bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Pain in the Intensive Care Patient
Authors: Gunning Kevin
Published: December 2014

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Critically ill patients commonly experience moderate to severe, acute pain that, if underestimated, may increase the risk of persistent or chronic pain and increase hospital stay. This problem is compounded by the difficulty that critically ill patients have in communicating their pain to staff on the intensive care unit. Accurate assessment of pain is therefore central to the care of the critically ill patient. Pain should be objectively and continuously assessed using a validated assessment tool. Guidelines recommend use of the Numeric Rating Scale, which has been shown to improve pain control and reduce the need for sedation. Non-pharmacological measures are an essential first step, but targeted analgesia remains the cornerstone of care. This approach is based on an individual plan for pain control for each patient, which is communicated to all caregivers to ensure consistency of therapy.
Optimum Sedation and Delirium Assessment in ICU
Authors: Page Valerie
Published: December 2014

Delirium is a common syndrome that affects up to 69% of patients in UK intensive care units (ICUs). It is effectively an acute organ failure – of the brain. Delirium is not benign – in itself it is an independent predictor of death. Delirium is associated with increased ICU and hospital length of stay, increased costs and long-term cognitive impairment. In the ICU, hypoactive delirium is common, easily missed and associated with a worse prognosis than hyperactive and mixed motoric subtypes of delirium. Routine screening with a validated assessment tool, such as the CAM-ICU, is recommended. To assess for delirium reliably, patients need to be responsive to a verbal stimuli, eg able to open their eyes in response to hearing their name. Analgesia-based sedation, which avoids over-sedation and aims to ensure patients are calm, cooperative and communicative, enables delirium to be assessed in the ICU. Local management guidelines should be agreed before introducing routine assessment of delirium into clinical practice, in order to promote adherence and ensure appropriate action if delirium is identified. If delirium is detected, the precipitating cause(s) should be addressed. If the patient is agitated or if it is felt that hypoactive delirium is delaying clinical progress, treatment with an antipsychotic should be considered.
The Nottingham Head Injury Register: A Survey of 1,276 Adult Cases of Moderate and Severe Traumatic Brain Injury in a British Neurosurgery Centre
Authors: Fuller Gordon , Pattani Hina , Yeoman Paddy
Published: December 2014

The Nottingham Head Injury Register was established as an audit and research tool for traumatic brain injury (TBI). Study aims included examination of the epidemiology of UK TBI and identification of factors improving management and outcome. Moderate and severe TBI patients admitted to a UK neurosurgery centre were recruited over a 10-year period from 1993 to 2003. A dataset covering all aspects of TBI, including demography, clinical features, investigations, management, complications and outcome were captured prospectively into a computerised database. The study group comprised 1,276 adult patients aged more than 16 years old. The median age of subjects was 35 years, with 78% of the population consisting of male patients. Road traffic accidents were responsible for 49% of injuries; 37% of the study population had moderate TBI and 63% severe TBI. CT brain scan was performed in 92% of cases showing a mass lesion in 41% and diffuse lesion in 59%. Traumatic subarachnoid haemorrhage was present in 34%. At 12 months 32% of patients had died, 13% were severely disabled, 22% were moderately disabled and 33% had made a good recovery. Findings were comparable with other previous large series of TBI patients from international studies. Registry data is useful to define TBI epidemiology and management, and in validation of prognostic scoring systems.
Review of Current Practice of Blood and Component Transfusion: Critical Issues for the Critically Ill Patient
Authors: Padmakumar Anand D , Bellamy Mark C
Published: December 2014

Major haemorrhage continues to be a leading cause of morbidity and mortality in a number of situations such as trauma, ruptured aneurysms, obstetrics, liver transplantation and gastrointestinal blood loss.1 In modern day clinical practice, clinicians have a range of blood components and specific clotting products at their disposal in the management of such patients. However, recent evidence is driving change in the optimal management of coagulopathy in major haemorrhage. The critically ill patient often exhibits deranged coagulation as assessed by laboratory tests. It is unclear the extent to which this is an epiphenomenon, and to what extent coagulation requires correction prior to either bedside or surgical intervention. There is increasing evidence to suggest that blood and component transfusions carry significant though poorly quantified risks. It is therefore prudent to exercise a selective approach to transfusion, avoiding ‘correction of the numbers’ when the risk of clinically important bleeding is small. In this article, we review current UK practice and evidence for use of blood and its components in the ICU setting. We also appraise more recent concepts such as the new coagulation model, acute coagulopathy of trauma and novel treatment strategies. We will discuss current guidelines and recommendations, and highlight potential areas for future research.
Chest Compression-Only CPR Improves Mortality Compared to Standard CPR
Authors: Mcilmoyle Keir
Published: December 2014

This meta-analysis shows a significantly increased chance of survival with chest-compression only cardiopulmonary resuscitation (CPR) compared to standard CPR, with an absolute increase in survival of 2.4% and a relative increase of 22%, number needed to treat (NNT)=41.

Level of evidence: 1++ (Meta-analysis of RCTs with homogeneity and a very low risk of bias).
A Protocol of No Sedation for Critically Ill Patients Receiving Mechanical Ventilation: A Randomised Trial
Authors: Harlow Georgina , Johnston Andrew McD
Published: December 2014

Mechanical ventilation without sedation reduces duration of ventilation.

Level of evidence: 1− (RCT with a high risk of bias)
Predicting Outcome after Traumatic Brain Injury
Authors: Reynolds Sandra
Published: December 2014

The purpose of this review is to look at the most recent work carried out on predicting outcome after traumatic brain injury (TBI). TBI is a leading cause of death and disability but prediction of long-term outcome for individual patients is difficult. In particular, predicting outcome in the first few hours or days after injury is limited by the paucity of scoring systems or clinical models available. Many clinical variables have been studied to determine if they may play a role in outcome prediction, including age, admission Glasgow Coma Score and pupillary reactivity. Newer variables being studied include serum biomarkers, abnormalities seen on magnetic resonance imaging and data obtained from evoked potentials and electroencephalography studies. There are many factors that impact on outcome and a perfect model is yet to be developed. Models must take into account the economic status of the country in which the trauma occurs. It is important that less affluent nations are not left behind in the search for accurate prognostic modelling.
Hypothermia in Traumatic Brain Injury – A Literature Review
Authors: Qiu Liming
Published: December 2014

Traumatic brain injury is the leading cause of death in young people. Induced hypothermia has been used as a therapeutic intervention to improve outcome, based on results of animal studies. This article reviews the mechanisms of brain injury, the results of animal and human studies and the reasons that human studies do not always reflect the success seen in animal studies and why results may be ‘lost in translation’ to treatment of patients. It concludes by suggesting further areas of work to investigate the clinical use of therapeutic hypothermia.
The Use of High-Flux Albumin Haemofiltration (HFAF) with Evaclio EC-2C™ in the Management of Liver Failure as a Bridge to Transplantation
Authors: Morris Craig , Rogerson David
Published: December 2014

A 44-year-old male who developed liver failure four years after orthotopic liver transplant was managed using high-flux albumin haemofiltration as a bridge to transplant. The technique, which involves using conventional haemofiltration with a plasma component separator using a filter with a sieving coefficient of 20% for albumin, is described.
Overdose of Ferrous Sulphate, Co-Dydramol and Non-Steroidal Anti-Inflammatory Drugs, Leading to Fatal Hepatotoxicity
Authors: Sharma Namita , Hall Alison , Holden Ann
Published: December 2014

A 27-year-old woman died within 48 hours of an overdose of ferrous sulphate, co-dydramol and non-steroidal anti-inflammatory drugs (NSAIDs) from shock secondary to acute liver failure. Her serum iron level at five hours postingestion was lower than that of many non-fatal, pure ferrous sulphate overdoses in published studies. This case highlights the importance of knowing the signs, symptoms and prognostication of ferrous sulphate toxicity and appreciation of the cumulative fatal effects of polypharmacy overdose.
The Effect of Repeated Audit on the Quality of Transfer of Brain-Injured Patients into a Regional Neurosciences Centre
Authors: Messer P Ben , Sweenie Alan C , Whittle Robert J , McEleavy Irene M
Published: December 2014

Brain injury is common and transfer of such patients to a neuroscience centre is a frequently occurring event. Transfer is a time of potential instability and can contribute to physiological changes that could cause secondary brain injury. UK data suggest that there has been a gradual improvement in quality and outcome of transfers of brain-injured patients during the last three decades. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) have published guidelines to improve the safety and quality of transfers. Over a seven-year period, we audited transfers four times and implemented three successive interventions aimed at improving the quality of transfers of brain-injured patients into the regional neurosciences centre. We observed a significant improvement in the transfer of patients according to AAGBI guidelines across most domains of patient care. The use of repeated cycles of audit and intervention significantly improved the quality of transfer of brain-injured patients, which could improve patient safety and outcome.
The Role of Early Tracheostomy in Patients with Posterior Fossa Haemorrhage in Neurocritical Care
Authors: Jessop Zita M , Kane Andrew D , Menon David K
Published: December 2014

Studies indicate that early tracheostomy may improve outcomes in critically ill patients, but there is a lack of data specifically relating to patients with posterior fossa haemorrhage. This retrospective study assesses the type and duration of airway management for patients with posterior fossa haemorrhage admitted to a neurocritical care unit (NCCU). Of the 21 patients identified, seven required no airway intervention, eight were managed with endotracheal intubation alone, and six required tracheostomy. Although the median length of airway management for patients with endotracheal intubation alone was two days (n=8), the median delay to tracheostomy was 11 days (n=6). Four patients requiring intubation did not survive their NCCU stay. No patient was successfully extubated later than two days post admission. We recommend early tracheostomy in patients who are not extubatable within a few days of admission but in whom admission characteristics and neurological progress otherwise suggest survival with useful recovery.
Mortality after Fluid Bolus in African Children with Severe Infection
Authors: Riste Michael , Ford Stephen
Published: December 2014

In a large group of critically ill African children, fluid boluses significantly increased 48-hour mortality. The results were most marked in those with haemoglobin levels less than 5 g/dL. The results do not support the routine use of bolus resuscitation in severely ill febrile children with impaired perfusion in African hospitals.

Level of evidence: 1B: individual randomised control trial with narrow confidence intervals.
Delirium Uncovered
Authors: Alce Timothy M , Page Valerie , Vizcaychipi Marcela P
Published: December 2014

Delirium is defined as an acute confusional state with a disturbance of consciousness and a change in cognition which is fluctuating and self-limited in the vast majority of the cases. It is common in intensive care, most frequently in its hypoactive manifestation, and is associated with increased morbidity and mortality. This article reviews the pathogenesis, risk factors, diagnostic assessment, prevention and management of delirium.
A Case of Refractory Seizures Caused by an Unusual Zoonosis
Authors: Walkington James , Hulgur Mruthunjaya , Yates David , Eynon C Andy
Published: December 2014

A 29-year-old female presented to the intensive care unit with refractory status epilepticus. Despite treatment with anticonvulsants and sedation, she continued to have EEG evidence of seizure activity that terminated only with volatile anaesthetic agents. There was serological evidence of exposure to a flavivirus. In the UK the only endemic flavivirus is Louping ill, which is closely related to tick-borne encephalitis. It was likely that this was the cause. She remained on intensive care for almost six months and failed to regain consciousness.
Real-Time Ultrasound-Guided Subclavian Vein Cannulation in Intensive Care Patients
Authors: Ibrahim Nader , Saha Rajnish
Published: December 2014

Real-time ultrasound-guided subclavian vein cannulation in intensive care patients has higher success and lower complication rates compared to the traditional landmark method.

Level of evidence: 1B (RCT with narrow CIs)
Trauma Resuscitation Using Echocardiography in a Deployed Military Intensive Care Unit
Authors: Hutchings Sam D , Rees Paul SC
Published: December 2014

Casualties with severe traumatic injury frequently suffer haemodynamic instability. There is interest in the use of transthoracic echocardiography (TTE) to assess haemodynamic status in intensive care resuscitation. We describe a feasibility study of focused TTE (fTTE) echocardiography in trauma resuscitation in a deployed military setting. fTTE was performed on patients admitted to ICU following severe injury. Data were collected on TTE view availability, LV function, volume status, and inferior vena cava (IVC) dimensions. Doppler of the LV outflow tract was performed to provide a velocity time integer (LVOT VTi) as an indicator of preload. Twenty-three patients were recruited, and 48 individual studies performed. TTE windows available were: parasternal long axis-68%, parasternal short axis-66%, apical 4-chamber-64%, subcostal-66%. IVC imaging was possible in 85%, and LVOT VTi Doppler in 37%. The mean maximal IVC diameter in volume-optimised patients (Group 1, n=19) was 2.07 cm (±0.07), compared with 1.47 (±0.06) in the hypovolaemic cohort (Group 2, n=23). The mean minimum IVC diameter in Group 1 was 1.93(±0.07) vs 1.03(±0.08) in Group 2. IVC collapsibility was 3.16% (±1.61%) in Group 1 vs 30.81%(±1.62) in Group 2. In 12%, profound hypovolaemia with systolic LV cavity obliteration was noted. fTTE suggested hypovolaemia in 69% of patients on admission to the study. Of patients arriving on the ICU following damage-control resuscitation only 31% were volume-optimised. fTTE led to a change in volume management strategy in 47% of cases. This study demonstrates, for the first time in a deployed military setting, that intensivist-delivered fTTE is feasible and changes resuscitation strategy in almost half of patients admitted to a deployed ICU.
Novel Uses of Arteriovenous Extra-Corporeal Membrane Carbon Dioxide Removal (AV-ECCO2R) – Two Case Studies
Authors: Hughes Tim , Slack Andrew , Bernal William , Wendon Julia , Finney Simon , Willars Chris , Auzinger Georg
Published: December 2014

Extracorporeal carbon dioxide removal (ECCO2R) device technologies have enhanced the management of acute respiratory distress syndrome (ARDS) and other lung pathologies necessitating low tidal volume protective ventilation. We report the novel use of the interventional Lung Assist Membrane Ventilator® (iLA, Novalung GmbH) in a multi-trauma patient with pulmonary contusion and pre-existing cyanotic congenital heart disease and in a patient with raised intracranial pressure in the context of acute liver failure and primary graft non-function. In both cases, heart-lung interactions were complex, but AV-ECCO2R brought about significant improvements in respiratory indices and left/right ventricular function. The device facilitated restoration of homeostasis where other therapeutic options were limited or had failed.
Activated Protein C does not Improve Mortality in Septic Shock
Authors: Dunne Kathryn , Cairns Chris
Published: December 2014

Compared with placebo, Drotecogin alpha (activated) offers no mortality benefit at either 28 or 90 days in critically ill adults with septic shock.

Level of evidence: 1B (well designed RCT)
Classic Cases Revisited: The Suicide of Kerrie Wooltorton
Authors: Szawarski Piotr
Published: December 2014

This article reviews the case of a patient who ingested ethylene glycol and who presented to hospital but refused treatment while she was assessed as having capacity. The author reviews issues surrounding the Mental Capacity Act 2005, assessment of capacity and a way forward when confronting this difficult situation.
Effect of Day and Time of Admission on Mortality in an Intensive Care Unit
Authors: Jansen Jan O , MacLennan Graeme S , Cuthbertson Brian H
Published: December 2014

Variations in outcome relating to out-of-hours care have received considerable attention. We conducted a retrospective cohort study to determine the effect of day and time of admission on mortality in an intensive care unit (ICU) with representative admission severity of illness. Data pertaining to 4,183 patients admitted between 2000 and 2007 were extracted from a prospectively maintained database. Case-mix adjustment was undertaken using the UK APACHE II probability of hospital death. The mean APACHE score was 20.9 with a median predicted hospital mortality of 32.5%. Actual hospital mortality was 30.8%. Compared with Wednesdays as the reference day, admission to ICU on any other given day was not associated with higher crude or case-mix adjusted mortality. Admission to ICU in the evening, compared with daytime admission, was associated with lower odds of crude hospital mortality, but this difference was no longer significant after case-mix adjustment. Case-mix adjusted in-hospital mortality does not vary with day and time of admission, even in patients with higher severity of illness and higher predicted mortality than previously reported.
Factitious Disorder in Intensive Care Unit — Are We Doing Enough?
Authors: Karukappadath Riaz , Russai Rita , Mohamed Nazia , Kovari Ferenc
Published: December 2014

A 23-year-old woman presented with clinical signs and symptoms suggestive of acute severe asthma requiring intensive care admission. She was later diagnosed to have factitious disorder. This case report highlights the importance of diagnosing factitious disorder in the intensive care unit and the teamwork required in dealing with such cases to prevent recurrence, mortality and litigation.
Plasma Exchange in Haemolytic-Uraemic Syndrome Secondary to E. Coli
Authors: Dodd Amy , Dudley Jan , Twigg Steven
Published: December 2014

A 12-year-old previously healthy girl presented with seizures, bloody diarrhoea and abdominal pain. A diagnosis of haemolytic-uraemic syndrome was made on the basis of the presence of haemolysis, thrombocytopenia and acute renal failure. This case report reviews clinical aspects of the syndrome. Plasma exchange has been used to treat cerebral symptoms in these patients and the dilemma surrounding its use is presented.
Intravenous Lipid Emulsion (ILE) Therapy for Severe Felodipine Toxicity
Authors: Barnicott Lee RC , Tarmey Nick T , Craig Gordon R , Thomas Simon HL
Published: December 2014

Intravenous lipid emulsion (ILE) is increasingly used for the treatment of poisoning caused by lipid-soluble drugs. We report a case of reversal of cardiovascular collapse after the use of ILE in a patient with a mixed overdose, mainly of the calcium channel blocker felodipine. Conclusions that can be drawn from a single case are limited, but this report provides circumstantial evidence of benefit of ILE for felodipine poisoning. The use of ILE appears justified in cases refractory to conventional therapy.
Tracheostomy on the Intensive Care Unit – A Two-Month Network-Wide Snapshot
Authors: Gill Steven , Low Wei Yang , Coggon J Mandy , Slaney Kerry , Stewart Paul , Norton Andrew , Beed Martin , Gardiner Dale
Published: December 2014

Tracheostomy is a common and invasive procedure performed on the intensive care unit and has significant associated complications. Current evidence is insufficient to clearly guide practice. We conducted a two-month prospective service evaluation of tracheostomy within our local critical care network. We found 80 tracheostomies were performed during this time. Tracheostomy was performed at a median of six days after commencement of invasive ventilation, most commonly using the Ciaglia technique. Eighteen tracheostomies (23%) were performed surgically. The facilitation of weaning from invasive ventilation was the most common indication for tracheostomy. The median (IQR) time from tracheostomy to completion of weaning from mechanical ventilation was seven (4–11) days and from tracheostomy to decannulation was 14 (9–26) days. Eleven patients (14%) sustained complications possibly relating to tracheostomy insertion, three of whom subsequently died, although tracheostomy insertion was only possibly linked to one of these deaths. While our sample is small, it benchmarks a UK critical care network's tracheostomy practice in the UK.
Improving the Timeliness of Time-Critical Transfers: Removing ‘Referral and Acceptance’ from the Transfer Pathway
Authors: Dickinson Phillip , Eynon C Andy
Published: December 2014

Where a ‘time-critical’ condition exists and care cannot be provided at the patient's current hospital, traditional ‘refer and accept’ pathways of care may delay immediate transfer. This paper describes how to identify time-critical patient groups and the sources of delay. This enabled a local clinical network to redesign the transfer process, resulting in the removal of specialist teams from the transfer decision-making process, changing the process from ‘refer and accept’ to ‘send and inform.’ In cases where referral to and acceptance by specialist teams were removed from the decision-making pathway, a median time saving of 1 hour 38 minutes was achieved.
Effect of Intravenous Haloperidol on the Duration of Delirium and Coma in Critically Ill Patients (Hope-ICU)
Authors: Drinkwater Bobbie , Billyard Thomas
Published: December 2014

In critically ill patients the administration of regular haloperidol did not reduce the incidence of delirium or coma.

Level of evidence: 1B (single-centre randomised controlled trial with low risk of bias)
Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest
Authors: Claxton Andrew , Saha Rajnish
Published: December 2014

In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit compared to a targeted temperature of 36°C.

Level of evidence: 1B (CEBM-RCT with narrow CIs)
A Prospective Observational Study of Significant Airway Events in Intensive Care
Authors: Chillingworth Simon , Slater Ben , Simpson Gavin
Published: December 2014

This is a single-centre, prospective, observational study that aimed to establish the incidence of airway events and the interventions required to manage these events in a 9-bedded general intensive care unit. During the 30-day study period there were 278 significant airway events requiring 332 interventions. Forty-six (16.5%) events were associated with hypoxia, and medical intervention was required for 25 events (9%) with the remainder managed by trained nurses or physiotherapists. The most frequent events were tube blockage due to secretions (47.8%) and circuit disconnection (14.3%). Events occurred more frequently in those ventilated with tracheostomy compared to endotracheal tube (event rate per ventilator day 1.76 vs 1), but these were less likely to lead to hypoxia (OR 2.93). We have found a rate of airway events of 1.22 per ventilator day and conclude that access to appropriately skilled and trained staff is required to manage these intensive care airway problems.
The Use of a Modified Delphi Technique to Create a List of ‘Top Ten Tips' for Communication with Patients and Relatives in Intensive Care
Authors: Banerjee Tamara , Taylor Nina , Brett Stephen , Young Keith , Peskett Mo
Published: December 2014

There are many barriers to good communication in intensive care. The authors used a Delphi technique to develop a set of ‘top tips' for good communication between doctors, patients and families in this environment. They worked with members of the Patients and Relatives Committee of the Intensive Care Society and ICUsteps, who have had experience of being patients or of having a relative who had been a patient receiving intensive care.
Oral Feed for Patients with a Tracheostomy: Balancing Risks and Benefits
Authors: Mullender Joanne Louise , Wheatley Emma Catherine , Nethercott Daniel Robert
Published: December 2014

Many patients on the intensive care unit have tracheostomies sited, following which some clinicians advocate that they should be fed via a nasogastric tube, as taking food orally might present a risk of aspiration. However, nasogastric (NG) tubes also have associated risks, harms and costs. The Royal Bolton Hospital is a district general hospital in the UK with an 8-bedded, mixed medical/surgical intensive care unit admitting around 430 level 3 patients per year. We describe our clinical practice in terms of a liberal attitude to offering oral feed to a selected group of patients with tracheostomies in situ. We postulate that this approach has several advantages and that the balance between risk and benefit must be assessed in each individual case. Expert assessment by Speech and Language therapists can help these judgements. Some beliefs regarding aspiration risk in patients with tracheostomies lack supporting evidence.
Hyperglycaemic Control in Paediatric Intensive Care
Authors: Price Louisa M , Sanders Luke R , Garg Atul , Johnston Andrew McD
Published: December 2014

In paediatric intensive care (≤16 years of age), tight glycaemic control is not associated with a mortality benefit. There is a higher risk of significant hypoglycaemia. In cardiac intensive care unit patients, this hypoglycaemia is associated with a significant increase in mortality.

Level of evidence: 2B (CEBM).
Vascularized medial femoral condyle graft for management of scaphoid non-union
Authors: Elgammal A. , Lukas B.
Published: December 2014

The purpose of this study was to assess the results of the management of difficult scaphoid non-unions using a vascularized medial femoral condyle graft. We operated on 30 patients with necrosis of the proximal pole or with severe humpback deformity or who presented with persistent non-union despite previous surgery. Twenty-four cases in our series showed full consolidation and six cases showed persistent non-union. The free vascularized medial femoral condyle bone graft can provide not only structural support, but also a consistent and good blood supply that results in excellent rates of union.

Level of evidence: IV
There’s No Crying in Baseball, or Is There? Male Athletes, Tears, and Masculinity in North America
Authors: MacArthur Heather J. , Shields Stephanie A.
Published: December 2014

We explore men’s negotiation of emotional expression within larger social discourses around masculinity. Drawing on the phenomenon of men’s crying within the competitive sports context, we demonstrate that although the prevailing image of men’s emotion is one of constricted expression and experience, inexpressivity is representative neither of typical nor ideal masculinity in contemporary dominant culture. We first review the literature on prevailing cultural beliefs about normative male emotional expression, then focus on literature specific to men’s tears. Turning to a discussion of masculinity and sports participation, we offer possible explanations for why counter normative emotional expressions may be particularly prevalent and public in the context of men’s competitive sports, despite wider cultural discourses that appear to discourage men’s openly expressive behavior.
Comment on “Methodological Innovations from the Sociology of Emotions – Theoretical Advances”
Authors: Stets Jan E.
Published: December 2014

Emotions are an emergent feature of interaction, and many of the articles in this special section touch on this. What I find interesting is that we get a glimpse into how emotions unfold in a situation, and how the flow of emotions in any study can run from participant to participant, participant to researcher, and researcher to participant. Part of this flow of emotions is influenced by reflexivity or the awareness of self and other feeling states, which is addressed by some of the contributors. What is particularly challenging is how to carefully study emotions as they surface in situations, and many of the contributors encourage us to pause and think about how to do this.
Investigation of the interaction phenomena between foot and insole by means of a numerical approach
Authors: Forestiero Antonella , Raumer Anna , Carniel Emanuele L , Natali Arturo N
Published: December 2014

The biomechanical response of foot with regard to interaction phenomena occurring at interface with insole inserted in the shoe is investigated by using a numerical approach. At this purpose, a complex three-dimensional model of the foot is defined from biomedical images, while insole conformation is acquired by laser scanner technique, leading to the finite element discretization. Foot tissues are characterized by means of specific constitutive visco-hyperelastic anisotropic formulations, recalling previous research activity. The mechanical behavior of insole material is analyzed by means of experimental compression tests that highlight the geometric and material non-linear response, represented by a hyperelastic formulation, while a hyperfoam formulation is assumed for the sole. Numerical analysis considers the mid-stance phase of the gait and allows to interpret the response of overall foot, insole and sole system. The investigation represents a preliminary step of a parametric analysis addressed to support footwear design considering different configurations of components. As matter of example, the influence of variation in insole material properties is reported.
Observation of gliding arc surface treatment
Authors: Kusano Y. , Zhu J. J. , Ehn A. , Li Z. S. , Aldén M. , Salewski M. , Leipold F. , Bardenshtein A. , Krebs N.
Published: December 2014

An alternating current (AC) gliding arc can be conveniently operated at atmospheric pressure and efficiently elongated into the ambient air by an air flow and thus is useful for surface modification. A high speed camera was used to capture dynamics of the AC gliding arc in the presence of polymer surfaces. A gap was observed between the polymer surface and the luminous region of the plasma column, indicating the existence of a gas boundary layer. The thickness of the gas boundary layer is smaller at higher gas flow-rates or with ultrasonic irradiation to the AC gliding arc and the polymer surface. Water contact angle measurements indicate that the treatment uniformity improves significantly when the AC gliding arc is tilted to the polymer surface. Thickness reduction of the gas boundary layer, explaining the improvement of surface treatment, by the ultrasonic irradiation was directly observed for the first time.
Flow sorting and exome sequencing reveal the oncogenome of primary Hodgkin and Reed-Sternberg cells
Authors: Reichel Jonathan , Chadburn Amy , Rubinstein Paul G. , Giulino-Roth Lisa , Tam Wayne , Liu Yifang , Gaiolla Rafael , Eng Kenneth , Brody Joshua , Inghirami Giorgio , Carlo-Stella Carmelo , Santoro Armando , Rahal Daoud , Totonchy Jennifer , Elemento Olivier , Cesarman Ethel , Roshal Mikhail
Published: December 2014

Key Points

We show feasibility of whole-exome sequencing on purified primary HRS cells and report recurrent genetic alterations characterizing cHL. B2M is the most frequently mutated gene in cHL, strongly associated with nodular sclerosis subtype, younger age, and better overall survival.
Silica-sol-based spin-coating barrier layer against phosphorous diffusion for crystalline silicon solar cells
Authors: Uzum Abdullah , Fukatsu Ken , Kanda Hiroyuki , Kimura Yutaka , Tanimoto Kenji , Yoshinaga Seiya , Jiang Yunjian , Ishikawa Yasuaki , Uraoka Yukiharu , Ito Seigo
Published: December 2014

The phosphorus barrier layers at the doping procedure of silicon wafers were fabricated using a spin-coating method with a mixture of silica-sol and tetramethylammonium hydroxide, which can be formed at the rear surface prior to the front phosphorus spin-on-demand (SOD) diffusion and directly annealed simultaneously with the front phosphorus layer. The optimization of coating thickness was obtained by changing the applied spin-coating speed; from 2,000 to 8,000 rpm. The CZ-Si p-type silicon solar cells were fabricated with/without using the rear silica-sol layer after taking the sheet resistance measurements, SIMS analysis, and SEM measurements of the silica-sol material evaluations into consideration. For the fabrication of solar cells, a spin-coating phosphorus source was used to form the n+ emitter and was then diffused at 930°C for 35 min. The out-gas diffusion of phosphorus could be completely prevented by spin-coated silica-sol film placed on the rear side of the wafers coated prior to the diffusion process. A roughly 2% improvement in the conversion efficiency was observed when silica-sol was utilized during the phosphorus diffusion step. These results can suggest that the silica-sol material can be an attractive candidate for low-cost and easily applicable spin-coating barrier for any masking purpose involving phosphorus diffusion.
Anti-tumor necrosis factor patent expiration and the risks of biocopies in clinical practice
Authors: Scheinberg Morton , Castañeda-Hernández Gilberto
Published: December 2014

Biosimilars that were not compared in clinical trials with the compound innovator are not true biosimilars (biocopies) and are associated with risks that the clinical rheumatologist should be aware of before generalized use. This article comments on various aspects surrounding the use of such biocopies in clinical rheumatology.
Reservoir characterization based upon the onset of time-lapse amplitude changes
Authors: Vasco Donald W. , Bakulin Andrey , Baek Hyoungsu , Johnson Lane R.
Published: December 2014

Time-lapse geophysical monitoring has potential as a tool for reservoir characterization, that is, for determining reservoir properties such as permeability. Onset times, the calendar times at which geophysical observations begin to deviate from their initial or background values, provide a useful basis for such characterization. We found that, in contrast to time-lapse amplitude changes, onset times were not sensitive to the exact method used to related changes in fluid saturation to changes in seismic velocities. As a consequence of this, we found that an inversion for effective permeability based upon onset times was robust with respect to variations in the rock-physics model. In particular, inversions of synthetic onset times calculated using Voigt and Reuss averaging techniques, but inverted using sensitivities from Hill’s averaging method, resulted in almost identical misfit reductions and similar permeability models. All solutions based on onset times recovered the large-scale, resolvable features of the reference model. Synthetic tests indicated that reliable onset times can be obtained from noisy seismic amplitudes. Testing also indicated that large-scale permeability variations can be recovered even if we used onset times from seismic surveys that were spaced as much as 300 days apart.
Estrogen-Like Potentiation of Ghrelin-Stimulated GH Secretion by Fulvestrant, a Putatively Selective ER Antagonist, in Postmenopausal Women
Authors: Veldhuis Johannes D. , Yang Rebecca J. , Wigham Jean R. , Erickson Dana , Miles John C. , Bowers Cyril Y.
Published: December 2014

Context:

Hyposomatotropism in healthy aging women reflects in part physiological estrogen (estradiol [E2]) depletion associated with menopause.

Objective and Design:

The purpose of this study was to test the hypothesis that low concentrations of endogenous E2 after menopause continue to drive GH secretion.

Setting:

The study was performed at the Mayo Center for Clinical and Translational Science.

Participants:

The participants were 24 postmenopausal women (aged 50–77 years with body mass index of 19–32 kg/m2).

Interventions:

This was a randomized, double-blind, placebo-controlled, parallel-cohort treatment study with placebo (PL) (n = 14) or the antiestrogen fulvestrant (FUL) (n = 10) for 3 weeks, followed by infusion of l-arginine with saline, GHRH, ghrelin, or both peptide secretagogues.

Outcomes:

GH concentrations were measured over 6 hours with 10-minute sampling and mass spectrometry measures of testosterone, E2, and estrone.

Results:

Concentrations of testosterone, E2, estrone, SHBG, IGF-I, LH, and FSH were not influenced by antiestrogen treatment. In contrast, GH rose from 0.096 ± 0.018 (PL) to 0.23 ± 0.063 μg/L (FUL, P = .033), and IGF-I binding protein type 3 (IGFBP-3) from 3.6 ± 0.18 to 4.0 ± 2.0 mg/L (P = .041). Conversely, prolactin fell from 7.1 ± 0.69 (PL) to 5.5 ± 0.57 μg/L (FUL) (P = .05), and IGF-I binding protein type 1 (IGFBP-1) fell from 44 ± 9.4 to 27 ± 4.3 μg/L (P = .048). Moreover, FUL vs PL potentiated mean GH responses to l-arginine/saline (P = .007), l-arginine/ghrelin (P = .008), and l-arginine/GHRH + ghrelin (P = .031), but not l-arginine/GHRH.

Conclusion:

The potent antiestrogen, FUL, amplifies fasting and secretagogue-driven GH secretion and IGFBP-3 concentrations in postmenopausal women without altering SHBG or sex steroid levels. FUL also suppresses prolactin and IGFBP-1, without altering IGF-I. Thus, a major antiestrogen mediates 3 actions of estrogen: agonism (GH), neutral effects (sex steroids), and estrogen antagonism (prolactin and IGFBP-1).
ESR Measurement of Hydroxyl Radicals in Micro-nanobubble Water
Authors: Tada Kaori , Maeda Masayuki , Nishiuchi Yusuke , Nagahara Jyunko , Hata Takashi , Zhuowei Zhao , Yoshida Yukihiro , Watanabe Shousuke , Ohmori Michio
Published: December 2014

Many scientists have elucidated that characteristics of micro-nanobubbles are distinctly different from those of normal bubbles. However, the physicochemical properties of micro-nanobubble water have not been sufficiently examined. In the present study, in order to generate free radicals by self-collapse phenomenon of micro-nanobubbles, an ESR measurement was conducted. As a result, micro-nanobubbles collapsed only with any physical forces while the self-collapse phenomenon of the micro-nanobubbles was not observed in the experiment.
Synthesis and Properties of Low-surface-energy Polyimides
Authors: Wang Hai-zhong , Ye Qian , Wang Xiao-Long
Published: December 2014

An aromatic diamine monomer, 1H,1H-perfluorooctyl 3,5-diaminobenzoate (PFD), was synthesized in three steps, which was used to prepare the polyimides containing pendant perfluoroalkyl chains via the polymerization of PFD with commercial 4,4′-(hexafluoroisopropylidene)diphthalic anhydride. Various characterization techniques including thermogravimetric analysis, infrared spectroscopy, and X-ray photoelectron spectroscopy were used to characterize the new polyimides with perfluoroalkyl chains. The resulting polyimide film exhibits hydrophobicity with a contact angle of 95° for water, and the calculated surface free energy is 37.4 mN m−1. Superhydrophobic surfaces were also demonstrated by coating the polyimide containing pendant perfluorooctyl chains on rough alumina substrate.
Bimetallic IrRh/CeO2–ZrO2 as a Highly Active Catalyst for NO–CO–C3H6–H2–O2 Reactions under Stoichiometric Conditions
Authors: Haneda Masaaki , Kaneko Takahiro , Kamiuchi Naoto , Ozawa Masakuni
Published: December 2014

The catalytic activity of Rh/CeO2–ZrO2 for NO–CO–C3H6–H2–O2 reactions under stoichiometric conditions was significantly improved by the addition of Ir. The optimum Ir/Rh atomic ratio was 1/9. The improvement was ascribed to the formation of finely divided Ir species on the surface of Rh particles. IrRh/CeO2–ZrO2 with an IrRh loading of 0.3 wt % showed high catalytic performance, which is comparable with that of 0.5 wt % Rh/CeO2–ZrO2, leading to minimize the Rh usage.
Synthesis and Optical-electronic Properties of a Novel Star-shaped Benzodithiophene Molecule
Authors: Sheng Ruiying , Liu Qian , Qiu Meng , Gu Chuantao , Zhou Yuanhang , Ren Junzhen , Sun Mingliang , Yang Renqiang
Published: December 2014

Benzodithiophene (BDT)-based star-shaped molecule (12TBDT) was synthesized by Stille coupling reactions. The star-shaped molecule shows high decomposition temperature (447 °C), low-lying HOMO level (−5.52 eV), and wide UV–vis absorption between 300 and 530 nm (Eg = 2.36 eV). DFT results show that the electron density of the HOMO and LUMO are localized on the thiophene and BDT groups. To the best of our knowledge, this is one of the earliest reports on star-shaped benzodithiophene molecules.
Emulsification by Phosphorylcholine-type Gemini Amphiphile as Active Interfacial Modifier
Authors: Sakai Kenichi , Fukushima Asako , Misono Takeshi , Endo Takeshi , Sakamoto Kazutami , Sakai Hideki , Abe Masahiko
Published: December 2014

We prepared oil-in-water emulsions with a phosphorylcholine-type gemini amphiphile (abbreviated as 18P-2-18N). The key emulsification process was found to be control of temperature; i.e., relatively stable emulsions were obtained when 18P-2-18N, hexadecane, and water were homogenized at 80 °C. We suggest that a liquid-crystalline 18P-2-18N phase stabilizes the oil/water interface at 80 °C, and then the transition to the gel phase at low temperature achieves further stabilization in a manner similar to the Pickering emulsion.
Geological conditions of coal bed methane occurrence in Handan - Fengfeng Mining area
Authors: Hao Guoqiang , Yang Yifeng , Jin Chao
Published: December 2014

The coal bed methane resources distribution of Handan - Fengfeng Mining area has the features of "richness in the midland and north while poorness in the south, and richness in the east while poorness in the west. Through the analysis of the geological factors causing the above phenomena, we get that: the coal metamorphism and hydrogeological condition are the major controlling factors, the former controls the north and south difference of coal bed methane resources distribution from the two aspects covering gas-generated quantity and adsorption capacity, while the latter controls the east and west difference of coal bed methane resources distribution; syncline and good cap rock conditions are necessary conditions for coal bed methane enrichment, but not the reason for causing the difference of coal bed methane resources distribution.
Fitting issues: The visual representation of time in family tree diagrams
Authors: Mitchell Marilyn
Published: December 2014

Family tree diagrams are a specific type of visual representation of time that serve a range of purposes. This research considers their semiosic development across western cultures using cases from the earliest extant copies of the eighth century to current online versions. Cases are taken from the fields of religion, genealogy, history, anthropology, genetics, and popular culture. The paper begins with a general model of tree design based upon the linguistic representation of time, or tense, and then discusses in case study fashion, how each design was composed to support its use. Composition is discussed using the visual variables of the direction of time on the page, the key reference point, scale, alphanumeric and pictorial symbols, symbol positions, and the size, colour, tone, and texture of symbols and graphic elements. The paper argues that choices for the direction of time flow in a tree (e.g. left-to-right, right-to-left, top-down, etc.) depend upon many factors, which are the use of the diagram, the amount of information that needs to fit onto the page, patterns of reading and writing, aesthetic needs, the linguistic metaphor of descent, cultural values, and the “ideal-real” continuum that exists along the vertical axis for some types of graphics.
Where semiosis begins when reading a text: On event perception
Authors: Bruche-Schulz Gisela
Published: December 2014

In this paper, I report on a set of data which, so I believe, give evidence of current experience as being conceptualized on the basis of conceptual structures that originate from different time scales. The data are obtained by a procedure that shows features of think-aloud protocols and eye-tracking research. The text which is read is a narrative, an excerpt from Saint-Exupéry’s Le Petit Prince. Five groups of readers, at different times and locations, were presented with the text in five different languages. They underlined the words for which something came to mind and jotted down responses in the margin of the one-page long text ad lib, in a time frame of ten minutes. Their responses, expressed by pictorial and written signs, testify to ways of perceiving elements in scenes and scenarios, in short, elements of the environment with which the readers interact at the moment of reading. When the jotted responses are correlated with the segmental positions in which they occur, regular patterns emerge, revealed by significant differences in response frequencies. The semantic properties of the linguistic material in these segmental positions signal the perceptual presence of (image-)schematic figure-ground relations that inhere in basic event structures. Different layers of semiosis, originating from different time scales, thus appear to simultaneously contribute to current experience, the latter being possible because of the expanded consciousness of the organism that discovered how to turn in on itself.
Epitypification of the name Colchicum montanum L. (Colchicaceae)
Authors: Rico Enrique , Martínez-Ortega M. Montserrat
Published: December 2014

The identity of the illustration previously selected as the lectotype of Colchicum montanum L. is shown to be demonstrably ambiguous. An epitype is designated that affixes the application of the name to the common “quitameriendas” that is widely distributed in the Iberian Peninsula.
Introduction to the OR Forum Article: “Design of Risk Weights”
Authors: Pinker Edieal J.
Published: December 2014

Comment on “Design of Risk Weights” by Paul Glasserman and Wanmo Kang.
The impact of the Supreme Court judgment in Cheshire West v P on the human rights of vulnerable patients
Authors: Griffith Richard
Published: December 2014

The UK Supreme Court's judgment in Cheshire West and Chester Council v P [2014] has had a huge impact on the promotion of human rights of vulnerable patients. The ruling emphasises the positive duty on the state and its organisations, such as the NHS, to have in place procedures that independently confirm that the human rights of those vulnerable patients are being applied in the same way as any other human being. This article discusses the background and basis for the Supreme Court's decision in Cheshire West and its impact on vulnerable patients.