bluuebunny/crossref_metadata_2025 huggingface dataset:
Sequential Changes in Erythrocyte Volume Distribution and Microcytosis Associated with Iron Deficiency in Kittens
Authors: Weiser M. G. , Kociba G. J.
Published: November 2015

Hemograms, erythrocyte volume distribution curves, serum iron and percent transferrin saturation determinations were done on samples from 50 kittens to characterize feline erythrocytic responses between one and ten weeks of age. At one week of age, all kittens had marked macrocytosis and anisocytosis. Most of the macrocytic cells no longer were present by five weeks. Macrocytes were replaced by erythrocytes of normal volume in 30% of the kittens. At five weeks of age, 70%of the kittens had produced microcytic cells which correlated with significantly lower packed cell volume values (p < 0.02) and mean corpuscular volume values (p < 0.001). By seven weeks of age, kittens with microcytosis were producing normocytic erythrocytes. Between two and four weeks of age, kittens with microcytosis had significantly lower serum iron and percent transferrin saturation values (p < 0.01) compared to kittens without microcytosis. Between five and seven weeks of age, all kittens had very high iron values which were significantly greater than those of healthy adult cats (p < 0.01). Six kittens with low iron values received an iron dextran injection at two to three weeks of age. At five weeks, these kittens had significantly greater mean corpuscular volumes, packed cell volumes (p < 0.01) and lower percentage of microcytic cells (p < 0.001) than littermate controls. These data demonstrate that transient microcytosis and anemia observed in kittens is attributable to iron deficiency. It also was demonstrated that erythrocyte volume distribution curves were more sensitive than the mean corpuscular volume in detecting microcytosis in kittens.
Dystrophy of the Diaphragmatic Muscles in Adult Meuse-Rhine-Yssel Cattle: Electromyographical and Histological Findings
Authors: Goedegebuure S.A. , Hartman W. , Hoebe H.P.
Published: November 2015

Electromyographic investigation of diaphragmatic muscles of Meuse-Rhine-Yssel cattle revealed a significant decreased duration of action potentials, while the number of polyphasic potentials was increased in four of seven cows. Histologically, the diaphragmatic muscles in all cows were affected severely, as characterized by variation in size of individual fibers, abundant vacuolar and hyaline degeneration with occasional fragmentation and phagocytosis, fiber splitting, apparent increase in internal nuclei, vesicular nuclei, chains of central nuclei, absence of regeneration, and proliferation of endomysial and perimysial connective tissue. Core-like structures seemed to be a hallmark of the disease. The intercostal muscles in all cows had core-like structures and some variation in fiber size; degenerative lesions did occur, but were less severe than in diaphragmatic muscles. In other skeletal muscles and cardiac muscles, core-like structures were present predominantly, indicating a generalized muscle disorder. No lesions were detected in the peripheral or central nervous systems.

The muscular alterations were classified as a progressive muscular dystrophy, with a suspicion of hereditary transmission. This dystrophy may be an important animal model.
Congenital Intestinal Aganglionosis in White Foals
Authors: Vonderfecht S.L. , Bowling A. Trommershausen , Cohen M.
Published: November 2015

A congenital and probably hereditary neurological defect has been identified in the intestinal tract of six foals produced from the breeding of overo (a type of spotting pattern) horses. The foals had white hair and pink skin with the exception of occasional pigmented foci about the muzzle, ventral abdomen, and hindquarters. The foals appeared normal at birth, but within a few hours developed symptoms of colic. At necropsy, the only significant finding was a narrow, pale segment of large intestine. This abnormality either was confined to the small colon and rectum or involved the entire colon and rectum. Microscopically, myenteric and submucosal neuronal plexuses were absent throughout the large intestine and extensive portions of the small intestine. The only other significant finding was the lack of melanin in the skin.
Clinical Sarcocystosis in Calves Fed Sarcocystis Hirsuta Sporocysts from Cats
Authors: Dubey J. P.
Published: November 2015

Lesions of sarcocystosis were studied in 14 calves necropsied between seven and 110 days after inoculation with 5000 to 25 million sporocysts of Sarcocystis hirsuta from cats. Calves developed fever, anemia, and diarrhea between 11 and 30 days after inoculation. The development of first generation meronts in arteries of small intestine, mesentery, and mesenteric lymph nodes seven to 25 days after inoculation was associated with vascular occlusion and necrosis of associated tissues. The development of second generation meronts in capillaries of striated muscles 15 to 23 days after inoculation was associated with necrosis, edema, and nonsuppurative myositis in heart and other muscles. Sixty-two days after inoculation lesions were reduced to focal areas of granulomatous inflammation around degenerating sarcocysts in striated muscles, but not in the heart.
Bacterial Colonization and Morphology of the Intestine in Porcine Escherichia Coli Enterotoxemia (Edema Disease)
Authors: Bertschinger H.U. , Pohlenz J.
Published: November 2015

Twenty-one pigs were divided into three groups. Pigs in one group were inoculated with the intestinal contents which included bacteria from a pig with edema disease. Pigs in another group were inoculated with a culture of Escherichia coli serogroup O 139:K12(B):H1 isolated from the aforementioned contents, and pigs in a third group served as uninoculated controls. The infection was similar following both inocula. Enterotoxemia developed in 11 of the 14 pigs allowed to survive for more than two days. The onset varied from two to seven days after inoculation. There were maximal viable counts of E. coli in the intestine from the second day post-inoculation and thereafter.

In frozen and paraffin sections, as well as by scanning electron microscopy, the organisms were seen on the surface of the small intestinal epithelium where they formed either isolated colonies or continuous layers. They colonized the lower small intestine more intensely than the upper section. The intestinal epithelium and the villi of infected pigs were indistinguishable morphologically from the tissues of three uninoculated control pigs.

The diarrhea which was observed in controls and inoculated pigs before inoculation and the villus atrophy in controls and inoculated pigs indicated a preexisting infection with at least one other agent.
Erythrocyte Volume Distribution Analysis and Hematologic Changes in Dogs with Iron Deficiency Anemia
Authors: Weiser G. , O'Grady M.
Published: November 2015

Hematologic features were characterized in 12 dogs with iron deficiency anemia attributable to chronic external blood loss. Consistent abnormalities in hemograms included moderate to marked reticulocytosis, decreased mean corpuscular volume, and decreased mean corpuscular hemoglobin concentration. Hypoproteinemia occurred in only four of 12 dogs. Consistent blood film findings included hypochromic cells, leptocytosis, and erythrocyte fragmentation. These dogs had significantly decreased serum iron values (p < 0.001) and percent transferrin saturation values (p < 0.001) compared with 33 clinically healthy adult dogs. The total iron binding capacity values of these dogs were not significantly different (p > 0.5) than those of the healthy dogs. Using erythrocyte volume distribution curves, the percentages of microcytic cells (≤ 45 fl) were determined to range from 20% to 82%. Sequential changes in erythrocyte subpopulations were evaluated in four dogs which received iron therapy. The hematologic response consisted of fairly rapid restoration of packed cell volume by production of normocytes followed by a more gradual replacement of residual microcytes by new normocytes.
Partition: On the Discriminations of Modernity
Authors: Walker R. B. J. , Krishna Sankaran
Published: November 2015

A couple of years after the Partition of the country, it occurred to the respective governments of India and Pakistan that inmates of lunatic asylums, like prisoners, should also be exchanged. Muslim lunatics in India should be transferred to Pakistan and Hindu and Sikh lunatics in Pakistani asylums should be sent to India.
The Global Panopticon? The Neoliberal State, Economic Life, and Democratic Surveillance
Authors: Gill Stephen
Published: November 2015

One impoverishes the question of power if one poses it simply in terms of legislation and constitution … the state and the state apparatus. Power is … more complicated, dense and pervasive…. It's impossible to get the development of productive forces characteristic of capitalism if you don't at the same time have apparatuses of power…. The system of power takes a pyramidical form. [The apex] and the lower elements of the hierarchy stand in a relationship of mutual support and conditioning…. The bourgeoisie … construct[ed] machines of power allowing circuits of profit, which in turn re-inforced and modified the power apparatuses in a mobile and circular manner … techniques of power are invented to meet the demands of production … in the broadest sense — it can be a matter of the “production” of destruction, as with the army…. The power of the bourgeoisie is self-amplifying, in a mode not of conservation but of successive transformations.1
Cultural Pluralism and the Limits of Diversity
Authors: Parekh Bhikhu
Published: November 2015

Almost every modern society includes groups whose ways of life are different from that of the mainstream society. The society wishes, and is right to wish, to preserve its way of life. However, that is also true of the constituent groups. This raises the question as to how the wider society should respond to their desire to preserve their ways of life and what it is to be done when the latter offend against its deeply held values. This article addresses that question.
Lakeside at Chautauqua's Holy Land
Authors: Long Burke O.
Published: November 2015

The Chautauqua Institution, founded in 1874 to train American Sunday school teachers, quickly developed programs aimed at encouraging a citizenry refined by Anglo-European, classical high culture and governed by Bible-centered Christian convictions. Avid Bible study, a walk-through model of biblical Palestine, smaller scale replicas of Jerusalem and the biblical Tabernacle, lectures and community rituals, costumed ‘Orientals’ enacting scenes of biblical life—these activities were central to Chautauqua's early identity. This essay explores how Chautauqua's realization of holy land in America embodied particular notions of the Bible, religious experience, cultural values, and ideologies of religion and national selfhood.
The Contribution of Royal Inscriptions for a Re-Evaluation of the Book of Kings as a Historical Source
Authors: Na'aman Nadav
Published: November 2015

The article examines the corpus of ancient Near Eastern royal inscriptions that refer directly to the histories of Israel and Judah in the late-tenth-ninth centuries BCE as a sample for examining the account of the book of Kings. It indicates that royal inscriptions are indispensable sources for evaluating the authenticity of the biblical history, as well as for tracing the sources available to the Dtr historian. The historian had some written sources, most of them for the history of the kingdom of Judah, on which he based his history of the late-tenth-ninth centuries BCE. But the number of sources at his disposal was small and the amount of material they contained was quite limited. In order to write a linear and continuous history of the two kingdoms, he filled in the many gaps by logical inferences ‘borrowed’ from the existing sources. Royal inscriptions indicate that some inferences are incompatible with the historical reality. Only by combining the biblical text with all other sources can we try to reconstruct, in spite of the many question marks, the history of the two kingdoms in that early period.
Genesis 1 and the Priestly Agenda
Authors: Firmage Edwin
Published: November 2015

The Priestly creation narrative of Gen. 1.1–2.4 is generally interpreted as a self-contained theological or historical exercise. Abstract exercises are alien, however, to the Priestly style. This article suggests the possibility that the author was a member of the Holiness School and that his purpose was to establish the philosophical foundation of the Holiness Code (H) by declaring that man is God's image, and therefore has the potential to become holy. The creation narrative sets the stage for the centerpiece of H, the dietary law of Leviticus 11. Usually attributed to P, this law shows itself to belong to H, and in fact to be one of the cornerstones of H's ideology. Intent on showing how world history was a preparation for the revelation of the laws of holiness at Sinai, the author of H emerges as one of the most important of the Hebrew Bible's author-redactors.
Migraine and Hypertension
Authors: Mathew NT
Published: November 2015

Association between mild to moderate hypertension and headache is probably coincidental. Severe sustained hypertension, malignant hypertension and paroxysmal hypertension (sudden rise) are associated with severe headache. Transient hypertension can occur during an attack of migraine or cluster headache. Hypertension may increase the frequency and severity of migraine in migraineurs and may transform an episodic migraine into chronic daily headache. Concomitant treatment of hypertension is important in these patients.
Recurrent Tolosa-Hunt Syndrome: A Report of Ten New Cases
Authors: Hannerz J
Published: November 2015

Ten patients (6F, 4M) with recurrent Tolosa-Hunt syndrome are reported. Besides ocular motor symptoms, one patient had trigeminal nerve involvement, one had ipsilateral ocular sympathicoplegia with miosis and ptosis, and one tinnitus during an episode of Tolosa-Hunt syndrome, ipsilateral to the pain side. One patient had Bell's palsy, one had a possible Raeder's syndrome, and one had a period of tinnitus between the Tolosa-Hunt syndrome episodes. Three of the 10 patients reported periods of periocular pain without ophthalmoplegia between the Tolosa-Hunt episodes, the pain located ipsilateral to the ophthalmoplegic side in the Tolosa-Hunt episodes. Systemic symptoms associated with Tolosa-Hunt syndrome, e.g., back pain, chronic fatigue, arthralgia, gut problems among others, occurred with the same frequency in these 10 patients as in an earlier report. Seventy per cent of the patients had signs of inflammation in serum during a period of Tolosa-Hunt syndrome. Orbital phlebograms showed pathologic signs in four of the five patients investigated during a Tolosa-Hunt period. One phlebogram was normal in a sixth patient when performed during a period of unilateral periocular pain without ophthalmoplegia. Magnetic resonance imaging of the head (with contrast) was only performed in three patients during the Tolosa-Hunt period: one showed signs of inflammation in the middle fossa and two were normal. In one of the patients with normal magnetic resonance imaging, the orbital phlebogram was pathologic. Steroid treatment promptly relieved the pain in all patients.
Familial Occurrence of Headache
Authors: Aromaa M , Rautava P , Sillanpää M , Helenius H , Ojanlatva A
Published: November 2015

Associations between the occurrences of headache among parents and their offspring during a 7-year follow-up were studied. Data were collected using a prestructured questionnaire from a representative population-based sample of 1443 families expecting their first child. Seven years later, another questionnaire was sent to 1132 families still included in the study. Questionnaires were returned by 968 families. One or either of the parents had experienced frequent headache in 47% of families (34% of the mothers and 19% of the fathers) before pregnancy. Of the 6-year-old children, 15% had headache disturbing daily activities. Mother's prepregnancy headache was a clear predictor of her child's preschool headache ( p = 0.006, OR = 1.7, 95% CI 1.2–2.4). In the clinical interview, the children with headache more often had first-degree and second-degree relatives with headache than the control children.
Gender as a Moderator of the Relation between Race-Related Stress and Mental Health Symptoms for African Americans
Authors: Greer Tawanda M. , Laseter Adrian , Asiamah David
Published: November 2015

The present study tested gender as a moderator of the relationship between race-related stress and mental health symptoms among African American adults. Because African American women are exposed to stressors associated with race and gender, we hypothesized that African American women would have higher levels of race-related stress and more severe mental health outcomes related to experiences of race-related stress compared to African American men. Multivariate analyses revealed that African American men had higher stress appraisals for institutional racism than did women. No significant gender differences were found for cultural and individual racism. Moderated regression analyses revealed that increases in stress appraisals for individual racism were associated with increases in anxiety and obsessive-compulsive symptoms for African American women. Race-related stress had no significant effects on mental health symptoms for African American men. The findings suggest that gender is an important factor in determining the impact of race-related stress on mental health.
Influence of L1 Orthography on Spelling English Words by Bilingual Children: A Natural Experiment Comparing Syllabic, Phonological, and Morphosyllabic First Languages
Authors: Dixon L. Quentin , Zhao Jing , Joshi R. Malatesha
Published: November 2015

This study examined the influence of first language (L1) orthography on bilingual children's spelling performance in their second language (L2), English. The subtests of spelling and letter-word identification from the Woodcock Proficiency Battery were administered to a sample of 285 six-year-olds in Singapore. All children received literacy instruction in English through the “look-say” method. Analyses of covariance showed a statistically significant effect of L1 on conventional spelling but not on phonological spelling, controlling for reading proficiency. The Chinese (morphosyllabic) group not only scored higher than the Malay (alphabetic) and Tamil (syllabic) groups overall, but also made more real-word substitution and transposition errors. The results are discussed in terms of the influence of L1 orthographic depth on spelling, and how learning disability specialists can utilize the information while evaluating the spelling/literacy skills of English L2 learners.
Support for Sunshine Bargaining in Florida: A Decade Later
Authors: West Jonathan P. , Feiock Richard C.
Published: November 2015

Collective bargaining with public employees in Florida is conducted in the sunshine. This empirical study examines support for sunshine bargaining (SB) in Florida and the effects of open meeting requirements on negotiations. Perceptions of the pros and cons of open bargaining are reported, and the effects of predictor variables on support for SB are analyzed. Findings show substantial support for open bargaining and suggest the need for revisions in generalizations reported in the literature concerning the consequences of public participation on negotiations. Experience-based attitudinal factors were more powerful than level of participation or demographic factors in explaining support for SB.
The Role of Negotiation in Planning, Management, and Policy Analysis
Authors: Rabinovitz Francine F.
Published: November 2015

Over the past two decades planners, analysts, and managers have all been urged to become more involved in the actual process of negotiation that surrounds all public policymaking. The article both summarizes the literature on how negotiation is emerging as a central feature of these three professions and provides three cases, all derived from litigation, in which the role of negotiator is required of the technician or neutral advisor. The article then suggests what is at stake when negotiation is adopted as a primary professional role.
Female employees find Iowa newspaper jobs satisfying
Authors: Lucht Tracy
Published: November 2015

A survey of female employees at Iowa newspapers shows these journalists highly value their newspaper jobs because of the importance, variety, autonomy and flexibility of their positions. However, many complained about low pay and lack of opportunity for advancement.
Hypotensive Reactions Associated with Platelet Transfusion Through Leukocyte Reduction Filters
Authors: Gauvin France , Toledano Baruch , Hume Heather A. , Lacroix Jacques
Published: November 2015

This article reports a case of hypotensive reaction following platelet transfusion (PT) and presents a possible etiologic mechanism implicating negatively charged leukocyte reduction filters (LRFs) and angiotensin converting enzyme (ACE) inhibitors. A 14-year-old boy with acute lymphoblastic leukemia was admitted to the pediatric intensive care unit (PICU) for respiratory failure following bone marrow transplantation. He was being treated with ACE inhibitors and was hemodynamically stable. He received a PT with a negatively charged bedside LRF the day his ACE inhibitor dose was doubled. His blood pressure (BP) dropped from 106/65 to 75/45. The PT was stopped and his BP was stabilized with a bolus of cristalloid. The same PT was restarted using a macroaggregate filter and his BP remained stable. This reaction was characterized by severe and isolated hypotension. It occurred while using a negatively charged bedside LRF in a patient who had a recent increase in ACE inhibitor therapy. The reaction did not recur when the LRF was replaced by a macroaggregate filter. This case provides further evidence to support the hypothesis that the use of negatively charged LRF may lead to hypotensive transfusion reactions in some patients. Bradykinin, which is generated when plasma is exposed to a negatively charged surface, and whose metabolism is decreased by ACE inhibitors, may play a role in these reactions.
The Severity and Cost of Child Abuse in the Pediatric Intensive Care Unit
Authors: Dominguez Troy E. , Chalom René , Costarino Andrew T.
Published: November 2015

The objective of this study was to describe the severity of illness, costs, and outcomes of child abuse (CA) patients in the pediatric intensive care unit (PICU) and to assess the importance of CA in predicting costs adjusting for severity of illness and diagnosis. A retrospective, cohort study was performed on a consecutive sample of 1, 376 patients admitted and discharged to a tertiary care PICU during fiscal year 1994. Demographic data, diagnoses, pediatric risk of mortality (PRISM) score, length of stay, and deaths were recorded. Hospital charges were converted into costs using cost:charge ratios. Functional outcomes of the CA patients were assessed at the time of discharge. There were 17 cases of CA in 1,376 admissions (1.24%). CA accounted for 6 of 85 deaths (7.06%) and the mortality rate was significantly higher than the rest of the PICU population (35–3% versus 5.8%, p < 0.01). In the traumatic brain injury (TBI) subgroup, total costs and daily costs were significantly higher in the CA patients ($11,926 versus $7,798, p = 0.013 and $3,400 versus $2,479, p = 0.01). Adjusting for severity of illness with multiple regression, there were no differences in costs identified in the CA patients. Nine of 11 (81.8%) CA patients with TBI were severely disabled or died. CA patients have an increased severity of illness, explaining much of the differences in costs seen with these patients. Further resources should be allocated toward prevention given the high costs and high morbidity and mortality in these patients.
Critical Illness in the Elderly: Review of Pathophysiology of Aging and Outcome of Intensive Care
Authors: Chelluri Lakshmipathi
Published: November 2015

The goal of this article is to review the literature on age and its influence on the pathophysiology of critical illness, outcome after critical illness, and end of life decision making in critically ill elderly patients. Sources for this review included the MEDLINE database and bibliographies of original articles, reviews, and book chapters. The population is aging and the need for medical care and its costs increase with increasing age. A majority of the elderly lead independent lives, although some need help with various functional activities related to daily living. It is difficult to separate the effects of aging from the effects of the comorbidities that develop with increasing age. The physiologic reserve decreases in the elderly and they may not be able to tolerate a critical injury or illness as well as a younger individual. As the elderlyare usually on multiple medications, they are prone to have more drug interactions and side effects, and need close monitoring of the drugs and adjustment of the dosage. Mortality after a critical illness in the elderly is higher compared to younger patients, and it is more related to the acuity of physiologic disturbance than age alone. The effect of age alone on long-term outcome is not well studied, but individuals with poor functional status and/or increased comorbidities have a poor short-term outcome. Functional status usually deteriorates after critical illness, but the long-term survivors usually recover functional abilities, and they are satisfied with their quality of life. Decision making at the end of life is difficult because of the paucity of data on long-term mortality and quality of life, lack of information about patient wishes, and the uncertainty of the prognosis. Because many elderly patients survive critical illness and may return to their previous lifestyle, age alone should not weigh heavily in end of life decisions. As with other age groups, end of life decisions in the elderly should be made after considering long-term outcomes, patient goals, and the benefits and burdens of life-sustaining technology.
Immunosuppression in Trauma Patients
Authors: Hoyt David B. , Ozkan A. Nuri
Published: November 2015

An immunosuppressed state develops following traumatic injury, which makes patients more prone to develop infection. A variety of disturbances accompany injury that affect both specific and nonspecific components of host defense. Many clinical studies have attempted to evaluate the many deficits that follow injury and place the patient at a higher risk for infection. Several components of host defense are affected simultaneously and include (1) cellular changes (decreased activation of T-lymphocyte subsets with decreased helper cells, increased suppressor T-cell function, increased but abnormal activity of macrophages, activation of polymorphonuclear leukocytes with depressed chemotaxis and killing); (2) depressed nonspecific and specific serum immunity (e.g., depressed fibronectin and immunoglobulin levels); (3) the presence of altered cytokine levels (interleukin-1 [IL-1], IL-2, IL-6, tumor necrosis factor) levels; (4) ongoing serum proteolytic activity; and (5) the generation of serum suppressive peptides. An in-depth understanding of the deficits that occur following injury in host defense will provide the basis for therapeutic intervention.
Syncope
Authors: Silver Kevin H. , Alpert Joseph S.
Published: November 2015

Syncope is a common admitting diagnosis to intensive care units; however, in half the cases, the etiology goes undiagnosed. The prognosis is adversely affected in patients with a cardiogenic etiology. We discuss the clinical presentation and pathophysiology of cardiovascular causes of syncope (including arrhythmia and conduction disturbances, myocardial disorders, and valvular disorders), vascular causes (obstruction and decreased venous return), peripheral vascular causes (arterial and venous), and noncardiovascular causes (neurological and hematological). A thorough history and physical examination are the best diagnostic tools. In addition, electrocardiograms and 24-hour telemetry monitoring are also useful. Other diagnostic tests should be ordered judiciously, depending on the findings of the initial evaluation. Medical or surgical treatment is directed at the underlying cause.
Critical Appraisal of Therapeutic Interventions in the Intensive Care Unit: Human Monoclonal Antibody Treatment in Sepsis
Authors: Cook Deborah J. , Jaeschke Roman , Guyatt Gordon H.
Published: November 2015

Using the medical literature to solve patient problems is challenging and rewarding. For intensive care physicians, this evidence-based medicine approach is more compelling when basic critical appraisal skills are developed. We highlight the important methodological points for interpreting the literature on treatment, using a cogent example from the critical care literature—monoclonal antibody therapy in sepsis. It is likely that as we move into the 1990s, growth in the number in the number of articles on immunotherapy in the sepsis syndrome will parallel the growth of the general biomedical literature.
Measuring Illness Severity in Newborn Intensive Care
Authors: Richardson Douglas K. , Tarnow-Mordi William O.
Published: November 2015

Measurement of illness severity has found increasing use in adult and pediatric intensive care research over the past decade. The development of illness severity indices for neonatal intensive care has lagged because birth weight has served as an excellent proxy for illness severity. However, a number of recent studies have shown marked variation in survival and morbidity among neonatal intensive care units (NICUs) despite birth weight adjustment, making clear the need for neonatal illness severity scoring. We discuss advantages and disadvantages of the 4 types of scoring systems used in adult intensive care—diagnosis, risk-factor, therapeutic, and physiological—and review their applications in adult and pediatric ICU research. Criteria for score design, as well as standards for validation and performance, are enumerated. The 30 neonatal scores fall in 5 major categories: obstetric risk, general use pediatric scores, predictors of developmental outcome, bronchopulmonary dysplasia risk, and acute mortality risk. Few have been adequately validated on large, concurrent independent samples. The most promising scores are those that measure acute physiological derangement on admission. Potential applications for these new illness severity scores are discussed.
Neuroleptic Malignant Syndrome: A Review for Intensivists
Authors: Prager Laura M. , Millham Frederick H. , Theodore Stern A.
Published: November 2015

Neuroleptic malignant syndrome (NAIS) is arare, potentially life-threatening disorder that results from the use of neuroleptics, a class of drugs that is being used with increasing frequency in intensive care units (ICUs). Unfortunately, critically ill patients typically have coexisting conditions that make accurate diagnosis of NAIS difficult and complicate treatment decisions. Diagnostic criteria, risk factors, and treatment options for NMS are discussed; case examples are provided.
Trauma Radiology: Part IV. Imaging of Acute Craniocerebral Trauma
Authors: Mirvis Stuart E. , Shanmuganathan K.
Published: November 2015

Diagnostic imaging has a key role in diagnosis and management of patients sustaining craniocerebral injuries from trauma. We review the current role of skull radiography, computed tomography (CT), and magnetic resonance (MR) in imaging patients sustaining craniocerebral trauma, and we describe the appearance of major forms of pathology as depicted by each modality. CT scan is used to assess quickly the extent of injury and to triage patients to observation, medical, or neurosurgical management. CT findings can be divided into primary craniocerebral injuries, including skull fractures; extraaxial hematomas (subdural and epidural); intraparenchymal injury, such as hematoma, contusion, and diffuse axonal shearing; and intraventricular or subarachnoid hemorrhage. Secondary manifestations of injury, such as cerebral edema and herniation, are also identified, and their course can be followed by serial CT. CT is crucial in assessing the outcome of surgical intervention and in identifying potential delayed complications of either head trauma or surgical intervention, including infection, delayed hemorrhage, cerebral infarction, and tension pneumocephalus. In recent years, MRI has been shown to be valuable in diagnosing cerebral injury. MRI has generally been shown to have greater overall accuracy than CT in identifying and characterizing most forms of traumatic cerebral pathology, but it is less accurate at demonstrating subarachnoid hemorrhage acutely, pneumocephalus, and calvarial fractures, particularly those involving the skull base. Moreover, MRI is still more difficult to perform than CT in critically ill patients, and it is generally far more time-consuming. However, MRI is unequivocally more accurate than CT at revealing certain lesions, particularly brainstem contusion, diffuse axonal shearing, predominantly nonhemorrhagic contusions, and thin collections of blood adjacent to bone, and it should be used selectively when these injuries are suspected.
Calcium Administration for Cardiovascular Support in Critically Ill Patients: When Is It Indicated?
Authors: Jankowski S. , Vincent J-L.
Published: November 2015

Calcium has a fundamental role in the maintenance of myocardial function and vascular tone. The ionized form of calcium is the most important physiologically, and this form needs to be measured to assess physiologically active calcium levels. Ionized hypocalcemia can occur as a result of various pathophysiological disturbances, and it is seen frequently in critically ill patients. Several investigators have observed a poorer prognosis in those patients with ionized hypocalcemia. It is unclear whether calcium supplementation is beneficial in these patients. It may improve cardiovascular performance, but, in contrast, it may contribute to cellular damage (especially during hypoxia following cardiopulmonary resuscitation). In sepsis, there may be an increased cellular influx of calcium, which may be deleterious to cellular function; indeed, calcium entry blockers in this situation may be protective. We review the role of calcium as an inotropic agent, its interaction with other inotropic agents, and its use during blood transfusion and during cardiopulmonary resuscitation.
Arthritis in Adults: Clinical Features, Outcome, and Intensive Care Requirements
Authors: Martens Peter B. , Ho George
Published: November 2015

A review of adults with septic arthritis was undertaken to evaluate outcome of treatment and intensive care requirements in a community-based teaching hospital. During an 80-month period (1986–1992), 38 cases of septic arthritis were identified. Underlying joint disease was present in 84% of patients. Mean age was 68 years, with a range of 26 to 100 years and a median of 70 years. Patients did not always initially display signs of infection; fever was present in only 42%, and leukocytosis was present in 67%. Total in-hospital mortality was 26%, but the mortality attributed to septic arthritis was 13%. Polyarticular septic arthritis occurred in 26% of patients and carried a 40% mortality. Twenty-four percent of patients required transfer to the intensive care unit (ICU); they had a 67% mortality. Three of four patients with polyarticular septic arthritis requiring intensive care died. Average length of hospital stay for survivors receiving a full course of antibiotics was 35 days; it diminished to 14 days for 5 uncomplicated cases who received home IV antibiotics. Eighty-nine percent of survivors had return of function of the affected joints. Thirty-two percent required surgical intervention, and 5% were complicated by osteomyelitis. Septic arthritis remains a costly disease affecting primarily the elderly with underlying joint disease. Polyarticular septic arthritis and the need for ICU care portend a high mortality. The functional outcome of those who recovered was generally good.
Delayed Bilateral Pneumothorax after Subclavian Vein Catheterization
Authors: Oropello John M. , Leibowitz Andrew , Sepulveda Pedro , Kuerer Henry , Benjamin Ernest
Published: November 2015

A delayed bilateral pneumothorax complicated unilateral left subclavian vein catheterization and required treatment with tube thoracostomy. This case is unique in the demonstration that bilateral pneumothorax can present in a delayed fashion, and that, as a result of a previously formed pleuropleural fistula, it can occur in patients with a history of noncardiac surgery involving median sternotomy. Historical data on delayed pneumothoraces and bilateral pneumothoraces are presented.
Cardiogenic Shock: Thrombolysis or Angioplasty?
Authors: Chou Tony M. , Amidon Thomas M. , Ports Thomas A. , Wolfe Christopher L.
Published: November 2015

Cardiogenic shock (CGS) occurs in 3 to 20% of patients presenting with acute myocardial infarction (MI), and it generally involves dysfunction of at least 40% of the total myocardial mass. Prior to the advent of balloon angioplasty and thrombolysis, in-hospital mortality was greater than 75%. This mortality rate has been consistent in reported series despite the advent of cardiac intensive care units, vasopressor, inotropic, and vasodilator therapy. Intra-aortic balloon counterpulsation therapy provides hemodynamic improvement, and it may provide some mortality benefit when used in conjunction with appropriate revascularization. Survival studies have shown that patency of the infarct-related artery is a strong predictor of survival. No randomized trials have been completed to examine which reperfusion therapy best treats this emergent situation. Subgroup analysis of large scale, multicenter trials, although underpowered, has shown no improvement in mortality with use of thrombolytic agents, leading many to advise use of mechanical intervention. In patients who present with acute MI with contraindications to thrombolysis, primary angioplasty is the treatment of choice. At selected centers, primary angioplasty is comparable to or better than thrombolytic therapy for patients presenting with acute MI, with or without CGS. Studies examining angioplasty in patients with CGS have shown high procedural success rates (75%) and reduced in-hospital mortality (44%), particularly in those patients with successful revascularization. Emergency bypass surgery may improve survival, but it is costly, unavailable to many, and often leads to excessive delays in therapy. If available, we believe that primary angioplasty is the treatment of choice for patients with CGS.
Gas Exchange during Gas and Liquid Ventilation
Authors: Mates Elisabeth A. , Hildebrandt Jacob , Hildebrandt Jacob
Published: November 2015

Liquid Ventilation with perfluorochemicals (PFC) violates many of our long-held assumptions about how the lung functions. However, the technique has been so successful in animal models of lung disease that it is currently being tested in clinical trials for the treatment of infant and acute (“adult”) respiratory distress syndrome in newborns, children, and adults. A common feature of both infant and acute respiratory distress syndromes is an inability of the lung's surfactant system to adequately lower surface tension, leading to regions of atelectasis. Liquid ventilation with PFC appears to ameliorate the disease process by lowering interfacial tension in the lung, opening regions of atelectasis, and improving gas exchange. To understand how gas exchange is successful during liquid ventilation requires careful re-evaluation of the assumptions underlying our current models of gas exchange physiology during normal gas ventilation. These assumptions must then be examined in light of the alterations in pulmonary physiology during liquid ventilation.
The Relationship of the ACCP/SCCM Consensus Conference Classification of Sepsis to Mortality and Multiorgan Dysfunction among Medical ICU Patients
Authors: Kollef Marin H. , Eisenberg Paul R.
Published: November 2015

To determine the relation between the proposed ACCP/SCCM Consensus Conference classification of sepsis and hospital outcomes, we conducted a single-center, prospective observational study at Barnes Hospital, St. Louis, MO, an academic tertiary care hospital. A total of 324 consecutive patients admitted to the medical intensive care unit (ICU) were studied for prospective patient surveillance and data collection. The main outcome measures were the number of acquired organ system derangements and hospital mortality. Fifty-seven (17.6%) patients died during the study period. The proposed classifications of sepsis (e.g., systemic inflammatory response syndrome [SIRS], sepsis, severe sepsis, septic shock) correlated with hospital mortality ( r = 0.330; p < 0.001) and development of an Organ System Failure Index (OSFI) of 3 or greater ( r = 0.426; p < 0.001). Independent determinants of hospital mortality for this patient cohort ( p < 0.05) were development of an OSFI of 3 or greater (adjusted odds ratio [AOR], 13.9; 95% confidence interval [CI], 6.4–30.2; p < 0.001); presence of severe sepsis or septic shock (AOR, 2.6; 95% CI, 1.2–5.6; p = 0.002), and an APACHE II score ≥ of 18 or greater (AOR, 2.4; 95% CI, 1.0–5.8; p = 0.045). Intra-abdominal infection (AOR, 19.1; 95% CI, 1.6–230.1; p = 0.011), an APACHE II score ≥ of 18 or greater (AOR, 8.9; 95% CI, 4.2–18.6; p < 0.001), and presence of severe sepsis or septic shock (AOR, 2.9; 95% CI, 1.5–5.4; p = 0.001) were independently associated with development of an OSFI of 3 or greater. These data confirm that acquired multiorgan dysfunction is the most important predictor of mortality among medical ICU patients. In addition, they identify the proposed ACCP/SCCM Consensus Conference classification of sepsis as an additional independent determinant of both hospital mortality and multiorgan dysfunction.
Clinical Information Systems for Intensive Care, Pediatric Critical Care, and Neonatology
Authors: Jose James H. , Adler Saul M. , Keyes William G. , Bradford James M.
Published: November 2015

Computer information systems are expected to soon take the place of current paper charting practices, and they offer great promise to assist management of the considerable amounts of data encountered in the information-rich environment of intensive care units (ICUs). Efforts to create an electronic medical record (EMR) have been underway for more than two decades, and major national organizations, such as the Institute of Medicine, have issued recommendations on standards. Benefits of an EMR include a legible patient record, enhanced communication, provision of timely reminders and alerts to clinicians, reduction of calculation errors, access to data bases for quality assurance and research, reduced healthcare costs, and improved patient outcomes. Despite these benefits, successful EMR implementations have been confined to a few committed institutions, and expensive failures have occurred. Practitioners of neonatology and pediatric intensive care are likely to have substantial difficulty implementing an EMR to fit their specialized needs because most experience in this area has been gained through care of adult patients, and systems being developed are oriented toward nonpediatric patients. It is therefore important to examine experience thus far with the functional components of an EMR so practitioners will be able to evaluate systems better as they become available. System components discussed include nursing charting facilities, lab reporting, physician order entry, physician progress notes, structured reports, decision support systems, and problem list management. Other concerns discussed include research and quality assurance functions, data access and confidentiality issues, and electronic mail. Maximizing the “structured data” content, as opposed to narrative content of an EMR, is an important priority, and progress on developing a uniform medical language is discussed. An approach to evaluating clinical information systems for use in the ICU is presented; it should assist practitioners of pediatric critical care and neonatology in identifying computer-based charting solutions that are optimal for infants and children, while cooperating with medical center-wide needs for compatibility and a common data base.
Diagnosis and Treatment of Gout in the Intensive Care Unit
Authors: Dellaripa Paul F.
Published: November 2015

Gout is a common cause of arthritis resulting from formation of monosodium urate crystals in synovial tissues. The incidence of this condition in the critically ill population is unknown, but gout can result in short-term morbidity and it can occasionally complicate management of a patient's primary condition. The diagnosis of gout should be considered in any patient in whom acute arthritis or bursitis develops. Aspiration of the involved joint or bursa and identification of crystals using either polarized or light microscopy are mandatory. Treatment options in critically ill patients differ from the usual treatment of gout because most critically ill patients have or are at risk for renal dysfunction and gastrointestinal bleeding, thus making use of nonsteroidal anti-inflammatory agents and colchicine hazardous. Intravenous colchicine in critically ill patients should be used with extreme caution, if at all, because the risk of bone marrow toxicity and other complications are well described in this patient population. Initial regimens should include use of adrenocorticotropic hormone, intra-articular corticosteroids, or systemic steroids. Analgesics may be beneficial as primary therapy in minor cases of acute gout, and they may be useful as adjunctive therapy in more severe cases. The role of colchicine as a prophylactic agent is discussed, as are treatment options in the allograft transplant population, in which rapidly progressive gout is increasingly common.
Urban Policy Revisited—Issues Resurface with a New Urgency
Authors: Nenno Mary K.
Published: November 2015

In 1969, U.S. Senator Daniel Patrick Moynihan, then Director of President Nixon's Urban Affairs Council, began a new national process of looking at the urbanization of the United States. This process was confirmed in the Urban Policy Reports required of the President under the 1977 Housing and Community Development Act. President Carter's two reports (1978 and 1980) detailed specific national initiatives to deal with urban problems. President Reagan's reports (1982, 1984, 1986, and 1988) sublimated urban issues under macro economic and fiscal strategies. In 1988, complex urban issues identified by Moynihan are resurfacing with a new urgency, building demand for revitalized federal initiatives.
Editorial Ethical Considerations of Clinical Research
Authors: Nesbitt Lori A.
Published: November 2015

As the drug development process continues to mature and the health care industry places increasing demands for newer and safer drugs, ethical judgments of clinical research by society will be made. Already, many ethical dilemmas faced by the clinical research industry are gaining attention; examples include: (1) “true” informed consent for human subjects, (2) conflicts of interest in medical research, (3) data interpretation by pharmaceutical and bio-technology companies, and (4) the obligation to disclose financial agreements between the investigator and the study sponsor to the patient. The following editorial outlines these issues in further detail.
Pharmacist Roles in Industrial Clinical Research and Regulatory Affairs
Authors: Edwards S. Albert
Published: November 2015

This article describes the roles of a pharmacist practicing in the areas of clinical research and regulatory affairs. The article also discusses clinical research and regulatory affairs in the pharmaceutical industry and includes information on what elements of a pharmacy background are useful and relevant, aswell as what a pharmacist can expect in these areas. The future growth of job opportunities is also discussed. Some information is also given on the clinical research process and the underlying scientific method, and selected Food and Drug Administration regulations on clinical research