bluuebunny/crossref_metadata_2025 huggingface dataset:
The intensive cardiac care unit team
Authors: Quinn Tom , Swahn Eva
Published: April 2015

Effective, safe health care is a multidisciplinary undertaking. From its inception, half a century ago, the concept of intensive coronary (now cardiac) care has drawn on the expertise of a range of professionals, particularly physicians working closely with nurses. As the evidence base for some aspects of the intensive cardiac care unit care has developed, the intensive cardiac care unit, in some instances, has striking similarities to the general intensive care unit, while paradoxically traditional intensive cardiac care unit functions have been devolved to other parts of the health care system such as the emergency department or pre-hospital care, and the concept of critical care ‘outreach’ has been further developed to take the expertise to patients on the general ward or even in the pre-hospital phase. With more intensive treatment policies for older people becoming the norm, the range of multi-comorbidities to be addressed by the clinical team requires input from a range of other specialties. Moreover, the increasing complexity of diagnostic and interventional techniques requires close collaboration with laboratory and imaging personnel. Thus, the intensive cardiac care unit team arguably extends beyond staff working solely within the physical structure of the intensive cardiac care unit to encompass a range of other professional and support staff, both within and outside the hospital setting.
Clinical assessment and monitoring of chest radiographs
Authors: Parkhomenko Alexander , Gurjeva Olga S , Yalynska Tetyana
Published: April 2015

This chapter reviews the main problems in obtaining portable X-rays in intensive cardiac care unit patients and describes specific features of radiographs taken in the supine anteroposterior position. It also includes a brief review of a systematic, multistep approach of evaluating the quality of radiographic images and describing the chest wall, pulmonary vasculature, the heart and its chambers, the great vessels, and the position of tubes, lines, and devices. This chapter covers the most common conditions for which chest radiographs are useful and provides intensive cardiac care unit physicians, cardiologists, cardiology fellows, and medical students with basic information on water retention, air collection, and lung-related problems. It also focuses on the monitoring of line and device placements (e.g. central venous catheters, tube malposition) and procedure-related abnormalities, which may be apparent on chest X-rays and are helpful for timely diagnoses.
Temporary pacing
Authors: Gorenek Bulent
Published: April 2015

Temporary cardiac pacing by electrical stimulation of the heart is indicated as a short-term treatment of life-threatening bradyarrhythmias or tachyarrhythmias. It can be used temporarily until the arrhythmias resolve or as a bridge to permanent pacing. Symptomatic bradycardias needing temporary pacing may occur in acute myocardial infarction, during percutaneous coronary intervention, and in patients with sinus node dysfunction. Temporary pacing can also be useful for terminating or suppressing some types of supraventricular and ventricular arrhythmias. Single-chamber, dual-chamber, or biventricular pacing modes can be used. In haemodynamically compromised patients, dual-chamber pacing is preferred. Ideally, this procedure is performed under fluoroscopy, but electrode catheters can also be inserted without fluoroscopy, with ECG and/or pressure monitoring. Several methods of temporary pacing are available: transvenous, external, and transoesophageal pacing. Transvenous pacing is the most commonly used technique. Although this method is safe and easy, some complications related to venous access or caused by the inserted electrode catheters or by an electrical dysfunction of the pacing device may occur, either during or after the implantation.
Donor organ management
Authors: Neyrinck Arne P , Ferdinande Patrick , Van Raemdonck Dirk , Van de Velde Marc
Published: April 2015

Organ transplantation is the standard treatment modality for end-stage organ disease in selected cases. Two types of potential organ donors can be identified: the brain-dead ‘heart-beating donors’, referred to as DBD (donation after brain death), and the warm ischaemic ‘non-heart-beating donors’, referred to as DCD (donation after circulatory death). Brain death induces several physiological changes in the DBD donor. An autonomic storm is characterized by massive catecholamine release, followed by autonomic depletion during a vasoplegic phase. This is associated with several hormonal changes (suppression of vasopressin, the hypothalamic-pituitary-adrenal axis, and the hypothalamic-pituitary-thyroid axis) and an inflammatory response. These physiological changes form the basis of organ donor management, including cardiovascular stabilization and hormonal therapy (including vasopressin and analogues, thyroid hormone, and cortisol). Donor management is the continuation of critical care, with a shift towards individual organ stabilization. An aggressive approach to maximize organ yield is recommended; however, many treatment strategies need further investigation in large randomized trials. DCD donors have now evolved as a valid alternative to increase the potential donor pool and challenge the clinician with new questions. Optimal donor comfort therapy and end-of-life care are important to minimize the agonal phase. A strict approach towards the determination of death, based on cardiorespiratory criteria, is prerequisite. Novel strategies have been developed, using ex situ organ perfusion as a tool, to evaluate and recondition donor organs. They might become more important in the future to further optimize organ quality.
Biomarkers of renal and hepatic failure
Authors: Plebani Mario , Mion Monica Maria , Zaninotto Martina
Published: April 2015

In the last few years, major advances have been achieved in the understanding of the molecular and pathophysiological mechanisms which underlie the complex interactions between the heart and the kidney, as well as between the heart and the liver. According to these new insights, new biomarkers have been proposed for better evaluating and monitoring patients affected by cardiovascular diseases. In addition, some biomarkers should be used as risk factors and for an early identification and treatment of these severe diseases. This chapter reviews the most important biomarkers for evaluating the ‘cardiorenal syndrome’, in particular, the measurement of serum creatinine and its use for calculating the glomerular filtration rate which, with the new and more efficient equation, namely Chronic Kidney Disease Epidemiology Collaboration, still remains the most widely used biomarker. The role of newer biomarkers will be explored. The measurement of cystatin C, representing additional information, particularly in paediatric age groups and in the early phase of kidney disease, plays an increasing role. Neutrophil gelatinase-associated lipocalin is a recently developed and very promising new biomarker for the diagnosis of acute kidney injury, while the well-known albumin/creatinine ratio has been re-evaluated as a simple and useful tool for an early identification of kidney disease. Regarding liver diseases, a growing body of evidence demonstrates the usefulness of non-invasive makers of hepatic fibrosis that may avoid the need for a liver biopsy in most patients. A promising field of research is represented by the role of non-alcoholic fatty liver disease in the pathogenesis of cardiovascular disease.
Atherosclerosis and thrombosis
Authors: Badimon Lina , Vilahur Gemma
Published: April 2015

Atherosclerosis is the main underlying cause of heart disease. The continuous exposure to cardiovascular risk factors induces endothelial activation/dysfunction which enhances the permeability of the endothelial layer and the expression of cytokines/chemokines and adhesion molecules. This results in the accumulation of lipids (low-density lipoprotein particles) in the extracellular matrix and the triggering of an inflammatory response. Accumulated low-density lipoprotein particles suffer modifications and become pro-atherogenic, enhancing leucocyte recruitment and further transmigration across the endothelium into the intima. Infiltrated monocytes differentiate into macrophages which acquire a specialized phenotypic polarization (protective or harmful), depending on the stage of the atherosclerosis progression. Once differentiated, macrophages upregulate pattern recognition receptors capable of engulfing modified low-density lipoprotein, leading to foam cell formation. Foam cells release growth factors and cytokines that promote vascular smooth muscle cell migration into the intima, which then internalize low-density lipoprotein via low-density lipoprotein receptor-related protein-1 receptors. As the plaque evolves, the number of vascular smooth muscle cells decline, whereas the presence of fragile/haemorrhagic neovessels increases, promoting plaque destabilization. Disruption of this atherosclerotic lesion exposes thrombogenic surfaces that initiate platelet adhesion, activation, and aggregation, as well as thrombin generation. Both lipid-laden vascular smooth muscle cells and macrophages release the procoagulant tissue factor, contributing to thrombus propagation. Platelets also participate in progenitor cell recruitment and drive the inflammatory response mediating the atherosclerosis progression. Recent data attribute to microparticles a potential modulatory effect in the overall atherothrombotic process. This chapter reviews our current understanding of the pathophysiological mechanisms involved in atherogenesis, highlights platelet contribution to thrombosis and atherosclerosis progression, and provides new insights into how atherothrombosis may be modulated.
Gender considerations in acute coronary syndromes
Authors: Swahn Eva , Alfredsson Joakim , Lawesson Sofia Sederholm
Published: April 2015

It is a very important issue to enlighten on gender differences and similarities regarding the management of patients with acute coronary syndromes. It is a fact that women have not been included in clinical trials in numbers equal to men, for whatever reason. In the future, it will be necessary to individualize, as much as possible, the management of patients, regardless of gender. To get there, it is necessary to have sufficient numbers of patients from both genders included in trials, or otherwise it is not possible to draw proper conclusions. Until now, most results regarding women and acute coronary syndromes have been based on substudy analyses with inadequate statistical power. If gender differences have become evident in studies with gender-mixed populations, it seems obvious that the calculated power to show significant differences is also inadequate for men. There is an urgent need of more research in this area, in order not to harm our patients with our treatment because of a paucity of knowledge. It is also as important not to withdraw proper treatment from certain individuals when they can benefit from it.
Conduction disturbances and pacemaker
Authors: Lavalle Carlo , Ricci Renato Pietro , Santini Massimo
Published: April 2015

The most frequent clinical conditions complicated by bradyarrhythmias or atrioventricular blocks seen in an emergency setting are the degeneration of the conduction system, acute myocardial infarction, drug toxicity, and hyperkalaemia. Pacemaker malfunction is another cause of potentially life-threatening bradyarrhythmias. The presence of signs/symptoms of hypoperfusion and the localization of the block condition the therapeutic approach. Treatment of bradyarrhythmias and atrioventricular block in a critical care setting may be preventative or therapeutic. A preventative approach is necessary when the risk of a sudden block with an inadequate ventricular escape rhythm is present, but the patient is asymptomatic. Symptomatic patients require immediate treatment. If the block is located at His bundle level or at bundle branch level, atropine may be ineffective and may even worsen the degree of the block. If drug administration is ineffective, transvenous temporary pacing is indicated. Transcutaneous cardiac pacing is another temporary method of pacing indicated in various critical clinical settings.
Ventricular tachyarrhythmias and implantable cardioverter–defibrillator
Authors: Ehrlich Joachim R , Hohnloser Stefan H
Published: April 2015

Few scenarios in intensive coronary care are commonly associated with as much fear and apprehension as the event of a ventricular tachyarrhythmia. This chapter provides information to help successfully manage such situations. Residents, fellows, and physicians involved in providing acute cardiac care are in need of broad background knowledge regarding the diagnostic and therapeutic means, as well as the prognostic implications of such events, in order to provide adequate medical care to their patients. The present chapter summarizes information on the pathophysiological basis of ventricular tachyarrhythmias and teaches tools to detect and correctly differentiate a ventricular from a supraventricular arrhythmia on the surface electrocardiogram. The chapter provides the reader with a summary of specific treatment modalities and information on indications for treatment with an implantable cardioverter-defibrillator. Last, the chapter deals with the management of device interventions (appropriately delivered for ventricular tachyarrhythmias or inappropriately delivered for other reasons) within the increasing population of patients fitted with an implantable cardioverter-defibrillator.
Myocarditis and pericarditis
Authors: Noutsias Michel , Maisch Bernhard
Published: April 2015

Transition of acute myocarditis to dilated cardiomyopathy occurs in approximately 20% of patients within a follow-up period of 33 months. Recent research has revealed the adverse prognostic impact of several clinical parameters for this scenario. Acute myocarditis and its sequelae dilated cardiomyopathy and inflammatory cardiomyopathy are often caused by viral infections. Histological evaluation of endomyocardial biopsies is critical for the diagnosis of the cardiomyopathy entity and for the clinical management of around 20% of the patients. Additionally, contemporary diagnostic procedures of endomyocardial biopsies are indispensable for the selection of inflammatory cardiomyopathy patients who will likely benefit from immunosuppression or antiviral (interferon) treatment. Immunoadsorption, with subsequent immunoglobulin substitution, is a further promising immunomodulatory treatment option for dilated cardiomyopathy patients, targeting primarily the anticardiac autoantibodies. Cardiac magnetic resonance has emerged as a valuable diagnostic approach for myocarditis and pericarditis. Myocardial late gadolinium enhancement has been associated with adverse outcome and sudden cardiac death. Bridging of the first 3–6 months with a wearable cardioverter–defibrillator, until a definitive decision on the implantation of an implantable cardioverter–defibrillator, is a growingly recognized cornerstone in the clinical management of patients with acute myocarditis with depressed left ventricular ejection fraction of <40% and new-onset dilated cardiomyopathy, respectively. Acute pericarditis is labelled idiopathic or suspected viral without adequate proof of the respective aetiology. Non-steroidal anti-inflammatory drugs and colchicine are proven and safe therapeutic mainstays for pericarditis, including the first attack. Pericardiocentesis is a lifesaving treatment of cardiac tamponade. Pericardioscopy and epicardial biopsies can contribute to the aetiological differentiation of pericardial effusions.
Aortic emergencies
Authors: Astarci Parla , Kerchove Laurent de , Khoury Gébrine el
Published: April 2015

Acute aortic dissections account for the leading and most feared of aortic emergencies. Acute dissections are associated with a dreadful mortality rate; therefore, an accurate diagnosis and immediate treatment are mandatory. The key point of a lifesaving management strategy is the distinction between acute type A dissection, uncomplicated type B dissection, and complicated type B dissection, and those including contained ruptured aorta (severe pleural effusion) and/or malperfusion syndrome (by end-organ ischaemia: paraplegia, intestinal ischaemia, renal insufficiency, limb ischaemia). Type A generally requires urgent surgery; uncomplicated type B dissections are treated conservatively, while complicated type B dissections are currently managed by means of minimally invasive endovascular techniques, eventually associated with a tight surgical time (e.g. in the case of limb ischaemia). Surgical repair of type A dissection consists of the replacement of the ascending aorta. The repair is extended proximally towards the aortic root and valve, and distally towards the aortic arch, in function of the lesions found and the clinical presentation of the patient (haemodynamic status, age, comorbidities). The emergence of endovascular techniques and the contribution of thoracic endovascular aortic repair, with thoracic stent-grafts deployed from the proximal descending aorta to reopen the true lumen and to seal the entry tear in type B dissections, have revolutionized the surgical treatment algorithm in this pathology, and thus the patient’s immediate and medium-term survival. In the same group of acute aortic syndromes, traumatic aortic isthmic ruptures are also life-threatening conditions and account for one of the main causes of death at the time of traumatic accidents. As in the case of complicated type B dissections, the introduction of aortic stent-grafts has changed the outcome of these patients.
Stroke
Authors: Leys Didier , Cordonnier Charlotte , Caso Valeria
Published: April 2015

Stroke is a major public health issue. Many are treatable in the acute stage, provided patients are admitted soon enough. The overall incidence of stroke in Western countries is approximately 2400 per year per million inhabitants, and 80% are due to cerebral ischaemia. The prevalence is approximately 12 000 per million inhabitants. Stroke is associated with increased long-term mortality, handicap, cognitive and behavioural impairments, recurrence, and an increased risk of other types of vascular events. It is of major interest to take the heterogeneity of stroke into account, because of differences in the acute management, secondary prevention, and outcomes, according to the subtype and cause of stroke. In all types of stroke, early epileptic seizures, delirium, increased intracranial pressure, and non-specific complications are frequent. In ischaemic strokes, specific complications, such as malignant infarcts, spontaneous haemorrhagic transformation, early recurrence, and a new ischaemic event in another vascular territory, are frequent. In haemorrhagic strokes, the major complication is the subsequent increased volume of bleeding. There is strong evidence that stroke patients should be treated in dedicated stroke units; each time 24 patients are treated in a stroke unit, instead of a conventional ward, one death and one dependence are prevented. This effect does not depend on age, severity, and the stroke subtype. For this reason, stroke unit care is the cornerstone of the treatment of stroke, aiming at the detection and management of life-threatening emergencies, stabilization of most physiological parameters, and prevention of early complications. In ischaemic strokes, besides this general management, specific therapies include intravenous recombinant tissue plasminogen activator, given as soon as possible and before 4.5 hours, otherwise aspirin 300 mg, immediately or after 24 hours in case of thrombolysis, and, in a few patients, decompressive surgery. In intracerebral haemorrhages, blood pressure lowering and haemostatic therapy, when needed, are the two targets, but surgery does not seem effective to reduce death and disability.
Bleeding and haemostasis disorders
Authors: Mannucci Pier Mannuccio
Published: April 2015

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke). To reduce the need of transfusion, haemostatic agents that decrease blood loss and transfusion requirements (antifibrinolytic amino acids, plasmatic prothrombin complex concentrates, recombinant factor VIIa) may be considered. However, the efficacy of these agents in the control of bleeding complications in acute coronary syndrome is not unequivocally established, and there is concern for an increased risk of re-thrombosis. A low platelet count is another cause of bleeding in the intensive cardiac care unit. The main aetiologies are drugs (unfractionated heparin and glycoprotein IIb/IIIa inhibitors), thrombotic microangiopathies, such as thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation, that are often paradoxically associated with thrombotic manifestations. In conclusion, evidence-based recommendations for the management of bleeding in patients admitted to the intensive cardiac care unit are lacking. Accurate assessments of the risk of bleeding in the individual and prevention measures are the most valid strategies.
Dysarthria
Authors: Shaibani Aziz
Published: April 2015

Slurring of speech is usually noticed by family members or friends before patients. It is usually associated with swallowing difficulty due to dual function of the tongue and due to frequent involvement of the tongue and pharyngeal muscles together. Dysphagia usually precedes dysarthria in myasthenia gravis and follows it in amyotrophic lateral sclerosis(ALS). Spastic dysarthria in the absence of tongue atrophy and fasciculations is a diagnostic challenge. Cerebellar dysarthria can be sorted out by its irregularity and the presence of other cerebellar sings such as ataxia and nystagmus. In advanced cases, anarthria becomes a total communication barrier and other means of communications should be established. This chapter describes features and presentations of different types of dysarthria.
Dysphonia
Authors: Shaibani Aziz
Published: April 2015

Dysfunction of the vocal cords (dysphonia) is not as common a manifestation of neuromuscular disorders as dysarthria. It is typically seen in central diseases such as Parkinson disease and spasmodic dysphonia. Certain muscle and nerve disorders affect the vocal cords, but in these cases other features of these diseases make the diagnosis easy. Myasthenia may present with only intermittent hoarseness early in the course of the disease. Consultation with an ear, nose, and throat (ENT) specialist is recommended to characterize the type of cords pathology. Hysterical hoarseness and weakness are not an unusual presentation to the neuromuscular clinics but again, they do not occur in isolation and other psychogenic symptoms such as give way weakness and functional gait disorder often lead to the right diagnosis.
Weakness of the Neck Muscles
Authors: Shaibani Aziz
Published: April 2015

The neck is furnished by dozens ofmuscles for flexion, extension, lateral bending, and rotation. It carries a 10-pound head at least two-thirds of every day. These muscles are under delicate central control, and they are subject to different central and peripheral malfunctions. Differential involvement of the neck flexors versus extensors helps in diagnosing different neuromuscular disorders. Weakness of the cervical extensors leads to head drop, a troubling condition that is caused by many neuromuscular disorders. Movement disorders such as cervical dystonia and Parkinson disease may also lead to head drop, causing confusion with neuromuscular causes such as myasthenia gravis and ALS. Head protrusion of the elderly (camptocormia) is a different entity.
Scapular Winging
Authors: Shaibani Aziz
Published: April 2015

Scapulae play a central role in arms abduction, and their failure causes poor abduction despite preserved arm abductors (deltoids and supraspinati). A good knowledge of the anatomy of the scapulae and their muscles and nerves is necessary. Unilateral winging is usually due to nerve pathology, but frank asymmetry is also typical for FSHD. Progressive bilateral scapular winging is seen in many myopathies, including muscular dystrophies and scapuloperoneal syndromes. Weakness of different scapular muscles leads to different scapular positions during arm movement. When the underlying disease is not treatable, surgical fixation of the scapulae on the chest wall will improve arm abduction.
Hyperreflexia
Authors: Shaibani Aziz
Published: April 2015

Hyperactive deep tendon reflexes area sign of upper motor neuron lesion. They are also commonly seen in normal but tense people. Proper technique of reflexes examination and experience play a major role in eliciting and categorizing deep tendon reflexes. Clonus is the highest degree of hyperreflexia. The most important neuromuscular disease associated with hyperreflexia is ALS due to degeneration of the cortical motor neurons. Diagnostic difficulty occurs when hyperreflexia and spasticity are the only findings. In these cases, PLS, HSP, and other causes of myelopathies should be entertained. Jaw clonus often indicates a lesion above the midpontine level. When hyperreflexia is found, it is wise to look for other features of upper motor neuron dysfunction such as positive Babiniski signs and hypertonia.
Numbness
Authors: Shaibani Aziz
Published: April 2015

Sensory symptoms are the most common symptoms in neuromuscular clinics, yet it is difficult to capture them in videos unless they have a very specific pattern and/or they are associated with objective loss of sensation. Distal sensory loss is a common neuropathic finding. Sensory neuropathies may also present with ataxia or severe pain. Multifocal sensory loss is usually vascular (vasculitis, diabetic amyotrophy). Intercostal pain and numbness are due to radiculopathy (diabetic, zoster, or compressive radiculopathy). Thoracic and abdominal radiculopathies are often misdiagnoses as acute coronary or abdominal emergencies respectively. The distribution of pain and the associated tingling and skin sensitivity to touch are important clues to their neuropathic nature.
Deformities
Authors: Shaibani Aziz
Published: April 2015

Deformities are important markers for congenital and hereditary neuromuscular disorders. Kyphosis, scoliosis, Pes Cavus, for example, are common in CMT and hereditary ataxias. Deformities may also result from long-term weakness and asymmetry. Chronic neuropathies with distal weakness may lead to gradual changes in the height of feet arches. A high foot arche that is corrected with wight bearing or manually, is usually not congenital. Other types of deformities are related to connective tissue pathology, which can be associated with neuromuscular disorders, for example multiple lipomatosis, scleroderma, contractures, nephrogenic systemic sclerosis, and so on. This chapter shows examples of these deformities. Musculoskeletal deformities may lead to entrapment neuropathies.
Clinical Signs
Authors: Shaibani Aziz
Published: April 2015

In clinical neuromuscular medicine, clinical signs are very important for elucidation of the right diagnosis. There is nothing better than videos to demonstrate these signs and their elicitation and significance. We selected several clinical signs from our video archives for this purpose. Babinski sign is an important clue to upper motor neuron dysfunction. Bell’s phenomenon is a normal response. Facilitation of reflexes is a strong indication of a presynaptic neuromuscular transmission disorder. By definition a sign is a clinical finding as opposed to a symptoms which is what the patient report. Some signs are transient and not captured during clinical examination. The advent of video recording ability to general public facilitate capturing of physical signs in videos.
Third-moment descriptions of the interplanetary turbulent cascade, intermittency and back transfer
Authors: Coburn Jesse T. , Forman Miriam A. , Smith Charles W. , Vasquez Bernard J. , Stawarz Julia E.
Published: April 2015

We review some aspects of solar wind turbulence with an emphasis on the ability of the turbulence to account for the observed heating of the solar wind. Particular attention is paid to the use of structure functions in computing energy cascade rates and their general agreement with the measured thermal proton heating. We then examine the use of 1 h data samples that are comparable in length to the correlation length for the fluctuations to obtain insights into local inertial range dynamics and find evidence for intermittency in the computed energy cascade rates. When the magnetic energy dominates the kinetic energy, there is evidence of anti-correlation in the cascade of energy associated with the outward- and inward-propagating components that we can only partially explain.
Generation of magnetic holes in fully kinetic simulations of collisionless turbulence
Authors: Roytershteyn Vadim , Karimabadi Homa , Roberts Aaron
Published: April 2015

The results of three-dimensional fully kinetic simulations of decaying turbulence with the amplitude of the fluctuating magnetic field comparable to that of the mean field are presented. Coherent structures in the form of localized depressions in the magnitude of the magnetic field are observed to form self-consistently in the simulations. These depressions bear considerable resemblance to the so-called magnetic holes frequently reported in spacecraft observations. The structures are pressure-balanced and tend to be aligned with the local magnetic field. In the smallest structures observed, the decrease in the magnetic field strength is compensated by an increase in the electron perpendicular pressure, such that the transverse size of these structures is comparable to the electron gyroradius inside the depression. It is suggested that the structures evolve self-consistently out of the depressions in the fluctuating magnetic field, rather than being the consequence of instability growth and saturation. This is confirmed by additional, small-scale simulations, including those with realistic mass ratio between protons and electrons.
Dissipation and heating in solar wind turbulence: from the macro to the micro and back again
Authors: Kiyani Khurom H. , Osman Kareem T. , Chapman Sandra C.
Published: April 2015

The past decade has seen a flurry of research activity focused on discerning the physics of kinetic scale turbulence in high-speed astrophysical plasma flows. By ‘kinetic’ we mean spatial scales on the order of or, in particular, smaller than the ion inertial length or the ion gyro-radius—the spatial scales at which the ion and electron bulk velocities decouple and considerable change can be seen in the ion distribution functions. The motivation behind most of these studies is to find the ultimate fate of the energy cascade of plasma turbulence, and thereby the channels by which the energy in the system is dissipated. This brief Introduction motivates the case for a themed issue on this topic and introduces the topic of turbulent dissipation and heating in the solar wind. The theme issue covers the full breadth of studies: from theory and models, massive simulations of these models and observational studies from the highly rich and vast amount of data collected from scores of heliospheric space missions since the dawn of the space age. A synopsis of the theme issue is provided, where a brief description of all the contributions is discussed and how they fit together to provide an over-arching picture on the highly topical subject of dissipation and heating in turbulent collisionless plasmas in general and in the solar wind in particular.
I12: the Joint Engineering, Environment and Processing (JEEP) beamline at Diamond Light Source
Authors: Drakopoulos Michael , Connolley Thomas , Reinhard Christina , Atwood Robert , Magdysyuk Oxana , Vo Nghia , Hart Michael , Connor Leigh , Humphreys Bob , Howell George , Davies Steve , Hill Tim , Wilkin Guy , Pedersen Ulrik , Foster Andrew , De Maio Nicoletta , Basham Mark , Yuan Fajin , Wanelik Kaz
Published: April 2015

I12 is the Joint Engineering, Environmental and Processing (JEEP) beamline, constructed during Phase II of the Diamond Light Source. I12 is located on a short (5 m) straight section of the Diamond storage ring and uses a 4.2 T superconducting wiggler to provide polychromatic and monochromatic X-rays in the energy range 50–150 keV. The beam energy enables good penetration through large or dense samples, combined with a large beam size (1 mrad horizontally × 0.3 mrad vertically). The beam characteristics permit the study of materials and processes inside environmental chambers without unacceptable attenuation of the beam and without the need to use sample sizes which are atypically small for the process under study. X-ray techniques available to users are radiography, tomography, energy-dispersive diffraction, monochromatic and white-beam two-dimensional diffraction/scattering and small-angle X-ray scattering. Since commencing operations in November 2009, I12 has established a broad user community in materials science and processing, chemical processing, biomedical engineering, civil engineering, environmental science, palaeontology and physics.
Serious case review findings on the challenges of self-neglect: indicators for good practice
Authors: Braye Suzy , Orr David , Preston-Shoot Michael
Published: April 2015

Purpose

– The purpose of this paper is to analyse in detail the findings from 40 serious case reviews (SCRs) involving adults who self-neglect, and to consider the commissioning and reporting of such inquiries in the context of accountability that also involves the Coroner and the Local Government Ombudsman.

Design/methodology/approach

– This study comprised a cross-case analysis of 32 SCRs, using a four-layer design of the adult and their living context, the team around the adult, the organisations around the team, and the Local Safeguarding Board around the organisations.

Findings

– Available reports tend towards description of events rather than appraisal of what influenced practice. They highlight the challenges in cases of self-neglect practice, including person-centred approaches, capacity assessment and securing engagement. Familiar themes emerge when the spotlight turns to professional and organisational networks, namely information-sharing, supervision, recording and compliance with procedures and legal rules. Some Local Safeguarding Adults Boards found the process of conducting and then using serious case reviews for service improvement challenging.

Research limitations/implications

– The cross-case approach to thematic analysis focuses on reports into situations where outcomes of professional and organisational intervention had been disappointing. Nonetheless, the themes derived from this analysis are similar to other research findings on what represents best practice when working with cases involving self-neglect.

Practical implications

– The paper identifies learning for the effective commissioning and conduct of SCRs, and for service improvement with respect to practice with adults who self-neglect.

Originality/value

– The paper offers further detailed analysis of a large sample of SCRs that builds the evidence-base for effective practice with adults who self-neglect and for efficient management of process of commissioning and conducting SCRs.
Abuse in care? A research project to identify early indicators of concern in residential and nursing homes for older people
Authors: Marsland David , Oakes Peter , White Caroline
Published: April 2015

Purpose

– The purpose of this paper is to contribute to the prevention of the abuse of older people in residential and nursing homes, through the identification of “early indicators of concern”. Such indicators support practitioners in identifying services in which older people are at risk of abuse, neglect and ill treatment.

Design/methodology/approach

– Semi-structured interviews were conducted with health and social care practitioners in two local authorities (in England and Scotland), who had visited services in which abuse or neglect had occurred. Practitioners were asked about the things that they had seen within the service which had caused them to become concerned.

Findings

– Over 90 early indicators of concern were identified. These indicators were grouped within six themes which identify key manifestations of service cultures which may promote the abuse of older people.

Practical implications

– Information and guidance has been developed to enable practitioners to recognise early indicators and identify services in which older people are at risk and in which actions are required to help prevent the onset of abuse.

Originality/value

– A range of studies have highlighted the importance of organisational cultures in promoting the abuse of older people. The early indicators identified through this research represent visible signs of such poor service cultures which can be observed by practitioners, enabling them to recognise services in which older people are at greater risk.
Why and how should the international volunteer tourism experience be improved?
Authors: Benson Angela M.
Published: April 2015

Purpose

– The purpose of this paper is to summarise the contributions made in this theme issue and draw conclusions about the issue’s key question “Why and how should the international volunteer tourism experience be improved?”, thereby providing a theme issue conclusion.

Design/methodology/approach

– This paper summarises and critically reviews the seven articles that have contributed to the theme issue.

Findings

– International volunteer tourism is a growing phenomenon that has received much criticism in the last decade and whilst there are a number of mechanisms to improve the quality of this sector as yet, there is little evidence to support any conclusion that there is wide-scale success in achieving best practice in quality assurance within the sector.

Originality/value

– This theme issue explores international volunteer tourism from a range of contributors, academics, a practitioner and a travel writer, who have engaged with a range of stakeholders to offer different perspectives. The theme issue as a whole offers the reader an opportunity to engage in a unique and wide-ranging discourse on quality and international volunteer tourism.
Elephants, orphans and HIV/AIDS
Authors: Phelan Kelly Virginia
Published: April 2015

Purpose

– This paper aims to explore the experiences of international volunteer tourists, or voluntourists, to Botswana. Wildlife conservation, health education and orphanage voluntourists are examined specifically.

Design/methodology/approach

– Qualitative data were collected through interviews with tourists who had completed or were in the midst of volunteer experiences.

Findings

– Findings revealed that international voluntourism opportunities in Botswana are challenging to locate and leave volunteers questioning their impact. Some of the difficulties associated with voluntourism in Botswana included the need for volunteers to pay to participate, the concern regarding whether volunteers were depriving locals of employment opportunities, hesitation about the authenticity of the experience and the lack of community ownership.

Practical implications

– This paper will be beneficial to industry practitioners as it details the challenges associated with international voluntourism and provides suggestions for ways to attract volunteers, engage them in the process and ensure both the organization and tourist have a positive and useful experience.

Originality/value

– The increased interest in international voluntourism is a trend which is unlikely to decelerate in the coming years. This paper advances the knowledge on voluntourism operations in Botswana which may be valuable to tourists, students, academicians, government policymakers and industry practitioners alike.
Weight estimation in paediatric resuscitation: A hefty issue in New Zealand
Authors: Britnell Sally , Koziol‐McLain Jane
Published: April 2015

Objective

To test the accuracy of weight estimation methods currently used in New Zealand to predict a child's weight in emergency resuscitation.

Methods

A prospective, observational study. Data were collected in July 2013 at five Auckland schools among children aged 5–10 years. Collected demographic information included age, ethnicity, sex and school decile. Standardised measures included weight, height and Broselow–Luten tape (2011 version, limited to children 43–143 cm) weight. Age‐based weight estimates were calculated for APLS, Shann and Theron formulae. Mean bias (actual weight – estimated weight) and clinical accuracy (proportion of estimates within 10% of actual weight) are reported. Bland–Altman plots illustrate agreement and 95% limits of agreement.

Results

The 376 participants weighed between 14.2 and 93.1 kg. The proportion of weight estimates within 10% of actual weight were 28.7%, 39.1% and 45.7% for the age‐based formula (Theron, APLS and Shann, respectively). The mean bias was negative for Theron (−6.5) and positive for APLS (7.8) and Shann (7.7). For the length‐based Broselow–Luten tape method (n = 305), the proportion of weight estimates within 10% of actual weight was 73.4% and mean bias was 1.1.

Conclusion

For children under 143 cm in height, the Broselow–Luten tape outperforms other weight estimation methods, accurately estimating weight in approximately three out of four children. The age‐based estimation methods performed poorly overall, with variation by age and ethnicity.
Physical Characterization of Wax/Oil Crystalline Networks
Authors: Martini Silvana , Tan Chin Yiap , Jana Sarbojeet
Published: April 2015

The objective of this research was to evaluate the physical properties of different types of wax/oil systems. Olive (OO), corn (CO), soybean (SBO), sunflower (SFO), safflower (SAFO), and canola (CAO) oils were mixed with sunflower oil wax (SFOW), paraffin wax (PW), and beeswax (BW) at different concentrations (1% to 10%). Results from this study show that the physical properties of wax/oil systems is affected not only by the concentration and type of wax used, but also by the type of oil used. In general, wax/oil systems formulated with SFOW generated crystalline networks with high enthalpies (1 to 22 J/g) and high G ′ values (2 to 6 × 106 Pa) compared with the values obtained for BW and PW. SFOW crystalline networks were characterized by needle‐like crystals independently of the wax concentrations and type of oil used. BW crystalline networks, however, were characterized by different crystal morphologies (needle‐like or spherulites) depending on the wax concentration and type of oil used. PW samples were characterized by a crystalline network formed by needle‐ and platelet‐like crystals. Enthalpy values of BW and PW samples were similar (0.3 to 20 J/g), but BW samples resulted in significantly higher (P < 0.05) G ′ values in the 5% and 10% samples with values of 3.9 × 106 and 6.1 × 105 Pa for 10% BW and PW, respectively.
Effect of hepatic insulin expression on lipid metabolism in diabetic mice
Authors: Qu Shen , Zhang Ting , Dong H. Henry
Published: April 2015

Background

Hypertriglyceridemia is a common lipid disorder that is characterized by elevated plasma levels of triglyceride (TG)‐rich particles, such as very low‐density lipoprotein (VLDL), in poorly controlled diabetes. The aim of the present study was to determine the potential therapeutic effect of hepatic insulin production on hypertriglyceridemia in mice.

Methods

Mice were induced diabetic and hypertriglyceridemic by streptozotocin (STZ) treatment. Using an adenovirus‐mediated gene transfer approach, we delivered rat preproinsulin cDNA into the liver of diabetic mice and then determined plasma TG metabolism. To investigate the mechanism by which hepatic insulin improves TG metabolism, we determined hepatic expression of apolipoprotein C‐III (ApoC‐III), a structural moiety and functional inhibitor of VLDL‐TG catabolism.

Results

Plasma VLDL‐TG levels were markedly elevated in STZ‐treated mice, and were accompanied by hyperglycemia and hypertriglyceridemia. These metabolic abnormalities were restored to near normal following hepatic insulin production in insulin vector‐treated diabetic mice. In contrast, hypertriglyceridemia and hyperglycemia persisted in control vector‐treated diabetic animals. Hepatic ApoC‐III expression became deregulated secondary to insulin deficiency, contributing to impaired TG metabolism in diabetic mice. Hepatic insulin production suppressed excessive hepatic ApoC‐III production to basal levels.

Conclusion

Hepatic insulin production is efficacious in correcting hypertriglyceridemia associated with insulin deficiency in diabetic mice.
Resveratrol inhibits inflammation and ameliorates insulin resistant endothelial dysfunction via regulation of AMP‐activated protein kinase and sirtuin 1 activities
Authors: Liu Zifeng , Jiang Cuihua , Zhang Jinghua , Liu Baolin , Du Qun
Published: April 2015

Background

Resveratrol is a phytoalexin with beneficial effects on human health. The aim of the present study was to investigate the effects of resveratrol on endothelial dysfunction involved in insulin signaling and inflammation.

Methods

Endothelial cells were stimulated with palmitate (PA) to induce insulin resistance characterized by a loss of insulin‐mediated nitric oxide (NO) production. Diabetes was induced in rats by fructose feeding. The effects of resveratrol and the mechanisms involved were investigated using an aortic relaxation assay and Western blot analysis.

Results

In endothelial cells, 0.1–10 μmol/L resveratrol suppressed IκB kinase β (IKKβ)/nuclear factor‐κB phosphorylation, as well as tumor necrosis factor‐α and interleukin‐6 production, and restored the insulin receptor substrate‐1 (Irs‐1)/Akt/endothelial NO synthase signaling pathway. Furthermore, resveratrol effectively inhibited the mitogenic actions of insulin by decreasing the secretion of endothelin‐1 and plasminogen activator inhibitor‐1. It also positively regulated AMP‐activated kinase (AMPK) and sirtuin 1 (SIRT1) activation, which contributed to the inhibition of inflammation implicated in endothelial insulin resistance. Stimulation with PA and long term‐fructose feeding impaired insulin‐mediated vessel dilation in rat aorta, whereas pretreatment of aortic rings with resveratrol (0.1–10 μmol/L) or treatment of rats with 5 or 20 mg/kg resveratrol counteracted these changes.

Conclusion

The results indicate that resveratrol inhibits inflammation and facilitates insulin phosphatidylinositol 3‐kinase signaling by beneficial modulation of IRS‐1 function partly via regulation of AMPK and SIRT1 activity in the endothelium.