bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-Perceived and Actual Motor Competence in Young British Children
Authors: Duncan Michael J. , Jones Victoria , O’Brien Wesley , Barnett Lisa M. , Eyre Emma L. J.
Published: January 2018

Children’s perception of their own motor competence is an important correlate of their actual motor competence. The current study is the first to examine this association in British children and the first to use both product and process measures of actual motor competence. A total of 258 children (139 boys and 119 girls; aged 4 to 7 years, Mean = 5.6, SD = .96) completed measures of self-perceived motor competence using the Pictorial Scale for Perceived Movement Competence in Young Children. Children were classified as “Low,” “Medium,” or “High” perceived competence based on tertile analysis. Actual motor competence was assessed with the Test of Gross Motor Development-2 (a process measure) and a composite of 10-m sprint run time, standing long jump distance, and 1-kg seated medicine ball throw (collectively, a product measure). Data for process and product measures were analyzed using a 2 (sex) × 3 (high, medium, low perceived competence) analysis of covariance, with body mass index, calculated from height and mass, and age controlled. Boys obtained significantly higher scores than girls for both the process ( p = .044) and product ( p = .001) measures of actual motor competence. Boys had significantly ( p = .04) higher scores for perceived competence compared to girls. Compared to children classified as medium and high self-perceived competence, children classified as low self-perceived competence had lower process ( p = .001) and product scores (i.e., medium, p = .009 and high, p = .0001) of actual motor competence. Age ( p = .0001) and body mass index ( p = .0001) were significantly associated with product motor competence. Strategies to enhance actual motor competence may benefit children’s self-perceived motor competence.
ELF and Communication Strategies: Are They Taken into Account in ELT Materials?
Authors: Vettorel Paola
Published: January 2018

The complex and varied sociolinguistic reality of World Englishes and English as a Lingua Franca (ELF) has important implications for English Language Teaching (ELT). Besides questioning the validity of the ‘native speaker model’, the complexity of Global Englishes raises several issues, both at a theoretical and at an applied level, particularly for teaching. A plurilithic rather than a monolithic (monolingual/monocultural) perspective is called for, one that can make learners aware of the different roles, contexts, linguistic and functional varieties of English, so that they can be prepared to effectively interact with speakers of different Englishes and in English as a Lingua Franca contexts.

Communication strategies have been shown to have a particularly significant role in English as a Lingua Franca communication, that is characterized by negotiation and co-construction of meaning; in these encounters, where different linguacultures meet, ELF speakers employ a range of pragmatic strategies to solve, or pre-empt, (potential) non-understandings often drawing on their plurilingual repertoires, too. Communication strategies can thus be said to play a fundamental role in effective communication, particularly in contexts where English is used as an international Lingua Franca.

In this light, it would seem important for ELT materials to include activities aimed at raising awareness and promoting practice of communication strategies, so that they can become an integral part of English as a Foreign Language (EFL) and English as a Second Language (ESL) classroom practices towards the development of communicative ‘capability’. This article will illustrate a study investigating whether ELT materials addressed at Italian upper secondary school students include activities and tasks related to communication strategies. The examination of textbooks published by Italian and international publishers from the 1990s to 2015 shows that, apart from a few interesting cases, consistent attention has not been given to this important area. Implications for further research on the inclusion of communication strategies in ELT will also be set forward.
Jailhouse Blues? The Adverse Effects of Pretrial Detention for Prison Social Order
Authors: Toman Elisa L. , Cochran Joshua C. , Cochran John K.
Published: January 2018

Scholarship suggests that individuals’ experiences in pretrial detention are especially straining. Relative to state prisons, local jails have high rates of inmate and officer turnover, more limited resources, and provide fewer services. Pretrial detention also constitutes an individual’s initial period of incarceration, during which social isolation and fear are experienced acutely but with fewer services in jail. This study assesses whether time spent in pretrial detention adversely affects prison social order. Findings suggest that longer terms of pretrial detention in jails are associated with a modest increase in the likelihood of misconduct later on during a stay in prison. Interaction effects indicate that more time spent in jail prior to imprisonment may be harmful for potentially at-risk inmates—specifically, younger inmates, female inmates, and inmates with mental illness. These results have implications for theory and research on prison experiences and social order and for understanding the adverse implications of pretrial detention and strains incurred in jail.
Rotor speed control strategy to avoid resonance frequencies of turbo-molecular pump
Authors: Chiu Hsin-Lin , Tsai Nan-Chyuan
Published: January 2018

A novel design of composite turbo-molecular pump (CTMP) is proposed. The major configuration of CTMP is composed by a coarse pump, a turbo-molecular pump (TMP) and a magnetic gear unit (MGU) capable of speed amplification. The modal analysis and the study on rotor/bearing dynamics are undertaken at first to estimate the resonance frequencies of the TMP blade rotor itself solely and the interactive dynamics of blade rotor/radial active magnetic bearing (BR/RAMB) subsystem. Secondly, an economical and efficient method by adjusting the angular acceleration speed of BR, namely RDPS, is proposed to ensure the natural frequencies of BR/RAMB sub-system are not driven by the rotor speed all the time. Besides, a speed route of rotor during the take-off cycle of TMP is proposed to satisfy the requirements of system stiffness and prevention of system resonance being driven. Finally, a position conversion method is introduced to solve the problem of distinct locations of gap sensors and the actual gap between rotor and the auxiliary bearings such that the measurement feedback to the controller, RDPS, becomes applicable to formulate the correct actions for providing enough gap margin to prevent collision of rotor against bearings. To sum up, the CTMP possesses the merit of reduction of electrical energy consumption by 17%, compared with the conventional TMP unit. By intensive computer simulations, the RDPS indeed manifests its outstanding performance to efficiently skip or bypass the natural frequencies of the closed-loop system within a very short time period and guarantee the system stability.
An Investigation of Executive Functioning in Pediatric Anxiety
Authors: Murphy Yolanda E. , Luke Anna , Brennan Elle , Francazio Sarah , Christopher Isabella , Flessner Christopher A.
Published: January 2018

Although science’s understanding (e.g., etiology, maintaining factors, etc.) of pediatric anxiety and related problems has grown substantially over recent years, several aspects to anxiety in youths remain elusive, particularly with relation to executive functioning. To this end, the current study sought to examine several facets to executive functioning (i.e., cognitive flexibility, inhibition, planning, working memory) within a transdiagnostic sample of youths exhibiting varying degrees of anxiety symptoms. One hundred six youths completed a comprehensive battery, including several self-report measures (e.g., Multidimensional Anxiety Scale for Children [MASC] or MASC-2) and an automated neurocognitive battery of several executive functioning tasks (Intradimensional/Extradimensional [IDED], Stop Signal [SST], Spatial Span [SSP], Stockings of Cambridge [SOC] tasks). Regression analyses indicated that youths exhibiting marked anxiety symptoms demonstrated increased planning time and probability of inhibition compared with youths with minimal or no anxiety symptoms. Youths with marked anxiety symptoms similarly demonstrated better cognitive flexibility (i.e., set shifting) compared with youths with minimal anxiety. In addition, analyses indicated a trend such that youths exhibiting marked anxiety symptoms demonstrated poorer working memory compared with youths with no anxiety symptoms. Group classification did not predict remaining outcomes. Limitations and future areas of research are discussed.
Know Thy Enemy: A Review and Agenda for Research on Competitor Identification
Authors: Gur Furkan Amil , Greckhamer Thomas
Published: January 2018

Competitor identification, a core element of competitive dynamics, has been of long-standing interest to researchers in management and related disciplines. This broad interest has resulted in various definitions and conceptualizations of competitor identification as well as various approaches to studying it, which impairs the integration of existing knowledge aimed at answering vital questions regarding its nature, processes, and implications. To help researchers confront the complexities underlying this phenomenon, we identify, review, and organize theory and research on competitor identification across the management, marketing, and industrial organization economics disciplines. Based on our review, we organize the identified literature into four perspectives on competitor identification labeled as industry-oriented, strategic groups–oriented, manager-oriented, and customer-oriented. For each of these perspectives, we also identify major research streams and these streams’ foci and contributions. Building on our review, we propose an agenda for future management research that addresses both unresolved debates in the reviewed literature and identifies new promising connections between competitor identification and specific areas of management theory and research. We organize this future research agenda into six main themes focusing on exploring the dynamics of competitor identification, building connections to research on interorganizational relations, building a practice and process perspective, expanding micro-oriented approaches, and exploring international and entrepreneurial dimensions of competitor identification.
Just for fun! How experimental spaces stimulate innovation in institutionalized fields
Authors: Cartel Mélodie , Boxenbaum Eva , Aggeri Franck
Published: January 2018

This paper examines the role of experimental spaces as a source of institutional innovation. We investigate the case of an experimental space that was instrumental in initiating the institutionalization of the European carbon market. Our findings highlight the key role of emotions in the simultaneous distancing from institutionalized patterns and engagement in an alternative action model. We subsequently develop a process model of how experimental spaces initiate institutional innovation in institutionalized fields. This model comprises three forms of institutional work. As previously established, boundary work consists in delineating the space from the field, hence mitigating external institutional pressures. We argue that two additional forms of institutional work are required when field conditions are unconducive to institutional innovation. Distancing work consists in designing rules and procedures that alleviate space members’ deep-seated attachment to the field’s dominant models. Anchoring work refers to the design of rules and procedures that connect the experimental space and the solution developed inside it to the field, hence facilitating its broader diffusion. We conclude with a discussion of how the design of experimental spaces and the deliberate use of emotions open new doors for generating institutional innovation.
The Language of New Terrorism: Differences in Psychological Dimensions of Communication in Dabiq and Inspire
Authors: Vergani Matteo , Bliuc Ana-Maria
Published: January 2018

We investigate differences in the psychological aspects underpinning Western mobilisation of two terrorist groups by analysing their English-language propaganda. Based on a computerised analysis of the language used in two English-language online magazines circulated by Islamic State of Iraq and Syria (ISIS) and al-Qaeda (i.e., Dabiq and Inspire), we found significant differences in their language—the ISIS’ language being higher in authoritarianism and its level of religiousness. In a follow-up experimental study, we found that being high in religiousness and authoritarianism predicts more positive attitudes towards the language used by ISIS, but not towards the language used by al-Qaeda. The results suggest that ISIS’ propaganda may be more effective in mobilising individuals who are more authoritarian and more focused on religion than that of al-Qaeda. These findings are consistent with the behaviour observed in recent homegrown terrorist attacks in the United States and Europe.
Experiments in Relational Finance: Harnessing the Social in Everyday Debt and Credit
Authors: Tooker Lauren , Clarke Chris
Published: January 2018

In the wake of successive crises, novel politics and ethics are emerging around attempts to institute a ‘new’ world of finance in the name of social relations. Financial start-ups and development organizations, often working alongside established financial institutions, are experimenting with the ‘social’ in order to create markets and scale up their activities. At the same time, people continue to advance social claims in finance out of concern for others. This article examines the rise, politics and ethics of this experimentation in what we call ‘relational finance’. Our argument is that by rendering the social dimensions of finance explicit, contemporary relational finance makes sociality available for marketization and politicization. We illustrate this claim with three examples of mobilizations of the social in everyday lending and borrowing: social collateral, social lending and social debt. Relational finance, we conclude, is far from an unproblematic ‘alternative’ but retains ethical and political potential.
Being noticed for the way you are: Social inclusion and high school students with vision impairment
Authors: Jessup Glenda M , Bundy Anita C , Hancock Nicola , Broom Alex
Published: January 2018

This study explored the social inclusion in high school of Australian students with vision impairment (VI). We sought to understand how students described school social inclusion, whether they felt included and what influenced these perceptions. As part of a larger mixed methods study, 12 students with VI, who had previously answered the Psychological Sense of School Membership (PSSM) questionnaire, were interviewed about the social aspects of school. These interviews were analysed thematically. Participants described social inclusion as about being noticed and not overlooked by others. While two-thirds of participants reported satisfactory social relationships in high school, one-third, including all those with additional disabilities, reported being teased or rejected by their school peers. Five themes encompassed the varying influences on school social inclusion. These were: (a) putting myself forward; (b) knowing me; (c) having control; (d) having a place to shine; and finally a negative influence (e) peer exclusion and rejection. These themes largely parallel those of competence, autonomy, and relatedness found in self-determination theory. This suggests that staff can enhance the social inclusion of students with VI by facilitating these students’ self-determination. In practice, this would require school staff to focus on enabling students with VI to explore and build on strengths, fully access the curriculum alongside their peers, and have time and opportunity to develop friendships with these peers.
The impact of visual impairment on nutritional status: A systematic review
Authors: Jones Nabila , Bartlett Hannah
Published: January 2018

The aim of this review was to evaluate the literature that has investigated the impact of visual impairment on nutritional status. We identified relevant articles through a multi-staged systematic approach. Fourteen articles were identified as meeting the inclusion criteria. The sample size of the studies ranged from 9 to 761 participants. It was found that visual impairment significantly affects nutritional status. The studies reported that visually impaired people have an abnormal body mass index (BMI); a higher prevalence of obesity and malnutrition was reported. Visually impaired people find it difficult to shop for, eat, and prepare meals. Most studies had a small sample size, and some studies did not include a study control group for comparison. The limitations of these studies suggest that the findings are not conclusive enough to hold true for only those who are visually impaired. Further studies with a larger sample size are required with the aim of developing interventions.
A New Dawn in Nationalism Studies? Some Fresh Incentives to Overcome Historiographical Nationalism
Authors: Storm Eric
Published: January 2018

Nationalism studies does not seem to be a very innovative field of research. The path-breaking views of Anderson, Gellner and Hobsbawm – all published in 1983 – still form the starting point for almost all existing investigations. Moreover, most recent studies focus on one national case, which implicitly results in a vast collection of ‘unique’ trajectories. However, over the last few years a number of highly original studies on the origins of nationalism, nation-state formation, banal nationalism, methodological nationalism and nation-building in a global perspective seem to announce a new dawn. Some of these refreshing interpretations – which will be discussed in this article – clearly demonstrate that historiographical nationalism still has a preponderant role in history writing. In the concluding paragraphs I will emphasize the need to overcome not only methodological nationalism, but also the terminological and normative nationalism that still dominates our discipline.
A Wide, Invisible Net: Administrative Deportation in Italy, 1863–1871
Authors: Garfinkel Paul
Published: January 2018

This article examines the legal history of domicilio coatto (forced residence), a system of summary police-administered deportation instituted by Italy’s Liberal government soon after national unification in 1861. Introduced in an emergency law in 1863, its limited purpose was to suppress a public-order crisis in the south. Within just eight years, however, forced residence had become a regular institution of Italian criminal justice. Not only did it remain as such until Mussolini’s seizure of power in 1922, but it also provided an important blueprint for confino di polizia, the Fascist variant of forced residence implemented in 1926. Focusing on the complex circumstances in which domicilio coatto emerged, the causes of its rapid transformation into a routine weapon of preventative policing, and the legal ideologies of its proponents, this article aims to explain why Italian legal experts crafted the highly repressive instrument and championed it as an essential, if not desirable, institution of ‘liberal’ criminal justice in the young constitutional monarchy. It argues that domicilio coatto was devised to be not simply an expedient for punishing political opponents, as scholars have long emphasized, but a regular instrument for thwarting what jurists and lawmakers considered to be the principal long-term threat to cementing Liberal rule: common crime. Such an interpretation sheds new light on the origins, objectives and historical significance of forced residence in Liberal Italy; at the same time, it offers a critical complement to the existing scholarship that has focused almost exclusively on the political uses of domicilio coatto.
A qualitative investigation into the patient-centered goal-setting practices of allied health clinicians working in rehabilitation
Authors: Cameron Lisa J , Somerville Lisa M , Naismith Catherine E , Watterson Dina , Maric Valentina , Lannin Natasha A
Published: January 2018

Objective:

To explore the ways clinicians engage rehabilitation patients in patient-centered goal setting and identify factors influencing the goal-setting process.

Design:

Ethnographic study utilizing observed practice—thematic analysis.

Setting:

Four rehabilitation wards of a large metropolitan hospital in Melbourne, Australia.

Subjects:

Participants included 17 rehabilitation patients, 18 allied health clinicians and one family member. Disciplines represented were speech pathology, occupational therapy, social work and physiotherapy.

Method:

Multiple qualitative methods were used. A total of 18 routine goal-setting interviews between clinicians and patients were audio recorded and transcribed. Together with associated entries in the patient medical record, transcripts were coded and developed into themes using thematic analysis. Finally, focus groups with clinicians were conducted to validate themes identified.

Results:

Three themes were identified describing factors which influence patient centeredness: “a goal-setting collaboration”—the interpersonal exchange between client and clinician; “the environment”—physical, temporal and structural; and “clinician self-awareness”—clinicians’ insight into the ways they influence goal setting. The practice of patient-centered goal setting varied considerably between clinicians. Goals developed were strongly influenced by the clinician’s views, although strategies of respect for the patient and reflective listening skills increased patient participation and the patient centeredness of goals developed.

Conclusion:

Goals developed with rehabilitation patients are more likely to be patient-centered when the interaction encourages the patient to express their needs and preferences, and these are heard by the clinician. For this to influence treatment, it must occur in an environment structured to support and value patient-centered goals.
Rethinking PGIS: Participatory or (post)political GIS?
Authors: Radil Steven M. , Anderson Matthew B.
Published: January 2018

Participatory GIS (PGIS) emerged from the contentious GIS debates of the 1990s as a means of political intervention in issues of social and environmental justice. PGIS has since matured into a distinct subfield in which GIS is used to enhance the political engagement of historically marginalized people and to shape political outcomes through mapping. However, this has proven to be difficult work. We suggest that this is because PGIS, particularly in its community development incarnations, though well-intentioned in endeavoring to enhance the voices of the excluded, is inherently limited because it primarily aims to enhance the inclusion and participation of the historically marginalized by working within established frameworks of institutionalized governance in particular places. This, we suggest, has left this mode of PGIS ill-equipped to truly challenge the political-economic structures responsible for (re)producing the very conditions of socio-economic inequality it strives to ameliorate. As a result, we argue that PGIS has become de-politicized, operating within, rather than disrupting, existing spheres of political-economic power. Moving forward, we suggest that PGIS is in need of being retheorized by engaging with the emergent post-politics literature and related areas of critical social and political theory. We argue that by adopting a more radical conception of democracy, justice, and ‘the political’, PGIS praxis can be recentered around disruption rather than participation and, ultimately, brought closer to its self-proclaimed goal of supporting progressive change for the historically marginalized.
Macroscopic Rotator Cuff Tendinopathy and Histopathology Do Not Predict Repair Outcomes of Rotator Cuff Tears
Authors: Sethi Paul M. , Sheth Chirag D. , Pauzenberger Leo , McCarthy Mary Beth R. , Cote Mark P. , Soneson Emma , Miller Seth , Mazzocca Augustus D.
Published: January 2018

Background:

Numerous studies have identified factors that may affect the chances of rotator cuff healing after surgery. Intraoperative tendon quality may be used to predict healing and to determine type of repair and/or consideration of augmentation. There are no data that correlate how gross tendon morphology and degree of tendinopathy affect patient outcome or postoperative tendon healing.

Purpose/Hypothesis:

The purposes of this study were to (1) compare the gross appearance of the tendon edge during arthroscopic rotator cuff repair with its histological degree of tendinopathy and (2) determine if gross appearance correlated with postoperative repair integrity. The hypothesis was that gross (macroscopic) tendon with normal thickness, no delamination, and elastic tissue before repair would have a correlation with low Bonar scores, higher postoperative American Shoulder and Elbow Surgeons (ASES) scores, and increased rates of postoperative tendon healing on ultrasound.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 105 patients undergoing repair of medium-size (1-3 cm) full-thickness rotator cuff tears were enrolled in the study. Intraoperatively, the supraspinatus tendon was rated on thickness, fraying, and stiffness. Tendon tissue was recovered for histological analysis based on the Bonar scoring system. Postoperative ASES and ultrasound assessment of healing were obtained 1 year after repair. Correlation between gross appearance of the tendon and rotator cuff histology was determined.

Results:

Of the 105 patients, 85 were followed the study to completion. The mean age of the patients was 61.6 years; Bonar score, 7.5; preoperative ASES score, 49; and postoperative ASES score, 86. Ninety-one percent of repairs were intact on ultrasound. Gross appearance of torn rotator cuff tendon tissue did not correlate with histological appearance. Neither histological (Bonar) score nor gross appearance correlated with multivariate analysis of ASES score, postoperative repair status, or demographic data.

Conclusion:

The degree of tendinopathy did not correlate with morphological appearance of the tendon. Neither of these parameters correlated with healing or patient outcome. This study suggests that the degree of tendinopathy, unlike muscle atrophy, may not be predictive of outcomes and that, on appearance, poor quality tendon has adequate healing capacity. Therefore, abnormal gross tendon appearance should not affect the repair effort or technique.
Incidence and Definition of Sepsis and Associated Organ Dysfunction
Authors: Dremsizov T.T. , Kellum J.A. , Angus D.C.
Published: January 2018

Aims

To discuss the incidence, outcome and predisposing factors to systemic inflammatory response syndrome (SIRS), sepsis, and multiple organ failure.

Methods

A qualitative review of the literature.

Results

Case definitions of sepsis and severe sepsis, though clarified recently, are still arbitrary. It seems, however, that SIRS is not useful in identifying severe sepsis while organ failure has become a cornerstone for this definition. Incidence of severe sepsis appears to be approximately 10% of all ICU admissions, totaling nearly one million cases annually in the U.S. alone, and rising. Mortality associated with these events is still high, especially among ICU patients. Recent studies have been demonstrating an association between a variety of genetic polymorphisms and progression to and dying from sepsis.

Conclusion

Recently there has been an increasing amount of information enabling characterization of the epidemiology of sepsis, which may help to direct appropriate care in the coming years.
Extended Daily Dialysis vs. Continuous Hemodialysis for ICU Patients with Acute Renal Failure: A Two-Year Single Center Report
Authors: Kumar V.A. , Yeun J.Y. , Depner T.A. , Don B.R.
Published: January 2018

Extended daily dialysis (EDD) is an easily implemented alternative to continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). Since EDD offers most of the advantages of CRRT, we sought to compare the effectiveness of these two modalities. In this 2-year study, 54 ICU patients with ARF were treated with either continuous hemodialysis (CHD) or EDD. Oliguria was present in 64% of patients who received CHD vs. 73% of EDD patients (p=NS) while 93% of CHD and 81% of EDD patients required mechanical ventilation (p=NS). Patients treated with EDD were younger than those who received CHD (47.0 ± 12.6 vs. 56.7 ± 13.7, p=0.009), but there were no significant differences in gender or mean APACHE II scores at the time of randomization. Mean arterial blood pressures measured during treatment were maintained between 70 and 80 mmHg for both EDD and CHD and average daily serum electrolyte levels fell within normal ranges for EDD and CHD. Average daily fluid input and output were 5.8 ± 3.3L and 6.0 ± 3.2 L for CHD vs. 3.3 ± 2.6 and 3.0 ± 1.7 L for EDD after exclusion of data from 2 burn patients. Hourly heparin anticoagulation rates were 1080 U/hour for CHD and 643 U/hour for EDD, p=0.02. Anticoagulation-free treatments were performed during 43% of all EDD treatments vs. 21% of all CHD treatments, p<0.001. Clotting of the dialyzer or circuit occurred at least once during 51% of all CHD treatment days vs. 22% of EDD treatments (p<0.001). We conclude that EDD is a safe, effective alternative to CRRT that offers comparable hemodynamic stability and excellent small solute control.
Prolonged Daily Intermittent Renal Replacement Therapy in ICU Patients by ICU Nurses and ICU Physicians
Authors: Naka T. , Baldwin I. , Bellomo R. , Fealy N. , Wan L.
Published: January 2018

Objectives

Prolonged daily intermittent renal replacement therapy (PDIRRT) has been proposed as a new form of treatment for severe acute renal failure (ARF). However, this treatment has so far implied a) full dependence on nephrological input, b) lack of any convective clearance and c) limited purification of dialysate water. The aim of this study was to establish the feasibility and safety of performing PDIRRT in the ICU with a) no nephrological input, b) the addition of some convective clearance with on-line fluid replacement and c) a new advanced water purification system.

Design

Prospective observational study.

Patients

Fourteen patients treated with PDIRRT.

Setting

ICU of tertiary institution.

Interventions

Treatment of patients with severe ARF and critical illness with PDIRRT. Prescription of treatment by ICU physicians. Conduct of treatment by ICU nurses. Use of combined convective and diffusive therapy with on-line generation of fluid replacement, application of a double-filtration water purification system.

Measurements and Main Results

We prospectively collected demographic, biochemical, hemodynamic and clinical data in 14 patients, who received 30 PDIRRT treatments for a cumulative treatment time of 205.4 hours. The mean age was 57.9 ± 16.0. Eight patients were male and 6 female. Their mean APACHE II score was 24.6 ± 5.9 and their SAPS II score was 41.7 ± 18.8. PDIRRT was used after at least 24 hours of initial stabilization with continuous veno-venous hemofiltration (CVVH). Blood flow was kept at 100ml/min dialysate flow at 200 ml/min and convective clearance varied from 21 ml/min to 33 ml/min. All patients were either anuric or oliguric (UO < 400 ml/day). Ten patients were on mechanical ventilation and 11 patients on vasopressor support. Mean treatment session time was 6.9 ± 1.8 hours. The mean pre-PDIRRT urea was 19.2 ± 6.9 mmol/L and the creatinine was 274 ± 116 μmol/L. The mean pre-PDIRRT lactate was 2.95 ± 2.24 mmol/L. Following treatment, all had significantly decreased to 13.2 ± 6.3 mmol/L, 215 ± 95 μmol/L and 2.25 ± 1.61 mmol/L, respectively (p=<0.0001, <0.0001, <0.05). Bicarbonate levels remained stable during treatment (23.0 ± 3.8 mmol/L to 23.1 ± 2.5 mmol/L). Mean norepinephrine dose changed from 8.8 ± 11.9 μg/min to 12.9 ± 27.0 μg/min after treatment (NS). There were no complications of therapy. Patient ICU survival was 71.4%.

Conclusions

PDIRRT with combined diffusive and convective clearance is an efficacious form of renal replacement, which can be safely and effectively conducted by ICU nurses following prescription by ICU physicians without any nephrological involvement and with adequate double filtration water purification.
Percutaneous Bridge to Heart Transplantation by Venoarterial ECMO and Transaortic Left Ventricular Venting
Authors: Fumagalli R. , Bombino M. , Borelli M. , Rossi F. , Colombo V. , Osculati G. , Ferrazzi P. , Pesenti A. , Gattinoni L.
Published: January 2018

We report a case in which life support for cardiogenic shock was achieved by a nonpulsatile venoarterial bypass, and left ventricular decompression was obtained by a catheter placed percutaneously through the aortic valve into the left ventricle. The blood drained from the left ventricle was pumped into the femoral artery. The normalization of left heart filling pressures allowed the resolution of pulmonary edema, and the patient underwent a successful heart transplantation following 7 days of mechanical cardiocirculatory support.
Pulsatile roller pump perfusion is safe in high risk patients
Authors: Kocakulak M. , Küçükaksu S. , Pişkin E.
Published: January 2018

In this study, controllability, safety, blood cell depletion, and hemolysis of a pulsatile roller pump in high-risk patients was evaluated. Sarns 8000 roller pump (Sarns, Terumo CVS, Ann Arbor, MI, USA) with a pulsatile control module was used as arterial pump in a clinical setting. Forty patients undergoing elective open heart surgery with high-risk either having chronically obstructive pulmonary disease or chronic renal failure were randomly included in the study to be operated on using pulsatile perfusion or non-pulsatile perfusion. Blood samples were withdrawn at induction of anesthesia, at the time of aortic clamping and de-clamping and at 1 hour and 24 hours following cessation of the bypass. Hematocrit and plasma free hemoglobin values were measured. We observed that the pulsatile roller pump perfusion and the extracorporeal circuit used in the clinical study is safe in high-risk patients undergoing cardiopulmonary bypass. We did not face any emboli, hemolysis, or technical problems. Pulsatile roller pump perfusion with Sarns 8000 heart-lung machine is a simple and reliable technique and can be easily applied during open heart surgery.
Hemoglobin Normalization Results in Lower Dialysis Dose, Despite High Dialysate Flow. Single Needle Offers Inadequate Dialysis
Authors: Vlassopoulos D.A. , Hadjiyannakos D.K. , Koutala K.G. , Iliopoulos A.N. , Diamantopoulou N.V. , Marioli S.I.
Published: January 2018

Anemia correction by erythropoietin favorably affects dialysis outcome but may also reduce dialysis efficiency increasing morbidity and mortality. Single needle dialysis (SN) and high dialysate flow (DF) are dialysis variations. We studied the effect of hemoglobin (Hb) normalization on dialysis adequacy under high DF. We also compared double needle (DN) and SN dialysis efficiency. Seventeen stable anuric patients (13 M, 4 F), aged 62 (40–90), on hemodialysis for 48 months (8–204), were studied in two, 6 months apart, periods of low (A) and high Hb (B), during a midweek 4 h dialysis with DN and SN. DF was 500 in A and 800ml/min in B. Rebound urea samples, 20 min post dialysis, were used for computer calculated double pool urea kinetics.

Hb levels were 128±8 g/L (B) vs. 119±14 g/L (A), P<0.03. Despite the use of higher DF less dialysis was delivered in B vs. A, under DN or SN (DN: URR 64.8±5.8 vs. 69.7±5.2%, Kt/Vequil. 1.09±0.19 vs. 1.26±0.21, nPCR 1.37±0.29 vs. 1.60±0.36g/kg/day, changes <0.001, SN: URR 49.7±7.5% vs. 52.6±8.8%, Kt/Vequil. 0.74±0.16 vs. 0.82±0.23, nPCR 1.05±0.33 vs. 1.20±0.31, changes NS). SN was found significantly (P<0.001) less efficient than DN in A and B. Serum creatinine drop was significantly (P<0.001) less in both periods with SN vs. DN. Hb (SN in B) correlated inversely to Kt/V (r = –0.5705, P<0.02) and URR (r = –0.6432, P=0.005).

Hb correction to normality is associated with a decrease in dialysis efficiency. The use of high dialysate flow does not compensate for this loss. SN delivers inadequate dialysis independently of dialysate flow or hemoglobin concentration.
In vitro Models to Test Orthopedic Biomaterials in View of Their Clinical Application in Osteoporotic Bone
Authors: Torricelli P. , Fini M. , Giavaresi G. , Giardino R.
Published: January 2018

The development of in vitro cell cultures, in association with in vivo experimentation, greatly improved the characterization of biomaterials for orthopedic devices before their clinical use. In recent years an increasing interest has arisen in the use of both pathological osteoblast cultures and animal models to perform in vitro and in vivo tests on biomaterial behavior. A growing number of prostheses, in fact, are implanted in osteoporotic patients, due to the increasing age of the population. Moreover, the presence of osteoporosis may affect bone-biomaterial osteointegration in these patients.

The present paper is a literature review and, after a short description of in vitro studies for characterization of osteoblasts derived from osteoporotic bone, the results of in vitro studies on biomaterial biocompatibility and osteointegration rate in the presence of osteoporotic bone derived osteoblast cultures are reported. Pathological cell culture models are able to demonstrate the different behavior of osteoblasts in response to biomaterials, when comparing normal and pathological conditions.
Current Trends in the Enhancement of Biomaterial Osteointegration: Biophysical Stimulation
Authors: Fini M. , Giavaresi G. , Setti S. , Martini L. , Torricelli P. , Giardino R.
Published: January 2018

To enhance bone implant osteointegration, many strategies for improving biomaterial properties have been developed which include optimization of implant material, implant design, surface morphology and osteogenetic coatings. Other methods that have been attempted to enhance endogenous bone healing around biomaterials are different forms of biophysical stimulations such as pulsed electromagnetic fields (PEMFs) and low intensity pulsed ultrasounds (LIPUS), which were initially developed to accelerate fracture healing. To aid in the use of adjuvant biophysical therapies in the management of bone-implant osteointegration, the present authors reviewed experimental and clinical studies published in the literature over the last 20 years on the combined use of biomaterials and PEMFs or LIPUS, and summarized the methodology, and the possible mechanism of action and effectiveness of the different biophysical stimulations for the enhancement of bone healing processes around bone implanted biomaterials.
In Vitro and in Vivo Hemocompatibility Evaluation of Graphite Coated Polyester Vascular Grafts
Authors: Arabi H. , Mirzadeh H. , Ahmadi S.H. , Amanpour S. , Rabbani S. , Abdi A.
Published: January 2018

Attempts have been made in this study to prepare a homogeneous and stable coating of graphite on polyester vascular grafts (GPVG) using an electrophoresis method to evaluate thromboresistant and blood compatibility of GPVG in comparison to non-coated PVG and InterGard (collagen sealed PVG) as control.

Lactate dehydrogenase (LDH) activity measurement was carried out on all PVG types to evaluate platelet adhesion. To examine tissue reaction GPVG and non-coated sheets of knitted polyester fabric were implanted simultaneously in the dorsal flank of rats subcutaneously. The GPVG, non-coated and control were implanted in descending aorta as end-to-end or end-to-side implantation substitution in 25 sheep for 4–60 weeks.

Results showed that the graphite coating on polyester vascular grafts reduced the number of adherent platelets and prevent platelet activation and spreading on the surface in comparison with non-coated and control. Pathological investigation showed inflammatory reactions were totally resolved after 12 weeks and there was no difference in the tissue reaction between graphite coated, non-coated and control patches. All grafts remained patent and there was no significant difference in patency rate between these three types of PVG. We found that GPVG has no need for pre-clotting and it showed lower platelet aggregation, thinner capsule formation and lower calcification after 15 months. However, suturing of GPVG was more difficult in comparison with the other types.
Evaluation of Adaptive Support Ventilation in Paralysed Patients and in a Physical Lung Model
Authors: Belliato M. , Palo A. , Pasero D. , Iotti G.A. , Mojoli F. , Braschi A.
Published: January 2018

Objective

Evaluation of the respiratory pattern selected by the Adaptive Support Ventilation (ASV) in ventilated patients with acute, chronic respiratory failure and normal lungs and in a physical lung model.

Design

We tested ASV both on patients and in a physical lung model, with a normal level of minute ventilation and with minute ventilation increased by 30%. In each patient, respiratory pattern, mechanics and blood gases were recorded.

Setting

General ICU of a University Hospital.

Results

In patients with normal lungs, mean values±SD were: tidal volume (Vt) 558.1±142.4mL, respiratory rate (RR) 12.6±1.3b/min and inspiratory time/total time ratio (Ti/Ttot) 42.4±4.1%; in COPD, mean values±SD were: Vt 724±171mL, RR 9.2±2.7b/min and Ti/Ttot 26.6±10.5%; in restrictive ones, mean values±SD were: Vt 550.2±77.0mL, RR 15.8±2.6b/min, Ti/Ttot 47.5±2.5%. In the lung model, at a normal setting, mean values±SD were: Vt 523±18.5mL, RR 14±0.0b/min, Ti/Ttot 44.0%, in COPD, mean values±SD were: Vt 678±0.0mL, RR 9±0.0b/min, Ti/Ttot 20±0.7%, in restrictive one, mean values±SD were: Vt 513±12.8mL, RR 15±0.0b/min, Ti/Ttot 48±1.5%. In model hyperventilation conditions in a normal setting a Vt of 582±16.6mL, RR 16±0.0b/min, Ti/Ttot 48±0.0% were selected, in the obstructive setting Vt 883±0.0mL, RR 9±0.0b/min, Ti/Ttot 20±0.0% and in a restrictive one Vt 545±8.4mL, RR 18±0.0b/min, Ti/Ttot 50±0.0%.

Conclusions

In normal patients ASV selected a ventilatory pattern close to the physiological one, in COPD almost a high expiratory time pattern and in restrictive ones a reduced tidal volume pattern. In the model the selection was similar. In the hyperventilation test, ASV chose a balanced increase in both Vt and RR.
The Role of Improved Water Quality on Inflammatory Markers in Patients Undergoing Regular Dialysis
Authors: Rahmati M.A. , Homel P. , Hoenich N.A , Levin R. , Kaysen G. A. , Levin N.W.
Published: January 2018

Hemodialysis utilizes large quantities of water for the preparation of dialysis fluid. Such water meets national standards and international standards but a considerable disparity exists between such standards with respect to microbiological purity. This study collated and retrospectively analyzed the impact of upgrading water systems from that specified in the US standards to those specified in European standards on clinical measures associated with inflammation in four metropolitan dialysis units for two periods. Two periods were compared, three months prior to and six months post upgrading the water treatment systems. The monthly total erythropoietin dosage and intravenous iron supplementation for each patient were also compared over these periods. Variables with significant pre-post differences were assessed using multivariate models to control for confounding factors.

The results indicated significant increases in hemoglobin, ferritin and TSat (all p < 0.0001) and albumin (p = 0.0001) were associated with improvement in water quality. Decreases in CRP and creatinine (both p < 0.0001) were also noted.

These findings suggest that the current regulations in the United States set the microbiological limits of water and dialysis fluid inappropriately high, and the limits should be revised downwards, since such an approach is reflected in improvement in markers of inflammation.
What's in the Pipeline about Bladder Reconstructive Surgery? Some Remarks on the State of the Art
Authors: Alberti C. , Tizzani A , Piovano M. , Greco A.
Published: January 2018

The fusion of engineering with cell biology and advances in biomaterials may lead to de novo construction of implantable organs. Engineering of neobladder from autologous urothelial and smooth muscle cells cultured on biocompatible, either synthetic or naturally-derived substrates, is now feasible in preclinical studies and may have clinical applicability in the near future. The development of a bioartificial bladder would warrant the prevention of both the metabolic and neoplastic shortcomings of the intestinal neobladder. Two tissue-engineering techniques for bladder reconstruction have been tested on animals: 1) the in vivo technique involves the use of naturally-derived biomaterials for functional native bladder regeneration 2) the in vitro technique involves the establishment of autologous urothelial and smooth muscle cell culture from the host's urinary tract, after which the cells are seeded on the biodegradable matrix-scaffold to create a composite graft that is implanted into the same host for complete histotectonic regeneration. Waiting for the creation of a complete tissue-engineered bladder with a trigone-shaped base, we suggest, in surgical oncology after radical cystectomy, the realization of conduit or continent pouch using tissue-engineered material.
Application of Blood Purification to Non-Renal Organ Failure
Authors: Kellum J.A. , Venkataraman R.
Published: January 2018

The application of artificial organs to the task of blood purification in the setting of non-renal organ failure simultaneously presents important challenges and opportunities. Failures of cardiovascular, hepatic, coagulation and immune systems are all characterized by dysregulation leading to multi-organ failure. When sustained, these conditions result in multiple organ system dysfunction and death and are far too common in modern intensive care units (ICUs). While the pathogenesis of each of these organ failures is complex and variable, brought about by a variety of underlying conditions, the potential to improve patient outcomes by simultaneously targeting multiple pathways can perhaps best be realized by blood purification. Unlike drug strategies, which are usually limited to one component of these complex networks, blood purification is, by its very nature, broad spectrum and self regulating. For example, as the concentration of mediators or toxins increases, so does removal. Furthermore, given the many failed trials of specific therapy, the recent focus of immunomodulatory therapy in sepsis has shifted to non-specific methods of influencing the entire inflammatory response without suppressing it. In this issue of the journal, members of the Acute Dialysis Quality Initiative (ADQI) present systematic reviews on the application of hemofiltration, ultrafiltration, plasma therapies and liver-assist therapy for the treatment of non-renal organ failure. The focus of these reviews is on clinical evidence as well as recommendations for future research.