bluuebunny/crossref_metadata_2025 huggingface dataset:
The biochemistry of neutralization
Authors: Trevino Richard J.
Published: November 2015

It has been shown that injections of low closes of common environmental antigens or irritants cause a reduced sensitivity during a subsequent exposure to the same antigen and irritant. On the basis of these findings, the following study was performed: 20 allergic patients who manifested allergic symptoms were observed during skin end‐point titration testing, which is described in the manuscript. During the testing procedure, 60% of the patients reported a complete relief of symptoms. It is postulated that a cytoprotective dose was given during the testing procedure that caused the symptoms to be relieved. The second part of the study was a double‐blind placebo control study in which 40 patients received the end‐point dose and 10 patients received placebo. All patients entered the study with allergic symptoms. None of the placebo patients reported any relief of symptoms when given their injection. Of patients who received the active ingredient, 67.5% reported relief of symptoms within 5 to 10 minutes after the subcutaneous administration of the active ingredient. With these findings, it is postulated that this low dose of active ingredient caused the production of prostaglandin E intracellularly, which causes an increase in cyclic AMP and a decrease in cyclic GMP, which results in the resolution of symptoms.
Neurotologic manifestations of chiari 1 malformation
Authors: Weber Peter C. , Cass Stephen P.
Published: November 2015

It is important for otolaryngologists to recognize Chiari malformations as part of the differential diagnosis of balance disorders because patients may initially be seen with symptoms referable to the vestibular system, including ataxia, nystagmus, or vertigo. The objective of this paper is to review the signs, symptoms, and vestibular test findings of a series of patients with Chiari 1 malformation. Six patients were identified by retrospective chart review with a diagnosis of Chiari malformation. Each patient had a complete otoneurologic examination and vestibular function testing. The results indicated that patients fell into two different vestibular test result profiles. First, patients with advanced symptoms demonstrated oculomotor dysfunction, central vestibular nystagmus, abnormal vestibular visual interaction, and abnormal tilt suppression of postrotatory nystagmus. On the other hand, a number of patients were identified with incidentally noted Chiari malformation on magentic resonance imaging scan who had a vestibular test profile consistent with peripheral vestibulopathy without signs and symptoms of central nervous system dysfunction. Guidelines are provided to help determine the extent of the group of symptoms attributable to an incidentally discovered Chiari malformation.
Sources of error in use of beta‐2 transferrin analysis for diagnosing perilymphatic and cerebral spinal fluid leaks
Authors: Skedros Demetrios G. , Cass Stephen P. , Hirsch Barry E. , Kelly Robert H.
Published: November 2015

Beta‐2 Transferrin Is A Protein Found In Cerebral Spinal Fluid And Inner Ear Perilymph, But Not In Blood, Nasal, Or Ear Secretions. The Clinical Use Of This Test Has Been Previously Demonstrated, But Sources Of Test Error Have Not Been Addressed. The Purpose Of This Study Was To Evaluate Sources Of Error Related To This Test In Order To Improve Its Clinical Use. We Reviewed The Specimens Submitted For Beta‐2 Analysis Over The First 12 Months Of Test Availability At Our Institution To Identify Potential Factors Leading To Test Error. Sources Of Error Were Categorized Into The Following Groups: Sample Collection, Delivery, And Extraction Factors; Assay Factors; Physician‐Related Factors; And Patient‐Related Factors. The Test For Beta‐2 Transferrin Is A Valuable Diagnostic Tool For The Management Of Difficult Clinical Problems, Provided The Physician Is Aware Of Potential Factors That Can Lead To Test Error And Clinical Mismanagement.
Tgf‐alpha protein and receptor localization in laryngotracheal tissue
Authors: King Jonathan D. , Stringer Scott P. , Chegini Nasser , Donnelly William H. , Cassisi Nicholas J. , Schultz Gregory S.
Published: November 2015

Both Normal Cell Turnover And Healing Of Laryngeal And Tracheal Injuries Involve Cell Migration And Mitosis. The Proteins That Regulate Normal Cell Turnover And Wound Healing In The Larynx And Trachea Have Not Been Established. It Is Possible That Peptide Growth Factors, Such As Transforming Growth Factor‐α (Tgfα) Acting Through Its Receptor (Egf/Tgfα‐R), Participate In The Regulation Of These Processes. To Investigate This Hypothesis, We Analyzed Laryngotracheal Cells For Tgfα Protein And Receptor In Normal And Postwounding Conditions. Tgfα Protein Was Detected By Immunohistochemical Analysis In Normal Ferret Laryngeal And Tracheal Mucosa. Specific Binding To The Egf/Tgfα Receptor In Membrane Homogenates Of Ferret Larynx And Trachea Reached Saturation After 60 Minutes At 37° C, And Was Effectively Displaced By Unlabeled Epidermal Growth Factor (Egf) Or Tgfα, But Not By Unlabeled Insulin, Angiotensin Ii, Or Basic Fibroblast Growth Factor. Scatchard Analysis Of The Specific Binding Indicated The Presence Of High‐Affinity (Kd = 117 Pmol) And Low‐Affinity (Kd = 40 Nmol) Binding Sites. The Maximum Number Of Available Binding Sites Was 73 Fmol/Mg Protein. Localization Of The Egf/Tgfα Receptor By Autoradiographic Analysis Of 125I‐Egf Binding To Sections Of Normal Ferret Larynx And Trachea Revealed Egf/Tgfα Receptors Throughout The Epithelium, With The Highest Grain Density In The Basal Layers. Quantitative Analysis Of Autoradiographic Grain Density Between Normal, Intubated, And Extubated Animals Revealed No Significant Differences. The Presence Of Tgfα Protein And Its Receptor In Normal And Wounded Larynx And Trachea Supports The Hypothesis That These Proteins Are Involved In Regulating Physiologic Responses Of Laryngotracheal Cells.
Hearing loss in infants with craniofacial anomalies
Authors: Hayes Deborah
Published: November 2015

Results of auditory brainstem response (ABR) evaluation of 145 infants, ages 6 months and younger with craniofacial anomalies (CFA), were examined to determined predicted degree and nature of hearing loss. Approximately 50% of infants demonstrated at least mild bilateral hearing loss. Presence and degree of hearing loss varied by CFA. All infants with bilateral aural atresia exhibited at least a moderate bilateral hearing loss; less than 20% of infants with isolated external ear anomalies (ear tags, isolated microtia) exhibited any degree of hearing loss. In 92% of infants with hearing loss, results of ABR were consistent with primarily conductive dysfunction. Implications for early identification and audiologic management of infants with CFA and hearing loss are discussed.
Chronic alcohol consumption‐the key risk factor for pharyngeal cancer
Authors: Maier Heinz , Sennewald Elke , Heller Gerhard Fischer Wolf‐Dieter , Weidauer H.
Published: November 2015

A case‐control study on oropharynx and hypopharynx cancer was carried out in the region of Heidelberg (in the southwest region of Germany). This report presents an analysis of the risk associated with alcohol and tobacco consumption based on 105 cases and 420 controls matched for age, sex, and area of residency.
Total and partial ossicular replacement prostheses in children
Authors: Kessler Alexander , Potsic William P. , Marsh Roger R.
Published: November 2015

Although ossicular reconstruction in children may carry a risk of failure because of recurrent middle ear disease, the procedure offers the potential for restoring binaural hearing during the school years when it is so critical. Of a series of 45 reconstructions with total and partial ossicular replacement prostheses, 6 were extruded for a surgical success rate of 87%. Of the successful cases, 74% had air‐bone gaps of 30 dB or better, and 74% had speech reception thresholds of 30 dB or better on initial postoperative audiogram. Outcomes for these children were comparable with those reported for adults, supporting the value of early reconstruction.
What can you do to Improve the Environment?
Authors: Butler R. Melvin
Published: November 2015

Medicine has a dual obligation concerning the environment: (1) to supply laboratory and clinical research to document harmful effects on the environment, and (2) to encourage changes in the environment to reduce or eliminate adverse health effects. This article presents individual and group actions for the improvement of the environment. The American Academy of Otolaryngology‐Head and Neck Surgery has developed a medical office pledge, “The Greening of Our Office for Improvement of Our Environment.” Physicians are encouraged to agree to certain principles for environmental improvement.
Distribution of Intraepithelial Nerve Fibers in the Feline Glottis
Authors: Matsuo Hiromichi , Shin Takemoto
Published: November 2015

It is well known that the protective laryngeal closure is elicited by mechanical or chemical stimulation of the epithelium in the glottis. In this study we used light microscopic observation and relative examination of the intraepithelial nerve fibers in the glottis to clarify the perceptive mechanism using immunohistochemical methods. In the anterior glottis, a moderate number of protein gene product 9.5‐immunoreactive intraepithelial nerve fibers were observed, most of which were found to be located just anterior to the vocal process. The number of fibers in the upper surface of the vocal fold was larger than that in the free edge and the lower surface. Only a few calcitonin gene‐related polypeptide‐immunoreactive fibers were seen, and substance P‐immunoreactive fibers were rarely seen. On the other hand, a dense distribution of protein gene product 9.5‐immunoreactive nerve fibers was observed throughout the epithelium of the posterior glottis. The number of calcitonin gene‐related peptide‐immunoreactive fibers was about 20% that of protein gene product 9.5‐immunoreactive fibers, whereas the number of substance P‐immunoreactive fibers was only 1% to 2%. The results of this study suggest the possible existence of regional differences in the perceptive mechanism between the anterior and posterior glottis.
Comparison of in Vivo and in Vitro Prostaglandin E2 Production by Squamous Cell Carcinoma of the Head and Neck
Authors: Snyderman Carl H. , Klapan Ivica , Milanovich Michelle , Heo Dae S. , Wagner Robin , Schwartz Donald , Johnson Jonas T. , Whiteside Theresa L.
Published: November 2015

Prostaglandin E2 has been identified as an immunosuppressive factor in patients with squamous cell carcinoma of the head and neck. Spontaneous prostaglandin E2 production by 21 cancer cell lines, which were obtained from 17 patients with squamous cell carcinoma of the head and neck, was determined by radioimmunoassay. In comparison with normal keratinocyte cultures, prostaglandin E2 production by cancer cell lines was significantly decreased (p < 0.0001). Prostaglandin E2 levels demonstrated no correlation to the site, stage, or histoUS‐pathologic differentiation of the tumor. In a separate group of 17 patients with squamous cell carcinoma of the head and neck, tumor cells were isolated from fresh tumor specimens, and 24‐hour PGE2 production in vitro was assayed. No correlation was found with tumor site, stage, or 2‐year disease‐free survival. Although prostaglandin E2 may have biologic significance in vivo in patients with squamous cell carcinoma of the head and neck, these findings suggest that measurements of tumor cell‐derived prostaglandin E2 are not predictive of biologic behavior.
Tracheoplasty Using Titanium Reconstructive Plates with Strap‐Muscle Flap
Authors: Casiano Roy A. , Patete Michael , Lindquist Todd
Published: November 2015

The reasons for unsuccessful decannulation after a laryngotracheoplasty may be multifactorial depending on the techniques used. Excessive granulation tissue may develop, necessitating further adjunctive procedures. Cartilaginous grafts may get infected, resorb, or collapse into the tracheal lumen. Bulky regional skin‐muscle flaps may dehisce under tension or collapse into the tracheal lumen. Medial migration of the split ends of the anterior cartilaginous tracheal rings ensues with subsequent restenosis. Donor‐site morbidity may compound these problems as well. During a 2.5‐year period, we have performed laryngotracheoplasty on nine patients with 60% to 100% tracheal stenosis using titanium reconstruction plates. The split anterior tracheal wall is fixed by the plates in its expanded position. A neurovascularized strap‐muscle flap is used to reconstruct the anterior tracheal wall. The flap becomes epithelialized with squamous epithelium within 3 weeks. Successful decannulation was possible in seven of the nine (78%) patients with no further respiratory problems. Of these, six required no further procedures. This technique offers a viable simple alternative to other methods of laryngotracheoplasty without the need for donor cartilage grafts or thick bulky Skin‐muscle flaps.
The Nasal Hinge
Authors: Adamson Peter A. , Morrow Todd A.
Published: November 2015

It is generally agreed that rhinoplasty is the most challenging procedure performed by the facial plastic surgeon. Mastery of nasal tip maneuvers to alter tip projection, rotation, and lobule refinement is intrinsic to successful rhinoplasty technique. The nasal hinge region comprises the most lateral aspect of the lower lateral cartilage. Its importance is often overlooked. As the foundation of the nasal base, It plays a key role in tip dynamics and can be sculpted to significantly modify projection, rotation, and lobule refinement. One hundred randomly selected rhinoplasty patients were studied with respect to the indications for hinge maneuvers, techniques applied, and resulting affect on tip aesthetics. Clinical results are shown. The applicability of these hinge techniques is compared with other lateral crural techniques. The importance of the hinge region in rhinoplasty dynamics and the necessity of knowledgeably applying surgical maneuvers in this region are discussed.
Decentralization and local government fiscal autonomy: evidence from the Greek municipalities
Authors: Psycharis Yannis , Zoi Maria , Iliopoulou Stavroula
Published: November 2015

Despite the widespread international trend toward decentralization, local municipalities in Greece still rely heavily on fiscally centralized revenue sources, thereby achieving a limited extent of tax or other forms of fiscal autonomy. This paper seeks to explain the determinants of local government fiscal autonomy in Greece over the 1999–2009 year period. By constructing a dataset with disaggregated revenue and expenditure subcategories for the first tier of local government and by applying panel data analysis techniques, it offers unique evidence that socioeconomic and demographic criteria along with political factors affect the level of fiscal autonomy of local government in the country. Our evidence also highlights the distinctive nature of Greece in geographical terms, reporting significant differences across diverse geographical regions (such as islands or mountainous areas). The paper aims at filling in part the gap in the existing research for Greece and at offering some insights from a fiscally centralized country to the current international debate on intracountry fiscal decentralization.
Additionality and regional public finance – Evidence from Italy
Authors: Del Bo Chiara F , Sirtori Emanuela
Published: November 2015

To what extent do EU Structural Funds complement or substitute domestic public funds? The intended and unintended effects of the transfer of additional funds on recipients' domestic public expenditure structures are considered and their existence is empirically evaluated. After reviewing the literature on the complementarity, substitutability and displacement effects of additional funds on national and regional public expenditures, we empirically assess these effects in relation to EU funds in Italy. The empirical analysis is based on data on the allocation of EU Structural Funds from 1996 to 2010 with a regional and thematic breakdown and on the Italian Regional Public Accounts. The aim is to develop a useful framework, which can aid in effectively assessing to what extent Structural Funds, or other supranational funds, complement domestic public investments. In light of empirical results, the current verification mechanism in force in the EU is examined, stressing potential weaknesses and proposing possible solutions.
Victims of the State: Genocides, Politicides and Group Repression since 1945
Authors: Harff Barbara , Gurr Ted Robert
Published: November 2015

The collective victimization of ethnic, religious, national and political groups by the state is discussed in this paper. It analyzes information on more than 60 communal and political groups which have been victimized in genocides and politicides since 1945 and about 90 communal and regional groups which in the late 1980s were the subjects of systematic political repression or discrimination. The prospects that the latter groups will be the victims of future geno/politicides are assessed. The uses of these datasets for future research on the causes of geno/politicide are considered in the conclusion.
Lipid Deposition in Different Fiber Types of Skeletal Muscle of Periparturient Dairy Cows
Authors: Roberts C. J. , Turfrey B. A. , Bland A. P.
Published: November 2015

The intracellular deposition of neutral lipid in skeletal muscle of dairy cows before and after calving has been studied in biopsy samples taken from 72 cows in three herds.

The amounts of neutral lipid in individual fibers were estimated using Oil red O-stained sections and an average value was calculated for each fiber type within a sample. Intracellular lipid deposition occurred mainly in type I fibers and reached its highest level one week after calving. The amount of lipid in muscle at this time showed a high correlation with the amount of lipid in liver and with the rate of lipid mobilization from tissue reserves.
The End of Cross-Cultural Relativism
Authors: Etzioni Amitai
Published: November 2015

Relativism is in retreat on many fronts; it is much less clear what will replace it.

One kind of relativism of special importance to international relations is the notion that members of one culture should not “judge” those of others—especially that the West should not pass judgment on the policies and values of other societies. If this facet of unbounded, normative pluralism is waning, too, what will take its place? Such a matter seems rather abstract, but its policy implications are many.
The Shunammite, the Shulamite and the Professor between Midrash and Midrash
Authors: Amit Yairah
Published: November 2015

This article intends to show the part the Hebrew Bible and the midrashic tools play in the life of modern Israeli society. It describes a debate published in a daily newspaper in 1997. The participants were a lecturer in Talmud who presented and analyzed a midrashic interpretation of 2 Kgs 4.27, a public figure who responded to that interpretation, and a biblical scholar who criticized the latter. While this debate illuminates the biblical story and its different interpretations ( derash and peshat), it also shows that interest in the Hebrew Bible and its scholarship remains very much alive to this day.
Teaching Reading in the 21st Century: A Glimpse at How Special Education Teachers Promote Reading Comprehension
Authors: Klingner Janette K. , Urbach Jennifer , Golos Deborah , Brownell Mary , Menon Shailaja
Published: November 2015

In this study, we conducted 124 observations of 41 special education teachers teaching reading to their third- through fifth-grade students with learning disabilities to determine the extent to which and in what ways they promoted students' reading comprehension. In 42 lessons, we did not observe any comprehension instruction. In 30 lessons, the only comprehension-related activity consisted of asking students questions about what they had read by means of mostly factual, rote-level questions. In 49 lessons, teachers provided additional comprehension instruction, although this mostly consisted of prompting students to use a strategy rather than providing explicit instruction. Predicting was the most common strategy observed. We rarely saw teachers use more complex strategies, such as finding the main idea or summarizing. Most special education teachers seemed unsure of how to promote their students' reading comprehension. We noted many missed opportunities to do so. Our findings suggest implications for researchers and teacher preparation programs.
Technology, Mathematics PS/RTI, and Students with LD: What Do We Know, What Have We Tried, and What Can We Do to Improve Outcomes Now and in the Future?
Authors: Allsopp David H. , McHatton Patricia Alvarez , Farmer Jennie L.
Published: November 2015

Effective integration of technology within mathematics problem solving/response to instruction (PS/RTI) for students with/at risk for identification of learning disabilities (LD) is the focus of this article. The discussion is situated within the current context of mathematics PS/RTI, the literature base relative to technology integration in mathematics for students with LD, and emerging 21st-century technologies. Limitations of the research base are identified, and suggestions for the future are provided. Next, a systematic framework for integration of technology in mathematics PS/RTI is introduced that incorporates consideration of (a) effective mathematics instructional practice within mathematics PS/RTI, and (b) the nature of the mathematics content and student learning barriers and strengths. Ways in which technology can enhance effective mathematics practices for students with LD are suggested, and implications for research, development, and practice are discussed.
Developing Effective Special Education Reading Teachers: The Influence of Professional Development, Context, and Individual Qualities
Authors: Dingle Mary P. , Brownell Mary T. , Leko Melinda M. , Boardman Alison Gould , Haager Diane
Published: November 2015

This study examined the impact of contextual and individual factors on the implementation of professional development (PD) content in the area of word study and fluency by three upper-elementary special education teachers. The PD effort included an initial PD institute, monthly cohort meetings, an online community forum, coaching, and opportunities for self-reflection. Interview data, observation field notes and ratings, meeting transcripts, and knowledge surveys were collected and analyzed. Using case study and cross-case analysis, three interrelated themes emerged that differentiated participating teachers' ability to effectively integrate the PD content into their classroom instruction: (a) content reading knowledge and pedagogical skills, (b) motivation to participate in the PD and to change instructional practice, and (c) individual teachers' willingness to enhance or modify the curriculum used in the classroom. Information related to these themes and their interrelationships is reported along with the implications for future research and practice in PD for special educators.
Broadening Our Horizons: Toward a Plurality of Methodologies in Learning Disability Research
Authors: Connor David J. , Gallagher Deborah , Ferri Beth A.
Published: November 2015

This article serves as an introduction to a special double issue of the Learning Disability Quarterly that seeks to engage the field in a respectful exchange about the need to expand research methodologies. In this article, we identify three interrelated concepts of interest to researchers in the field of learning disabilities (LD) — learning, disability, and research — and examine how the cultural location(s) of each serve(s) to influence decisions about and possibilities for researching learning disabilities. Subsequently, we urge greater use of a plurality of methods than is reflected in traditional LD research, sharing examples of what knowledge is currently lost, minimized, disregarded, or omitted, while articulating examples of what could be gained. Finally, by relating research on LD to schools, classroom life, and individuals identified as having learning disabilities, we advocate for more responsive research and a greater acceptance of epistemic reflexivity within the LD research community.
The Actuarial Turn in the Science of Learning Disabilities
Authors: Danforth Scot
Published: November 2015

In the mid-1970s, Donald Hammill and his colleagues authored three scathing critiques of the two most trusted scientific traditions of learning disability treatment — movement education and psycholinguistic training (Hammill, 1972; Hammill & Larsen, 1974; Hammill, Goodman, & Wiederholt, 1974). These critical reviews of research rejected the older model of clinical science that had served as the foundation of the field of learning disabilities and celebrated an actuarial form of research. Was Hammill actually proclaiming a change in the orientation toward scientific research, a paradigm shift involving philosophical commitments and methodological practices? This article explores the history of both the foundational clinical science and the new actuarial science that rose to prominence in the field of learning disabilities in the 1970s.
Complicating, Not Explicating: Taking up Philosophy in Learning Disability Research
Authors: Allan Julie
Published: November 2015

This article provides an introduction to theoretical ideas and practices from the so-called “philosophers of difference” — Foucault, Derrida, and Deleuze and Guattari — as an invitation to think differently about the construction of learning disability and to envision new forms of learning. Two key concepts, Foucault's transgression and Deleuze and Guattari's rhizome, are presented, and examples from research on learning disability and other dimensions of disability are given to illustrate their potential. The theoretical practices of deconstruction, developed by Derrida, and Deleuze and Guattari's rhizomatic analysis are also presented and exemplified. The article argues that these theoretical concepts and practices, if taken up, shift the researcher towards an ethics of research and toward greater responsibility. Implications are discussed in the final part of the paper.
Performance Appraisal and the Creation of Training and Development Expectations: A Weak Link in MBO-Based Appraisal Systems
Authors: Daley Dennis
Published: November 2015

The performance appraisal process, in its fullest development, can assist an organization in identifying areas in which its employees need improvement and in identifying individual strengths that can be developed. Based on a 1983 survey of Iowa public employees, this article examines the training and development needs identification aspect of the Iowa MBO/Performance Standards appraisal system, taking particular note of its relationship to perceptions of organizational success. Survey respondents were inclined to indicate that the performance appraisal process neither helped them develop plans for training nor aided them in receiving needed training. These attitudes, in turn, negatively affected perceptions of how fair the performance appraisal process itself was, and how successful the organization was felt to be.
Executive Satisfaction with Managerial Performance Appraisal in City Government
Authors: Amnions David N.
Published: November 2015

The methods used by municipal executives to appraise the performance of upper management subordinates differ substantially among major U.S. cities. Responses from 122 municipalities indicate a wide variety of appraisal techniques in use by cities that systematically assess managerial performance, but further reveal that less than two-thirds use any kind of formal, documented system whatsoever. In this article, appraisal system characteristics are examined for their relationship to executive satisfaction with appraisal practices. The findings suggest that system conformance to initial design, subordinate involvement, and feedback frequency are among the system characteristics most relevant to chief executive satisfaction with upper management appraisal.
A New Breed of Public Executive: Top Level Exempt Managers in State Government
Authors: Roberts Deborah D.
Published: November 2015

The author surveyed how top management posts are filled in the 50 state governments. Below their direct patronage powers, governors and their political appointees have increasing influence over a netherworld of policy-involved exempt, unclassified, noncompetitive, management contract, senior executive services, and “at will employment” personnel classes. These “exempt managers” serve as a buffer between the top political appointees and the traditional protected civil service, and they are increasingly more career and merit oriented. Firings are rare due to the need for competence and continuity and the legal ambiguities of these employees' rights, but their ambiguous roles need more professional definition.
Intergenerational Differences, Merit Pay, and Loyalty in State and Local Government
Authors: Fox Siegrun F.
Published: November 2015

Following up on leads in the business literature, this study analyzes whether younger managers and professionals in state and local government are less loyal than their senior colleagues, and if so, whether merit pay can reverse the trend. The quasi-experimental research design tested for variation in organizational commitment that could be attributed to (1) age, (2) pay procedure, and (3) pay level. The experimental group received pay raises in merit increments, while the control group obtained salary increases in some other way. Correlation analysis revealed weak, but statistically significant effects of age, merit pay, and salary on the respondents’ loyalty scores, with one unexpected exception. Pay co-varied relatively strongly with the organizational commitment of older respondents in the experimental group.
Prognosis of Accidental Hypothermia in the Urban Setting
Authors: Roeggla M. , Holzer M. , Roeggla G. , Frossard M. , Wagner A. , Laggner A. N.
Published: November 2015

Our goal was to study the outcome and factors affecting outcome in patients with accidental hypothermia in the urban setting. A retrospective cohort study was done on patients admitted to the emergency department with accidental hypothermia (core temperature less than 35°C) from 1991 to 1998. Patients received general intensive care (fluid replacement, mechanical ventilation, cardiopulmonary resuscitation) and were rewarmed actively by intravenous application of warmed fluids, warmed air, pleural lavage, or cardiopulmonary bypass as indicated. Rewarming was successful in 76 of 80 patients (95%) and hospital mortality was 34%. Survivors differed significantly from nonsurvivors with respect to demographic data (indoor finding, homelessness, alcohol abuse, chronic psychiatric disorder, presumed acute alcohol or drug intoxication), findings on admission [severity of hypothermia, systolic blood pressure, heart rate, multiple organ failure (MOF) score, hypothermia outcome score (HOS), BUN, creatinine, CPK, bilirubin, AST, platelet count], but not with respect to therapeutic modalities (mechanical ventilation, volume replacement, pleural lavage, mechanical ventilation, vasopressors, cardiopulmonary bypass). Rewarming time in nonsurvivors, however, was significantly longer. In logistic regression analysis only indoor occurrence, BUN, and platelet count proved to be independent predictors of in-hospital mortality. Survival of patients found outdoors was significantly higher than that of patients found indoors (p < 0.0001). Our study demonstrates that although rewarming and resuscitation are highly effective, accidental urban hypothermia is a condition with a significant in-hospital mortality. There were only a few independent indicators of unfavorable outcome, of which indoor occurrence was by far the most important. Therefore indoor occurrence of hypothermia has to be acknowledged as a risk factor of poor outcome in accidental urban hypothermia.
Hyperviscosity Syndrome
Authors: Gertz Morie A. , Kyle Robert A.
Published: November 2015

Hyperviscosity syndrome is clinically manifested by oronasal bleeding, retinal hemorrhages, and variable neurological symptoms. It occurs when resistance to flow of blood increases sharply, resulting in impaired transit through the microcirculatory system. The most common cause of hyperviscosity is increased concentrations of gamma globulins, either monoclonal in malignant disease or polyclonal, usually seen with rheumatic disorders. Increased numbers of red blood cells, as in polycythemia vera, can result in viscous blood. Extreme increases in concentrations of mature and immature white blood cells can also produce hyperviscosity. Treatment with plasma exchange is required when the clinical syndrome is symptomatic. Although plasma exchange is not a completely benign procedure, it represents the most effective method of controlling hyperviscosity.
Propofol Anesthesia for Elective Cardioversion of, Pediatric Intensive Care Unit Patients with Congenital Heart Disease
Authors: Hertzog James H. , Campbell Joyce K. , Dalton Heidi J. , Cockerham John T. , Hauser Gabriel J.
Published: November 2015

Propofol is an intravenous sedative-hypnotic anesthetic agent that has been increasingly employed to facilitate elective direct current cardioversion in adult patients. Little information is available about use of propofol in pediatric intensive care unit patients with congenital heart disease undergoing elective cardioversion. We report our experience with 33 cardioversions performed in our pediatric intensive care unit using propofol anesthesia. Propofol provided good subjective conditions for cardioversion in all patients, and 97% of cardioversions successfully converted atrial flutter into a sinus rhythm. Mean induction time was 5.97 ± 3.54 minutes, and recovery time was 28.08 ± 22.88 minutes. Length of stay in the pediatric intensive care unit was 3.84 ± 1.20 hours. Transient hypotension occurred during 24% of cardioversions, whereas brief periods of respiratory depression were present during 30% of cardioversions. Propofol anesthesia can be successfully administered during elective cardioversion in pediatric intensive care unit patients with congenital heart disease provided that appropriate cardiorespiratory monitoring and supportive therapies are in place.
The Management of Sepsis: A Practical Review
Authors: Marik Paul E. , Varon Joseph
Published: November 2015

The incidence of the sepsis syndrome has increased dramatically in the last few decades. During this time we have gained new insights into the pathophysiologic mechanisms leading to organ dysfunction in sepsis and the importance of the host-bacterial interactions in mediating many of these processes. This knowledge has led to new therapeutic approaches and the investigation of a number of novel agents. An assessment of these approaches is presented to aid clinicians in the management of patients with severe sepsis. Criteria used to select studies included their relevance to the management of sepsis and their pertinence to clinicians. Appropriate antibiotic selection and volume resuscitation remain the cornerstone of treatment of septic patients. Hydroxyethyl starch solutions have theoretical advantages over crystalloids; there is, however, no data that the type of resuscitation fluid alters outcome. Vasoactive agents are required in patients who remain hemodynamically unstable or have evidence of tissue hypoxia after adequate volume resuscitation. Although dopamine is widely used, dobutamine and norepinephrine are our vasoactive agents of choice. Dopamine has no proven role in oliguric patients, with early dialysis recommended in patients with acute renal failure. The preferred method of renal replacement therapy remains to be determined. Blood products should be used cautiously in patients with disseminated intravascular coagulation. Therapeutic strategies that interfere with the immune system have not been proven to improve the outcome in unselected groups of patients. However, immunomodulation may prove to have a role in select subgroups of patients. Antibiotic therapy and intensive physiological support continues to be the main approach to the management of patients with severe sepsis. Despite the development of numerous novel therapeutic agents, these drugs have not been demonstrated to improve patient outcome.
Alveolar Hemorrhage
Authors: Sandur Sunder , Dweik Raed A. , Arroliga Alejandro C.
Published: November 2015

Alveolar hemorrhage (AH) is a clinical syndrome with diverse etiologies both immune and nonimmune. The defining pathological feature of AH is the presence or absence of pulmonary capillaritis. The antineutrophil cytoplasmic antibody (ANCA) related vasculitis and systemic lupus erythematosus are the commonest causes of immune AH with pulmonary capillaritis, whereas Goodpasture's syndrome and idiopathic pulmonary hemosiderosis are common causes of immune AH without pulmonary capillaritis. The major nonimmune causes of AH are primarily drug induced, or due to hematological malignancy and disorders of coagulation. Clinical features of AH include: dyspnea, fever, hemotypsis, bilateral crackles and pallor. Hypoxemia and bilateral diffuse airspace disease on the chest radiograph with relative sparing of the bases and apices which most often clears within 48 hours after its onset further characterize this syndrome. The major clinical implications of this syndrome are its potential to cause respiratory failure in severe cases and its sequelae of pulmonary fibrosis with associated morbidity and disability. In addition, AH may be the initial manifestation of a systemic immune disorder which can be managed optimally if recognized early. The diagnosis of AH is confirmed by bronchoalveolar lavage by demonstrating a progressively bloody return on successive aliquots of instilled saline or hemosiderin laden macrophages in the bronchoalveolar lavage fluid. The open lung biopsy remains the gold standard for the diagnosis of AH but is reserved for inapparent cases in whom corticosteroids and immunosuppressive therapy may be life saving. Serologic testing and examination of the urine sediment are useful adjuncts to the diagnosis. The treatment of AH is primarily supportive while an attempt is made to determine its etiology and initiate specific therapy. Glucocorticoids and cyclophosphamide are the cornerstones of therapy in immune AH with adjunctive plasmapheresis in life-threatening cases.
Pharmacists as Laboratory-Based Researchers
Authors: Markowitz John S. , White Roger
Published: November 2015

Pharmacists are presently involved in many areas of laboratory-based drug research. Major areas of research interest include drug assay, drug stability, protein binding studies, phenotyping, and in vitro assessment of antimicrobials. While pharmacy training provides excellent background training for laboratory-based research, further training is indicated to develop laboratory research skills. This paper discusses qualifications of pharmacists as researchers and provides a brief review of some of the areas of research currently pursued by many laboratory-based pharmacist-researchers
Nutraceuticals: Pharmacy's Challenge and Opportunity
Authors: Nickel Ronald O.
Published: November 2015

The rapid increase in the use of nutraceuticals by large segments of the American population presents both a challenge and professional opportunity for pharmacists. Nutraceuticals include dietary supplements, functional foods, and medicinal foods. The regulations regarding the marketing and advertising of nutraceuticals are less stringent than those governing pharmaceuticals. Quality control standards for nutraceuticals vary significantly among manufacturers. Information regarding clinical effectiveness and interaction of nutraceuticals with pharmaceuticals is not readily accessible to many pharmacy practitioners. Pharmacists' formal education in recent decades deemphasized the clinical use of natural products. While the growing public interest in nutraceuticals presents a new opportunity to pharmacy for patient service, the current regulatory and information climate presents significant challenges to the rendering of such service.
Radical Change Management (RCM): From Managing Pyramids to Managing in Chaos
Authors: Sharma Subhash
Published: November 2015

The nature of organisations has been changing over the last fifty years. At one point of time, the paradigm of the pyramid provided the basis for the creation and development of organisations. ‘Design of Organisations’ was based on the pyramid metaphor. However, in due course, a new paradigm evolved. The pyramid gave way to the matrix. Matrix organisations became the buzzword. Empiricists provided new formulations of hypotheses for ‘design of organisations’. With the advent of Information Technology, a new concept and a new metaphor for ‘design of organisations’ was evolved. Now, organisations are experiencing chaos, leading to ‘dissipative structures’ and ‘amoeba structures’ as a basis for organisations to operate in a chaotic environment. This calls for flexible structures, team work and trust. The metaphor of ‘dissipative structures’ captures the essence of ever changing organisations. There is a paradigm shift from managing pyramids to managing dissipative structures. Hence, the need for Radical Change Management.
Electronic Retailing: Indian Scenario
Authors: Mitra Subrata , Ralli Anirudh , Somasekhar V. , Cherian Jojoe
Published: November 2015

Electronic retailing or e-tailing has grown over the years and is expected to grow further in the coming years. The major challenges to the e-tailers worldwide are how to attract and retain customers, and how to streamline operations to become profitable. In India, e-tailing is a relatively new phenomenon, which is yet to pick up any significant volume. The major impediments to growth in e-tailing in India are lack of computer literacy, poor communications infrastructure and customer preference to shop in physical stores. It is expected that the government will take quick actions to improve infrastructure and remove legal and regulatory barriers to facilitate the growth of e-tailing. E-tailers, on the other hand, have to develop innovative strategies to increase their customer base, and streamline supply chain operations to turn a profit.
Leveraging ICTs for Agricultural Development: A case study of E-choupals of ITC
Authors: Singh Sukhpal
Published: November 2015

In the emerging environment of reduced role of the state in agricultural marketing and input supply and the increasing space being provided to the private sector, it becomes imperative to explore the role of the corporate agribusinesses and information technology in building better linkages with farmers. There have been a few experiments in this regard in India in the recent past. This article examines one such case of E-choupals of ITC Ltd. in order to examine the role of information technology in agricultural development. After detailing the design and structure of the project, it goes on to examine its performance. It is found that the project has been able to re-intermediate the local agents instead of dis-intermediating them which would have been more difficult. The project has benefited both, the farmers and the company, in reducing transactions costs and realising better net returns from their operations as it could reduce information asymmetries.
Knowledge Management And Organisational Flexibility: Linkages And Implications
Authors: Ahuja Shiri , Shankar Ravi , Banwet D.K.
Published: November 2015

The paper highlights the issues playing an important role in increasing flexibility of business organizations and the interaction between knowledge management and organizational flexibility. A system dynamics approach is adopted for modeling the linkages and for this purpose a causal loop diagram has been developed. The results provide insight into the interactions of different variables of the system that play important role in deploying knowledge management and help in achieving the organization flexibility.
A Study On The Level Of Awareness, Interest And Adoption Of Supply Chain Management (Scm) Packages Among Corporates
Authors: Shajahan S.
Published: November 2015

A study was conducted by the author among 100 Corporates in Chennai during April and July 2004 for portraying their varying level of awareness, interest and adoption of SCM packages in their business operations. To control the response bias and to increase the reliability of the data, a structured pattern of questions was also used during descriptive survey research. Statistical tests were employed for the data analysis using SPSS. The discriminant function emerged out of the study findings explicitly takes a logistic form that is typical of adoption behaviour of new technology based SCM services in their business operations.

Furthermore, the discriminant function designed by the authors signify shift in adoption and ’push’ behaviour and will predict the group membership among current users, future users and non-users of SCM packages by gauging their level of interest and awareness status which was, in turn, measured on a five point scale. The study findings also pointed out the need for a clear business strategy among Corporates who are planning to implement SCM packages within 18 months for experiencing quick business results. Finally the study concluded that awareness and interest levels were the two determinants which separated users from non users of SCM packages among Corporates in Chennai
Motivational Needs: A Comparative Study Of Public And Private Sector Associates
Authors: Lather Anu Singh , Jain Shilpa
Published: November 2015

This Study consists of a sample of 480 associates of public and private sector in the age range of 20- 55 years. Employee Motivation Schedule was administered to all the subjects individually A 2X4 factorial design was applied to compare the difference of motivational needs of public and private sector associates at different levels.
Intellectual Property Rights and Technology Development: The Case of Software Industry
Authors: Singh Inderjeet , Kumar Pramod
Published: November 2015

Software, the major component of digital world, is all about the using the power of ideas to solve problems. The relation of software industry and the Intellectual Property Rights is a tricky one. There is a debate going on worldwide on the issue: copyright or open end free software? As per the legal opinion. IPR provisions must be implemented irrespective of a firm, industry or country is concerned. But from an analyst's point of view, this issue needs to be viewed in a wider perspective. The paper is an attempt to analyze the IPRs with reference to socio-economic dynamics of software piracy.
Day-Of-The-Week Effect And Indian Stock Market
Authors: Sharma Vandana , Singh Balwinder
Published: November 2015

The current study contributes to the literature by considering the impact of capital market reforms, especially rolling settlement effect on the trading days of the week, on Indian stock exchanges as the stock market was full of fluctuations and different capital reforms were undertaken during the period of fourteen years from January 1992 to October 2005. The study is based on daily closing prices of Sensex. The results of descriptive and ARIMA (Autoregressive Integrated Moving Average) tests indicate the presence of weekend effect during the aggregated time period, i.e. negative Monday returns and positive Friday returns, consistent with Cross (1973), French (1980), Gibbons and Hess (1981), Rogalski (1984), Jaffe and Westerfield (1985), and Chaudhury (1991). For the period of pre-rolling settlement, i.e. 1996-2001, Wednesday-Thursday and Wednesday-Friday returns are significantly correlated and for the period of post-rolling settlement, i.e. 2001-5, Friday-Monday, Tuesday-Friday, and Wednesday-Friday returns are significantly correlated.