bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonlinear pricing and exclusion: I. buyer opportunism
Authors: Choné Philippe , Linnemer Laurent
Published: April 2015

We study the exclusionary properties of nonlinear price‐quantity schedules in an Aghion‐Bolton style model with elastic demand and product differentiation. We distinguish three regimes, depending on whether and how the price charged by the dominant firm depends on the quantity purchased from the rival firm. We find that the supply of rival good is distorted downward. Moreover, given the quantity supplied from the rival, the buyer may opportunistically purchase inefficiently many units from the dominant firm to pocket quantity rebates. We show that the possibility for the buyer to dispose of unconsumed units attenuates the opportunism problem and limits the exclusionary effects of nonlinear pricing.
Changes in the Blood Serum Levels of the Costimulatory Soluble B7‐H4 Molecule in Pregnant Women During the Peripartal Phase
Authors: Mach Pawel , Gellhaus Alexandra , Wicherek Lukasz , Schmidt Boerge , Kimmig Rainer , Kasimir‐Bauer Sabine , Köninger Angela
Published: April 2015

Problem

B7‐H4, a transmembrane protein that negatively regulates T lymphocytes, seems to play a role in the suppression of the im\mune response at the maternal–fetal interface. The aim of this study was to compare the blood serum concentration levels of soluble B7‐H4 (sB7‐H4) prepartal and postpartal in both women who experienced spontaneous onset of labor and those who underwent elective cesarian section.

Method of study

Blood was obtained from 30 prepartal and postpartal women who delivered at the University Hospital of Essen between 2011 and 2012. These patients were further divided into two subgroups depending on the advancement of labor. The sB7‐H4 blood serum concentration levels of the women in the groups were then determined by ELISA (BIOZOL, Eching, Germany).

Results

In women who underwent elective cesarian section, a significant increase in sB7‐H4 blood serum concentration levels occurred postpartal, while in women who experienced spontaneous onset of labor, no differences between prepartal and postpartal concentration levels were observed. The sB7‐H4 blood serum concentration levels on the day after delivery in the women who experienced spontaneous labor and those who underwent elective cesarian section were comparable; however, higher blood serum concentration levels of sB7‐H4 were observed prepartal in women with spontaneous onset of labor compared to those found in the women about to undergo elective cesarian section.

Conclusion

These changes in sB7‐H4 blood serum concentration levels suggest that this protein is involved in immunological changes associated with the spontaneous onset of labor and post‐delivery homeostasis.
Selective immediate responders to amoxicillin and clavulanic acid tolerate penicillin derivative administration after confirming the diagnosis
Authors: Blanca‐Lopez N. , Perez‐Alzate D. , Ruano F. , Garcimartin M. , de la Torre V. , Mayorga C. , Somoza M. L. , Perkins J. , Blanca M. , Canto M. G. , Torres M. J.
Published: April 2015

Background

An increasing number of patients show immediate selective hypersensitivity reactions to clavulanic acid (CLV) and amoxicillin (AX), probably due to their increased prescription. The maintenance of this response should be established.

Objective

To assess that the immediate hypersensitivity selective response to AX or to CLV is maintained after repeated administration of penicillin G (PG)/penicillin V (PV) and AX.

Methods

Patients with proven immediate hypersensitivity to AX (Group A) or CLV (Group B) were included. Diagnosis was performed using skin tests with major and minor determinants of PG (PPL/MDM), AX and CLV and by drug provocation test (DPT) if required. Selectivity was established by confirming tolerance to PG/PV (Group A) and to PG/PV and AX (Group B). The maintenance of the selective response was verified by repeating DPT, 15 days after the initial investigation, with the same procedure.

Results

Of 51 patients, 78% belonged to Group A and 22% to Group B. Most had anaphylaxis. In Group A, 72% were skin test positive; 28% required DPT. In Group B, 63% were skin test positive; 37% required DPT. Only two AX‐selective cases developed positive responses after re‐provocation with PG/PV. No cases selective for CLV developed a positive response to PG, PV or AX.

Discussion

The selective response to AX appears consistent, and a response to penicillin determinants only develops in a minority of cases. For the case of CLV, the selective response appears not to be modified by exposure to penicillin determinants, meaning that patients with CLV allergy can take penicillin derivatives safely.
Failed validation of risk prediction model for intervention in renal colic patients after emergency department evaluation
Authors: Dean Tanya , Crozier Jack , Klim Sharon , Kelly Anne‐Maree
Published: April 2015

Background

It has been reported that three criteria (size of calculus ≥6 mm, visual analogue scale pain score at discharge ≥2 cm and location above mid‐ureter; the Papa criteria) were sensitive for predicting patients who require intervention (surgery or lithotripsy) within 28 days of index emergency department (ED) visit for ureteric colic. It was suggested that absence of these criteria identified a group for whom early follow‐up may not be needed. No validation has been reported. We aimed to validate these criteria.

Methods

Retrospective cohort study of patients with clinical presentation of ureteric colic and radiologically proven renal tract stones. Data collected included demographics, clinical features, features of the stone, imaging results and 28‐day outcome. Outcome of interest was performance of the Papa criteria for prediction of urological intervention by clinical performance analysis. We also undertook a post hoc analysis to identify predictors of urological intervention for the group overall and for the subgroup discharged from ED.

Results

Two hundred and twenty‐four patients were studied (median age 49, 79% male) with 75 (33%) requiring urological intervention within 28 days. The presence of any of the Papa criteria had sensitivity for urological intervention of 83.9% (95% confidence interval (CI) 71.2–91.9%) with specificity of 47.7% (95% CI 38.9–56.6%), positive predictive value of 40.9% (95% CI 31.9–50.4%) and negative predictive value of 87.3% (95% CI 76.8–93.7%). Nine patients with no Papa criteria had intervention: 12.7% (95% CI 6.8–22.4%).

Conclusion

The Papa criteria are not sufficiently accurate to determine which patients require intervention or a subgroup who do not need specialist urological follow‐up.
An Alternative Approach for Perioperative Extracorporeal Life Support Implantation
Authors: Saeed Diyar , Maxhera Bujar , Westenfeld Ralf , Lichtenberg Artur , Albert Alexander
Published: April 2015

Central veno‐arterial extracorporeal membrane oxygenation (ECMO) is traditionally implanted using direct cannulation of the aorta and right atrium. We aim to summarize the outcome of patients who underwent perioperative central ECMO implantation using an alternative surgical approach, which allows sternum closure and does not require resternotomy at the time of explantation. We retrospectively reviewed patients who required veno‐arterial ECMO support at our institution between January 2013 and July 2014. Inclusion criteria were patients undergoing central ECMO implantation using the above‐mentioned implantation technique. Nine patients (65 ± 14 years) were supported using this technique. Four patients underwent coronary bypass surgery as a primary surgery and the other five patients had combined coronary and valve surgeries. The average duration of ECMO support was 9 ± 7 days (range 1–24 days). The dominant postoperative complication was renal failure, which occurred in eight patients (89%). In four patients (44%), the ECMO was successfully removed. Survival rate to discharge was 22%. In conclusion, this study showed the feasibility of this alternative ECMO implantation technique. No technical issues were encountered. Extended support duration and reducing resternotomy risks may be the main advantages of this technique compared with conventional ECMO implantation methods.
Severe cellulitis and abdominal wall emphysema following laparoscopic colonic surgery: A case report
Authors: Tanaka Ryo , Kameyama Hitoshi , Chida Tadasu , Kanda Tatsuo , Kano Yosuke , Ichikawa Hiroshi , Hanyu Takaaki , Ishikawa Takashi , Kosugi Shin‐ichi , Wakai Toshifumi
Published: April 2015

Abdominal wall emphysema is a common complication of laparoscopic surgery. This condition is usually harmless; however, if an infection occurs, it can develop into a serious condition such as necrotizing fasciitis. We report a case of a 51‐year‐old woman suffering from severe cellulitis that spread from an area of abdominal wall emphysema after laparoscopic surgery for sigmoid colon cancer. Recognizing this complication, early diagnosis, and prompt treatment are cornerstones for successful management of this potentially fatal disease.
Laparoscopic resection of a paraganglioma located on the border of the thoracic and abdominal cavities using a transabdominal‐transdiaphragmatic approach
Authors: Sunose Yutaka , Hirai Keitaro , Nakazawa Seshiru , Yoshinari Daisuke , Ogawa Hiroomi , Tsukagoshi Hiroshi , Takahashi Norifumi , Yamazaki Hodaka , Motegi Yoko , Miyamae Yohei , Igarashi Takamichi , Takahashi Kengo , Katoh Ryuji , Tanaka Kazumi , Takeyoshi Izumi
Published: April 2015

We treated a 64‐year‐old woman with high blood pressure. Catecholamine metabolite levels were elevated in the blood and urine. CT revealed a densely stained tumor on the right side of the descending aorta dorsal to the inferior vena cava. PET‐CT revealed abnormal accumulation of 18F‐fluorodeoxyglucose, and 123I‐meta‐iodo‐benzylguanidine uptake was apparent on scintigraphy. The tumor was determined to be a paraganglioma located on the border between the thoracic and abdominal cavities, and laparoscopic tumorectomy was performed. The patient was placed in the left lateral position. The right lobe of the liver was turned over, and we cut the diaphragm to expose the front of the tumor. We resected the straight artery flowing in from the aorta and removed the tumor safely. Herein, we describe the removal of a paravertebral paraganglioma located in the border of the thoracic and abdominal cavities with a laparoscopic transabdominal‐transdiaphragmatic approach.
V‐loc™ capable of grasping surrounding tissue causes obstruction at the jejunojejunostomy after Roux‐en‐Y laparoscopic gastric bypass
Authors: Oor Jelmer , de Castro Steve , van Wagensveld Bart
Published: April 2015

Because of the increasing number of morbidly obese patients, laparoscopic Roux‐en‐Y gastric bypass surgery is increasingly being performed to treat these patients and achieve sustained weight loss. Postoperative abdominal symptoms suggestive of impaired gastrointestinal passage are a diagnostic challenge after Roux‐en‐Y gastric bypass. Here, we present the case of a V‐loc™‐induced obstruction at the jejunojejunostomy caused by the ability of the V‐loc suture to grasp surrounding tissue that required re‐laparoscopy. To our knowledge, this specific type of postoperative complication after Roux‐en‐Y gastric bypass has not been described previously.
Case report of a laparoscopically resected rectal villous tumor associated with electrolyte depletion syndrome
Authors: Igarashi Kazuharu , Nakamura Takatoshi , Sato Takeo , Tsutsui Atsuko , Miura Hirohisa , Ogura Naoto , Naito Masanori , Yamanashi Takahiro , Watanabe Masahiko
Published: April 2015

A 70‐year‐old woman had been aware of lower extremity weakness and anal discomfort for 3 years. A soft, elastic, palm‐sized mass covered by a large amount of mucus was found protruding from the anus. Biopsy revealed a villous adenoma. On the basis of these results, a villous adenoma associated with electrolyte depletion syndrome was diagnosed. After electrolyte abnormalities were improved by fluid replacement therapy, laparoscopic abdominoperineal resection was performed. The surgically resected specimen was a circumferential villous tumor measuring 210 × 140 mm. The histopathological diagnosis was an intramucosal papillary adenocarcinoma. The patient recovered uneventfully after surgery, and the electrolyte abnormalities gradually improved. She was discharged on the 28th postoperative day. The electrolyte levels normalized about 3 months after surgery.
Teaching, Learning and Bion's Model of Digestion
Authors: Edwards Judith
Published: April 2015

In this paper the author is using Bion's model of the digestive process, among other models, in order to think about how teaching of theory can be approached as a task and undertaken in practice. Beginning with the ideas of Plato, she discusses how new ideas may be best conveyed, and how psychoanalytic theory teachers (using the teaching of Melanie Klein's ideas here to make her points) may make what they teach acceptable and ‘digestible’ to students. She uses some material from a theory group as well as a baby observation group, and concludes that in group teaching the responsibility for the taking on and elaboration of ideas – a process of digestion – is shared by the teacher and by the group. As psychoanalytic workers need to be able to ‘manage uncertainty’ in daily practice, this state of mind can usefully also be held by the theory teacher. The process of digestion will vary according to the composition of any group, drawing out different facets of understanding in both ‘teachers’ and ‘learners’, and may well draw on other vertices beyond that of psychoanalysis. These links will aid the process of digesting ideas, and will also be evident in the author style, structure and content of this paper.
Online and social media presence of Australian and New Zealand urologists
Authors: Davies Nicholas , Murphy Declan G. , van Rij Simon , Woo Henry H. , Lawrentschuk Nathan
Published: April 2015

Objective

To assess the online and social media presence of all practising Australian and New Zealand urologists.

Subjects and Methods

In July 2014, all active members of the Urological Society of Australia and New Zealand (USANZ) were identified. A comprehensive search of Google and each social media platform (Facebook, Twitter, LinkedIn and YouTube) was undertaken for each urologist to identify any private websites or social media profiles.

Results

Of the 435 urologists currently practising in Australia and New Zealand, 305 (70.1%) have an easily identifiable social media account. LinkedIn (51.3%) is the most commonly used form of social media followed by Twitter (33.3%) and private Facebook (30.1%) accounts. About half (49.8%) have a private business website. The average number of social media accounts per urologist is 1.42 and 16 urologists (3.7%) have an account with all searched social media platforms. Over half of those with a Twitter account (55.9%) follow a dedicated urology journal club and have a median (range) number of ‘followers’ of 12 (1–2 862). Social media users had a median (range) of 2 (0–8 717) ‘tweets’ on Twitter, 2 (1–45) LinkedIn posts and 1 (1–14) YouTube video.

Conclusion

This study represents a unique dataset not relying on selection or recall bias but using data freely available to patients and colleagues to gauge social media presence of urologists. Most Australian and New Zealand urologists have a readily identifiable online and social media presence, with widespread and consistent use across both countries.
Ofatumumab capacity to deplete B cells from chronic lymphocytic leukaemia is affected by C4 complement exhaustion
Authors: Tempescul Adrian , Bagacean Cristina , Riou Catherine , Bendaoud Boutahar , Hillion Sophie , Debant Marjolaine , Buors Caroline , Berthou Christian , Renaudineau Yves
Published: April 2015

The management of patients with chronic lymphocytic leukaemia (CLL) has improved with the utilisation of ofatumumab as a novel anti‐CD20 monoclonal antibody. However, as half of the patients fail to respond to the treatment, the aim of this study was to evaluate circulating CLL cell depletion and clinical response according to the context of complement activation and FcγRIIIA polymorphism in ten CLL patients with relapsed/refractory disease. At the end of the treatment, results indicated that circulating CD5+ CD19+ CLL cell depletion was major (<0.01 × 109/L) in 4 of 10 patients, partial (>50% decrease) in 4 of 10 patients and ineffective for the two other patients. No clinical modifications were observed following ofatumumab introduction. Ofatumumab administration leads to a rapid and important exhaustion of complement C4 levels in patients with initial lymphocytosis. C4 exhaustion was accelerated in a non‐responder patient, and incomplete in two patients with partial circulating depletion. Moreover, delaying weekly to monthly ofatumumab injections improved CLL cell depletion in two patients. FcγRIIIA 158 polymorphism (FF n = 6 and VF n = 4) was not associated with major and/or partial circulating CLL cell depletion. In conclusion, ofatumumab induces an important C4 exhaustion that needs to be taken into account when treating CLL patients with ofatumumab.
Tendonitis of branches of the superficial digital flexor tendon in Standardbred racehorses: 15 cases
Authors: Tricaud C. , Cousty M. , Alexandre A. , Tessier C. , David F.
Published: April 2015

This case report describes the clinical and ultrasonographic findings and performance outcome of distal tendonitis of the superficial digital flexor tendon (SDFT) in Standardbred racehorses. Cases with distal tendonitis of the SDFT in isolation (not associated with a metacarpal lesion) were reviewed retrospectively. The clinical and ultrasonographic findings and performance outcome were reviewed. The injury was located on the left forelimb in 67% (10/15) of horses and on the right forelimb in 33% (5/15). None of the horses were affected bilaterally. The lateral branch was involved in 80% of the cases (12/15) and medial branch in 20% (3/15). None of the horses were affected biaxially. Mean time between injury and first start ± s.d. was 302 ± 142 days. Returning to racing was observed in 93% of the horses (14/15), with a reinjury rate of 22% (2/9). For horses which raced after the injury, the number of starts, shows and wins was not significantly different before and after injury, regardless of the location of the lesion. Tendonitis of branches of the SDFT in isolation carries a good prognosis in Standardbred racehorses. A higher return to racing and a lower reinjury rate may be expected compared to lesions in the metacarpal region.
“The Penny Lunch has Spread Faster than the Measles”: Children's Health and the Debate over School Lunches in New York City, 1908–1930
Authors: Ruis A. R.
Published: April 2015

A few days before Thanksgiving in 1908, the home economist Mabel Hyde Kittredge initiated a school lunch program at an elementary school in Hell's Kitchen, serving soup and bread to hungry children in the infamous Manhattan neighborhood. The following year, she founded the School Lunch Committee (SLC), a voluntary organization composed of home economists, educators, physicians, and philanthropists dedicated to improving the nutritional health and educational prospects of schoolchildren. By 1915, just seven years after the initiative began, the SLC was serving 80,000 free or low-price lunches a year to children at nearly a quarter of the elementary schools in Manhattan and the Bronx. Most of the schools were located in the city's poorest districts, and experience showed that the lunches were reaching those most in need at minimal cost to the organization. All the food served was inspected by the Health Department, and the meals were nutritionally balanced and tailored to the ethnic tastes and religious requirements of different school populations. Sparse but compelling evidence indicated that the program had reduced malnourishment among the children who partook, and teachers and principals at participating schools reported reductions in behavioral problems, dyspepsia, inattentiveness, and lethargy.
The Search for High‐Impact Diagnostic and Management Tools for Low‐ and Middle‐Income Countries: A Self‐Powered Low‐Cost Blood Pressure Measurement Device Powered by a Solid‐State Vibration Energy Harvester
Authors: Bilgen Onur , Kenerson John G. , Akpinar‐Elci Muge , Hattery Rebecca , Hanson Lisbet M.
Published: April 2015

The World Health Organization has established recommendations for blood pressure measurement devices for use in low‐resource venues, setting the “triple A” expectations of Accuracy, Affordability, and Availability. Because of issues related to training and assessment of proficiency, the pendulum has swung away from manual blood pressure devices and auscultatory techniques towards automatic oscillometric devices. As a result of power challenges in the developing world, there has also been a push towards semiautomatic devices that are not dependent on external power sources or batteries. Beyond solar solutions, disruptive technology related to solid‐state vibrational energy harvesting may be the next iterative solution to attain the ultimate goal of a self‐powered low‐cost validated device that is simple to use and reliable.
Toll‐like receptor 2 agonist Pam3CSK4 up‐regulates FcεRI receptor expression on monocytes from patients with severe extrinsic atopic dermatitis
Authors: Song Z. , Deng X. , Chen W. , Xu J. , Chen S. , Zhong H. , Hao F.
Published: April 2015

Background

Both microbial antigens and allergens are important factors that can trigger atopic dermatitis (AD). Monocytes from patients with AD have been found to express increased and sustained levels of high‐affinity IgE receptor (FcεRI) and Toll‐like receptor 2 (TLR2). We hypothesized that putative interactions exist between TLR2 and FcεRI on monocytes in the pathogenesis of AD.

Objective

This study aimed to understand whether activation of TLR2 by Pam3CSK4 would influence the expression of FcεRI, and whether mitogen‐activated protein kinase (MAPK) signalling pathways were involved in such regulation.

Methods

Peripheral blood monocytes from patients with severe extrinsic AD or healthy control patients were treated with the TLR2 agonist Pam3CSK4. The expression of FcεRI, intracellular TNF‐α and MAPK family members were analysed by real‐time quantitative PCR, flow cytometry and western blotting.

Results

Monocytes from patients with severe extrinsic AD expressed higher levels of surface FcεRIα than were found in monocytes from healthy controls. Stimulation of human monocytes from patients with Pam3CSK4, but not lipopolysaccharide (LPS), resulted in the up‐regulation of surface FcεRI expression by inducing p38 phosphorylation. Pretreatment with a specific inhibitor of p38 kinase inhibited the Pam3CSK4‐induced up‐regulation of FcεRIα, suggesting the involvement of the p38 pathway in the regulation of this process.

Conclusion

Our findings indicated interactions between TLR2 and FcεRI occurred via the activation of p38 in patients with severe extrinsic AD, which might indicate insights into understanding the mechanisms of how bacterial infection can exacerbate the clinical features of AD.
Age‐related trends in vertebral dimensions
Authors: Junno Juho‐Antti , Paananen Markus , Karppinen Jaro , Niinimäki Jaakko , Niskanen Markku , Maijanen Heli , Väre Tiina , Järvelin Marjo‐Riitta , Nieminen Miika T. , Tuukkanen Juha , Ruff Christopher
Published: April 2015

Several studies have demonstrated age‐related changes in vertebral dimensions. Vertebral size has been reported to increase among elderly adults, with periosteal apposition resulting in increased cross‐sectional area (CSA) of the vertebral corpus combined with reduction in bone mineral density. These changes in CSA are observed to be sex‐specific, as the pronounced increase of vertebral CSA is found only in elderly males. However, the reduction in bone mineral density in old age is apparent within both sexes. It is thus hypothesized that higher fracture risk in elderly women is a result of their incapacity to increase vertebral size and thus adapt to bone mineral reduction. In this study, our aim was to explore whether the onset of these changes could be ascribed to specific age intervals and whether the proposed differences between the sexes are as great as previously suggested. To conduct this study we utilized two large early 20th century skeletal collections known as Terry and Bass (n = 181). We also utilized data from two lumbar spine magnetic resonance imaging samples as a modern‐day reference (n = 497). Age, sex and ethnicity of all individuals were known. Vertebral CSA was determined by measuring three width and length dimensions from the corpus of the fourth lumbar vertebra (L4). Our results indicate only a moderate association between age and vertebral CSA. This association was observed to be relatively similar in both sexes, and we thus conclude that there is no clear sex‐specific compensatory mechanism for age‐related bone loss in vertebral size.
Feminist Ethics and Religious Ethics
Authors: Mohrmann Margaret
Published: April 2015

This focus issue is a conversation at and about the interface of feminist ethics and religious ethics, in order to show what these multifaceted fields of intellectual endeavor and practical import have to say to each other, to teach and to learn. The seven essays approach that dialogue from a variety of angles and traditions, reflecting the fecundity of both fields and the wide‐ranging concerns of colleagues in religious ethics who share commitments and methods with feminist ethics.
First Report of Peronospora belbahrii on Sweet Basil in Baja California Sur, México
Authors: Bastidas Mirella Romero , Picazo Liliana Saucedo , Amador Bernardo Murillo , Garibay Alejandra Nieto , Barragan Hever Latisnere , Hernandez Montiel Luis G.
Published: April 2015

In Baja California Sur, Mexico, a foliar disease occurred on sweet basil which seriously affected its quality and yield. The most common symptoms were yellowing and necrosis on leaves, caused by a downy mycelium growth on the lower leaf surface. Symptomatic leaves from two sampling sites were collected for morphological studies and molecular analysis of pathogen DNA. Based on morphological characteristics (sporangiophore size of 240–530 × 7–11 μm, branches of 5–8 order and a sporangia size of 27–31 × 21–25 μm) and molecular analysis (the GenBank blast of the PCR assays showed unique rDNA sequence data with 99% similarity to P. belbahrii), the pathogen was identified as Peronospora belbahrii, the causal agent of basil downy mildew. This is the first report of P. belbahrii affecting sweet basil in Mexico.
Sedation scoring and managing abilities of intensive care nurses post educational intervention
Authors: Ramoo Vimala , Abdullah Khatijah Lim , Tan Patrick SK , Wong Li Ping , Chua Yan Piaw , Tang Li Yoong
Published: April 2015

Background

Inappropriate sedation assessment can jeopardize patient comfort and safety. Therefore, nurses' abilities in assessing and managing sedation are vital for effective care of mechanically ventilated patients.

Aims and objectives

This study assessed nurses' sedation scoring and management abilities as primary outcomes following educational interventions. Nurses' perceived self‐confidence and barriers to effective sedation management were assessed as secondary outcomes.

Design

A post‐test‐only quasi‐experimental design was used. Data were collected at 3 and 9 months post‐intervention.

Methods

A total of 66 nurses from a 14‐bed intensive care unit of a Malaysian teaching hospital participated. The educational interventions included theoretical sessions, hands‐on sedation assessment practice using the Richmond Agitation Sedation Scale, and a brief sedation assessment tool. Nurses' sedation scoring and management abilities and perceived self‐confidence level were assessed at both time points using self‐administered questionnaires with case scenarios. Sedation assessment and management barriers were assessed once at 9 months post‐intervention.

Results

Median scores for overall accurate sedation scoring (9 months: 4·00; 3 months: 2·00, p = 0·0001) and overall sedation management (9 months: 14·0; 3 months: 7·0, p = 0·0001) were significantly higher at 9 months compared to 3 months post‐intervention. There were no significant differences in the perceived self‐confidence level for rating sedation level. Overall perceived barrier scores were low (M = 27·78, SD = 6·26, possible range = 11·0–55·0). Patient conditions (M = 3·68, SD = 1·13) and nurses' workload (M = 3·54, SD = 0·95) were the greatest barriers to effective sedation assessment and management. Demographic variables did not affect sedation scoring or management abilities.

Conclusions

Positive changes in nurses' sedation assessment and management abilities were observed, indicating that adequate hands‐on clinical practice following educational interventions can improve nurses' knowledge and skills.

Relevance to clinical practice

Educational initiatives are necessary to improve ICU practice, particularly in ICUs with inexperienced nurses.
Alternative framings of alternative food: A typology of practice
Authors: Sharp Emma L. , Friesen Wardlow , Lewis Nicolas
Published: April 2015

‘Alternative’ food initiatives (AFIs) are often interpreted as political movements, constructed as defiant alternatives to industrial agri‐food relations, and represented by a performance of singular alterity. This understanding of alternative collapses into a mere politics of identity, criticised in the literature for its oversimplification. In this paper, we utilise an established methodological framework that retains AFI diversity, to create a novel typology of AFIs by diverse and embodied practice rather than animating political project. In doing so, we point to the political potential for AFIs to ‘do’ food otherwise and make different worlds.
Upper Ordovician chondrichthyan‐like scales from North America
Authors: Andreev Plamen S. , Coates Michael I. , Shelton Richard M. , Cooper Paul R. , Smith M. Paul , Sansom Ivan J.
Published: April 2015

Studies of Ordovician micromeric fish scales from the Sandbian of North America have identified a number of scale‐based taxa potentially referable to the chondrichthyans and therefore can be among the stratigraphically oldest representatives of the clade described to date. Two of these, Tezakia hardingensis gen. et sp. nov. and Canyonlepis smithae gen. et sp. nov., are formally described herein. Tezakia gen. nov. scales are composed exclusively of tubular dentine and possess polyodontocomplex crowns with a characteristically large primordial odontode. Similar scale crown architecture has been reported only in the reputed chondrichthyan Altholepis composita (Lower Devonian of Podolia, Ukraine), and on these grounds, the two are united within the newly erected Altholepidiformes ordo nov. Multiple odontocomplexes are also a feature of Canyonlepis gen. nov. scale crowns; however, the latter do not demonstrate prominent primordial odontodes and are supported by a base composed of acellular bone. Additional data suggest that both taxa possess a combination of characteristics (areal crown growth, scale symmetry, linear odontocomplex architecture and absence of enamel, osteons, cancellous bone and hard‐tissue resorption) previously documented to occur only in chondrichthyan scales. This study contributes to a growing body of evidence that reveals the presence of diverse tissue types (bone, tubular and atubular dentine) and morphogenetic patterns (odontocomplex and non‐odontocomplex type of scale crown growth) in the dermal skeleton of putative Ordovician chondrichthyans.
Hydrologic and edaphic constraints on Schoenoplectus acutus, Schoenoplectus californicus, and Typha latifolia in tidal marsh restoration
Authors: Sloey Taylor M. , Willis Jonathan M. , Hester Mark W.
Published: April 2015

The demand for an improved knowledge base for planning and management of tidal marsh restoration worldwide has become more fully recognized. In the Sacramento‐San Joaquin Bay Delta, California, U.S.A., concerns have arisen about the degradation of the Delta and key ecosystem services. One restoration method proposed includes intentionally breaching levees that protect agricultural lands to re‐establish a hydrology that encourages tidal marsh development. Our research investigated relevant constraints on vegetation establishment and expansion of key tidal marsh species. We transplanted three macrophyte species (Schoenoplectus acutus, Schoenoplectus californicus, and Typha latifolia) using two transplant types (rhizomes and adults) in locations that varied in hydrologic and edaphic conditions at Liberty Island, a post‐levee breach tidal marsh restoration site. Two years of monitoring revealed that transplanted adults outperformed rhizomes. In addition, S. californicus exhibited greater survival and vegetation expansion. S. californicus vegetation expansion covered a maximum area of approximately 23 m2, which is two orders of magnitude (OOM) greater than the maximum area covered by S. acutus (approximately 0.108 m2) and three OOM greater than T. latifolia (approximately 0.035 m2). Results suggest that hydrologic regime and degree of soil compaction are influential in controlling vegetation establishment and expansion. Greater vegetation expansion occurred in transplant sites characterized by a deeper surface layer of non‐compacted soil in conjunction with shorter durations of flooding. Information derived from this study is valuable to restoration planning in the Delta and other tidal marshes worldwide where these species occur, especially in terms of setting restoration goals and trajectories based on site‐specific environmental characteristics.
Data Dependent Cells Chi‐Square Test With Recurrent Events
Authors: Adekpedjou Akim , De Mel WITHANAGE A. , Zamba Gideon KD
Published: April 2015

We consider a recurrent event wherein the inter‐event times are independent and identically distributed with a common absolutely continuous distribution function F. In this article, interest is in the problem of testing the null hypothesis that F belongs to some parametric family where the q‐dimensional parameter is unknown. We propose a general Chi‐squared test in which cell boundaries are data dependent. An estimator of the parameter obtained by minimizing a quadratic form resulting from a properly scaled vector of differences between Observed and Expected frequencies is used to construct the test. This estimator is known as the minimum chi‐square estimator. Large sample properties of the proposed test statistic are established using empirical processes tools. A simulation study is conducted to assess the performance of the test under parameter misspecification, and our procedures are applied to a fleet of Boeing 720 jet planes' air conditioning system failures.
Predicting Persistence of Nonsuicidal Self‐Injury in Suicidal Adolescents
Authors: Yen Shirley , Kuehn Kevin , Melvin Caitlin , Weinstock Lauren M. , Andover Margaret S. , Selby Edward A. , Solomon Joel B. , Spirito Anthony
Published: April 2015

Prospective predictors of persistent nonsuicidal self‐injury (NSSI) were examined in adolescents admitted to an inpatient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months. Seventy‐one (77%) participants reported NSSI at baseline, and 40 (56%) persisted at the 6 month follow‐up. Those who endorsed automatic positive reinforcement (APR) as the predominant reason for NSSI were more likely to persist in NSSI. Depression over follow‐up, but not at baseline, also predicted persistence. These results suggest that helping high‐risk adolescents to identify alternative ways of generating emotion(s) to counter the effects of APR that may accompany NSSI should be a high priority treatment target.
Teaching and Learning Guide for “Gender In/equality in Worker‐owned Businesses”
Authors: Sobering Katherine
Published: April 2015

This teaching and learning guide accompanies the article, “Gender In/equality in Worker‐owned Businesses,” which reviews existing literature on gender in businesses with employee stock ownership plans, worker cooperatives, and communes. Worker ownership has attracted renewed interest as a possible solution to the social and economic problems confronting our society. In worker‐owned businesses, workers have greater control over what they produce, how they produce it, and how they are compensated. If workers ran things themselves, so the story goes, jobs would be better and workplaces would be more equal. What do we actually know about work in alternative organizations? Do women fare better? Can they offer alternatives or solutions to the gender inequality that permeates working life? This teaching and learning guide provides supplemental information to facilitate the use of this article in the classroom. This includes a list of recommended readings, online resources, a sample syllabus, focus questions, and project suggestions.
The Conflictual Model of Analysis in Studies on the Media Representation of Islam and Muslims: A Critical Review
Authors: Faimau Gabriel
Published: April 2015

This article examines ‘the West versus Islam’ paradigm in the studies on the representation of Islam and Muslims in the Western media. It argues that while offering insights which uncover the hidden oppressive power that drives the representation of cultural differences, the use of the conflictual model of analysis in exploring media representations of Islam and Muslims provides no space for understanding the creative, dialogic formation in the encounter of individuals and people from different religious and cultural backgrounds. This conflictual model of analysis normally employs a simplistic, binary system of thinking, and is therefore inadequate as a response to the complex challenges faced by a multicultural society. To develop this argument, the article reviews various studies on media representations of Islam and Muslims that have relied on this model. In the light of the inadequacy of the conflictual model of analysis, the article suggests a shift to a dialogic model of analysis as developed in the politics of recognition as an alternative framework that accommodates the possibility of transformation in the encounter of individuals, people and cultures in a multicultural society.
Regime Type, Peace, and Reciprocal Effects
Authors: Enia Jason , James Patrick
Published: April 2015

Objectives

This study explores potential reciprocity in the relationship of democracy with peace. In the decade since introduction of a potential causal role for conflict relative to regime type in the 1990s, a number of theoretical and empirical advances have been made. These steps forward include an innovative statistical technique for estimating multiple equations with categorical dependent variables.

Methods

We use a system of equations to explore the reciprocal relationship. In our statistical model, we employ a variety of new independent variables and novel measurements of established independent variables that have emerged in the conflict processes literature.

Results

We find that the reciprocal relationship between conflict and regime type is sustained as a theoretically and empirically valid way to think about these two concepts.

Conclusions

Our results support the idea that reciprocity should find a place within the continuing trajectory of the neo‐Kantian research program.
Difficulties in hematopoietic progenitor cell collection from a patient with TEMPI syndrome and severe iatrogenic iron deficiency
Authors: Belizaire Roger , Sykes David B. , Chen Yi‐Bin A. , Spitzer Thomas R. , Makar Robert S.
Published: April 2015

BACKGROUND

Collection of hematopoietic progenitor cells by apheresis (HPC‐A) requires separation of cells by density. Previous studies highlighted the challenges of HPC‐A collection from patients with abnormal red blood cells (RBCs). TEMPI syndrome is a recently described condition defined by teleangiectasias, elevated erythropoietin and erythrocytosis, monoclonal gammopathy, perinephric fluid collections, and intrapulmonary shunting. Patients with TEMPI syndrome have responded to therapies used to treat plasma cell dyscrasias and may benefit from autologous HPC transplantation. We report HPC‐A collection from a patient with TEMPI syndrome that was complicated by severe iron deficiency.

STUDY DESIGN AND METHODS

The patient received granulocyte–colony‐stimulating factor (G‐CSF) and plerixafor for HPC mobilization and underwent 3 days of HPC‐A collection.

RESULTS

The patient presented for collection with a microcytic erythrocytosis. Over 3 days, approximately 50 L of whole blood was processed, and 2 × 108 CD34+ cells were collected (2.8 × 106 CD34+ cells/kg). The mean collection efficiency (CE), percentage of mononuclear cells, hematocrit (Hct), and RBC count were 18%, 90%, 14%, and 9 × 1011, respectively. Altering collection variables to avoid RBC contamination reduced CE. Ficoll preparations of the products after freeze‐thaw showed RBC contamination and hemolysis. Postthaw viability exceeded 95%. The products were not RBC reduced or washed. There were no adverse reactions during or after infusion.

CONCLUSIONS

HPC‐A collection from a patient with TEMPI syndrome was complicated by microcytic erythrocytosis, leading to RBC contamination and hemolysis in the product. Adequate HPCs were collected and the patient tolerated infusion without RBC depletion or washing. Our report highlights difficulties of HPC‐A collection from iron‐deficient patients.
Reducing error in feline platelet enumeration by addition of Iloprost to blood specimens: comparison to prostaglandin E1 and EDTA
Authors: Tvedten Harold W. , Bäcklund Kerstin , Lilliehöök Inger E.
Published: April 2015

Background

Prostaglandin E1 (PGE1) and Iloprost inhibit platelet aggregation and should prevent or minimize preanalytic error with feline platelet enumeration.

Objectives

The objective was to compare the relative effectiveness in reducing errors in platelet enumeration by adding Iloprost to feline EDTA blood specimens in comparison to adding PGE1 or EDTA alone. In addition, a grading system for platelet aggregation in blood smears was evaluated for effectiveness in predicting prominent errors and compared to ADVIA's PLT‐CLM flag. Finally, the use of plateletcrit in feline blood with platelet aggregation was evaluated.

Methods

Blood specimens from 35 cats were included. Blood was collected into EDTA tubes with or without Iloprost or PGE1, and was rapidly mixed. Platelet count (PLT), plateletcrit (PCT), mean platelet volume (MPV), and platelet flags were determined with an ADVIA 2120. Manual PLT was performed with a Leucoplate stain. PLT was determined by an IDEXX VetAutoread hematology analyzer (QBC).

Results

Neither addition of Iloprost nor PGE1 to EDTA blood specimens completely prevented platelet aggregation. Iloprost‐treated specimens had the least severe aggregation. PGE1 was better than EDTA alone. Significant errors in PLT results were consistently identified by the grading system. ADVIA's PLT‐CL flag usually predicted significant errors in PLT. QBC PLT results showed high imprecision. Manual PLT error was smaller than ADVIA PLT in EDTA specimens with aggregation.

Conclusions

Adding Iloprost to feline blood specimens improved platelet enumeration accuracy. A grading system for severity of platelet aggregation and usually the ADVIA's PLT‐CL alarm predicted specimens with significant errors in platelet enumeration.
Ophthalmic abnormalities secondary to periocular or ocular snakebite (pit vipers) in dogs—11 cases (2012–2014)
Authors: Martins Bianca C. , Plummer Caryn E. , Gelatt Kirk N. , Brooks Dennis E. , Czerwinski Sarah E. , Monk Caroline , Greenberg Shari M. , Mangan Brendan G. , Londoño Leonel , Bolfer Luiz , Bandt Carsten , Schaer Michael
Published: April 2015

Objective

To describe ophthalmic abnormalities secondary to periocular and ocular snakebite in dogs.

Animal Studied

Retrospective review of medical records from dogs presenting to the Small Animal Hospital at University of Florida following snakebites to the face (2012–2014). Two groups were identified: periocular bites (PB) and ocular bites (OB).

Results

Records from eleven dogs matched the search criteria and were included in the study (PB=9, 81.8%; OB=2, 18.2%). Both OB cases involved the cornea. Facial edema, blepharospasm, chemosis, and conjunctival hyperemia occurred in all cases (100%). Hemorrhage from the eyelids occurred in eight cases (72.7%; PB=7, OB=1). Subconjunctival hemorrhage occurred in seven cases (63.6%; PB=6, OB=1). Third eyelid laceration and nictitans gland prolapse occurred in 1 case each (9%; PB=1). Lagophthalmia was present in three cases (27.3%; PB=3), with secondary corneal ulcer in two cases (18.2%; PB=2). Corneal ulcer due to direct corneal bite occurred in two cases (18.2%—partial thickness with melting 1 and full thickness 1). Uveitis was present in 6 cases (54.5%; PB=4, OB=2), with flare and miosis in 4 cases (36.4%; PB=2, OB=2). Hyphema, fibrin in anterior chamber, and cataract occurred in one case (9%; OB=1). Vision loss occurred in two cases (18.2%; PB=2), secondary to retinal degeneration (PB=1) and amaurosis (PB=1). Mean follow‐up time was 7 weeks (range: 3 days–11 months). Most clinical signs had resolved by last examination.

Conclusions

Periocular symptoms were more commonly observed than ocular alterations, regardless of bite location. Appropriate supportive therapy should be instituted according to clinical signs.
Computer Techniques for Evaluating Gas Turbine Heat Recovery Applications
Authors: Stewart J. C.
Published: April 2015

The design of gas turbine heat recovery boiler systems is based on several engineering and economic parameters that require lengthy iterative calculations. Computer programs have been developed which reduce the time factor and provide the optimum design for a given set of exhaust conditions and steam requirements. This paper describes programs which provide an installed cost estimate that can be used to evaluate the affect of variations in boiler pinch point, back pressure, stack temperature, superheated steam temperature, feed water approach temperature, and supplementary firing for any gas turbine heat recovery application. Another program provides operating performance of the selected boiler design through a range of exhaust conditions due to ambient or load changes, and also for changes in the steam capacity or pressure requirements. Data from this program is used to plot performance “maps” for the full range of “off-design” operating conditions.
Design Aspects Surrounding the Alberta Gas Trunk Line’s New 20,000-HP Gas Turbine Compressor Set
Authors: Williams R. B.
Published: April 2015

The Alberta Gas Trunk Line’s new 20,000-hp gas turbine compressor set is one of the largest and most modern aircraft derivatives available to industry to date. This paper describes the various aspects of station and unit design for the compressor package. The additional operational flexibility gained as a result of adding this unit to our existing 12,500-hp station is described. The paper will also present a description of the station’s control system, including unit controls, surge controls, and other features of the instrumentation. Trunk Line is concerned with keeping the availability of the unit high, and as such, the paper will describe some features which help keep downtime to a minimum.