bluuebunny/crossref_metadata_2025 huggingface dataset:
The interplay between austerity, domestic territorial reform and European Union Cohesion Policy: Multi-level Governance and the application of the partnership principle in Greece
Authors: Chardas Anastassios
Published: October 2014

The purpose of this article is to assess the influences exerted by European Union Cohesion Policy to the patterns of governance of the sub-national actors in Greece and the role played by the latest wave of territorial reforms and the austerity measures that were introduced following the fiscal crisis of 2010 in these processes. It does that through the deployment of the theoretical frameworks of Multi-level Governance and the application of the principle of partnership. The principle of partnership has been an integral aspect of the regulatory framework governing the Cohesion Policy and has remained so after all the reforms of the Structural Funds. The aims of the partnership principle are mediated through domestic policy practices which, in the case of Greece, have been highly centralised. An assessment regarding the changes of governance towards greater sub-national involvement about the current programming period (2008–2013) indicates that there has hardly been any turn towards Multi-level Governance whilst the principle of partnership was only applied in a superficial way. These issues are pertinent in light of the ‘Kalikratis’ plan, which was introduced in 2010 in order to modernise the sub-national authorities, as well as the austerity measures that followed the fiscal crisis which has engulfed Greece since 2010. The interplay between the domestic territorial reforms introduced by ‘Kalikratis’, the austerity measures and the superficial patterns of internalisation of the principle of partnership has led to the rescaling of governance and to less spending, further undermining the already diminished capacities for participation by the sub-national authorities.
Economic Burden of Disease-Associated Malnutrition in China
Authors: Linthicum Mark T. , Thornton Snider Julia , Vaithianathan Rhema , Wu Yanyu , LaVallee Chris , Lakdawalla Darius N. , Benner Jennifer E. , Philipson Tomas J.
Published: October 2014

Disease-associated malnutrition (DAM) is a well-recognized problem in many countries, but the extent of its burden on the Chinese population is unclear. This article reports the results of a burden-of-illness study on DAM in 15 diseases in China. Using data from the World Health Organization (WHO), the China Health and Nutrition Survey, and the published literature, mortality and disability-adjusted life years (DALYs) lost because of DAM were calculated; a financial value of this burden was calculated following WHO guidelines. DALYs lost annually to DAM in China varied across diseases, from a low of 2248 in malaria to a high of 1 315 276 in chronic obstructive pulmonary disease. The total burden was 6.1 million DALYs, for an economic burden of US$66 billion (Chinese ¥ 447 billion) annually. This burden is sufficiently large to warrant immediate attention from public health officials and medical providers, especially given that low-cost and effective interventions are available.
Music Education for All?
Authors: Bledsoe Ryan N.
Published: October 2014

School music programs are changing. For years the music education profession has emphasized large ensemble experiences for reasons that include quality of music making, sense of community, and individual and collective pride for many of the students involved. As a high school saxophonist, I valued that experience, but other high school students—both in my time and now—have equally rewarding music-making experiences outside of school. Who are these people? What do their experiences tell us? This article includes the stories of three adult music makers, whose pathways did not include school music experiences past their elementary years. As adults they all create music, and two of them are active performers. Why was there no place for them in school music programs? Is there a place for them now?
Topics, Texts, and Critical Approaches
Authors: Spee James C. , Fraiberg Allison
Published: October 2014

In light of recent critiques of management education, this article examines the Carnegie Report’s argument that the core components of liberal arts education (Analytical Thinking, Multiple Framing, The Reflective Exploration of Meaning, and Practical Reasoning) can and should be integrated into the undergraduate business curriculum. It then reviews prior efforts to draw on liberal learning in management education and provides an illustration of integration in the design of a required undergraduate management course for working adults. Included is a template that faculty can follow to better integrate Colby’s four dimensions of liberal learning into their business and management courses, with emphasis on the reflective exploration of meaning. In addition to course specifics, the article explores learning outcomes and student/administrative/institutional responses, as well as limitations, challenges, and opportunities for the future.
Fracture toughness of welded joints of a steam turbine low pressure rotor
Authors: Shen M-H Herman , Akanda Sajedur R , Liu Xia , Wang Peng
Published: October 2014

In order to ensure safety and reliability of a steam turbine welded rotor, the present investigation focused on evaluation of the crack resistance parameter of the base metal (BM), weld metal (WM), and heat affected zone (HAZ) of a turbine rotor welded joint constituent at both room temperature and 300℃. The property of crack resistance was evaluated in terms of fracture energy JIc or plane strain fracture toughness KJIc. Three-point bend experiments were performed to obtain a J-integral based crack resistance curve ( J–R curve) from a single specimen in accordance with ASTM E1820, from which the fracture toughness was determined. To construct a J–R curve, the corresponding crack extension was calculated by incorporating the crack opening displacement measured by a clip-gage, in a compliance method. From the experimental results, the WM was found to have the lowest KJIc values whereas the HAZ was found to have the highest KJIc values at both room and high temperature although the HAZ had little or no crack extension during the experiments. It was also observed that the HAZ samples fractured with crack jumped toward the fusion line. Microstructural root-cause analysis of the abnormal HAZ behavior was performed and discussed.
Influence of Contralateral Radiographs on Accuracy of Anatomic Reduction in Surgically Treated Calcaneus Fractures
Authors: Kwon John Y. , Zurakowski David , Ellington J. Kent
Published: October 2014

Background:

The purpose of this study was to determine whether obtaining a radiograph of the uninjured contralateral calcaneus (template) before surgery allowed for more precise restoration of Bohler’s angle and calcaneal length when performing open reduction internal fixation (ORIF) of intra-articular calcaneus fractures.

Methods:

Patients who sustained an intra-articular calcaneus fracture requiring surgery who met inclusion criteria were prospectively randomized into those who had a preoperative template obtained for review at the time of ORIF (group 1) versus those who had the contralateral radiograph obtained after surgery (group 2).

Results:

There was no benefit of the preoperative template in allowing for more anatomic restoration of Bohler’s angle or calcaneal length. Operative time was decreased with the use of a preoperative template when using the extensile lateral or percutaneous approaches.

Conclusion:

Preoperative templating of the uninjured contralateral calcaneus did not allow for more anatomic reduction or restoration of pre-injury morphology of the calcaneus undergoing operative fixation as based on Bohler’s angle and calcaneal length. Templating may be of benefit by reducing operative time.

Level of Evidence:

Level II, prospective comparative series.
A Comparison of Mindfulness-Based Group Training and Skills Group Training in Adults With ADHD
Authors: Edel Marc-Andreas , Hölter Tanja , Wassink Kristina , Juckel Georg
Published: October 2014

Objective: To compare a novel “third wave” mindfulness-based training program with an established skills training derived from dialectical behavior therapy, to reduce ADHD symptoms and improve mindfulness and self-efficacy. Method: Ninety-one adults with ADHD (combined and inattentive type, mainly medicated) were non-randomly assigned to and treated within a mindfulness-based training group (MBTG, n = 39) or a skills training group (STG, n = 52), each performed in 13 weekly 2-hr sessions. Results: General linear models with repeated measures revealed that both programs resulted in a similar reduction of ADHD symptoms, and improvement of mindfulness and self-efficacy. However, the effect sizes were in the small-to-medium range. A decrease in ADHD symptoms ≥30% was observed in 30.8% of the MBTG participants and 11.5% of the STG participants. Conclusion: The comparatively weak results may be due to limitations such as the absence of randomization, the lack of a control group without intervention, and the lack of matching groups for borderline, depression, and anxiety status. Moreover, audio instructions for home exercises and more stringent monitoring of participants’ progress and eventual absence from sessions might have improved the outcome.
Two-level language games: International relations as inter-lingual relations
Authors: Wigen Einar
Published: October 2014

To the extent that polities interact across linguistic boundaries, international relations are also inter-lingual relations. Since relations and practices are given meaning in language, it has to be possible to give at least a minimum of shared meaning to mutual relations in order for inter-lingual relations to function smoothly. Otherwise, the divergence of meaning and consequently also of social expectations will limit the possible extent and quality of those relations. Nevertheless, International Relations has not theorised inter-lingual relations. This article addresses this deficiency by proposing a theory of ‘conceptual entanglement’ as an approach to studying how compatibility of meaning comes about and is maintained between linguistic communities and hence also between polities. With the ‘expansion of international society’ from the 19th century onwards, linguistic divides have gradually narrowed, especially in terms of political vocabularies. Yet, residues remain, making inter-lingual relations qualitatively different for different pairs of languages, and thus also for polities. The article elaborates on how conceptual entanglement is an aspect of ‘entry’ into international society by using the theory on the case of how the French concept of ‘civilisation’ was translated into Ottoman and became part of the political vocabulary of the Ottoman Empire and later Turkey.
Dissociative disorders and possession experiences in Israel: A comparison of opiate use disorder patients, Arab women subjected to domestic violence, and a nonclinical group
Authors: Somer Eli , Ross Colin , Kirshberg Revital , Bakri Rana Shawahdy , Ismail Shefa
Published: October 2014

This study examined the association between exposure to domestic violence and dissociative symptoms. A sample of 68 Israeli opiate use disorder patients in recovery, 80 battered Arab Israeli women, and 103 respondents from a community sample participated in structured interviews that included the Dissociative Disorders Interview Schedule (DDIS), the Dissociative Trance Disorder Interview Schedule (DTDIS), and the Dissociative Experiences Scale (DES). As predicted, community participants reported significantly less exposure to traumatizing events and lower levels of dissociative psychopathology than individuals sampled from specialized treatment centers. In all, 91% of battered female participants were taxon-positive for dissociative disorder with 1 of every 2 respondents reporting symptoms corresponding to dissociative amnesia and depersonalization disorder, suggesting that this group may be particularly vulnerable to dissociative psychopathology. Extrasensory and paranormal experiences (ESP) and dissociative trance disorder experiences were strongly related to dissociative experiences and features of dissociative identity disorder (DID). These statistical associations suggest that dissociative disorders and ESP/trance experiences may share an underlying construct. Further research is needed on trauma and dissociation among female victims of domestic abuse in patriarchal, collectivist societies, particularly in the Arab world.
Exploring the usefulness of structural–functional approaches to analyse governance of planning systems
Authors: Potts Ruth , Vella Karen , Dale Allan , Sipe Neil
Published: October 2014

Existing planning theories tend to be limited in their analytical scope and often fail to account for the impact of many interactions between the multitudes of stakeholders involved in strategic planning processes. Although many theorists rejected structural–functional approaches from the 1970s, this article argues that many of structural–functional concepts remain relevant and useful to planning practitioners. In fact, structural–functional approaches are highly useful and practical when used as a foundation for systemic analysis of real-world, multi-layered, complex planning systems to support evidence-based governance reform. Such approaches provide a logical and systematic approach to the analysis of the wider governance of strategic planning systems that is grounded in systems theory and complementary to existing theories of complexity and planning. While we do not propose its use as a grand theory of planning, this article discusses how structural–functional concepts and approaches might be applied to underpin a practical analysis of the complex decision-making arrangements that drive planning practice, and to provide the evidence needed to target reform of poorly performing arrangements.
Environmental education action research with immigrant children in schools: Space, audience and influence
Authors: Blanchet-Cohen Natasha , Di Mambro Giulietta
Published: October 2014

This article considers environmental projects as means for engaging elementary school-aged immigrant children in their community. Based on an environmental research project with children aged 9–12 involved in their school’s Green Committee (GC), we identify multiple components for enabling meaningful children’s participation. Space was essential in creating a context for children to discover and express their voice. The combination of capacity-building and research activities as well as rapport-building between children, adults and the environment fostered care and ownership. Reaching out to a variety of audiences including peers and parents helped orient and strengthen the GC’s actions. The children were listened to but also actively sought and responded to audiences. Influence involved receiving external funding, completing landscaping of the school’s front courtyard as well as engagement with adults considering (or not) members’ views. The project showed that if supported by committed and facilitating adult educators these children remained motivated and that their process had the power to lead others into action and change. Children valued the socio-physical and aesthetic aspects of the environment, and furthermore, their engagement provided them with a sense of belonging. The GC experience itself illustrates how an action research project that involves a small group of children can serve as a model to create meaningful participation of children and broader partnerships in schools on collective interests.
As Networks Fail
Authors: Paasonen Susanna
Published: October 2014

Network connections failing, logins not functioning, and servers not responding evoke both affective sharpness and disturbing itchiness that cannot be easily smoothed out. This article draws on forty-five student essays describing the sensations evoked by technological failure and explores them as vignettes into the affective dynamics evoked by constant connectivity to, and dependency on, network media. By asking how the essays articulate and configure the notion of “the user,” the article suggests that devices and applications are the loci of potentiality that may or may not be available and which impact—increase, sustain, or diminish—the users’ capacity to act. Furthermore, it argues that visceral responses to technological failure are intimately tied to the uncertainty and instability of users’ sense of control in ways that call into question the very notion of “the user” itself.
A Case of Hemiabdominal Myoclonus
Authors: Nociti Viviana , Servidei Serenella , Luigetti Marco , Iorio Raffaele , Lo Monaco Mauro , Mirabella Massimiliano , Frisullo Giovanni , Della Marca Giacomo
Published: October 2014

Myoclonus consists of sudden, brief, involuntary jerky muscular contractions. Central and peripheral nervous system lesions are involved in the pathogenesis of this movement disorder. Symptomatic or secondary spinal myoclonus is the most common form. A 68-year-old woman was diagnosed with hemiabdominal spinal myoclonus. Occasional and very mild involuntary repetitive movements of the hemiabdomen began immediately after surgery for uterine cancer. After surgery for laparocele, secondary to the uterine cancer surgery, performed under spinal anesthesia, there was severe worsening of movements. Neuroradiological investigations failed to demonstrate spinal injury, while neurophysiological studies showed impairment of the right central somatosensory pathway. Considering the low resolution of magnetic resonance imaging in the evaluation of thoracic level, we suggest an extensive neurophysiological evaluation in patients with spinal myoclonus.
Observation may be an inadequate approach for injured extremities with single tibial vessel run-off
Authors: Dua Anahita , Desai Sapan S , Johnston Sean , Chinapuvvula Naga R , DuBose Joseph , Charlton-Ouw Kristofer , Azizzadeh Ali , Burgess Andrew , Wade Charles E , Fox Charles J , Holcomb John B
Published: October 2014

Introduction

Trauma patients with sudden loss of distal perfusion due to tibial injuries are frequently not offered vascular interventions if a single vessel retains patency. We hypothesized that sudden loss of either all or some tibial vasculature would result in increased non-operative failure and higher amputation rates.

Methods

In this retrospective observational study, all traumatically injured patients from 2009 to 2012 with CT-angiogram–confirmed anterior tibial, posterior tibial, or peroneal artery injuries were included.

Results

From 2009 to 2012, 437 patients were admitted with arterial extremity injury of which 234 (53%) were lower extremity. From this group, 84 (36%) patients were identified with CT-angiogram–confirmed limited or no flow in the tibial arteries. A total of 44% (4/9) with 0 or 1 tibial vessel failed observation while only 8% (2/27) failed if they had 2 or 3 patent vessels ( p < 0.05). Amputation rate was inversely related the number of open tibial vessels. There were 2.7 open tibial vessels in the limb salvage group compared to 1.1 in the amputation group ( p < 0.05).

Conclusion

Patients who failed an initial trial of observation were significantly more likely to have 0 or 1 tibial vessels patent. The number of open tibial vessels is significantly associated with limb salvage.
Carved out indications and patents in Australia: The story continues
Authors: Condon Wayne
Published: October 2014

The decision of the Australian High Court in Apotex Pty Ltd v Sanofi-Aventis Australia Pty Ltd (the leflunomide case) gave the highest judicial endorsement to the practice of “carving out” patented treatment indications from the registered indications for a new generic drug. The High Court held in that case that the removal of reference to any patented treatment indication was sufficient for the generic entrant to avoid liability for contributory or secondary patent infringement. It remained to be seen, however, how this judicial authority would be applied in other circumstances. We now have further judicial guidance on the approach that courts are likely to take to this issue and this article examines a recent decision of the Australian Federal Court applying the “leflunomide principle” in the context of a preliminary injunction application.
Suitability petitions and Pediatric Research Equity Act evaluation—Basic understanding and recent case studies
Authors: Chokshi Nirav Amitkumar
Published: October 2014

Prior to Pediatric Research Equity Act’s enactment, Food and Drug Administration had approved several suitability petitions to permit abbreviated new drug applications to be submitted for drugs that had a different active ingredient, dosage form, or route of administration than their reference-listed drugs. Pediatric Research Equity Act does not impose pediatric assessment requirements on abbreviated new drug applications for generic drugs. However, abbreviated new drug applications submitted under an approved suitability petition under section 505(j)(2)(C) of the Act and the said difference from the reference-listed drugs are subject to the pediatric assessment requirements that Pediatric Research Equity Act imposes. In the federal notice dated 23 February 2007, Food and Drug Administration explained that the approval of 128 suitability petitions was being withdrawn because abbreviated new drug applications were never submitted and Pediatric Research Equity Act requires that all applications submitted on or after 1 April 1999, for a new active ingredient, new indication, new dosage form, new dosing regimen, or new route of administration containing an assessment of the safety and effectiveness of the drug for the claimed indications in relevant pediatric subpopulations unless the requirement is waived or deferred. Underlining information in this article helps in understating the Pediatric Research Equity Act, pediatric assessment for suitability petitions, pediatric review committee and its role, types of pediatric waivers, and its importance in suitability petitions. Also there are several examples provided for the Pediatric Research Equity Act assessment in recently filed suitability petitions by the various firms.
All that wheezes: A young infant with a mediastinal mass
Authors: Callanan Deborah L , Tong Timothy , Doski John J
Published: October 2014

Wheezing infants are frequently encountered in the emergency department. Bronchiolitis is the most commonly seen cause. Radiographs are not recommended in the routine management of bronchiolitis. We present the case of a young wheezing infant with a mildly abnormal chest x-ray whose cystic hygroma caused life-threatening respiratory distress soon after he was admitted to the hospital.
Long-Acting Reversible Contraceptive Use in Urban Women From a Title X–Supported Boston Community Health Center
Authors: Ricciotti Hope A. , Dodge Laura E. , Ramirez Christina I. , Barnes Katherine , Hacker Michele R.
Published: October 2014

Background: Unintended and adolescent pregnancy disproportionately affects minority populations, but the effect of age, race and ethnicity on the use of long-acting reversible contraception (LARC) has not been well studied. Objective: The objective of this pilot study was to examine LARC use over a 5-year period among women receiving care at a Boston community health center. Methods: Retrospective cohort study of LARC method use among black, Hispanic, and white women receiving care at the Dimock Center from 2006 to 2010. Results: This study included 276 women (60.1% black, 18.5% Hispanic, and 9.1% white). LARC was not used as a first-line method in the majority (96.0%), regardless of age, race, and ethnicity; yet nearly half identified a long-acting contraceptive as their method of choice. Conclusions: The findings of this pilot study reveal opportunities to reduce unintended pregnancy through increased LARC use, which may be accomplished by provider and patient education.
ABT-199 mediated inhibition of BCL-2 as a novel therapeutic strategy in T-cell acute lymphoblastic leukemia
Authors: Peirs Sofie , Matthijssens Filip , Goossens Steven , Van de Walle Inge , Ruggero Katia , de Bock Charles E. , Degryse Sandrine , Canté-Barrett Kirsten , Briot Delphine , Clappier Emmanuelle , Lammens Tim , De Moerloose Barbara , Benoit Yves , Poppe Bruce , Meijerink Jules P. , Cools Jan , Soulier Jean , Rabbitts Terence H. , Taghon Tom , Speleman Frank , Van Vlierberghe Pieter
Published: October 2014

Key Points

High levels of the anti-apoptotic factor BCL-2 can be therapeutically exploited by the BH3 mimetic ABT-199 in human T-ALL.
Managing high-risk CLL during transition to a new treatment era: stem cell transplantation or novel agents?
Authors: Dreger Peter , Schetelig Johannes , Andersen Niels , Corradini Paolo , van Gelder Michel , Gribben John , Kimby Eva , Michallet Mauricette , Moreno Carol , Stilgenbauer Stephan , Montserrat Emili
Published: October 2014

Allogeneic hematopoietic stem cell transplantation (HSCT) has been considered as the treatment of choice for patients with high-risk chronic lymphocytic leukemia (HR-CLL; ie, refractory to purine analogs, short response [<24 months] to chemoimmunotherapy, and/or presence of del[17p]/TP53 mutations). Currently, treatment algorithms for HR-CLL are being challenged by the introduction of novel classes of drugs. Among them, BCR signal inhibitors (BCRi) and B-cell lymphoma 2 antagonists (BCL2a) appear particularly promising. As a result of the growing body of favorable outcome data reported for BCRi/BCL2a, uncertainty is emerging on how to advise patients with HR-CLL about indication for and timing of HSCT. This article provides an overview of currently available evidence and theoretical considerations to guide this difficult decision process. Until the risks and benefits of different treatment strategies are settled, all patients with HR-CLL should be considered for treatment with BCRi/BCL2a. For patients who respond to these agents, there are 2 treatment possibilities: (1) performing an HSCT or (2) continuing treatment with the novel drug. Individual disease-specific and transplant-related risk factors, along with patient’s preferences, should be taken into account when recommending one of these treatments over the other.
Seventy-two hours of mild hypothermia after cardiac arrest is associated with a lowered inflammatory response during rewarming in a prospective observational study
Authors: Bisschops Laurens LA , van der Hoeven Johannes G , Mollnes Tom E , Hoedemaekers Cornelia WE
Published: October 2014

Introduction

Whole-body ischemia and reperfusion trigger a systemic inflammatory response. In this study, we analyzed the effect of temperature on the inflammatory response in patients treated with prolonged mild hypothermia after cardiac arrest.

Methods

Ten comatose patients with return of spontaneous circulation after pulseless electrical activity/asystole or prolonged ventricular fibrillation were treated with mild therapeutic hypothermia for 72 hours after admission to a tertiary care university hospital. At admission and at 12, 24, 36, 48, 72, 96 and 114 hours, the patients' temperature was measured and blood samples were taken from the arterial catheter. Proinflammatory interleukin 6 (IL-6) and anti-inflammatory (IL-10) cytokines and chemokines (IL-8 and monocyte chemotactic protein 1), intercellular adhesion molecule 1 and complement activation products (C1r-C1s-C1inhibitor, C4bc, C3bPBb, C3bc and terminal complement complex) were measured. Changes over time were analyzed with the repeated measures test for nonparametric data. Dunn's multiple comparisons test was used for comparison of individual time points.

Results

The median temperature at the start of the study was 34.3°C (33.4°C to 35.2°C) and was maintained between 32°C and 34°C for 72 hours. All patients were passively rewarmed after 72 hours, from (median (IQR)) 33.7°C (33.1°C to 33.9°C) at 72 hours to 38.0°C (37.5°C to 38.1°C) at 114 hours (P <0.001). In general, the cytokines and chemokines remained stable during hypothermia and decreased during rewarming, whereas complement activation was suppressed during the whole hypothermia period and increased modestly during rewarming.

Conclusions

Prolonged hypothermia may blunt the inflammatory response after rewarming in patients after cardiac arrest. Complement activation was low during the whole hypothermia period, indicating that complement activation is also highly temperature-sensitive in vivo. Because inflammation is a strong mediator of secondary brain injury, a blunted proinflammatory response after rewarming may be beneficial.
Automated patient-ventilator interaction analysis during neurally adjusted non-invasive ventilation and pressure support ventilation in chronic obstructive pulmonary disease
Authors: Doorduin Jonne , Sinderby Christer A , Beck Jennifer , van der Hoeven Johannes G , Heunks Leo MA
Published: October 2014

Introduction

Delivering synchronous assist during non-invasive ventilation (NIV) is challenging with flow- or pressure-controlled ventilators, especially in patients with chronic obstructive pulmonary disease (COPD). Neurally adjusted ventilatory assist (NAVA) uses diaphragm electrical activity (EAdi) to control the ventilator. We evaluated patient-ventilator interaction in patients with COPD during NIV with pressure support ventilation (PSV) and NAVA using a recently introduced automated analysis.

Methods

Twelve COPD patients underwent three 30-minute trials: 1) PSV with dedicated NIV ventilator (NIV-PSVVision), 2) PSV with intensive care unit (ICU) ventilator (NIV-PSVServo-I), and 3) with NIV-NAVA. EAdi, flow, and airway pressure were recorded. Patient-ventilator interaction was evaluated by comparing airway pressure and EAdi waveforms with automated computer algorithms. The NeuroSync index was calculated as the percentage of timing errors between airway pressure and EAdi.

Results

The NeuroSync index was higher (larger error) for NIV-PSVVision (24 (IQR 15 to 30) %) and NIV-PSVServo-I (21 (IQR 15 to 26) %) compared to NIV-NAVA (5 (IQR 4 to 7) %; P <0.001). Wasted efforts, trigger delays and cycling-off errors were less with NAVA (P <0.05 for all). The NeuroSync index and the number of wasted efforts were strongly correlated (r2 = 0.84), with a drastic increase in wasted efforts after timing errors reach 20%.

Conclusions

In COPD patients, non-invasive NAVA improves patient-ventilator interaction compared to PSV, delivered either by a dedicated or ICU ventilator. The automated analysis of patient-ventilator interaction allowed for an objective detection of patient-ventilator interaction during NIV. In addition, we found that progressive mismatch between neural effort and pneumatic timing is associated with wasted efforts.
Body temperature affects cerebral hemodynamics in acutely brain injured patients: an observational transcranial color-coded duplex sonography study
Authors: Stretti Federica , Gotti Miriam , Pifferi Silvia , Brandi Giovanna , Annoni Federico , Stocchetti Nino
Published: October 2014

Introduction

Temperature changes are common in patients in a neurosurgical intensive care unit (NICU): fever is frequent among severe cases and hypothermia is used after cardiac arrest and is currently being tested in clinical trials to lower intracranial pressure (ICP). This study investigated cerebral hemodynamics when body temperature varies in acute brain injured patients.

Methods

We enrolled 26 patients, 14 with acute brain injury who developed fever and were given antipyretic therapy (defervescence group) and 12 who underwent an intracranial neurosurgical procedure and developed hypothermia in the operating room; once admitted to the NICU, still under anesthesia, they were re-warmed before waking (re-warming group). We measured cerebral blood flow velocity (CBF-V) and pulsatility index (PI) at the middle cerebral artery using transcranial color-coded duplex sonography (TCCDS).

Results

In the defervescence group mean CBF-V decreased from 75 ± 26 (95% CI 65 to 85) to 70 ± 22 cm/s (95% CI 61 to 79) (P = 0.04); the PI also fell, from 1.36 ± 0.33 (95% CI 1.23 to 1.50) to 1.16 ± 0.26 (95% CI 1.05 to 1.26) (P = 0.0005). In the subset of patients with ICP monitoring, ICP dropped from 16 ± 8 to 12 ± 6 mmHg (P = 0.003). In the re-warming group mean CBF-V increased from 36 ± 10 (95% CI 31 to 41) to 39 ± 13 (95% CI 33 to 45) cm/s (P = 0.04); the PI rose from 0.98 ± 0.14 (95% CI 0.91 to 1.04) to 1.09 ± 0.22 (95% CI 0.98 to 1.19) (P = 0.02).

Conclusions

Body temperature affects cerebral hemodynamics as evaluated by TCCDS; when temperature rises, CBF-V increases in parallel, and viceversa when temperature decreases. When cerebral compliance is reduced and compensation mechanisms are exhausted, even modest temperature changes can greatly affect ICP.
Heparin therapy reduces 28-day mortality in adult severe sepsis patients: a systematic review and meta-analysis
Authors: Wang Changsong , Chi Chunjie , Guo Lei , Wang Xiaoyang , Guo Libo , Sun Jiaxiao , Sun Bo , Liu Shanshan , Chang Xuenan , Li Enyou
Published: October 2014

Introduction

There are approximately 19 million new cases of sepsis worldwide each year. Among them, more than one quarter of patients die. We aimed to assess the effects of heparin on short-term mortality in adult patients with sepsis and severe sepsis.

Methods

We searched electronic databases (Medline, Embase, and Cochrane Library databases; the Cochrane Controlled Trials Register) and conference proceedings (Web of Knowledge (Conference Proceedings Citation Index - Science, Conference Proceedings Citation Index - Social Sciences & Humanities)) from inception to July 2014, expert contacts and relevant websites. Controlled trials of heparin versus placebo in sepsis or severe sepsis were identified. In total two reviewers independently assessed eligibility, and four authors independently extracted data; consensus was reached by conference. We used the chi-square test and I2 to assess statistical heterogeneity (P <0.05). The primary analysis was based on the fixed-effect model to produce pooled odds ratios with 95% confidence intervals.

Results

A total of nine publications were included in the meta-analysis. Heparin decreased 28-day mortality (n = 3,482, OR = 0.656, 95% CI = 0.562 to 0.765, P <0.0001). According to the meta-analysis of 28-day mortality, heterogeneity was not found among the eight randomized clinical trials (RCTs) (I2 = 0.0%). Heparin had no effect on bleeding events in sepsis (seven RCTs, n = 2,726; OR = 1.063; 95% CI = 0.834 to 1.355; P = 0.623; and I2 = 20.9%). Subgroup analysis demonstrated that the sample size may be a source of heterogeneity, but experimental design was not.

Conclusions

Heparin may reduce 28-day mortality in patients with severe sepsis, at the same time, there was no increase in the risk of bleeding in the heparin group. We recommend the use of heparin for sepsis and severe sepsis.
Should central venous catheter be systematically removed in patients with suspected catheter related infection?
Authors: Lorente Leonardo , Martín María M , Vidal Pablo , Rebollo Sergio , Ostabal María I , Solé-Violán Jordi ,   Vascular Catheter Working Group of GTEIS/SEMICYUC
Published: October 2014

Introduction

Best clinical practice for patients with suspected catheter-related infection (CRI) remains unclear according to the latest Infectious Diseases Society of America (IDSA) guidelines. Thus, the objective of this study was to analyze clinical practice concerning the central venous catheter (CVC) and its impact on prognosis in patients with suspected CRI.

Methods

We performed a prospective, multicenter, observational study in 18 Spanish Intensive Care Units (ICUs). Inclusion criteria were patients with CVC and suspected CRI. The following exclusion criteria were used: age less than 18 years; pregnancy; lactation; human immunodeficiency virus; neutropenia; solid or haematological tumor; immunosuppressive or radiation therapy; transplanted organ; intravascular foreign body; haemodynamic instability; suppuration or frank erythema/induration at the insertion site of the CVC, and patients with bacteremia or fungemia. The end-point of the study was mortality at 30 days of CRI suspicion.

Results

The study included 384 patients. In 214 (55.8%) patients, CVC was removed at the moment of CRI suspicion, in 114 (29.7%) CVC was removed later and in 56 (14.6%) CVC was not removed. We did not find significant differences between survivors (n =311) and non-survivors (n =73) at 30 days according to CVC decision (P =0.26). The rate of confirmed catheter-related bloodstream infection (CRBSI) was higher in survivors than in non-survivors (14.5% versus 4.1%; P =0.02). Mortality rate was lower in patients with CRBSI than in the group of patients whose clinical symptoms were due to other causes (3/48 (6.25%) versus 70/336 (20.8%); P =0.02). We did not find significant differences in mortality in patients with confirmed CRBSI according to CVC removal at the moment of CRI suspicion (n =38) or later (n =10) (7.9% versus 0; P =0.99).

Conclusion

In patients with suspected CRI, immediate CVC removal may be not necessary in all patients. Other aspects should be taken into account in the decision-making, such as vascular accessibility, the risk of mechanical complications during new cannulation that may be life-threatening, and the possibility that the CVC may not be the origin of the suspected CRI.
Tackling the economic burden of postsurgical complications: would perioperative goal-directed fluid therapy help?
Authors: Manecke Gerard R , Asemota Angela , Michard Frederic
Published: October 2014

Introduction

Pay-for-performance programs and economic constraints call for solutions to improve the quality of health care without increasing costs. Many studies have shown decreased morbidity in major surgery when perioperative goal directed fluid therapy (GDFT) is used. We assessed the clinical and economic burden of postsurgical complications in the University HealthSystem Consortium (UHC) in order to predict potential savings with GDFT.

Methods

Data from adults who had a major surgical procedure in 2011 were screened in the UHC database. Thirteen post-surgical complications were tabulated. In-hospital mortality, hospital length of stay and costs from patients with and without complications were compared. The risk ratios reported by the most recent meta-analysis were used to estimate the potential reduction in post-surgical morbidity with GDFT. Potential cost-savings were calculated from the actual and anticipated morbidity rates.

Results

A total of 75,140 patients met the search criteria, and 8,421 patients developed one or more post-surgical complications (morbidity rate 11.2%). In patients with and without complications, in-hospital mortality was 12.4% and 1.4% (P <0.001), mean hospital length of stay was 20.5 ± 20.1 days and 8.1 ± 7.1 days (P <0.001) and mean direct costs were $47,284 ± 49,170 and $17,408 ± 15,612 (P <0.001), respectively. With GDFT, morbidity rate was projected to decrease to 8.0 - 9.3%, yielding gross costs savings of $43 M - $73 M for the study population or $569 - $970 per patient.

Conclusion

Postsurgical complications have a dramatic impact (+172%) on costs. Potential costs savings resulting from GDFT are substantial. Perioperative GDFT may be recommended not only to improve quality of care but also to decrease costs.
U-SPECT-BioFluo: an integrated radionuclide, bioluminescence, and fluorescence imaging platform
Authors: van Oosterom Matthias N , Kreuger Rob , Buckle Tessa , Mahn Wendy A , Bunschoten Anton , Josephson Lee , van Leeuwen Fijs WB , Beekman Freek J
Published: October 2014

Background

In vivo bioluminescence, fluorescence, and single-photon emission computed tomography (SPECT) imaging provide complementary information about biological processes. However, to date these signatures are evaluated separately on individual preclinical systems. In this paper, we introduce a fully integrated bioluminescence-fluorescence-SPECT platform. Next to an optimization in logistics and image fusion, this integration can help improve understanding of the optical imaging (OI) results.

Methods

An OI module was developed for a preclinical SPECT system (U-SPECT, MILabs, Utrecht, the Netherlands). The applicability of the module for bioluminescence and fluorescence imaging was evaluated in both a phantom and in an in vivo setting using mice implanted with a 4 T1-luc + tumor. A combination of a fluorescent dye and radioactive moiety was used to directly relate the optical images of the module to the SPECT findings. Bioluminescence imaging (BLI) was compared to the localization of the fluorescence signal in the tumors.

Results

Both the phantom and in vivo mouse studies showed that superficial fluorescence signals could be imaged accurately. The SPECT and bioluminescence images could be used to place the fluorescence findings in perspective, e.g. by showing tracer accumulation in non-target organs such as the liver and kidneys (SPECT) and giving a semi-quantitative read-out for tumor spread (bioluminescence).

Conclusions

We developed a fully integrated multimodal platform that provides complementary registered imaging of bioluminescent, fluorescent, and SPECT signatures in a single scanning session with a single dose of anesthesia. In our view, integration of these modalities helps to improve data interpretation of optical findings in relation to radionuclide images.
A finite-volume solution to the geophysical electromagnetic forward problem using unstructured grids
Authors: Jahandari Hormoz , Farquharson Colin G.
Published: October 2014

The application of unstructured grids can improve the solution of total field electromagnetic problems because these grids allow efficient local refinement of the mesh at the locations of high field gradients. Unstructured grids also provide the flexibility required for representing arbitrary topography and subsurface interfaces. We investigated the generalization of the standard Yee’s staggered scheme to unstructured tetrahedral-Voronoï grids using a finite-volume approach. We discretized the Helmholtz equation for the electric field in the frequency domain and solved the problem to find the projection of the total electric field along the edges of the tetrahedral elements. To compute the electric and magnetic fields at the observation points, an interpolation technique was employed, which uses the edge vector interpolation functions of the tetrahedral elements. To verify the presented scheme, two examples were evaluated, which revealed the computation of the total and secondary fields due to electric and magnetic sources in half-spaces that contain anomalous bodies. The results had good agreement with those from the literature. For the second example, accuracy studies were conducted to better understand the relative importance of different refinements in the grid and also the effect of the general quality of the grid. The results revealed the utmost importance of the quality of the tetrahedral grid and refinement at the observation locations. To validate the versatility of the approach, we synthesized helicopter-borne data for a model of the Ovoid ore body at Voisey’s Bay, Labrador, Canada, which had good agreement with real data.
Up-Regulated Expression of WNT5a Increases Inflammation and Oxidative Stress via PI3K/AKT/NF-κB Signaling in the Granulosa Cells of PCOS Patients
Authors: Zhao Yue , Zhang Chunmei , Huang Ying , Yu Yang , Li Rong , Li Min , Liu Nana , Liu Ping , Qiao Jie
Published: October 2014

Context:

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder accompanied by chronic low-grade inflammation, but the molecular mechanism remains unclear.

Objective:

We investigated the action of WNT5a in the development of chronic inflammation in PCOS and the related molecular signaling pathways.

Design and Setting:

This was a prospective study conducted at the Division of Reproduction Center, Peking University Third Hospital.

Patients:

A total of 35 PCOS patients and 87 control women who reported to the clinic for the in vitro procedure and the cause of marital infertility was male azoospermia were included.

Main Outcome Measures:

Mural granulosa cells (GCs) of 35 PCOS patients and 37 controls were collected during oocyte retrieval and gene expression was analyzed. The human KGN cells and mural GCs from 50 control subjects (six to eight samples were pooled together for each experiment) were cultured in vitro. The regulation of inflammation and oxidative stress was confirmed by quantitative PCR, flow-cytometric assay, and dual-luciferase reporter assay after inflammatory stimuli or WNT5a overexpression. Relevant signaling pathways were identified using specific inhibitors.

Results:

Our data demonstrate significantly elevated WNT5a expression in the mural GCs of PCOS patients compared with the controls. Lipopolysaccharide stimulation increased WNT5a expression in KGN cells and mural GCs, and BAY-117082 and pyrrolidinedithiocarbamic acid [nuclear factor-κB (NF-κB) inhibitor] treatments suppressed WNT5a mRNA below the control level. WNT5a overexpression also enhanced the expression of inflammation-related genes and increased intracellular reactive oxygen species, whereas both BAY-117082 and LY-294002 (phosphatidylinositol 3-kinase inhibitor) significantly inhibited WNT5a-induced inflammation and oxidative stress.

Conclusions:

WNT5a acts as a proinflammatory factor in human ovarian GCs. The up-regulated expression of WNT5a in PCOS increases inflammation and oxidative stress predominantly via the phosphatidylinositol 3-kinase/AKT/NF-κB signaling pathway. The proinflammatory cytokines induced might further enhance WNT5a expression via NF-κB-dependent regulation, indicating a novel regulatory system for chronic inflammation in PCOS.
Amiodarone as a class III antiarrhythmic drug
Authors: O'Donovan Kate
Published: October 2014

Amiodarone is a broad-spectrum, class III antiarrhythmic drug, used in the treatment of supraventricular and ventricular arrhythmias. It is a highly lipid-soluble compound which is distributed through various organs such as the lungs, the eyes, skin and liver. The impact of this distribution contributes to the potential for adverse effects. The purpose of this article is to provide an overview of amiodarone in the clinical area in relation to pharmacokinetics and pharmacodynamics and the potential for adverse effects. This article provides the nurse in the critical care area and out-patient setting with evidence-based information regarding its indications and the importance of follow-up appointments.
Getting hospital inspections right for children and young people
Authors: Glasper Alan
Published: October 2014

Professor Alan Glasper assesses an independent report prepared for the Care Quality Commission on the care of children and young people in hospital. The report suggests major changes to the way inspections of children's services are conducted
Ebola: where did it come from and where might it go?
Authors: Boulton Jacqueline
Published: October 2014

Over the last few months, a plethora of headlines have focused on the ebola epidemic sweeping West Africa. On 8 August 2014 this outbreak was defined as a Public Health Event of International Concern by the World Health Organization. Closer to home the focus has been on the possibility of an outbreak in the UK, with calls for specialist nurses to be trained in monitoring travellers at airports. The recent infection of a nurse from Sussex while caring for patients with ebola in Sierra Leone has heightened the interest and need for information on this until now neglected tropical disease. Additionally, an unprecedented collaborative effort to speed up trials on the development of a vaccine has just begun in Oxford. This article discusses the origins of the virus, its symptoms and its modes of transmission. The challenges of managing the virus are discussed, together with current progress on its treatment and prevention, and the implications for nurses in the UK.