,2,4-triazol-1-yl)but-2-ene (1,4-btbe). The IR spectrum suggests the presence of protonated carboxylic acid, deprotonated carboxylate and triazolyl groups. The purity of the bulk sample was confirmed by elemental analysis and X-ray powder diffraction. Single-crystal X-ray diffraction analysis reveals that the CdII ions adopt a five-coordinated distorted trigonal–bipyramidal geometry, coordinated by three O atoms from three different 1,3,5-HBTC2− ligands and two N atoms from two different 1,4-btbe ligands; the latter are situated on centres of inversion. The CdII centres are bridged by 1,3,5-HBTC2− and 1,4-btbe ligands into an overall three-dimensional framework. When the CdII centres and the tetradentate 1,4-btbe ligands are regarded as nodes, the three-dimensional topology can be simplified as a binodal 4,6-connected network. Thermogravimetric analysis confirms the presence of lattice water in (I). Photoluminescence studies imply that the emission of (I) may be ascribed to intraligand fluorescence.
The dangers of infection: school medical inspection in Brazil (the 1910s)
Authors: Rocha Heloísa Helena Pimenta , Silva Henrique Mendonça da
Published: August 2017

Purpose

The purpose of this paper is to investigate the introduction of school medical inspection (SMI) in Rio de Janeiro and São Paulo (Brazil) during the 1910s, in a process aligned with the international debate that, since the late nineteenth century, sustained the need of services that focused on the sanitary inspection of schools and their students. It analyzes the purposes guiding the creation of these services and their connections to the spheres of public health and education, highlighting the role taken by the concerns about issues such as the control of infectious diseases, particularly tuberculosis.

Design/methodology/approach

The study consists of a historical analysis using as sources the legislation and documents produced by the SMI. The documents are examined in correlation with the positions defended at international conferences held at the period.

Findings

The study evidences the intricacies of the introduction of SMI services in the Brazilian states that were pioneers in this area. It examines their relations to guidelines established in international forums, which certainly played an important role in the Brazilian efforts. It also allowed to highlight the relations between efforts to create medical inspections in school and those aiming at fighting infectious diseases.

Originality/value

The paper contributes to a better comprehension of the efforts regarding social hygiene and particularly the hygiene of schools and their students in a period in which the state takes greater responsibilities for its population.
Driving quality in product development in a Malaysian optoelectronic firm
Authors: Aligula Geoffrey K. , Kok Chee Kuang , Sim Hock Kheng
Published: August 2017

Purpose

This paper aims to demonstrate how the five phases of design for six sigma approach as defined by define-measure-analyse-design-validate (DMADV) are adopted towards the development of an optoelectronic product to address the unexplored development issues related to micron-scale tolerances of internal diameters in plastic moulded parts. In addition, the structured product development approach is used to address the critical-to-quality (CTQ) characteristics that define the quality of the final product.

Design/methodology/approach

In line with DMADV, the presented methodology used various tools at each development stage to address key requirements of critical concern in the project. This included the ideal use of computer-aided design (CAD) simulation tool to identify CTQ parameters, failure mode effect analysis as a predictive tool to identify the major defects, while adopting root-cause-analysis to identify the fundamental causes of the major defects, design of experiment, and statistical analysis using Minitab Software for data-driven decision-making.

Findings

The two major defects that hindered the mass production of quality products were eliminated, and the overall development of the product significantly improved. Additionally, a quality control strategy approach was implemented to “lock in” the quality.

Originality/value

The case study presented develops and adopts a structured approach from DMADV with the key focus of addressing a micron-scale tolerance conflict between the design and manufacturing tolerance requirements of an optoelectronic product. The uniqueness of the case study is the adoption and application of CAD simulation at the Define phase of the DMADV process to address the CTQ issue of the product developed.