bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Perceived Risk, Uncertainty, and Trust on Coastal Climate Change Adaptation Planning
Authors: Kettle Nathan P. , Dow Kirstin
Published: September 2014

This study examines support for climate adaptation planning and the role of perceived risk, uncertainty, and trust on adaptation of U.S. coastal communities. This assessment is based on the analysis of web-based questionnaires ( n = 137) among state, local, and non-government organization (NGO) planners in Alaska, Florida, and Maryland. Ordinal regression and correlation analysis were used to assess which factors are related to support for adaptation during two planning stages. Findings from this study suggest the influence of perceived risk, uncertainty, and trust on support for climate change adaptation (CCA) varies across two stages of adaptation planning (support for the development of plans and willingness to allocate human and financial resources to implement plans). The disaggregation of planning entities into different study areas and levels of management revealed significant differences in the relationship between perceived risk, uncertainty, and trust and support for CCA planning. These findings have implications for the design of communication and engagement strategies.
School nurses’ descriptions of concerns arising during pupils’ health check-ups: A qualitative study
Authors: Poutiainen Hannele , Holopainen Arja , Hakulinen-Viitanen Tuovi , Laatikainen Tiina
Published: September 2014

Objective:

To describe the concerns and modes of action of Finnish school nurses during pupils’ health check-ups.

Methods:

Focus group interviews with 17 school nurses were performed in 2011 and again in 2013. Data were analysed using inductive content analysis.

Results:

School nurses’ concerns were mostly associated with the psychosocial development of pupils and with problems in the family, for example, the loss of a parental role. With regard to physical health, school nurses were particularly concerned with obesity among pupils. The new phenomenon of cyberbullying also caused concern. School nurses were able to identify the causes for their concern at school health check-ups, but they were uncertain regarding how they should act and finding the right mode of action and sufficient multidisciplinary support when pupils had problems.

Conclusion:

The concern of school nurses at health check-ups was mainly associated with pupils’ health habits, their psychosocial development and family characteristics, and with addressing the need to taking the health behaviours and well-being of the entire family into consideration during health check-ups. Linked-up processes in school health care and multidisciplinary collaboration within schools are of primary importance in supporting the work of nurses and in promoting pupils’ well-being and health.
Effects of Task Precision Demands on Behavioral and Physiological Changes During a Repetitive Asymmetric Lifting Activity
Authors: Mehta Jay P. , Lavender Steven A. , Jagacinski Richard J. , Sommerich Carolyn M.
Published: September 2014

Objective:

This study investigated the effects of task precision demands on behavioral and physiological changes during repetitive asymmetric lifting.

Background:

Repetitive lifting encountered in manual material handling leads to muscle fatigue and is a documented risk factor for low back disorder.

Method:

A total of 17 healthy volunteers performed repetitive asymmetric lifting for 60 min (10 lifts/min). Task precision demands were imposed by varying the entry width onto the destination conveyor. Physiological changes were assessed using near-infrared spectroscopy obtained from the erector spinae muscles. Three-dimensional spine kinematics and moment responses were quantified to understand behavioral changes during the lifting activity.

Results:

Task precision demands showed no effect on erector spinae muscle oxygenation levels. Behavioral changes associated with repetitive lifting included increases in the overall lift duration, peak forward bending motion, and three-dimensional movement velocities of the spine, along with a decrease in the lateral bending moment. Relative to low precision demands, high precision demands resulted in 20% longer placement periods, which, in turn, resulted in a 12% increase in the time-integrated twisting postures and a 10% increase in the time-integrated lateral bending moments during load placement.

Conclusion:

The elevated risk of low back injury when lifting under greater precision demands is likely due to the sustained spine twisting and the sustained lateral bending moment on the spine in the final phase of these lifts.

Application:

Understanding behavioral changes to repetitive asymmetric lifting, especially for tasks requiring greater precision can be used to support injury prevention efforts.
For a Sociology of Deceit: Doubled Identities, Interested Actions and Situational Logics of Opportunity
Authors: Shilling Chris , Mellor Philip A
Published: September 2014

Deceit occupies a significant role in historical conceptualizations of social order, but dominant approaches to the subject are limited by the normative assumptions and conceptions of agency and structure on which they rest. This article suggests that renewed sociological engagement with deceit is overdue and can illuminate the ‘situational logics of opportunity’ within modernity (Archer, 2010). Focusing on the contemporary era, and building upon Simmel’s argument that individuals lead a ‘doubled existence’, within and outside social forms, we view deceit as neither a personal trait nor an effect of social structures. Instead, it emerges through, and assumes contrasting meanings as a consequence of, people’s interested and strategic engagements with the social world. Developing this theoretical analysis substantively, we then focus on several examples of how deceit is used to subvert or reaffirm boundaries between ‘insider’ and ‘outsider’ groups, including those emergent from sociology’s own ‘doubled existence’ relative to modern life.
An Experimental Evaluation on the Utility of Burglary Profiles Applied in Active Police Investigations
Authors: Fox Bryanna Hahn , Farrington David P.
Published: September 2014

This study evaluated the effect on burglary arrest rates when using statistically derived behavioral profiles for burglary offenses and offenders in active police investigations. To do this, an experiment was conducted where one police agency that used the profiles was compared with three matched police agencies that did not. Burglary arrest rates were studied 4 years before and 1 year after the profile was implemented. Results show that the arrest rates for the treated agency increased by 3 times as compared with the control agencies. The interaction effect between treatment/control agency and pretest/posttest arrest rates was significant, showing that the experimental intervention had an effect, after controlling for pre-existing differences between the agencies. These findings on the utility of offender profiling, the first to be derived from an experiment conducted in active police investigations, suggest that the statistically based behavioral profiles could be a useful tool in increasing arrest rates for police.
Transcending the medical/media opposition in research on news coverage of health and medicine
Authors: Hallin Daniel C , Briggs Charles L
Published: September 2014

Health and medicine are major topics of news coverage, but research on health and medical reporting has remained mainly confined to specialist subfields, with less impact on broader academic fields, including journalism studies, than would seem warranted by its importance. This article argues that assumptions implicit in much of this literature have limited the development of a wider tradition of research on health journalism. We point particularly to what we call the linear-reflectionist perspective, which sees health journalism as an often-flawed mechanism for transmitting pre-existing medical knowledge to the mass public. We propose an alternative framework that seeks to illuminate the complexity and importance of this field of study.
Use of Generalized Linear Mixed Models for Network Meta-analysis
Authors: Tu Yu-Kang
Published: September 2014

In the past decade, a new statistical method—network meta-analysis—has been developed to address limitations in traditional pairwise meta-analysis. Network meta-analysis incorporates all available evidence into a general statistical framework for comparisons of multiple treatments. Bayesian network meta-analysis, as proposed by Lu and Ades, also known as “mixed treatments comparisons,” provides a flexible modeling framework to take into account complexity in the data structure. This article shows how to implement the Lu and Ades model in the frequentist generalized linear mixed model. Two examples are provided to demonstrate how centering the covariates for random effects estimation within each trial can yield correct estimation of random effects. Moreover, under the correct specification for random effects estimation, the dummy coding and contrast basic parameter coding schemes will yield the same results. It is straightforward to incorporate covariates, such as moderators and confounders, into the generalized linear mixed model to conduct meta-regression for multiple treatment comparisons. Moreover, this approach may be extended easily to other types of outcome variables, such as continuous, counts, and multinomial.
An evaluation of psychological consultation to social workers
Authors: Dimaro Lian , Moghaddam Nima , Kyte Zoe
Published: September 2014

Although providing psychological consultation to the network around looked after children is a popular intervention within the practice literature, there is little evidence examining its value for social workers. This study utilised mixed methods, integrated through an explanatory sequential design, to explore the extent to which psychological consultation met social workers’ goals and in what way it made a difference. Feedback questionnaires were collated from 48 social workers attending such consultations. Two focus groups were then held with consulting clinicians to gain their perspectives on consultation and the feedback obtained. The survey data demonstrated that social workers wanted a broad range of input and support from consultation, which they reported was largely provided. This reinforced clinicians’ perspectives of consultation as a valuable service. Surprisingly, the survey data implied that consultation had a limited impact in terms of making a difference. This is discussed in relation to the methodology and challenges of gaining feedback. An improved model of evaluation is subsequently proposed.
Analysis of Audit Fees for Nonprofits
Authors: Verbruggen Sandra , Christiaens Johan , Reheul Anne-Mie , Van Caneghem Tom
Published: September 2014

In contrast to the extensive research on audit fees of for-profit companies, literature on nonprofit audit fees is limited. In this article, audit fee determinants are tested using a Belgian sample of nonprofits. We find that Big4 auditors charge fee premiums, and that nonprofit expert auditors charge lower fees when expertise is measured at audit partner level (as opposed to audit firm level). These findings hold after controlling for self-selection by using propensity score matching. We also address the resource dependence and agency characteristics of nonprofit audit clients and find that both are relevant in explaining audit pricing.
Effect of micro-inclusions on subsurface-initiated rolling contact fatigue of a railway wheel
Authors: Zeng Dongfang , Lu Liantao , Zhang Jiwang , Jin Xuesong , Zhu Minhao
Published: September 2014

The objectives of this paper are to investigate the size of the maximum micro-inclusion in a railway wheel using ultrasonic fatigue testing and to evaluate the effect of the micro-inclusion on subsurface-initiated rolling contact fatigue of the railway wheel. Fatigue specimens with a large risk volume were quenched, tempered and oxynitrocarburized to increase both the strength of the matrix and the resistance to surface corrosion, which ensured that all of the specimens fractured from the internal inclusion under water cooling. The test results show that the size of the micro-inclusion obtained using the fatigue method are much larger than those obtained by a traditional surface analysis method, which means that the accuracy of the fatigue method is higher than that of the traditional method. The maximum square root of the micro-inclusion area and the maximum length of the major axis of the elliptical micro-inclusion for a full-sized railway wheel are estimated using the statistics of extreme values method to be 296 µm and 736 µm, respectively. Based on the estimated maximum micro-inclusion sizes and principles of fracture mechanics, the critical loading of the railway wheel for both subsurface-initiated fatigue and fatigue initiated at a deep-lying material defect are obtained.
The Promise and Problems of Organizational Culture
Authors: O’Reilly Charles A. , Caldwell David F. , Chatman Jennifer A. , Doerr Bernadette
Published: September 2014

Studies of organizational culture are almost always based on two assumptions: (a) Senior leaders are the prime determinant of the culture, and (b) culture is related to consequential organizational outcomes. Although intuitively reasonable and often accepted as fact, the empirical evidence for these is surprisingly thin, and the results are quite mixed. Almost no research has jointly investigated these assumptions and how they are linked. The purpose of this article is to empirically link CEO personality to culture and organizational culture to objective measures of firm performance. Using data from respondents in 32 high-technology companies, we show that CEO personality affects a firm’s culture and that culture is subsequently related to a broad set of organizational outcomes including a firm’s financial performance (revenue growth, Tobin’s Q), reputation, analysts’ stock recommendations, and employee attitudes. We discuss the implications of these findings for future research on organizational culture.
Comparison of rehospitalization rates in France and the United States
Authors: Gusmano Michael , Rodwin Victor , Weisz Daniel , Cottenet Jonathan , Quantin Catherine
Published: September 2014

Objective

To compare rates of 30-day all-cause rehospitalization in France and the US among patients aged 65 years and older and explain any difference between the countries.

Methods

To calculate rehospitalization rates in France, we use an individual identifying variable in the national hospital administrative dataset to track unique individuals aged 65 years or more hospitalized in France in 2010. To calculate the proportion of rehospitalized patients (65+) who received outpatient visits between the time of initial discharge and rehospitalization, we linked the hospital database with a database that includes all medical and surgical admissions. We used step by step regression models to predict rehospitalization.

Results

Rates of rehospitalization in France (14.7%) are lower than among Medicare beneficiaries in the US (20%). We find that age, sex, patient morbidity and the ownership status of the hospital are all correlated with rehospitalization in France.

Conclusions

Lower rates of rehospitalization in France appear to be due to a combination of better access to primary care, better health among the older French population, longer lengths of stay in French hospitals and the fact that French nursing homes do not face the same financial incentive to rehospitalize residents.
Developing and Testing Locally Derived Mental Health Scales
Authors: Weaver Lesley Jo , Kaiser Bonnie N.
Published: September 2014

Cross-cultural studies of mental health and illness generally adhere to one of two agendas: the comparison of mental health between sites using standard measurement tools, or the identification of locally specific ways of discussing mental illness. Here, we illustrate a methodological approach to measuring mental health that unites these two agendas. Using examples from our work in India and Haiti, we show how researchers can use mixed methods to identify idioms of distress, develop locally derived tools to measure them, evaluate the psychometric properties of these tools, and contextualize the results with relevant ethnographic information. Such an approach is beneficial because it generates results that attend to important cross-cultural differences in expressions of distress while still maintaining comparability of mental health and illness across research sites.
Comparing Food Label Experiments Using Samples from Web Panels versus Mall Intercepts
Authors: Chang LinChiat , Lin Chung-Tung Jordan
Published: September 2014

To regulate health messages on food labels, the U.S. Food and Drug Administration (FDA) traditionally relied on mall intercepts to collect consumer data. In recent years, web surveys have presented a viable alternative for presenting visual stimuli with more control and efficiency in data collection. However, there is a paucity of empirical data that compares mall intercept versus web panel samples to inform the relative merits and weaknesses of each sample source and their corresponding impact on study outcomes. We analyzed an FDA experiment deployed concurrently on a sample of consumers intercepted at shopping malls and a sample of consumers recruited by a web panel. Despite sample differences in demographics, topic knowledge, and time spent on survey, results from the core experiment were the same, that is, both samples yielded the same conclusions about the effects of the food label statements on consumer perceptions and intentions.
How to Close a Limb Fasciotomy Wound
Authors: Kakagia Despoina
Published: September 2014

Early fasciotomy is the gold standard of prevention and treatment of compartment syndrome; however, the resulting wounds may significantly increase morbidity. To address the challenge of timely and safe closure of fasciotomy wounds, numerous methods have been described. A thorough search of medical databases PubMed/MEDLINE, ScienceDirect, SCOPUS, EMBASE, and Google Scholar was conducted for articles published between 1976 and 2013 using the search terms “limb fasciotomy wound closure,” “open wound management,” “skin stretching,” and “fasciotomy complications.” A total of 49 articles on technique descriptions, case reports of 2 or more patients, and of complications and comparative studies regarding limb fasciotomy wound closure were included. Details of the duration of treatment, advantages and disadvantages, direct cost, and complications were data extracted for each technique from the 49 studies included in this overview. Thorough knowledge of available techniques and their comparative advantages is essential for their clinical implementation, careful selection of patients, management of possible complications, decreased morbidity, and hospital recovery time and is also crucial for optimization of functional and aesthetic outcomes.
Congenital cytomegalovirus infection: Clinical presentation, epidemiology, diagnosis and prevention
Authors: van Zuylen Wendy J , Hamilton Stuart T , Naing Zin , Hall Beverly , Shand Antonia , Rawlinson William D
Published: September 2014

Cytomegalovirus is the most common congenital infection causing serious disease in infants. It is the leading infectious cause of sensorineural hearing loss and neurodevelopmental disability in developed countries. Despite the clinical importance of congenital cytomegalovirus, surveys show there is limited awareness and knowledge in the medical and general community about congenital cytomegalovirus infection. This article reviews the clinical features, global epidemiology, transmission and risk factors for cytomegalovirus infections. It also highlights several major advances made in recent years in the diagnosis and prevention of cytomegalovirus infection during pregnancy. Although research is ongoing, no therapy is currently proven to prevent or treat maternal, fetal or neonatal cytomegalovirus infection. Education of women regarding hygiene measures can help prevent cytomegalovirus infection and are currently the best strategy to prevent congenital cytomegalovirus disease.
The Election that Forgot the Environment? Issues, EMOs, and the Press in Australia
Authors: Lester Libby , McGaurr Lyn , Tranter Bruce
Published: September 2014

The 2013 Australian federal election campaign has been described as the campaign that “forgot the environment.” We test this claim by comparing the news representation of the environment and environmental movement organizations (EMOs) in Australian federal elections from 1990 to 2013, and consider how coverage of environmental issues and organizations has changed over time. We also analyze the intensity and range of coverage of EMOs and environmental issues during the 2013 election campaign in relation to behind-the-scenes media practices of EMOs, including the circulation of media releases and other campaign material, and levels of activity on social media and organization Web sites. We find that this activity did not translate into high visibility in news media for EMOs. We offer tentative evidence of a link between the dominance of climate change coverage and the poor visibility of EMOs and other environmental issues.
Relationships of diboride phases in Al–Ti(Zr)–B alloys
Authors: Wang X. , Han Q.
Published: September 2014

The relationships of diboride phases in Al–Ti(Zr)–B alloys with a variable Ti/B ratio close to the stoichiometry of TiB2 were studied. The formation of diboride solid solutions was confirmed. A grain refinement mechanism is proposed as that diboride particles in the Al–Ti–B master alloys reacting with aluminium upon adding into an aluminium melt and release titanium into the melt through forming a (Ti,Al)B2 solid solution and maintain a thin dynamic Ti rich layer on the surfaces of the (Ti,Al)B2 particles, which nucleates α-Al grains in solidification. The poisoning effect of zirconium on grain refinement of aluminium by Al–Ti–B master alloys is also discussed.
Degradation mechanism for high temperature erosion in surface modified IN718 superalloy
Authors: Thirugnanasambantham K. G. , Natarajan S.
Published: September 2014

Nickel based superalloy, Inconel 718, is one of the main candidates for high temperature applications such as air craft, land base and marine turbines. This technical paper deals with high temperature erosion behaviour and its mechanism of Al2O3–40TiO2 (A40T) coating on Inconel 718 alloy. Al2O3–40TiO2 coatings through plasma spray method were made on Inconel 718. The erosion behaviour of the A40T coating was studied using hot air jet erosion experiments at 800°C with varying parameters like angle of impingement and erodent velocity. Characterisation of the samples was carried out using SEM images, and mechanisms of erosion are discussed. Images (SEM) reveal that the A40T coating exhibit ductile and brittle behaviour by ploughing and network cracking with grain chipping at 45° angle of impingement, while at 90°, it is brittle behaviour by network cracking and grain ejection. This investigation concludes that A40T coating on IN718 provides good erosion resistance at elevated temperatures.
Microstructure and mechanical properties of Cr–V–C–N films
Authors: Heo S. Y. , Shin J. H. , Kim D.-I. , Oh J. Y. , Zhang S. H. , Kim K. H.
Published: September 2014

Quaternary Cr–V–C–N films were deposited on Si wafers through a hybrid system of arc ion plating and sputtering techniques in an Ar/N2/CH4 gaseous mixture. In this work, the effects of vanadium on the microstructural evolution, mechanical properties and friction mechanism of Cr–V–C–N films were investigated. The results showed that quaternary Cr–V–C–N films consisted of nanosized crystallites of (Cr,V)(C,N) and amorphous VCN phases. The Cr–10·4 at-%V–C–N film possessed the higher hardness value of 34 GPa, compared to the 27 GPa of a Cr(C,N) film. Additionally, the friction coefficients of the Cr–V–C–N films were reduced from 0·38 for the Cr–C–N film to 0·27 for the Cr–10·4 at-%V—C–N film. Atomic force microscopy (AFM) and Auger electron spectroscopy (AES) analyses also revealed that the amorphous phase VCN phases played a role in reducing the friction coefficients of the films. The a-VCN phase (vanadium rich) was believed to cause a tribochemical reaction with ambient air during the wear process.
Gray platelet syndrome: proinflammatory megakaryocytes and α-granule loss cause myelofibrosis and confer metastasis resistance in mice
Authors: Guerrero Jose A. , Bennett Cavan , van der Weyden Louise , McKinney Harriet , Chin Melody , Nurden Paquita , McIntyre Zoe , Cambridge Emma L. , Estabel Jeanne , Wardle-Jones Hannah , Speak Anneliese O. , Erber Wendy N. , Rendon Augusto , Ouwehand Willem H. , Ghevaert Cedric
Published: September 2014

Key Points

Proinflammatory MKs from mice with GPS drive the extension of myelofibrosis, splenomegaly, and emperipolesis. The lack of preformed α-granules in Nbeal2−/− platelets leads to protection against cancer metastasis.
Endothelial dysfunction and renal fibrosis in endotoxemia-induced oliguric kidney injury: possible role of LPS-binding protein
Authors: Castellano Giuseppe , Stasi Alessandra , Intini Angelica , Gigante Margherita , Di Palma Anna Maria , Divella Chiara , Netti Giuseppe Stefano , Prattichizzo Clelia , Pontrelli Paola , Crovace Antonio , Staffieri Francesco , Fiaccadori Enrico , Brienza Nicola , Grandaliano Giuseppe , Pertosa Giovanni , Gesualdo Loreto
Published: September 2014

Introduction

The pathophysiology of endotoxemia-induced acute kidney injury (AKI) is characterized by an intense activation of the host immune system and renal resident cells by lipopolysaccharide (LPS) and derived proinflammatory products. However, the occurrence of renal fibrosis in this setting has been poorly investigated. The aim of the present study was to investigate the possible association between endothelial dysfunction and acute development of tissue fibrosis in a swine model of LPS-induced AKI. Moreover, we studied the possible effects of coupled plasma filtration adsorption (CPFA) in this setting.

Methods

After 9 hours from LPS infusion and 6 hours of CPFA treatment, histologic and biochemical changes were analyzed in pigs. Apoptosis and endothelial dysfunction were assessed on renal biopsies. The levels of LPS-binding protein (LBP) were quantified with enzyme-linked immunosorbent assay (ELISA). Endothelial cells (ECs) were stimulated in vitro with LPS and cultured in the presence of swine sera and were analyzed with FACS and real-time RT-PCR.

Results

In a swine model of LPS-induced AKI, we observed that acute tubulointerstitial fibrosis occurred within 9 hours from LPS injection. Acute fibrosis was associated with dysfunctional alpha-smooth muscle actin (α-SMA)+ ECs characterized by active proliferation (Ki-67+) without apoptosis (caspase-3-). LPS led to EC dysfunction in vitro with significant vimentin and N-cadherin expression and increased collagen I mRNA synthesis. Therapeutic intervention by citrate-based CPFA significantly prevented acute fibrosis in endotoxemic animals, by preserving the EC phenotype in both peritubular capillaries and renal arteries. We found that the removal of LBP from plasma was crucial to eliminate the effects of LPS on EC dysfunction, by blocking LPS-induced collagen I production.

Conclusions

Our data indicate that EC dysfunction might be pivotal in the acute development of tubulointerstitial fibrosis in LPS-induced AKI. Selective removal of the LPS adaptor protein LBP might represent a future therapeutic option to prevent EC dysfunction and tissue fibrosis in endotoxemia-induced AKI.
Prognostic implications of conversion from nonshockable to shockable rhythms in out-of-hospital cardiac arrest
Authors: Goto Yoshikazu , Maeda Tetsuo , Nakatsu-Goto Yumiko
Published: September 2014

Introduction

The prognostic significance of conversion from nonshockable to shockable rhythms in patients with initial nonshockable rhythms who experience out-of-hospital cardiac arrest (OHCA) remains unclear. We hypothesized that the neurological outcomes in those patients would improve with subsequent shock delivery following conversion to shockable rhythms and that the time from initiation of cardiopulmonary resuscitation by emergency medical services personnel to the first defibrillation (shock delivery time) would influence those outcomes.

Methods

We analyzed the data of 569,937 OHCA adults with initial nonshockable rhythms. The data were collected in a nationwide Utstein-style Japanese database between 2005 and 2010. Patients were divided into subsequently shocked (n =21,944) and subsequently not-shocked (n =547,993) cohorts. The primary study endpoint was 1-month favorable neurological outcome (Cerebral Performance Categories scale, category 1 or 2).

Results

In the subsequently shocked cohort, the ratio of 1-month favorable neurological outcome was significantly higher than that in the subsequently not-shocked cohort (1.79% versus 0.60%, P <0.001). Multivariate logistic regression analysis for 11 prehospital variables revealed that when the shock delivery time was less than 20 minutes, subsequent shock delivery was significantly associated with increased odds of 1-month favorable neurological outcomes (adjusted odds ratios (95% confidence interval), 6.55 (5.21 to 8.22) and 2.97 (2.58 to 3.43) for shock delivery times less than 10 minutes and from 10 to 19 minutes, respectively). However, when the shock delivery time was more than or equal to 20 minutes, subsequent shock delivery was not associated with increased odds of 1-month favorable neurological outcomes.

Conclusions

In patients with an initial nonshockable rhythm after OHCA, subsequent conversion to shockable rhythms during emergency medical services resuscitation efforts was associated with increased odds of 1-month favorable neurological outcomes when the shock delivery time was less than 20 minutes.
Don’t miss the diagnosis of sepsis!
Authors: Marik Paul E
Published: September 2014

The early detection and treatment of sepsis are the most important factors in improving the outcome of patients with this condition. However, many patients admitted to hospital experience a long delay in the diagnosis of sepsis. Furthermore, it is not uncommon for febrile patients to be sent home from the Emergency Department or the physician’s office with the diagnosis of ‘flu’ only to return hours or days later in overt septic shock. The early diagnosis of sepsis may be challenging as many of the signs and symptoms are non-specific. Clinical studies suggest that early diagnosis of sepsis requires a high index of suspicion and comprehensive clinical evaluation together with laboratory tests, including a complete blood count with differential, lactate and procalcitonin levels.
Prehospital intravenous access and fluid resuscitation in severe sepsis: an observational cohort study
Authors: Seymour Christopher W , Cooke Colin R , Heckbert Susan R , Spertus John A , Callaway Clifton W , Martin-Gill Christian , Yealy Donald M , Rea Thomas D , Angus Derek C
Published: September 2014

Introduction

Prompt treatment of severe sepsis in the Emergency Department reduces deaths, but the role of prehospital fluid resuscitation is unknown. We sought to determine the risk-adjusted association between prehospital fluid administration and hospital mortality among emergency medical services (EMS) patients admitted with severe sepsis.

Methods

We performed a prospective, observational study of patients hospitalized with severe sepsis on admission among 45,394 adult EMS encounters taken to 15 hospitals from 11/2009 to 12/2010 by a two-tier EMS system in King County, Washington. The region mandated recording of prehospital intravenous catheter and fluid administration in prehospital records, along with detailed demographic, incident, physiologic, and hospital adjustment variables. We determined the effect of prehospital intravenous catheter or fluid versus no catheter or fluid on all-cause mortality using multivariable logistic regression.

Results

Of all encounters, 1,350 met criteria for severe sepsis on admission, of whom 205 (15%) died by hospital discharge, 312 (23%) received prehospital intravenous fluid, 90 (7%) received a prehospital catheter alone and 948 (70%) did not receive catheter or fluid. EMS administered a median prehospital fluid volume of 500 mL (interquartile range (IQR): 200, 1000 mL). In adjusted models, the administration of any prehospital fluid was associated with reduced hospital mortality (Odds ratio =0.46; 95% Confidence interval: 0.23, 0.88; P =0.02) compared to no prehospital fluid. The odds of hospital mortality were also lower among severe sepsis patients treated with prehospital intravenous catheter alone (Odds ratio =0.3; 95% Confidence interval: 0.17 to 0.57; P <0.01).

Conclusions

In a population-based study, the administration of prehospital fluid and placement of intravenous access were associated with decreased odds of hospital mortality compared with no prehospital catheter or fluid.
The lower limit of intensity to control uremia during continuous renal replacement therapy
Authors: Yasuda Hideto , Uchino Shigehiko , Uji Makiko , Ohnuma Tetsu , Namba Yoshitomo , Katayama Shinshu , Kawarazaki Hiroo , Toki Noriyoshi , Takeda Kenta , Izawa Junichi , Tokuhira Natsuko , Nagata Isao ,   JSEPTIC Clinical Trial Group
Published: September 2014

Introduction

The recommended lower limit of intensity during continuous renal replacement therapy (CRRT) is 20 or 25 mL/kg/h. However, limited information is available to support this threshold. We aimed to evaluate the impact of different intensities of CRRT on the clearance of creatinine and urea in critically ill patients with severe acute kidney injury (AKI).

Methods

This is a multicenter retrospective study conducted in 14 Japanese ICUs in 12 centers. All patients older than 18 years and treated with CRRT due to AKI were eligible. We evaluated the effect of CRRT intensity by two different definitions: daily intensity (the mean intensity over each 24-h period) and average intensity (the mean of daily intensity during the period while CRRT was performed). To study the effect of different CRRT intensity on clearance of urea and creatinine, all patients/daily observations were arbitrarily allocated to one of 4 groups based on the average intensity and daily intensity: <10, 10-15, 15-20, and >20 mL/kg/h.

Results

Total 316 patients were included and divided into the four groups according to average CRRT intensity. The groups comprised 64 (20.3%), 138 (43.7%), 68 (21.5%), and 46 patients (14.6%), respectively. Decreases in creatinine and urea increased as the average intensity increased over the first 7 days of CRRT. The relative changes of serum creatinine and urea levels remained close to 1 over the 7 days in the “<10” group. Total 1,101 daily observations were included and divided into the four groups according to daily CRRT intensity. The groups comprised 254 (23.1%), 470 (42.7%), 239 (21.7%), and 138 observations (12.5%), respectively. Creatinine and urea increased (negative daily change) only in the “<10“ group and decreased with the increasing daily intensity in the other groups.

Conclusions

The lower limit of delivered intensity to control uremia during CRRT was approximately between 10 and 15 mL/kg/h in our cohort. A prescribed intensity of approximately 15 mL/kg/h might be adequate to control uremia for patients with severe AKI in the ICU. However, considering the limitations due to the retrospective nature of this study, prospective studies are required to confirm our findings.
Perioperative blood transfusion is associated with a gene transcription profile characteristic of immunosuppression: a prospective cohort study
Authors: Fragkou Paraskevi C , Torrance Hew D , Pearse Rupert M , Ackland Gareth L , Prowle John R , Owen Helen C , Hinds Charles J , O’Dwyer Michael J
Published: September 2014

Introduction

Blood transfusion in the perioperative period has frequently been associated with an excess of nosocomial infections. Whilst transfused whole blood induces specific host immune alteration that may predispose to nosocomial infections, the immunomodulating properties associated with leukodepleted blood remain incompletely understood. In this study, we explore the hypothesis that the transfusion of leukodepleted allogeneic blood during or following major gastrointestinal surgery is associated with an immunosuppressed phenotype, which may in turn predispose to postoperative infectious complications.

Methods

Patients aged over 45 years undergoing scheduled inpatient major gastrointestinal surgery were recruited. Gene expression profiles of specific inflammatory genes were assayed from blood collected preoperatively, at 24 and at 48 hours after surgery. Genes were selected based on their ability to represent specific immune pathways. Gene expression was quantified using quantitative real-time polymerase chain reaction (qRT-PCR) to measure messenger RNA (mRNA) levels. Postoperative infections were documented using predefined criteria.

Results

One hundred and nineteen patients were recruited. Fifteen (13%) patients required blood transfusion within 24 hours of surgery, 44 (37%) patients developed infections and 3 (2%) patients died prior to discharge. Patients receiving a blood transfusion were more likely to develop postoperative infections (P =0.02) and to have lower tumour necrosis factor alpha (TNFα), interleukin (IL)-12, IL-23 and RAR-related orphan receptor gamma T (RORγt) gene expression in the postoperative period (P <0.05). The TNFα/IL-10 mRNA ratio at 24 hours (P =0.0006) and at 48 hours (P =0.01) was lower in patients receiving a blood transfusion over this period. Multivariable analysis confirmed that these observations were independent of the severity of the surgical insult.

Conclusions

An association between an immunosuppressive pattern of gene expression and blood transfusion following major elective gastrointestinal surgery is described. This gene expression profile includes a reduction in the activity of innate immunity and T helper cell type 1 (Th1) and T helper cell type 17 (Th17) pathways in those patients receiving a blood transfusion. Blood transfusion was also associated with an excess of infectious complications in this cohort. A mechanistic link is suggested but not proven.
Lack of replication of interactions between polymorphisms in rheumatoid arthritis susceptibility: case–control study
Authors: Ferreiro-Iglesias Aida , Calaza Manuel , Perez-Pampin Eva , Lopez Longo Francisco J , Marenco Jose L , Blanco Francisco J , Narvaez Javier , Navarro Federico , Cañete Juan D , de la Serna Arturo R , Gonzalez-Alvaro Isidoro , Herrero-Beaumont Gabriel , Pablos Jose L , Balsa Alejandro , Fernandez-Gutierrez Benjamin , Caliz Rafael , Gomez-Reino Juan J , Gonzalez Antonio
Published: September 2014

Introduction

Approximately 100 loci have been definitively associated with rheumatoid arthritis (RA) susceptibility. However, they explain only a fraction of RA heritability. Interactions between polymorphisms could explain part of the remaining heritability. Multiple interactions have been reported, but only the shared epitope (SE) × protein tyrosine phosphatase nonreceptor type 22 (PTPN22) interaction has been replicated convincingly. Two recent studies deserve attention because of their quality, including their replication in a second sample collection. In one of them, researchers identified interactions between PTPN22 and seven single-nucleotide polymorphisms (SNPs). The other showed interactions between the SE and the null genotype of glutathione S-transferase Mu 1 (GSTM1) in the anti–cyclic citrullinated peptide–positive (anti-CCP+) patients. In the present study, we aimed to replicate association with RA susceptibility of interactions described in these two high-quality studies.

Methods

A total of 1,744 patients with RA and 1,650 healthy controls of Spanish ancestry were studied. Polymorphisms were genotyped by single-base extension. SE genotypes of 736 patients were available from previous studies. Interaction analysis was done using multiple methods, including those originally reported and the most powerful methods described.

Results

Genotypes of one of the SNPs (rs4695888) failed quality control tests. The call rate for the other eight polymorphisms was 99.9%. The frequencies of the polymorphisms were similar in RA patients and controls, except for PTPN22 SNP. None of the interactions between PTPN22 SNPs and the six SNPs that met quality control tests was replicated as a significant interaction term—the originally reported finding—or with any of the other methods. Nor was the interaction between GSTM1 and the SE replicated as a departure from additivity in anti-CCP+ patients or with any of the other methods.

Conclusions

None of the interactions tested were replicated in spite of sufficient power and assessment with different assays. These negative results indicate that whether interactions are significant contributors to RA susceptibility remains unknown and that strict standards need to be applied to claim that an interaction exists.
Tapping into the endocannabinoid system to ameliorate acute inflammatory flares and associated pain in mouse knee joints
Authors: Krustev Eugene , Reid Allison , McDougall Jason J
Published: September 2014

Introduction

During the progression of rheumatoid arthritis (RA), there are frequent but intermittent flares in which the joint becomes acutely inflamed and painful. Although a number of drug therapies are currently used to treat RA, their effectiveness is variable and side effects are common. Endocannabinoids have the potential to ameliorate joint pain and inflammation, but these beneficial effects are limited by their rapid degradation. One enzyme responsible for endocannabinoid breakdown is fatty acid amide hydrolase (FAAH). The present study examined whether URB597, a potent and selective FAAH inhibitor, could alter inflammation and pain in a mouse model of acute synovitis.

Methods

Acute joint inflammation was induced in male C57BL/6 mice by intra-articular injection of 2% kaolin/2% carrageenan. After 24 hr, articular leukocyte kinetics and blood flow were used as measures of inflammation, while hindlimb weight bearing and von Frey hair algesiometry were used as measures of joint pain. The effects of local URB597 administration were then determined in the presence or absence of either the cannabinoid (CB)1 receptor antagonist AM251, or the CB2 receptor antagonist AM630.

Results

URB597 decreased leukocyte rolling and adhesion, as well as inflammation-induced hyperaemia. However, these effects were only apparent at low doses and the effects of URB597 were absent at higher doses. In addition to the anti-inflammatory effects of URB597, fatty acid amide hydrolase (FAAH) inhibition improved both hindlimb weight bearing and von Frey hair withdrawal thresholds. The anti-inflammatory effects of URB597 on leukocyte rolling and vascular perfusion were blocked by both CB1 and CB2 antagonism, while the effect on leukocyte adherence was independent of cannabinoid receptor activation. The analgesic effects of URB597 were CB1 mediated.

Conclusions

These results suggest that the endocannabinoid system of the joint can be harnessed to decrease acute inflammatory reactions and the concomitant pain associated with these episodes.
Assessing outcomes for cost-utility analysis in depression:
comparison of five multi-attribute utility instruments with two
depression-specific outcome measures
Authors: Mihalopoulos Cathrine , Chen Gang , Iezzi Angelo , Khan Munir A. , Richardson Jeffrey
Published: September 2014

Background

Many mental health surveys and clinical studies do not include a
multi-attribute utility instrument (MAUI) that produces quality-adjusted
life-years (QALYs). There is also some question about the sensitivity of
the existing utility instruments to mental health.

Aims

To compare the sensitivity of five commonly used MAUIs (Assessment of
Quality of Life – Eight Dimension Scale (AQoL-8D), EuroQoL–five dimension
(EQ-5D-5L), Short Form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3),
15D) with that of disease-specific depression outcome measures
(Depression Anxiety Stress Scales (DASS-21) and the Kessler Psychological
Distress Scale (K10)) and develop ‘crosswalk’ transformation algorithms
between the measures.

Method

Individual data from 917 people with self-report depression collected as
part of the International Multi-Instrument Comparison Survey.

Results

All the MAUIs discriminated between the levels of severity measured by
the K10 and the DASS-21. The AQoL-8D had the highest correlation with the
disease-specific measures and the best goodness-of-fit transformation
properties.

Conclusions

The algorithms developed in this study can be used to determine
cost-effectiveness of services or interventions where utility measures
are not collected.
The ubiquitin ligase FbxL7 regulates the Dachsous-Fat-Dachs system in Drosophila
Authors: Rodrigues-Campos Mariana , Thompson Barry J.
Published: September 2014

The atypical cadherins Dachsous (Ds) and Fat (Ft) are required to control the size and shape of tissues and organs in animals. In Drosophila, a key effector of Ds and Ft is the atypical myosin Dachs, which becomes planar polarised along the proximal-distal axis in developing epithelia to regulate tissue size via the Hippo pathway and tissue shape via modulating tension at junctions. How Ds and Ft control Dachs polarisation remains unclear. Here, we identify a ubiquitin ligase, FbxL7, as a novel component of the Ds-Ft-Dachs system that is required to control the level and localisation of Dachs. Loss of FbxL7 results in accumulation of Dachs, similar to loss of Ft. Overexpression of FbxL7 causes downregulation of Dachs, similar to overexpression of the Ft intracellular domain. In addition to regulating Dachs, FbxL7 also influences Ds in a similar manner. GFP-tagged FbxL7 localises to the plasma membrane in a Ft-dependent manner and is planar polarised. We propose that Ft recruits FbxL7 to the proximal side of the cell to help restrict Ds and Dachs to the distal side of the cell.
The C2-domain protein QUIRKY and the receptor-like kinase STRUBBELIG localize to plasmodesmata and mediate tissue morphogenesis in Arabidopsis thaliana
Authors: Vaddepalli Prasad , Herrmann Anja , Fulton Lynette , Oelschner Maxi , Hillmer Stefan , Stratil Thomas F. , Fastner Astrid , Hammes Ulrich Z. , Ott Thomas , Robinson David G. , Schneitz Kay
Published: September 2014

Tissue morphogenesis in plants requires communication between cells, a process involving the trafficking of molecules through plasmodesmata (PD). PD conductivity is regulated by endogenous and exogenous signals. However, the underlying signaling mechanisms remain enigmatic. In Arabidopsis, signal transduction mediated by the receptor-like kinase STRUBBELIG (SUB) contributes to inter-cell layer signaling during tissue morphogenesis. Previous analysis has revealed that SUB acts non-cell-autonomously suggesting that SUB controls tissue morphogenesis by participating in the formation or propagation of a downstream mobile signal. A genetic screen identified QUIRKY (QKY), encoding a predicted membrane-anchored C2-domain protein, as a component of SUB signaling. Here, we provide further insight into the role of QKY in this process. We show that like SUB, QKY exhibits non-cell-autonomy when expressed in a tissue-specific manner and that non-autonomy of QKY extends across several cells. In addition, we report on localization studies indicating that QKY and SUB localize to PD but independently of each other. FRET-FLIM analysis suggests that SUB and QKY are in close contact at PD in vivo. We propose a model where SUB and QKY interact at PD to promote tissue morphogenesis, thereby linking RLK-dependent signal transduction and intercellular communication mediated by PD.