bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study
Authors: Rajajee Venkatakrishna , Fletcher Jeffrey J , Rochlen Lauryn R , Jacobs Teresa L
Published: February 2011

Introduction

Ultrasound (US) performed prior to percutaneous tracheostomy (PT) may be useful in avoiding injury to pretracheal vascular structures and in avoiding high placement of the tube. Bedside real-time US guidance with visualization of needle path is routinely utilized for other procedures such as central venous catheterization, and may enhance the safety and accuracy of PT without causing airway occlusion or hypercarbia. Our objective was to demonstrate that PT performed under real-time US guidance with visualization of needle path during tracheal puncture is feasible, including in patients with features that increase the technical difficulty of PT.

Methods

Mechanically ventilated patients with acute brain injury requiring tracheostomy underwent US guided PT. The orotracheal tube was withdrawn using direct laryngoscopy. The trachea was punctured under real-time US guidance (with visualization of the needle path) while using the acoustic shadows of the cricoid and the tracheal rings to identify the level of puncture. After guidewire passage the site and level of entry was verified using the bronchoscope, which was then withdrawn. Following dilatation and tube placement, placement in the airway was confirmed using auscultation and the "lung sliding" sign on US. Bronchoscopy and chest X-ray were then performed to identify any complications.

Results

Thirteen patients successfully underwent US guided PT. Three patients were morbidly obese, two were in cervical spine precautions and one had a previous tracheostomy. In all 13 patients bronchoscopy confirmed that guidewire entry was through the anterior wall and between the first and fifth tracheal rings. There was no case of tube misplacement, pneumothorax, posterior wall injury, significant bleeding or other complication during the procedure.

Conclusions

Percutaneous tracheostomy performed under real-time ultrasound guidance is feasible and appears accurate and safe, including in patients with morbid obesity and cervical spine precautions. Larger studies are required to further define the safety and relative benefits of this technique.

Trial registration

UMIN Clinical Trials Registry, UMIN000005023.
Postcards in Persia: randomised controlled trial to reduce suicidal behaviours 12 months after hospital-treated self-poisoning
Authors: Hassanian-Moghaddam Hossein , Sarjami Saeedeh , Kolahi Ali-Asghar , Carter Gregory L.
Published: February 2011

Background

Hospital-treated self-poisoning is common, with limited effective interventions for reducing subsequent suicidal behaviour.

Aims

To test the efficacy of a postcard intervention to reduce suicidal behaviour.

Method

Randomised controlled trial of individuals who self-poisoned (n = 2300), the intervention consisted of nine postcards sent over 12 months versus usual treatment. Outcomes assessed at 12 months (n = 2113) were suicidal ideation, suicide attempts and self-cutting (proportion and event rates).

Results

There was a significant reduction in any suicidal ideation (relative risk reduction (RRR) = 0.31, 95% CI 0.22–0.38), any suicide attempt (RRR = 0.42, 95% CI 0.11–0.63) and number of attempts (incidence rate ratios (IRR) = 0.64, 95% CI 0.42–0.97). There was no significant reduction in any self-cutting (RRR = 0.14, 95% CI −-0.29 to 0.42) or self-cutting events (IRR = 1.03 95% CI 0.76–1.39).

Conclusions

A postcard intervention reduced suicidal ideation and suicide attempts in a non-Western population. Sustained, brief contact by mail may reduce suicidal ideation and suicide attempts in individuals who self-poison.
Auxilin is required for formation of Golgi-derived clathrin-coated vesicles during Drosophila spermatogenesis
Authors: Zhou Xin , Fabian Lacramioara , Bayraktar Jennifer L. , Ding Hong-Mei , Brill Julie A. , Chang Henry C.
Published: February 2011

Clathrin has previously been implicated in Drosophila male fertility and spermatid individualization. To understand further the role of membrane transport in this process, we analyzed the phenotypes of mutations in Drosophila auxilin (aux), a regulator of clathrin function, in spermatogenesis. Like partial loss-of-function Clathrin heavy chain (Chc) mutants, aux mutant males are sterile and produce no mature sperm. The reproductive defects of aux males were rescued by male germ cell-specific expression of aux, indicating that auxilin function is required autonomously in the germ cells. Furthermore, this rescue depends on both the clathrin-binding and J domains, suggesting that the ability of Aux to bind clathrin and the Hsc70 ATPase is essential for sperm formation. aux mutant spermatids show a deficit in formation of the plasma membrane during elongation, which probably disrupts the subsequent coordinated migration of investment cones during individualization. In wild-type germ cells, GFP-tagged clathrin localized to clusters of vesicular structures near the Golgi. These structures also contained the Golgi-associated clathrin adaptor AP-1, suggesting that they were Golgi-derived. By contrast, in aux mutant cells, clathrin localized to abnormal patches surrounding the Golgi and its colocalization with AP-1 was disrupted. Based on these results, we propose that Golgi-derived clathrin-positive vesicles are normally required for sustaining the plasma membrane increase necessary for spermatid differentiation. Our data suggest that Aux participates in forming these Golgi-derived clathrin-positive vesicles and that Aux, therefore, has a role in the secretory pathway.
Genetic mosaic analysis reveals a major role for frizzled 4 and frizzled 8 in controlling ureteric growth in the developing kidney
Authors: Ye Xin , Wang Yanshu , Rattner Amir , Nathans Jeremy
Published: February 2011

The developing mammalian kidney is an attractive system in which to study the control of organ growth. Targeted mutations in the Wnt receptors frizzled (Fz) 4 and Fz8 lead to reduced ureteric bud growth and a reduction in kidney size, a phenotype previously reported for loss of Wnt11. In cell culture, Fz4 and Fz8 can mediate noncanonical signaling stimulated by Wnt11, but only Fz4 mediates Wnt11-stimulated canonical signaling. In genetically mosaic mouse ureteric buds, competition between phenotypically mutant Fz4−/− or Fz4−/−;Fz8−/− cells and adjacent phenotypically wild-type Fz4+/− or Fz4+/−;Fz8−/− cells results in under-representation of the mutant cells to an extent far greater than would be predicted from the size reduction of homogeneously mutant kidneys. This discrepancy presumably reflects the compensatory action of a network of growth regulatory systems that minimize developmental perturbations. The present work represents the first description of a kidney phenotype referable to one or more Wnt receptors and demonstrates a general strategy for revealing the contribution of an individual growth regulatory pathway when it is part of a larger homeostatic network.
Compartmentalized Notch signaling sustains epithelial mirror symmetry
Authors: Wibowo Indra , Pinto-Teixeira Filipe , Satou Chie , Higashijima Shin-ichi , López-Schier Hernán
Published: February 2011

Bilateral symmetric tissues must interpret axial references to maintain their global architecture during growth or repair. The regeneration of hair cells in the zebrafish lateral line, for example, forms a vertical midline that bisects the neuromast epithelium into perfect mirror-symmetric plane-polarized halves. Each half contains hair cells of identical planar orientation but opposite to that of the confronting half. The establishment of bilateral symmetry in this organ is poorly understood. Here, we show that hair-cell regeneration is strongly directional along an axis perpendicular to that of epithelial planar polarity. We demonstrate compartmentalized Notch signaling in neuromasts, and show that directional regeneration depends on the development of hair-cell progenitors in polar compartments that have low Notch activity. High-resolution live cell tracking reveals a novel process of planar cell inversions whereby sibling hair cells invert positions immediately after progenitor cytokinesis, demonstrating that oriented progenitor divisions are dispensable for bilateral symmetry. Notwithstanding the invariably directional regeneration, the planar polarization of the epithelium eventually propagates symmetrically because mature hair cells move away from the midline towards the periphery of the neuromast. We conclude that a strongly anisotropic regeneration process that relies on the dynamic stabilization of progenitor identity in permissive polar compartments sustains bilateral symmetry in the lateral line.
Continuous live imaging of adult neural stem cell division and lineage progression in vitro
Authors: Costa Marcos R. , Ortega Felipe , Brill Monika S. , Beckervordersandforth Ruth , Petrone Ciro , Schroeder Timm , Götz Magdalena , Berninger Benedikt
Published: February 2011

Little is known about the intrinsic specification of adult neural stem cells (NSCs) and to what extent they depend on their local niche. To observe adult NSC division and lineage progression independent of their niche, we isolated cells from the adult mouse subependymal zone (SEZ) and cultured them at low density without growth factors. We demonstrate here that SEZ cells in this culture system are primarily neurogenic and that adult NSCs progress through stereotypic lineage trees consisting of asymmetric stem cell divisions, symmetric transit-amplifying divisions and final symmetric neurogenic divisions. Stem cells, identified by their astro/radial glial identity and their slow-dividing nature, were observed to generate asymmetrically and fast-dividing cells that maintained an astro/radial glia identity. These, in turn, gave rise to symmetrically and fast-dividing cells that lost glial hallmarks, but had not yet acquired neuronal features. The number of amplifying divisions was limited to a maximum of five in this system. Moreover, we found that cell growth correlated with the number of subsequent divisions of SEZ cells, with slow-dividing astro/radial glia exhibiting the most substantial growth prior to division. The fact that in the absence both of exogenously supplied growth factors and of signals provided by the local niche neurogenic lineage progression takes place in such stereotypic fashion, suggests that lineage progression is, to a significant degree, cell intrinsic or pre-programmed at the beginning of the lineage.
Development and validation of an arterial blood gas analysis interpretation algorithm for application in clinical laboratory services
Authors: Park Sang Hyuk , An Dongheui , Chang You Jin , Kim Hyun Jung , Kim Kyung Min , Koo Tai Yeon , Kim Sollip , Lee Woochang , Yang Won Seok , Hong Sang-Bum , Chun Sail , Min Won-Ki
Published: February 2011

Background

Arterial blood gas analysis (ABGA) is a useful test that estimates the acid–base status of patients. However, numerically reported test results make rapid interpretation difficult. To overcome this problem, we have developed an algorithm that automatically interprets ABGA results, and assessed the validity of this algorithm for applications in clinical laboratory services.

Methods

The algorithm was developed based on well-established guidelines using three test results (pH, PaCO2 and [HCO3−]) as variables. Ninety-nine ABGA test results were analysed by the algorithm. The algorithm's interpretations and the interpretations of two representative web-based ABGA interpretation programs were compared with those of two experienced clinicians.

Results

The concordance rates between the interpretations of each of the two clinicians and the algorithm were 91.9% and 97.0%, respectively. The web-based programs could not issue definitive interpretations in 15.2% and 25.3% of cases, respectively, but the algorithm issued definitive interpretations in all cases. Of the 10 cases that invoked disagreement among interpretations by the algorithm and the two clinicians, half were interpreted as compensated acid–base disorders by the algorithm but were assessed as normal by at least one of the two clinicians. In no case did the algorithm indicate a normal condition that the clinicians assessed as an abnormal condition.

Conclusions

The interpretations of the algorithm showed a higher concordance rate with those of experienced clinicians than did two web-based programs. The algorithm sensitively detected acid–base disorders. The algorithm may be adopted by the clinical laboratory services to provide rapid and definitive interpretations of test results.
Structural Changes of Milk Components during Acid-Induced Coagulation Kinetics as Studied by Synchronous Fluorescence and Mid-Infrared Spectroscopy
Authors: Boubellouta Tahar , Galtier Virginie , Dufour Eric
Published: February 2011

Dynamic oscillatory experiments and front-face synchronous fluorescence spectroscopy and mid-infrared (mid-IR) spectroscopy have been used to investigate structure evolution, at the macroscopic and molecular levels, during milk acidification kinetics. The studies were performed using skim milk, at two different temperatures (30°C and 40°C), to which was added glucono-δ-lactone (GDL) to generate different structural changes in casein micelles and gels. Synchronous fluorescence spectra were recorded in the 250–500 nm excitation wavelength range using an offset of 80 nm between the excitation and emission monochromators for each system during the 300 min acidification kinetics. The change in the fluorescence intensity at 281 nm reflects the pH-induced physicochemical changes of casein micelles and, in particular, structural changes in the micelles in the pH range 5.5–5.0. Regarding mid-infrared spectroscopy, the region located between 1700 and 1500 cm−1, corresponding to the amide I and II bands, and the 1500–900 cm−1 region, called the fingerprint region, were considered for the characterization of milk coagulation kinetics. Changes in the absorbance at 1063 cm−1 as a function of pH for kinetics recorded at 30°C and 40°C reflected pH-induced phosphate dissolution in the pH range 5.5–5.0. Compared to rheometry, which reveals microstructure changes only in the gel state, spectroscopic methods make it possible to monitor molecular structure changes in micelles throughout the acidification processes.
Multivariate Calibration and Instrument Standardization for the Rapid Detection of Diethylene Glycol in Glycerin by Raman Spectroscopy
Authors: Gryniewicz-Ruzicka Connie M. , Arzhantsev Sergey , Pelster Lindsey N. , Westenberger Benjamin J. , Buhse Lucinda F. , Kauffman John F.
Published: February 2011

The transfer of a multivariate calibration model for quantitative determination of diethylene glycol (DEG) contaminant in pharmaceutical-grade glycerin between five portable Raman spectrometers was accomplished using piecewise direct standardization (PDS). The calibration set was developed using a multi-range ternary mixture design with successively reduced impurity concentration ranges. It was found that optimal selection of calibration transfer standards using the Kennard–Stone algorithm also required application of the algorithm to multiple successively reduced impurity concentration ranges. Partial least squares (PLS) calibration models were developed using the calibration set measured independently on each of the five spectrometers. The performance of the models was evaluated based on the root mean square error of prediction (RMSEP), calculated using independent validation samples. An F-test showed that no statistical differences in the variances were observed between models developed on different instruments. Direct cross-instrument prediction without standardization was performed between a single primary instrument and each of the four secondary instruments to evaluate the robustness of the primary instrument calibration model. Significant increases in the RMSEP values for the secondary instruments were observed due to instrument variability. Application of piecewise direct standardization using the optimal calibration transfer subset resulted in the lowest values of RMSEP for the secondary instruments. Using the optimal calibration transfer subset, an optimized calibration model was developed using a subset of the original calibration set, resulting in a DEG detection limit of 0.32% across all five instruments.
Spectrofluorimetric Determination of SN-38, a Promising New Anti-Tumor Agent, in the Presence and Absence of Organized Media
Authors: Rodríguez-Cáceres Maria Isabel , Gil Diego Bohoyo , Durán-Merás Isabel , Sánchez Maria C. Hurtado
Published: February 2011

This study focuses on the spectrofluorimetric behavior of the camptothecin derivative 7-ethyl-10-hydroxycamptothecin (SN-38) alone and in the presence of organized media and also on its potential analytical applications. SN-38 displays native fluorescence in both lactone and carboxylate form, which has been the base for development of two spectrofluorimetric methods, one for the lactone form (acidic media) and another for the carboxylate form (basic media). In an attempt to improve the understanding of SN-38, its interaction with several cyclodextrins and surfactants has been studied using spectrofluorimetry. Consequently, the optimal working conditions for the determination of SN-38 have been established in both the presence and the absence of organized media. The proposed methods were applied to human urine, using liquid–liquid extraction for clean-up of the samples, with satisfactory recoveries. No interference of the urine matrix was observed.
Angle-Constrained Alternating Least Squares
Authors: Windig Willem , Keenan Michael R.
Published: February 2011

When resolving mixture data sets using self-modeling mixture analysis techniques, there are generally a range of possible solutions. There are cases, however, in which a unique solution is possible. For example, variables may be present (e.g., m/z values in mass spectrometry) that are characteristic for each of the components (pure variables), in which case the pure variables are proportional to the actual concentrations of the components. Similarly, the presence of pure spectra in a data set leads to a unique solution. This paper will show that these solutions can be obtained by applying angle constraints in combination with non-negativity to the solution vectors (resolved spectra and resolved concentrations). As will be shown, the technique goes beyond resolving data sets with pure variables and pure spectra by enabling the analyst to selectively enhance contrast in either the spectral or concentration domain. Examples will be given of Fourier transform infrared (FT-IR) microscopy of a polymer laminate, secondary ion mass spectrometry (SIMS) images of a two-component mixture, and energy dispersive spectrometry (EDS) of alloys.
Spectroscopic Investigation in the Mid- and Far-Infrared Regions of Phosphorus Fertilizers Derived from Thermochemically Treated Sewage Sludge Ash
Authors: Vogel Christian , Kohl Anka , Adams Christian
Published: February 2011

Inorganic phosphorus and nitrogen-phosphorus-potassium (NPK) fertilizers based on phosphates from thermochemically treated sewage sludge ash were analyzed using mid-infrared (mid-IR) and far-infrared (FIR) spectroscopy. The different compounds present in the fertilizers were qualitatively determined with the help of recorded reference spectra of pure substances. Differentiation between various phosphates and other compounds such as sulfates, nitrates, and oxides was possible using combined interpretation of the mid-IR and FIR spectra. The results are in agreement with previous X-ray diffraction (XRD) measurements of the same samples. The main phosphate phases detected were NH4H2PO4, MgHPO4-3H2O, Mg3(PO4)2, Ca5(PO4)5Cl, CaHPO4-2H2O, Ca(H2-PO4)2-H2O, and AlPO4. Furthermore, K2SO4, NH4NO3, Fe2O3, and SiO2 were identified in the IR spectra. However, ammonium and sulfate compounds were only identified in the mid-IR region but were not detectable in the FIR region.
Automated Measurements of Road Cracks Using Line-Scan Imaging
Authors: Yao Xun , Yao Ming , Xu Bugao
Published: February 2011

This paper presents a new line-scan imaging system for automated measurements of road crack. The system consists of off-the-shelf hardware for real-time image acquisition and the customized image-analysis software for crack detection. A line-scan camera with 2 k pixels, a GigE interface, and a line rate up to 36 kHz was used to scan 3.6-m wide pavements at highway speeds, and a laser line projector was used to cast a transverse beam that overlays the scanline of the camera to eliminate shadows of vehicles and roadside objects and to maintain consistent lighting conditions. In the crack detection algorithms, a pavement image was first divided into grids of 8×8 pixels, and each grid was classified either as a non-crack or crack grid (called seed) using the pixel information of the grid and the overall background. Then, seeds in the vicinity were connected based on geometrical and intensity constrains. The connected seeds served as a candidate for a crack, which were further verified by using the contrast to the pixels along its trace. The paper also reports the experimental results on a designated pavement that was manually rated by an expert, and scanned three-times by the system. The statistic analysis showed that the difference in crack length between the manual and automatic measurements was less than 10 %, and no significant difference among the multiple scans by the system.
Nanometeraufgelöste Koordinatenmesstechnik mit elektrischer Werkstückantastung
Authors: Hoffmann Jörg , Schuler Alexander
Published: February 2011

Koordinatenmesstechnik gehört vor allem im Maschinenbau zu den Kernelementen der industriellen Qualitätssicherung. Ihre Anwendung kann auch in der Mikrotechnologie zur Bewältigung zahlreicher Herausforderungen im Bereich der geometrischen Werkstückprüfung beitragen, wenn es gelingt praktische Probleme der taktilen Antastung bei der Messung von Mikromerkmalen zu überwinden. Mit kleiner werdenden Tastelementen — Voraussetzung für die Antastung von Mikromerkmalen — wird es überproportional schwieriger, statische und dynamische Antastkräfte so zu begrenzen, dass Beschädigungen von Werkstück und/oder Tastsystem vermieden werden können. Am Lehrstuhl Qualitätsmanagement und Fertigungsmesstechnik der Universität Erlangen-Nürnberg wurde als Alternative zu taktilen Tastsystemen ein berührungslos arbeitendes, auf elektrischer Wechselwirkung beruhendes 3D-Mikrotastsystem entwickelt und wissenschaftlich untersucht, welches für 3D Mikrokoordinatenmesstechnik und Nanometer-aufgelöste Topographiemessungen eingesetzt werden kann.
The developing ovary of the South American plains vizcacha, Lagostomus maximus (Mammalia, Rodentia): massive proliferation with no sign of apoptosis-mediated germ cell attrition
Authors: Leopardo N P , Jensen F , Willis M A , Espinosa M B , Vitullo A D
Published: February 2011

Apoptosis-dependent massive germ cell death is considered a constitutive trait of the developing mammalian ovary that eliminates 65–85% of the germinal tissue depending on the species. After birth and during adult lifetime, apoptotic activity moves from the germ cell proper to the somatic compartment, decimating germ cells through follicular atresia until the oocyte reserve is exhausted. In contrast, the South American rodentLagostomus maximusshows suppressed apoptosis-dependent follicular atresia in the adult ovary, with continuous folliculogenesis and massive polyovulation, which finally exhausts the oocyte pool. The absence of follicular atresia in adultL. maximusmight arise from a failure to move apoptosis from the germinal stratum to the somatic compartment after birth or being a constitutive trait of the ovarian tissue with no massive germ cell degeneration in the developing ovary. We tested these possibilities by analysing oogenesis, expression of germ cell-specific VASA protein, apoptotic proteins BCL2 and BAX, and DNA fragmentation by TUNEL assay in the developing ovary ofL. maximus. Immunolabelling for VASA revealed a massive and widespread colonisation of the ovary and proliferation of germ cells organised in nests that disappeared at late development when folliculogenesis began. No sign of germ cell attrition was found at any time point. BCL2 remained positive throughout oogenesis, whereas BAX was slightly detected in early development. TUNEL assay was conspicuously negative throughout the development. These results advocate for an unrestricted proliferation of germ cells, without apoptosis-driven elimination, as a constitutive trait ofL. maximusovary as opposed to what is normally found in the developing mammalian ovary.
Involvement of BCL2 family members in the regulation of human oocyte and early embryo survival and death: gene expression and beyond
Authors: Boumela Imene , Assou Said , Aouacheria Abdel , Haouzi Delphine , Dechaud Hervé , De Vos John , Handyside Alan , Hamamah Samir
Published: February 2011

In women, up to 99.9% of the oocyte stockpile formed during fetal life is decimated by apoptosis. Apoptotic features are also detected in human preimplantation embryos bothin vivoandin vitro. Despite the important consequences of cell death processes to oocyte competence and early embryonic development, little is known about its genetic and molecular control. B cell lymphoma-2 (BCL2) family proteins are major regulators of cell death and survival. Here, we present a literature review on BCL2 family expression and protein distribution in human and animal oocytes and early embryos. Most of the studies focused on the expression of two antagonistic members: the founding and survival family member BCL2 and its proapoptotic homolog BAX. However, recent transcriptomic analyses have identified novel candidate genes related to oocyte and/or early embryonic viability (such asBCL2L10) or commitment to apoptosis (e.g.BIK). Interestingly, some BCL2 proteins appear to be differentially distributed at the subcellular level during oocyte maturation and early embryonic development, a process probably linked to the functional compartmentalization of the ooplasm and blastomere. Assessment of BCL2 family involvement in regulating the survival of human oocytes and embryos may be of particular value for diagnosis and assisted reproductive technology. We suggest that implications of not only aberrant gene expression but also abnormal subcellular protein redistribution should be established in pathological conditions resulting in infertility.
Sustained and Rapid Chromosome Movements Are Critical for Chromosome Pairing and Meiotic Progression in Budding Yeast
Authors: Brown Megan Sonntag , Zanders Sarah , Alani Eric
Published: February 2011

Telomere-led chromosome movements are a conserved feature of meiosis I (MI) prophase. Several roles have been proposed for such chromosome motion, including promoting homolog pairing and removing inappropriate chromosomal interactions. Here, we provide evidence in budding yeast that rapid chromosome movements affect homolog pairing and recombination. We found that csm4Δ strains, which are defective for telomere-led chromosome movements, show defects in homolog pairing as measured in a “one-dot/two-dot tetR-GFP” assay; however, pairing in csm4Δ eventually reaches near wild-type (WT) levels. Charged-to-alanine scanning mutagenesis of CSM4 yielded one allele, csm4-3, that confers a csm4Δ-like delay in meiotic prophase but promotes high spore viability. The meiotic delay in csm4-3 strains is essential for spore viability because a null mutation (rad17Δ) in the Rad17 checkpoint protein suppresses the delay but confers a severe spore viability defect. csm4-3 mutants show a general defect in chromosome motion but an intermediate defect in chromosome pairing. Chromosome velocity analysis in live cells showed that while average chromosome velocity was strongly reduced in csm4-3, chromosomes in this mutant displayed occasional rapid movements. Lastly, we observed that spo11 mutants displaying lower levels of meiosis-induced double-strand breaks showed higher spore viability in the presence of the csm4-3 mutation compared to csm4Δ. On the basis of these observations, we propose that during meiotic prophase the presence of occasional fast moving chromosomes over an extended period of time is sufficient to promote WT levels of recombination and high spore viability; however, sustained and rapid chromosome movements are required to prevent a checkpoint response and promote efficient meiotic progression.
Nosocomial Infection Reduction in VLBW Infants With a Statewide Quality-Improvement Model
Authors: Wirtschafter David D. , Powers Richard J. , Pettit Janet S. , Lee Henry C. , Boscardin W. John , Ahmad Subeh Mohammad , Gould Jeffrey B.
Published: February 2011

OBJECTIVE:

To evaluate the effectiveness of the California Perinatal Quality Care Collaborative quality-improvement model using a toolkit supplemented by workshops and Web casts in decreasing nosocomial infections in very low birth weight infants.

DESIGN:

This was a retrospective cohort study of continuous California Perinatal Quality Care Collaborative members' data during the years 2002–2006. The primary dependent variable was nosocomial infection, defined as a late bacterial or coagulase-negative staphylococcal infection diagnosed after the age of 3 days by positive blood/cerebro-spinal fluid culture(s) and clinical criteria. The primary independent variable of interest was voluntary attendance at the toolkit's introductory event, a direct indicator that at least 1 member of an NICU team had been personally exposed to the toolkit's features rather than being only notified of its availability. The intervention's effects were assessed using a multivariable logistic regression model that risk adjusted for selected demographic and clinical factors.

RESULTS:

During the study period, 7733 eligible very low birth weight infants were born in 27 quality-improvement participant hospitals and 4512 very low birth weight infants were born in 27 non–quality-improvement participant hospitals. For the entire cohort, the rate of nosocomial infection decreased from 16.9% in 2002 to 14.5% in 2006. For infants admitted to NICUs participating in at least 1 quality-improvement event, there was an associated decreased risk of nosocomial infection (odds ratio: 0.81 [95% confidence interval: 0.68–0.96]) compared with those admitted to nonparticipating hospitals.

CONCLUSIONS:

The structured intervention approach to quality improvement in the NICU setting, using a toolkit along with attendance at a workshop and/or Web cast, is an effective means by which to improve care outcomes.
Racial, Ethnic, and Socioeconomic Disparities in the Prevalence of Cerebral Palsy
Authors: Wu Yvonne W. , Xing Guibo , Fuentes-Afflick Elena , Danielson Beate , Smith Lloyd H. , Gilbert William M.
Published: February 2011

OBJECTIVE:

Racial and ethnic disparities in cerebral palsy have been documented, but the underlying mechanism is poorly understood. We determined whether low birth weight accounts for ethnic disparities in the prevalence of cerebral palsy and whether socioeconomic factors impact cerebral palsy within racial and ethnic groups.

METHODS:

In a retrospective cohort of 6.2 million births in California between 1991 and 2001, we compared maternal and infant characteristics among 8397 infants with cerebral palsy who qualified for services from the California Department of Health Services and unaffected infants.

RESULTS:

Overall, black infants were 29% more likely to have cerebral palsy than white infants (relative risk: 1.29 [95% confidence interval: 1.19–1.39]). However, black infants who were very low or moderately low birth weight were 21% to 29% less likely to have cerebral palsy than white infants of comparable birth weight. After we adjusted for birth weight, there was no difference in the risk of cerebral palsy between black and white infants. In multivariate analyses, women of all ethnicities who did not receive any prenatal care were twice as likely to have infants with cerebral palsy relative to women with an early onset of prenatal care. Maternal education was associated with cerebral palsy in a dose-response fashion among white and Hispanic women. Hispanic adolescent mothers (aged <18 years) had increased risk of having a child with cerebral palsy.

CONCLUSIONS:

The increased risk of cerebral palsy among black infants is primarily related to their higher risk of low birth weight. Understanding how educational attainment and use of prenatal care impact the risk of cerebral palsy may inform new prevention strategies.
Population Case-Control Study of Cerebral Palsy: Neonatal Predictors for Low-Risk Term Singletons
Authors: McIntyre Sarah , Badawi Nadia , Brown Chris , Blair Eve
Published: February 2011

OBJECTIVES:

For singletons with cerebral palsy (CP) who were born at term, the goals were (1) to determine the proportion not admitted to a Special Care Unit/NICU (NICU), (2) to compare clinical descriptions of those admitted to NICUs and those not admitted, and (3) to identify neonatal predictors of CP among those not admitted to a NICU.

METHODS:

A total-population case- (N = 442) control (N = 468) study of, singleton, term-born infants with CP, as ascertained from the Western Australian Cerebral Palsy Register, was performed.

RESULTS:

All types of CP were represented among the 67% of term infants with CP (N = 295) who were not admitted to a NICU, which also included 54% of the subjects with the most severe impairments. Independent neonatal predictors were abnormalities of tone (odds ratio [OR]: 7.3 [95% confidence interval [CI]: 2–26.8]), temperature regulation (OR: 4.1 [95% CI: 1.2–14]), consciousness (OR: 3.7 [95% CI: 2–7]), and fontanelles (OR: 4.4 [95% CI: 0.8–23]), requirement for resuscitation (OR: 2.9 [95% CI: 2.2–12.9]), and birth defects (OR: 5.1 [95% CI: 2.4–10]). The risk of CP increased with the number of factors, but 58% of subjects who were not admitted to a NICU exhibited none of these factors.

CONCLUSIONS:

Neonatal predictors of CP among term infants not admitted to a NICU were identified. However, 39% of all term singletons with CP were not admitted to a NICU and exhibited none of these predictors.
The Scope of Nonsuicidal Self-Injury on YouTube
Authors: Lewis Stephen P. , Heath Nancy L. , St Denis Jill M. , Noble Rick
Published: February 2011

OBJECTIVE:

Nonsuicidal self-injury, the deliberate destruction of one's body tissue (eg, self-cutting, burning) without suicidal intent, has consistent rates ranging from 14% to 24% among youth and young adults. With more youth using video-sharing Web sites (eg, YouTube), this study examined the accessibility and scope of nonsuicidal self-injury videos online.

METHODS:

Using YouTube's search engine (and the following key words: “self-injury” and “self-harm”), the 50 most viewed character (ie, with a live individual) and noncharacter videos (100 total) were selected and examined across key quantitative and qualitative variables.

RESULTS:

The top 100 videos analyzed were viewed over 2 million times, and most (80%) were accessible to a general audience. Viewers rated the videos positively (M = 4.61; SD: 0.61 out of 5.0) and selected videos as a favorite over 12 000 times. The videos' tones were largely factual or educational (53%) or melancholic (51%). Explicit imagery of self-injury was common. Specifically, 90% of noncharacter videos had nonsuicidal self-injury photographs, whereas 28% of character videos had in-action nonsuicidal self-injury. For both, cutting was the most common method. Many videos (58%) do not warn about this content.

CONCLUSIONS:

The nature of nonsuicidal self-injury videos on YouTube may foster normalization of nonsuicidal self-injury and may reinforce the behavior through regular viewing of nonsuicidal self-injury–themed videos. Graphic videos showing nonsuicidal self-injury are frequently accessed and received positively by viewers. These videos largely provide nonsuicidal self-injury information and/or express a hopeless or melancholic message. Professionals working with youth and young adults who enact nonsuicidal self-injury need to be aware of the scope and nature of nonsuicidal self-injury on YouTube.
Implementation of Goal-Directed Therapy for Children With Suspected Sepsis in the Emergency Department
Authors: Cruz Andrea T. , Perry Andrew M. , Williams Eric A. , Graf Jeanine M. , Wuestner Elizabeth R. , Patel Binita
Published: February 2011

BACKGROUND:

Suboptimal care for children with septic shock includes delayed recognition and inadequate fluid resuscitation.

OBJECTIVE:

To describe the implementation of an emergency department (ED) protocol for the recognition of septic shock and facilitate adherence to national treatment guidelines.

PATIENTS AND METHODS:

Root-cause analyses and morbidity and mortality conferences identified system problems with sepsis recognition and management. A group of ED and critical care physicians met to identify barriers and create solutions.

RESULTS:

To facilitate sepsis recognition, a computerized triage system alarmed on abnormal vital signs, and then toxic-appearing children or children at high risk for invasive infection were placed in a resuscitation room. To facilitate timely delivery of interventions, additional nursing, respiratory therapy, and pharmacy personnel were recruited. Fluids were administered via syringe delivery; standardized laboratory studies and antibiotics were ordered and prioritized. Frequent vital-sign measurements and interventions were documented on a graphical flow sheet to facilitate interpretation of physiologic response to therapy. After protocol initiation, there were 191 encounters in 167 patients with suspected sepsis. When compared with children seen before the protocol, time from triage to first bolus decreased from a median of 56 to 22 minutes (P < .001) and triage to first antibiotics decreased from a median of 130 to 38 minutes (P < .001).

CONCLUSIONS:

The protocol resulted in earlier recognition of suspected sepsis and substantial reductions in both time to receipt of time-sensitive interventions and a decrement in treatment variation.
Votive Inscriptions on the Sculptures of Early Medieval Samatata-Harikela, Bengal
Authors: Prasad Birendra Nath
Published: February 2011

In this paper, I attempt to look into the patterns of social patronage to Buddhism and Brahmanism in the Samatata-Harikela subregion of early medieval Bengal through the prism of votive inscriptions on sculptures. I have also looked into some of the social and religious processes that were in operation in this part of early medieval Bengal. I have argued that despite being part of the cultural and socio-economic matrix of early medieval Bihar and Bengal, Samatata-Harikela had some peculiarities of its own. That, however, does not justify treating this entire area as a ‘frontier’. This paper questions those historiographical models which explain the Islamization of this area in terms of Islam being the ‘harbinger of rice revolution’ in the same during the medieval period.
The Dialectic of Divine ‘Grace’ and ‘Justice’ in St Augustine and Sri-Vaisnavism
Authors: Barua Ankur
Published: February 2011

This article is an investigation into whether it is possible to trace certain parallels between the conception of the divine reality as ‘gracious’ from within the contextualized vocabularies of both Christian thought and some forms of South Indian Vaisnavite devotional belief and practice. We explore the nature of a certain dialectic that appears in the thought of St Augustine, namely, between God’s prevenient grace and God’s justice: on the one hand, if grace is offered to human beings on the basis of their prior merits, it is not an unmerited gift that is freely and unconditionally given by God, but, on the other, if God does not graciously approach all human beings, the divine salvific will seems to be ‘arbitrary’, at least from a human perspective. Some Vaisnavite theologians have grappled with a similar dialectic in conceptualizing the relation between Brahman who ‘graciously’ elects the devotee and Brahman who is the ‘just’ supervisor of the karmic order of retributions and rewards: on the one hand, if Brahman is under the sway of the law of moral causation, Brahman is not supreme over the world, but, on the other, if Brahman liberates only a few individual selves without regard to operation of the karmic principle, Brahman is partial to them.
Swami Krpalvananda
Authors: Goldberg Ellen
Published: February 2011

This paper examines the life and teachings of Swami Krpalvananda (1913–1981) with specific reference to Mark Singleton and Richard Smith’s (2008) notion of the ‘circular construction of authority’. Within the transnational practice of modern yoga, Kripalu’s life serves as an authoritative voice and sets the standard by which all yoga experience is measured within his monastic and lay community. Thus the details of Krpalvananda’s life including biography, autobiography and hagiography are analysed and three key elements, namely pranotthana via saktipata initiation, prana-yoga, and divine body (divya deha) are highlighted as features not typically seen in other modern approaches.
Krishna Prasadam
Authors: Dwyer Graham
Published: February 2011

In the Hare Krishna movement ritually sanctified food (known as prasadam) lies at the heart of key religious and ceremonial activity, and has progressively become the main rallying point for the movement’s preaching strategy or mission in the West. This article examines the experiential and doctrinal import of prasadam in the lives of adherents of the Krishna Consciousness movement and discusses its role as a preaching or proselytizing tool. As a means by which the movement today seeks to recruit new followers into its fold, the article looks at the movement’s programme of taking sanctified food to the public, with a particular focus on Hare Krishna Food for All missionary activity in London.
Controversies in the Adjuvant Therapy of High-Grade Gliomas
Authors: Holdhoff Matthias , Grossman Stuart A.
Published: February 2011

The 2-year survival rate of patients with glioblastoma accrued to research studies increased from 10% to nearly 40% from 2000 to 2010. These improvements began with the demonstration of a survival benefit when daily temozolomide was administered with 6 weeks of standard radiation and for 6 months thereafter. This treatment regimen is often associated with significant lymphopenia, thrombocytopenia, and progressive blood–brain barrier dysfunction that can result in clinical and radiologic deterioration without true tumor progression (“pseudoprogression”). With new evidence that combining this cytotoxic agent with radiation improves survival in this malignancy, many investigators have modified the regimen to further improve patient outcomes. These largely uncontrolled studies highlight controversies regarding the optimal therapy of this disease. This review focuses on the following selected controversies: (a) What is the appropriate temozolomide dose, schedule, and duration in the postradiation period? (b) How should other U.S. Food and Drug Administration–approved therapies (such as carmustine wafers and bevacizumab) be incorporated into this treatment regimen? (c) Should the results in glioblastoma be extrapolated to patients aged >70 and to patients with lower grade gliomas? and (d) How should novel therapeutic approaches be added to radiation and temozolomide in clinical trials for patients with newly diagnosed glioblastoma?
Treatment of Intrabony Defects After Impacted Mandibular Third Molar Removal With Bioabsorbable and Non‐Resorbable Membranes
Authors: Corinaldesi Giuseppe , Lizio Giuseppe , Badiali Giovanni , Morselli‐Labate Antonio M. , Marchetti Claudio
Published: February 2011

Background: Mandibular second molar (M2) periodontal defects after third molar (M3) removal in high‐risk patients are a clinical dilemma for clinicians. This study compares the healing of periodontal intrabony defects at distal surfaces of mandibular M2s using bioabsorbable and non‐resorbable membranes.

Methods: Eleven patients with bilateral probing depths (PDs) ≥6 mm distal to mandibular M2s and intrabony defects ≥3 mm, related to the total impaction of M3s, were treated with M3 extraction and covering of the surgical bone defect with a bioabsorbable collagen barrier on one side and a non‐resorbable expanded polytetrafluoroethylene (ePTFE) barrier contralaterally. The PD, clinical attachment level (CAL), M2 mobility, and furcation class probing were evaluated preoperatively and 3, 6, and 9 months postoperatively. Intraoral periapical radiographs were taken immediately preoperatively and 3 and 9 months postoperatively.

Results: Both treatment modalities were successful. At 9 months, the mean PD reduction was 5.2 ± 3.9 mm for bioabsorbable sites and 5.5 ± 3.0 mm for non‐resorbable sites; the CAL gain was 5.9 ± 3.3 mm and 5.5 ± 3.4 mm, respectively. The outcome difference between the two sites for PD and CAL did not differ statistically (P >0.05) at any assessment time.

Conclusion: Bioabsorbable collagen membranes in guided tissue regeneration treatment of intrabony defects distal to the mandibular M2 obtained the same marked PD reductions and CAL gains as non‐resorbable ePTFE membranes after M3 extraction.
Antibody Responses to Periodontopathic Bacteria in Relation to Rheumatoid Arthritis in Japanese Adults
Authors: Okada Moe , Kobayashi Tetsuo , Ito Satoshi , Yokoyama Tomoko , Komatsu Yasutaka , Abe Asami , Murasawa Akira , Yoshie Hiromasa
Published: February 2011

Background: Periodontopathic bacteria have been implicated as contributory to the etiology of rheumatoid arthritis (RA). Anticyclic citrullinated peptide (CCP) antibodies and rheumatoid factor (RF) were shown to be associated with RA. This study examines whether serum levels of antibodies to periodontopathic bacteria may affect clinical and laboratory profiles of RA.

Methods: The study participants consisted of 80 patients with RA, and 38 age‐, sex‐, smoking status–, and periodontal condition–balanced healthy controls. After periodontal and rheumatologic examination, serum levels of immunoglobulin G (IgG) antibodies to Porphyromonas gingivalis (Pg), Prevotella intermedia, Aggregatibacter actinomycetemcomitans (Aa) (previously Actinobacillus actinomycetemcomitans), and Eikenella corrodens (Ec) and those of anti‐CCP antibodies and RF were determined by an enzyme‐linked immunosorbent assay.

Results: Patients with RA showed significantly higher levels of anti–Pg and anti‐CCP antibodies than controls (P = 0.04 and P <0.0001). In contrast, IgG responses to Aa and Ec in patients with RA were significantly lower than those in controls (P <0.0001 and P = 0.0001). Multiple logistic regression analysis revealed a significant association of anti–Pg and anti–Aa IgG responses with RA, after adjustment for age, sex, and smoking (P = 0.005 and P = 0.02). Anti–Pg titer displayed a significant correlation with RF levels, probing depth, and clinical attachment level (P = 0.03, P = 0.03, and P = 0.02).

Conclusion: These results suggest that serum levels of anti–Pg IgG antibodies were associated with RA, and might affect serum levels of RF and periodontal condition in patients with RA.
Partition Perforation Optimization for Horizontal Wells Based on Genetic Algorithms
Authors: Zhiming Wang , Jianguang Wei , Hui Jin
Published: February 2011

Because of heterogeneity in permeability along horizontal wellbores, early water breakthrough and rapid water-cut increase are always observed in high-permeability completion intervals when a uniform perforating scheme, as a common practice, is applied throughout the wellbore. Optimization on perforation parameters along horizontal intervals helps homogenize the inflow-velocity profile and thus is critically important for enhanced oil recovery. This paper derives a coupled reservoir/wellbore flow model that is based on inflow-velocity-control theory. Genetic algorithms are applied to solve the model because they excel in obtaining the global optimal on discrete functions. The optimized perforating strategy applies a low perforation density in high-permeability intervals and high perforation density in low-permeability intervals. As a result, the inflow-velocity profile is homogenized and idealized.