bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Traditional Remedies Useful in Management of Fibromyalgia and Chronic Fatigue Syndrome? A Review Study
Authors: Mahjoub Fatemeh , Salari Roshanak , Noras Mohammad Reza , Yousefi Mahdi
Published: June 2017

Fibromyalgia and chronic fatigue syndrome are disorders that often occur simultaneously and are characterized by widespread pain and persistent fatigue. The patients are associated with disability and impairment social and physical functions. There are many remedies in traditional Persian medicine suggested for management of the disease complaints. The aim of this study was to investigate the clinical presentations and pathophysiology of disorders with the basic and principal textbook of traditional Persian medicine written by Avicenna ( Canon of Medicine). According to Persian medicine, the term E’aya can be matched by mentioned disorders. Avicenna believed that strenuous activities play an important role in the beginning of some types of fatigue. He classified fatigue into 4 groups, and in each type the clinical symptoms varied. The multifaceted entity of fibromyalgia and chronic fatigue syndrome in Persian medicine and conventional medicine suggests multidisciplinary therapies in management of these disabling disorders.
Effectiveness of Workplace Interventions for Depression in Asia: A Meta-Analysis
Authors: Lau Rebecca W. M. , Mak W. H.
Published: June 2017

This meta-analysis is the first study conducted in Asia to quantitatively review the effectiveness of depression interventions in the Asian workplace. We identified 19 controlled intervention studies with a total sample size of 3,325 subjects representing different industry sectors in Mainland China, Hong Kong, Japan, Malaysia, and South Korea. Interventions were coded as Cognitive-Behavioral, Multimodal, Alternative, Organizational, and Strength-Based, which were delivered face-to-face or mediated by a computer or telephone. Overall, the results of a pooled mean effect size (Cohen’s d) of 0.417 (95% confidence interval [CI] = [0.257, 0.576]) revealed a significant and moderate positive effect of workplace interventions on the alleviation of depressive symptoms within the Asian workforce. This effectiveness could justify the increasing organizational need for investing in enhancing workplace mental health, as promoted by the World Health Organization. Moreover, ancillary moderator analyses in this study identified several key factors to further enhance the effectiveness of workplace interventions. Specifically, in addition to conventional cognitive-behavioral interventions, alternative and novel interventions with indigenous components and mediated interventions with interactive elements were found to have practical significance in the Asian workplace.
Exploring Cultural Identity, Personality, and Social Exposure Correlates to College Women’s Intercultural Competence
Authors: Peifer Janelle S. , Yangchen Tenzin
Published: June 2017

College students’ intercultural competence (ICC) has become a focus of many higher education institutions. Yet, more work can be done to explore what variables play a role in this complex and multifaceted process. The current study investigated the association between the outcomes (i.e., cognitive, intrapersonal, and interpersonal domains of ICC), cultural identity (i.e., majority group and international status), personality traits (i.e., extraversion, agreeableness, conscientiousness, neuroticism, and intellect/imagination), and social exposure (i.e., racial/ethnic and international diversity of friendships) for a culturally diverse sample of 179 incoming college women. After controlling for the cultural identity, personality traits, and social exposure variables, majority group status and intellect/imagination significantly predicted students’ openness to considering varied cultural perspectives (i.e., cognitive knowing). Findings indicated that White students had higher scores on the Cognitive Knowing subscale of ICC compared with students of Color. In addition to social cultural exposure, conscientiousness remained as a significant predictor of cognitive knowledge (i.e., factual knowledge, understanding, and awareness of various cultures) after controlling for all the other variables in the model. Extraversion and neuroticism persisted as a significant predictor of the intrapersonal identity and self-awareness component of ICC. Next, agreeableness and racial/ethnic diversity of friendships were key predictors of intrapersonal affect or cultural-emotional intelligence and attunement. Intellect/imagination, racial/ethnic, and international diversity of friendships all significantly predicted interpersonal sociocultural interaction. Finally, agreeableness and racial/ethnic diversity of friendships was linked with the social responsibility component of intercultural competence. The findings and their implications for higher education are discussed.
An Assessment of Care-Seeking Behavior in Asikuma-Odoben-Brakwa District: A Triple Pluralistic Health Sector Approach
Authors: Amegbor P. M.
Published: June 2017

Discussions and studies on Ghana’s pluralistic health care system usually ignore or downplay self-care as a crucial sector in this system of care. In view of this, this study uses a triple sector approach of the pluralistic health care system as advocated by Kleinman to assess care-seeking behaviors of residents in the Asikuma-Odoben-Brakwa District (Ghana). The results of cross-tabulation analysis demonstrate that respondents’ general care–seeking behavior is different from the type of care sought for last illness before the study. Data for the study were obtained from 227 urban and rural respondents in the study district in 2013. The findings indicate that factors such as geographic location, health insurance, and perception of the cost of professional care had a bearing on residents’ general care–seeking behavior. However, age, sex, relationship status, economic status, and proximity to nearest biomedical care service influenced the type of treatment sought for last illness. The approach use of the study demonstrates that self-care remains a general avenue of care for residents, whereas in times of severe illness, respondents often rely on professional biomedical care. The use of professional indigenous care services is generally low due to the financial burden associated with its use.
The Goddess Kāmākhyā: Religio-political Implications in the Tribalisation Process
Authors: Rosati Paolo Eugenio
Published: June 2017

This article examines the cross-cultural influence that worked on the absorption process of the goddess Kāmākhyā (Assam) within the Brahmanic pantheon, through a correlation of textual and historical-religious pieces of evidence. 2 2  This article is an enlarged and revised version of a paper that I presented on 18 September 2015 during the sixth Coffee Break Conference (17–19 September) held at the Italian Institute of Oriental Studies of ‘Sapienza’ University of Rome. In Assam, the cross-cultural interaction, between local tribes and Indo-Aryan speakers, began around 200 BCE–100 CE—when the Vedic culture had already changed from its earlier theological pattern. Therefore, after had been influenced by a long cross-cultural negotiation, the early medieval north-eastern purāṇas transformed the dakṣayajña myth, legitimising the temple of Kāmākhyā on Nīlācala as the greatest śākta pīṭha (seat of power), where the yoni (vulva) of Sat ī was preserved. In this way, the Purāṇas reconnected Nīlācala–Kāmākhyā not only to the sexual symbolism, but also to an ancient cremation ground and its death imaginary–a fact that the systematisation of the yoginī cult (ninth–eleventh century) into the Yoginī Kaula school corroborated. In this cross-cultural context, the early medieval Assamese dynasties emerged tied to the danger of liminal powers—linked to both the heterodox śākta-tantra sects and tribal traditions that were harnessed by the kings through the exoteric and esoteric rituals practised at Kāmākhyā.
Jobless Recovery and Structural Change: A VAR Approach
Authors: Chen Li-Hsueh , Cui Zhen
Published: June 2017

This study uses a vector autoregression approach to examine the link between jobless recoveries and the fast employment expansion in finance, health and education (FHE) sectors. Both reduced-form estimates and impulse responses indicate a negative effect of the expansion on aggregate employment. While the expansion Granger causes aggregate employment fluctuations, up to 40 per cent of the error variance of those fluctuations can be explained by innovations in the expansion. Moreover, movements in aggregate employment are reduced by 25 per cent when the expansion is accounted for. Therefore, the fast expansion of the FHE sectors is shown to have notably contributed to the onset of jobless recoveries.

JEL Classification: E24, E32, C32
Empirical Regularities of Inflation Volatility: Evidence from Advanced and Developing Countries
Authors: Banerjee Shesadri
Published: June 2017

How does volatility of inflation differ across the economies? Addressing this research question, the article undertakes an empirical exercise on monthly consumer price inflation over the sample period of M01, 1958 to M02, 2016 for 41 countries using the generalized autoregressive conditional heteroscedasticity (GARCH) (1, 1) model. The country-level analysis shows a modest difference of conditional volatility of inflation between the advanced and developing economies. However, this difference increases after controlling the country-specific traits by fixed effect panel estimation using generalized methods of moments on the estimated GARCH series. It is observed that, in the long run, the conditional variability of inflation is nearly three and half times greater in developing countries compared to advanced countries.

JEL Classification: E10, E30, E31
Euglycemic Diabetic Ketoacidosis With Prolonged Glucosuria Associated With the Sodium-Glucose Cotransporter-2 Canagliflozin
Authors: Kelmenson Daniel A. , Burr Kelsey , Azhar Yusra , Reynolds Paul , Baker Chelsea A. , Rasouli Neda
Published: June 2017

Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve glycemic control by a reversible inhibition of the sodium-glucose cotransporters in the renal proximal tubules resulting in increased urinary glucose. This unique mechanism, independent of insulin secretion and beta cell function, has made this class of medication desirable in patients with type 2 diabetes. However in May 2015, the US Food and Drug Administration issued a safety warning pertaining to the development of diabetic ketoacidosis (DKA) with the use of SGLT2 inhibitors. DKA associated with SGLT2 inhibitors frequently develops in the absence of hyperglycemia, which makes the diagnosis more challenging. Due to the reversible inhibition of SGLT2 by this class of medication, a quick recovery of glucosuria after cessation of medication is expected. In this article, we present a case of a 50-year-old woman with type 2 diabetes who developed euglycemic DKA after initiating therapy with canagliflozin. This case of DKA associated with SGLT2 inhibitor use was unique due to her hypoglycemic presentation and persistent glucosuria. SGLT2 inhibitors such as canagliflozin may predispose patients not only to diabetic ketoacidosis but also to prolonged glucosuria.
Pancreatic Cancer Heralded by Worsening Glycemic Control: A Report of Two Cases
Authors: Desai Dimpi , Rao Devika , Sukrithan Vineeth , Weinstein Eleanor , Goyal Akankasha , Schubart Ulrich
Published: June 2017

Pancreatic ductal adenocarcinoma is the third leading cause of cancer-related death in the United States. Since it is usually diagnosed at an advanced stage, its prognosis remains poor. The initial presentation varies according to the tumor location. The most common presenting signs are weight loss, jaundice, and pain. Several epidemiological, clinical, and experimental studies over the past 2 decades have shown that long-standing diabetes is a modest risk factor for pancreatic cancer. However, new-onset diabetes has also been observed to be an early manifestation of pancreatic cancer. We report 2 cases where worsening glycemic control led to the diagnosis of pancreatic cancer.
Role of Repeat Muscle Compartment Pressure Measurements in Chronic Exertional Compartment Syndrome of the Lower Leg
Authors: van Zantvoort Aniek P. M. , de Bruijn Johan A. , Winkes Michiel B. , Hoogeveen Adwin R. , Teijink Joep A. W. , Scheltinga Marc R.
Published: June 2017

Background:

The diagnostic gold standard for diagnosing chronic exertional compartment syndrome (CECS) is a dynamic intracompartmental pressure (ICP) measurement of the muscle. The potential role of a repeat ICP (re-ICP) measurement in patients with persistent lower leg symptoms after surgical decompression or with ongoing symptoms after an earlier normal ICP is unknown.

Purpose:

To study whether re-ICP measurements in patients with persistent CECS-like symptoms of the lower leg may contribute to the diagnosis of CECS after both surgical decompression and a previously normal ICP measurement.

Study Design:

Case series; Level of evidence, 4.

Methods:

Charts of patients who underwent re-ICP measurement of lower leg compartments (anterior [ant], deep posterior [dp], and/or lateral [lat] compartments) between 2001 and 2013 were retrospectively studied. CECS was diagnosed on the basis of generally accepted cutoff pressures for newly onset CECS (Pedowitz criteria: ICP at rest ≥15 mmHg, ≥30 mmHg after 1 minute, or ≥20 mmHg 5 minutes after a provocative test). Factors predicting recurrent CECS after surgery or after a previously normal ICP measurement were analyzed.

Results:

A total of 1714 ICP measurements were taken in 1513 patients with suspected CECS over a 13-year observation period. In all, 201 (12%) tests were re-ICP measurements for persistent lower leg symptoms. Based on the proposed ICP cutoff values, CECS recurrence was diagnosed in 16 of 62 previously operated compartments (recurrence rate, 26%; 53 patients [64% female]; median age, 24 years; age range, 15-78 years). Recurrence rates were not different among the 3 lower leg CECS compartments (ant-CECS, 17%; dp-CECS, 33%; lat-CECS, 30%; χ2 = 1.928, P = .381). Sex (χ2 = 0.058, P = .810), age ( U = 378, z = 1.840, P = .066), bilaterality (χ2 = 0.019, P = .889), and prefasciotomy ICP did not predict recurrence. Re-ICP measurements evaluating 20 compartments with previously normal ICP measurements (15 patients [53% female]; mean age, 31 ± 10 years) detected CECS in 3 compartments (15%, all ant-CECS).

Conclusion:

Previous fasciotomy for lower leg CECS or previously normal muscle pressure (ICP) do not rule out CECS as a cause of persisting lower leg symptoms. Repeat ICP measurement may have a potential role in the evaluation of patients with persistent lower leg complaints. However, other reasons for lower leg exertional pain must always be considered prior to secondary surgery.
Impression Management and Retrospective Sense-Making in Corporate Annual Reports: Banks’ Graphical Reporting During the Global Financial Crisis
Authors: Jones Michael John , Melis Andrea , Gaia Silvia , Aresu Simone
Published: June 2017

This study investigates two potentially complementary reporting scenarios in annual reports: reactive impression management and retrospective sense-making. It examines stock market performance graphs in European listed banks’ annual reports before and during the global financial crisis. Our results indicate that banks reacted to the global financial crisis by omitting stock market performance graphs from the annual report and from its most prominent sections. On the other hand, banks reduced favorable distortions and favorable performance comparisons. No significant evidence of retrospective sense-making is found. Overall, the findings are consistent with impression management incorporating human cognitive biases, with companies preferring misrepresentation by omission over misrepresentation by commission. Under high public scrutiny, banks appear to seek to provide a more favorable view by concealing negative information rather than by favorable distortions or comparisons. The study contributes to the development of impression management theories. It uses a psychological interpretation that incorporates human cognitive biases, rather than adopting a purely economically based perspective.
Stress, Sleep, and Performance on Standardized Tests: Understudied Pathways to the Achievement Gap
Authors: Heissel Jennifer A. , Levy Dorainne J. , Adam Emma K.
Published: June 2017

Stress exposure, and subsequent biological responses to stress exposure, can negatively affect cognitive functioning and test performance. Stress exposure affects multiple biological systems, including sleep and the activity of the hypothalamic-pituitary-adrenal (HPA) axis and its primary hormonal product, cortisol. Sleep and cortisol interact with each other, and both affect cognitive performance. Stress, sleep, and cortisol also vary by race-ethnicity and socioeconomic status, and as a result, they may serve as potential pathways contributing to racial-ethnic and socioeconomic achievement gaps. Effects of stress on academic performance could occur either during the learning process or in response to the acute stress of testing. Interventions to limit stress exposure, reduce perceived stress, and promote optimal stress hormone levels and sleep may help students arrive in the classroom prepared to learn and to perform well on tests. These measures may particularly benefit low-income and minority students and may play a role in reducing achievement gaps.
The Neurobiological Mechanisms of Generalized Anxiety Disorder and Chronic Stress
Authors: Patriquin Michelle A. , Mathew Sanjay J.
Published: June 2017

Two classification systems are now at the forefront of clinical psychiatric research: (1) Diagnostic and Statistical Manual, Fifth Edition and (2) the National Institutes of Mental Health Research Domain Criteria. Herein, we propose that these two classification systems are complementary rather than mutually exclusive, and when combined provide important information for understanding aspects of the pathophysiology related to Generalized Anxiety Disorder (GAD). The neurobiological literature for GAD and one relevant research domain criteria component, sustained threat, are reviewed from multiple units of analysis (genetic, neuroimaging, neuroendocrine, and psychophysiological). It is hypothesized that generating a comprehensive, biologically based understanding of the relationship between GAD, sustained threat, and the measureable units of analysis will provide information critical to design the most effective treatments.
Persistent Placoid Maculopathy Treatment Response Imaged With OCT Angiography
Authors: Kovach Jaclyn L.
Published: June 2017

A 70-year-old Caucasian gentleman presented with decreased vision in the left eye and a subtle whitish macular plaque in the left eye and pigment mottling bilaterally. Indocyanine green angiography (ICGA) and optical coherence tomography angiography (OCTA) revealed left macular hypoperfusion. Systemic evaluation was negative for infectious or inflammatory disorder. A diagnosis of persistent placoid maculopathy was made and systemic immunosuppression was initiated. A marked improvement in macular perfusion was noted on ICGA and OCTA following 1 week of immunosuppression, providing additional evidence of an inflammatory rather than ischemic etiology.
Nonalcoholic fatty liver disease in chronic obstructive pulmonary disease
Authors: Viglino Damien , Jullian-Desayes Ingrid , Minoves Mélanie , Aron-Wisnewsky Judith , Leroy Vincent , Zarski Jean-Pierre , Tamisier Renaud , Joyeux-Faure Marie , Pépin Jean-Louis
Published: June 2017

Nonalcoholic fatty liver disease (NAFLD) is independently linked to cardiometabolic morbidity and mortality. Low-grade inflammation, oxidative stress and ectopic fat, common features of chronic obstructive pulmonary disease (COPD), might contribute to the development of NAFLD.

We aimed to investigate the prevalence of NAFLD and to evaluate the relationship between various types of liver damage and COPD severity, comorbidities and circulating inflammatory cytokines. Validated noninvasive tests (FibroMax: SteatoTest, NashTest and FibroTest) were used to assess steatosis, nonalcoholic steatohepatitis (NASH) and liver fibrosis. Patients underwent an objective assessment of COPD comorbidities, including sleep studies. Biological parameters included a complete lipid profile and inflammatory markers.

In COPD patients the prevalence of steatosis, NASH and fibrosis were 41.4%, 36.9% and 61.3%, respectively. In multivariate analysis, SteatoTest and FibroTest were significantly associated with sex, body mass index (BMI), untreated sleep apnoea and insulin resistance, and, in addition, COPD Global Initiative for Chronic Obstructive Lung Disease stage for SteatoTest. Patients with steatosis had higher tumour necrosis factor-α levels and those with NASH or a combination of liver damage types had raised leptin levels after adjustment for age, sex and BMI.

We concluded that NAFLD is highly prevalent in COPD and might contribute to cardiometabolic comorbidities.
Pedobarography as a clinical tool in the management of diabetic feet in New Zealand: a feasibility study
Authors: Gurney Jason K. , Kersting Uwe G. , Rosenbaum Dieter , Dissanayake Ajith , York Steve , Grech Roger , Ng Anthony , Milne Bobbie , Stanley James , Sarfati Diana
Published: June 2017

Background

The peripheral complications of diabetes mellitus remain a significant risk to lower‐limb morbidity. In New Zealand, risk of diabetes, comorbidity and lower‐limb amputation are highly‐differential between demographic groups, particularly ethnicity. There is growing and convincing evidence that the use of pedobarography – or plantar pressure measurement – can usefully inform diabetic foot care, particularly with respect to the prevention of re‐ulceration among high‐risk patients.

Methods

For the current feasibility study, we embedded pedobarographic measurements into three unique diabetic foot clinic settings in the New Zealand context, and collected pedobarographic data from n = 38 patients with diabetes using a platform‐based (Novel Emed) and/or in‐shoe‐based system (Novel Pedar). Our aim was to assess the feasibility of incorporating pedobarographic testing into the clinical care of diabetic feet in New Zealand.

Results and Conclusions

We observed a high response rate and positive self‐reported experience from participants. As part of our engagement with participants, we observed a high degree of lower‐limb morbidity, including current ulceration and chronic foot deformities. The median time for pedobarographic testing (including study introduction and consenting) was 25 min. Despite working with a high‐risk population, there were no adverse events in this study. In terms of application of pedobarography as a clinical tool in the New Zealand context, the current feasibility study leads us to believe that there are two avenues that deserve further investigation: a) the use of pedobarography to inform the design and effectiveness of offloading devices among high‐risk diabetic patients; and b) the use of pedobarography as a means to increase offloading footwear and/or orthoses compliance among high‐risk diabetic patients. Both of these objectives deserve further examination in New Zealand via clinical trial.
Aerosolized Vasodilators for the Treatment of Pulmonary Hypertension in Cardiac Surgical Patients: A Systematic Review and Meta-analysis
Authors: Elmi-Sarabi Mahsa , Deschamps Alain , Delisle Stéphane , Ased Hosham , Haddad François , Lamarche Yoan , Perrault Louis P. , Lambert Jean , Turgeon Alexis F. , Denault André Y.
Published: June 2017

BACKGROUND:

In cardiac surgery, pulmonary hypertension is an important prognostic factor for which several treatments have been suggested over time. In this systematic review and meta-analysis, we compared the efficacy of inhaled aerosolized vasodilators to intravenously administered agents and to placebo in the treatment of pulmonary hypertension during cardiac surgery. We searched MEDLINE, CENTRAL, EMBASE, Web of Science, and clinicaltrials.gov databases from inception to October 2015. The incidence of mortality was assessed as the primary outcome. Secondary outcomes included length of stay in hospital and in the intensive care unit, and evaluation of the hemodynamic profile.

METHODS:

Of the 2897 citations identified, 10 studies were included comprising a total of 434 patients.

RESULTS:

Inhaled aerosolized agents were associated with a significant decrease in pulmonary vascular resistance (−41.36 dyne·s/cm5, P= .03) and a significant increase in mean arterial pressure (8.24 mm Hg, P= .02) and right ventricular ejection fraction (7.29%, P< .0001) when compared to intravenously administered agents. No significant hemodynamically meaningful differences were observed between inhaled agents and placebo; however, an increase in length of stay in the intensive care unit was shown with the use of inhaled aerosolized agents (0.66 days, P= .01). No other differences were observed for either comparison.

CONCLUSIONS:

The administration of inhaled aerosolized vasodilators for the treatment of pulmonary hypertension during cardiac surgery is associated with improved right ventricular performance when compared to intravenously administered agents. This review does not support any benefit compared to placebo on major outcomes. Further investigation is warranted in this area of research and should focus on clinically significant outcomes.
Virtual Reality as an Adjunctive Nonpharmacological Sedative During Orthopedic Surgery Under Regional Anesthesia: A Pilot and Feasibility Study
Authors: Chan Peter Y. , Scharf Simon
Published: June 2017

This pilot study assessed the feasibility and potential for any possible sedation sparing effect of immersive virtual reality (IVR) therapy on patients undergoing joint replacement surgery under regional anesthesia. Nine participants were given IVR, regional anesthetic, and sedation. Ten received conventional care. Mean propofol usage was 155 ± 45 mg/h in the conventional care group and 63 ± 21 mg/h in the IVR group (P = .088, mean difference −91.6 mg/h, 95% confidence interval, −200 to 16.87 mg/h). There was no significant difference in postoperative satisfaction between the 2 groups. This pilot study demonstrates that it is possible to safely provide IVR in an operating theater environment and may confer a sedation sparing effect. A larger, more powered, and randomized study is needed to assess this effect.
Improving Performance by Monitoring the Success Rate of Peripheral Nerve Blocks
Authors: Bakker Sietske M. K. , Stienstra Rudolf
Published: June 2017

In our hospital, we introduced a system to measure the collective and individual efficacy of brachial plexus and popliteal nerve blocks with the objective to create transparency as an instrument for monitoring and improvement. Initially, individual results were anonymous, but after 1 year anonymity was lifted within the team of anesthesiologists and results are now discussed quarterly. Collective performance of interscalene, supraclavicular, and popliteal blocks improved significantly over time. Sharing and discussing collective and individual performance has resulted in critical self-appraisal and increased willingness to learn from each other and strengthened the team’s ambition for further improvement.
Cardiorespiratory Alterations Following Acute Normovolemic Hemodilution in a Pediatric and an Adult Porcine Model: A Prospective Interventional Study
Authors: Albu Gergely , Sottas Cédric , Dolci Mirko , Walesa Magali , Peták Ferenc , Habre Walid
Published: June 2017

BACKGROUND:

Acute normovolemic hemodilution (ANH) is considered as a blood-sparing intervention during the perioperative management. We aimed at comparing the cardiopulmonary consequences of ANH between adult pigs and weaned piglets to establish the effects of lowering hematocrit in these age groups, and thereby testing the hypothesis that difference in the age-related physiological behavior will be reflected in the cardiorespiratory changes following ANH.

METHODS:

ANH was achieved in anesthetized, mechanically ventilated adult minipigs and 5-week-old weaned piglets by stepwise blood withdrawal (10 mL/kg) with crystalloids replacement. Cardiorespiratory assessments consisted of measuring airway resistance, respiratory tissue elastance, effective lung volume, extravascular lung water, mean arterial pressure, pulmonary blood flow, and cardiac output. Respiratory and hemodynamic measurements were made at control conditions and following each ANH condition obtained with 5 to 7 steps.

RESULTS:

ANH induced immediate and progressive increases in airway resistance and tissue elastance in both groups, with more pronounced worsening in adults despite the similar decreases in hematocrit. The increases in extravascular lung water were significantly greater in the adult population with the differences in mean (DM) of 25.1% (95% confidence interval [CI], 5.3%–44.9%). Progressive ANH led to significant decreases in the DM of pulmonary blood flow (45.3%; 95% CI, 19.8%–70.8%) and mean arterial pressure (36.3%; 95% CI, 18.7%–53.9%) only in adults, whereas cardiac output increased significantly only in the piglets (DM, 51.6; 95% CI, 14.2%–89.0%).

CONCLUSIONS:

While ANH led to mild detrimental cardiorespiratory changes in weaned piglets, gradual developments of bronchoconstriction, lung tissue extravasation and stiffening, and deteriorations in systemic and pulmonary hemodynamics were observed in adults. ANH may exert age-dependent cardiorespiratory effect.
Reproductive and metabolic state differences in olfactory responses to amino acids in a mouth brooding African cichlid fish
Authors: Nikonov Alexandre A. , Butler Julie M. , Field Karen E. , Caprio John , Maruska Karen P.
Published: June 2017

Olfaction mediates many crucial life-history behaviors such as prey detection, predator avoidance, migration, and reproduction. Olfactory function can also be modulated by an animal’s internal physiological and metabolic states. While this is relatively well-studied in mammals, little is known about how internal state impacts olfaction in fishes, the largest and most diverse group of vertebrates. Here we apply electro-olfactograms (EOGs) in the African cichlid fish Astatotilapia burtoni to test the hypothesis that olfactory responses to food-related cues (i.e. L-amino acids; Alanine and Arginine) vary with metabolic, social, and reproductive state. Dominant males (reproductively-active, reduced feeding) had greater EOG magnitudes to amino acids at the same tested concentration than subordinate males (reproductively-suppressed, greater feeding and growth rates). Mouth brooding females, which are in a period of starvation while they brood fry in their mouths, had greater EOG magnitudes to amino acids at the same tested concentration than both recovering and gravid females that are feeding. Discriminant function analysis on EOG magnitudes also grouped the male (subordinate) and female (recovering, gravid) phenotypes with higher food intake together and distinguished them from brooding females and dominant males. The slope of the initial negative phase of the EOG also showed intra-sexual differences in both sexes. Our results demonstrate that the relationship between olfaction and metabolic state observed in other taxa is conserved to fishes. For the first time, we provide evidence for intra-sexual plasticity in the olfactory response to amino acids that is influenced by fish reproductive, social, and metabolic state.
New insights into the pathogenesis and prevention of tuberous sclerosis-associated neuropsychiatric disorders (TAND)
Authors: Gipson Tanjala T. , Johnston Michael V.
Published: June 2017

Tuberous sclerosis complex (TSC) is a multi-system disorder resulting from mutations in either the TSC1 or TSC2 genes leading to hyperactivation of mechanistic target of rapamycin (mTOR) signaling. TSC is commonly associated with autism (61%), intellectual disability (45%), and behavioral, psychiatric, intellectual, academic, neuropsychological, and psychosocial difficulties that are collectively referred to as TSC-associated neuropsychiatric disorders (TAND). More than 90% of children with TSC have epilepsy, including infantile spasms, and early onset of seizures, especially infantile spasms, is associated with greater impairment in intellectual development compared with individuals with TSC without seizures. Development of the mTOR inhibitors everolimus and sirolimus has led to considerable progress in the treatment of renal angiomyolipomata, pulmonary lymphangioleiomyomatosis, and subependymal giant cell astrocytomas in the brain. However, similar therapeutic progress is needed in the treatment of TAND.
The dynamic upper limit of human lifespan
Authors: Newman Saul , Easteal Simon
Published: June 2017

We respond to claims by Dong et al. that human lifespan is limited below 125 years. Using the log-linear increase in mortality rates with age to predict the upper limits of human survival we find, in contrast to Dong et al., that the limit to human lifespan is historically flexible and increasing. This discrepancy can be explained by Dong et al.’s use of data with variable sample sizes, age-biased rounding errors, and log(0) instead of log(1) values in linear regressions. Addressing these issues eliminates the proposed 125-year upper limit to human lifespan.
Recent advances in the management of chronic obstructive pulmonary disease
Authors: Rosenberg Sharon R , Kalhan Ravi
Published: June 2017

Novel pharmacotherapies introduce additional options to providers and patients in how to best treat chronic obstructive pulmonary disease (COPD). Emerging data question the role of inhaled corticosteroids in COPD treatment, particularly as combination dual bronchodilator pharmacotherapies demonstrate robust results. For those maximized on pharmacotherapy with continued dyspnea or exacerbations or both, emerging bronchoscopic procedures may offer additional therapy in select patients. This review focuses on data supporting the use of novel ultra bronchodilators, particularly in combination, and on the role for inhaled corticosteroid withdrawal and new bronchoscopic procedures.
Russia-West: Civilizational War
Authors: Багдасарян  , Bagdasaryan Vardan
Published: June 2017

Relevance of the presented book determined by escalation of international tension in the modern world, strain of relations of Russia on the block of the western states.
To Identify the reasons and deep sources of this conflict – a task which is put and solved in the monograph "Russia – the West: civilization war".
The author shows the historical reproducibility of the Russian-western opposition which is standing out through the entire periods of history from the Middle Ages till our time. The conflict relations with the Western world reveal in the book through the category of "civilization war". In the monograph it is shown the fundamental differences in the civilizational values of the West and Russia why the agenda of world development offered by them led objectively to the conflict differed. The content of the western global historical project and the Russian valuable alternative are considered.
The book can have practical interest for the state managers, and also for all who think of the due strategy of Russia, of its positioning in the world.
The use of modern dressings in managing split-thickness skin graft donor sites: a single-centre randomised controlled trial
Authors: Kazanavičius M. , Cepas A. , Kolaityte V. , Simoliuniene R. , Rimdeika R.
Published: June 2017

Objective:

To identify the most appropriate, most suitable and most efficient dressing for split-thickness skin graft (STSG) donor sites. Comparing the wound healing rate, pain severity and duration, as well as the dressing change frequency in four randomised patient groups.

Methods:

A single-centre non-blinded randomised controlled trial was carried out during 2010–2014. All patients treated for skin defects/lesions (due to burns, trauma or ulcers) using STSG were included in the study. All patients were randomly allocated in four different donor site treatment groups; polyurethane (PU group, Mepilex); polyurethane with silicone membrane (PUSM group; Mepilex border,); transparent, breathable film (TBF group; Mepitel film) and cotton gauze dressings (CG group) using Excel 2007. We evaluated: wound healing time, pain severity and duration, the frequency of dressing change, donor site re-epithelialisation, donor site complications (signs of inflammation or infection). Patients were assessed on postoperative days: 1, 3, 6, 9, 12, 15, 18 and 21.

Results:

After random allocation of study participants the number of patients in each group were: PU group n=25; PUSM group n=24; TBF group n=24; CG group n=25. The groups were homogenous according to gender, age, main pathology, donor site area and wound size. The STSG donor site healing time varied from 9 to 21 days. The mean healing time in the CG group was 14.76 days, whereas in the PU, PUSM, and TBF group it was significantly shorter; 12.25 days, 11.63 days and 10 days, respectively. Patients in the TBF group demonstrated the most rapid healing time with 66.7% of STSG donor sites healed by postoperative day 9. The pain duration interval in modern dressing groups (PU, PUSM and TBF groups) was 0–9 days, whereas it was 6–18 day in the CS group. Pain intensity mean on postoperative day 1 was 2.21 in the PU group; 1.67 in the PUSM group; 1.46 in the TBF group and 3.04 in the CG group. The average pain duration in Group PU, PUSM, and TBF was 4.08 days; 2.5 days; 2.29 days, respectively. The average number of times each dressing was changed in each group was, 2.83 times in the PU group and PUSM group and 1.46 times in the TBF group. The CG dressing group were changed once when the donor site wound re-epithelialised. There was one patient in the PU group who experienced signs of infection, was treated accordingly and excluded from the study.

Conclusion:

The fastest healing time was demonstrated by patients in the TBF group. The pain was not as severe and for a shorter period of time in modern dressing study groups. However, the pain was lightest and felt shortest in TBF dressing group. The modern dressings PU and PUSM had to be changed more frequently than TBF.
The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK
Authors: Guest J. F. , Vowden K. , Vowden P.
Published: June 2017

Objective:

To estimate the patterns of care and related resource use attributable to managing acute and chronic wounds among a catchment population of a typical clinical commissioning group (CCG)/health board and corresponding National Health Service (NHS) costs in the UK.

Method:

This was a sub-analysis of a retrospective cohort analysis of the records of 2000 patients in The Health Improvement Network (THIN) database. Patients' characteristics, wound-related health outcomes and health-care resource use were quantified for an average CCG/health board with a catchment population of 250,000 adults ≥18 years of age, and the corresponding NHS cost of patient management was estimated at 2013/2014 prices.

Results:

An average CCG/health board was estimated to be managing 11,200 wounds in 2012/2013. Of these, 40% were considered to be acute wounds, 48% chronic and 12% lacking any specific diagnosis. The prevalence of acute, chronic and unspecified wounds was estimated to be growing at the rate of 9%, 12% and 13% per annum respectively. Our analysis indicated that the current rate of wound healing must increase by an average of at least 1% per annum across all wound types in order to slow down the increasing prevalence. Otherwise, an average CCG/health board is predicted to manage ~23,200 wounds per annum by 2019/2020 and is predicted to spend a discounted (the process of determining the present value of a payment that is to be received in the future) £50 million on managing these wounds and associated comorbidities.

Conclusion:

Real-world evidence highlights the substantial burden that acute and chronic wounds impose on an average CCG/health board. Strategies are required to improve the accuracy of diagnosis and healing rates.
Pressure ulcers prevention efficacy of an alternating pressure air mattress in elderly patients: E²MAO a randomised study
Authors: Sauvage P. , Touflet M. , Pradere C. , Portalier F. , Michel J-M. , Charru P. , Passadori Y. , Fevrier R. , Hallet-Lezy A-M. , Beauchêne F. , Scherrer B.
Published: June 2017

Objective:

Our aim was to compare Axtair One, an alternating pressure air mattress (APAM), with a viscoelastic foam mattress (VFM) in elderly patients at moderate to high risk of developing pressure ulcers (PUs).

Method:

A randomised, controlled, superiority, parallel-group, open-label, multicentre study, was conducted, between February 2012 and March 2015, in nine French, medium- and long-term stay facilities. Eligible patients were aged 70 and over, had no PUs on enrolment, were bedridden for at least 15 hours per day, had reduced mobility, an absent or minimal positioning capability, a Braden score <14, a nutritional status score >12 and a Karnofsky score <40%. The primary endpoint was the appearance of PUs over a 30-day monitoring period. The primary objective was to demonstrate a 50% reduction in instantaneous risk of PUs in the APAM versus the VFM group. Secondary objectives were to determine if preventive care was less frequent in the APAM group, the instantaneous relative risk of PUs (hazard ratio) was constant over time and the comfort experienced was higher in the APAM group and to verify the uniformity of the preventive benefit of an APAM, regardless of the level of exposure to major risk factors for PUs.

Results:

We randomised 76 patients (39 in the APAM group and 37 in the VFM group). The groups were comparable on enrolment and throughout the study. The cumulative risk of PUs was estimated at 6.46% [95% confidence interval (CI): 1.64; 23.66] in the APAM group and at 38.91% [95% CI: 24.66; 57.59] in the VFM group, p=0.001 (log-rank test). The adjusted hazard ratio according to the Cox model with four prognostic factors for the appearance of PUs was 7.57 [95% CI: 1.67; 34.38, p=0.009]. Preventive care proved to be equivalent in both groups. The only risk factor significantly associated with an increased risk of PUs was the type of mattress (VFM). The comfort and tolerance perceived by the patients were both high and similar in the two groups. The constancy over time of the preventive benefit of an APAM could not be verified because of the lack of a sufficient number of events (appearance of PUs) in the APAM group.

Conclusion:

The APAM was superior to a VFM for preventing PUs in elderly patients, bedridden for more than 15 hours per day, severely dependent, at moderate-to high-risk of PUs, with an instantaneous risk for the appearance of PUs 7.57 times greater in the VFM group than in the APAM group. This study provides descriptive information and evidence for practice.
Efficacy of arginine-enriched enteral formulas for the healing of pressure ulcers: a systematic review
Authors: Liu P. , Shen W-Q , Chen H-L
Published: June 2017

Objective:

Arginine improves healing and modulates inflammation and the immune response. This systematic review aimed to assess the effect of arginine-enriched enteral formulas in pressure ulcer (PU) healing.

Method:

Systematic computerised searches of PubMed, Web of Knowledge, Scopus, ENTRAL and CINAHL databases were performed from their inception to 20 January 2016. Randomised controlled trials (RCTs) were included in this systematic review. We used the Jadad scale as a quality assessment tool.

Results:

There were seven RCTs with 369 patients included in this systematic review; four RCTs assessed healing by PU area reduction. All of them reported arginine-enriched enteral nutrition led to a significant improved PU healing compared with standard hospital diet in 2–12 weeks follow-up. Among these four RCTs, one enrolled malnourished patients, one enrolled non-malnourished patients, and the other two studies did not restrict the nutritional status of the patients. Using the Pressure Ulcer Scale for Healing (PUSH) four RCTs assessed healing of PU, all reporting arginine-enriched enteral nutrition resulted in a significant PUSH score improvement compared with control at follow-up. Using the Pressure Sore Status Tool (PSST) one RCT assessed healing of PUs, finding patients receiving arginine had the lowest PSST scores compared with controls. An RCT compared healing with two doses of arginine (4.5g versus 9g), but no difference was found between the doses.

Conclusion:

Evidence showed that arginine-enriched enteral nutrition led to a significant improvement in PU healing. It was effective not only in malnourished patients, but also in non-malnourished patients.
Chronic venous disease and wound infection: approaches, prevention and outcome measures from EWMA
Authors: Fronzo Camila
Published: June 2017

In May, BSN medical hosted two clinical symposia at the 2017 EWMA conference. These described the challenges in reducing the costs of treatment for patients with chronic venous disease (CVD), the importance of compression therapy and physical activity in the management and prevention of leg ulcers, and the obstacles in treating wound infection, among other topics. Camila Fronzo, JWC chief sub editor, was there to summarise the main points of each session.
PTSD, available support and development of services in the UK Ambulance Service
Authors: Dodd Greg
Published: June 2017

The role of front line ambulance staff in the UK has developed so rapidly that it is almost unrecognisable from days gone by, when scoop and run tactics were commonplace. With additional responsibilities, pressurised decision making and a range of sometimes complex interventions, unique pressures have also developed. The purpose of this article is to review pertinent information relating to how these additional pressures can metamorphose into specific conditions such as post traumatic stress disorder (PTSD). The prevalence of this and other debilitating conditions such as depression and anxiety specific to the ambulance service is reflected upon, whilst existing support from the ambulance service is examined. By broadening both knowledge and confidence relating to this increasingly significant problem, formulation of our own local improvements can take place in the near future.
Making transnational markets: the institutional politics behind the TTIP
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Assistant Professor, University of Amsterdam. Email: m.bartl@uva.nl. Many thanks to Daniela Caruso, Candida Leone, Fernanda Nicola and a number of friends and colleagues who have commented on the earlier versions of this paper. I would also like to warmly thank the two anonymous peer reviewers for their insightful comments. The remaining errors are mine.
Authors: Marija Bartl
Published: June 2017

The Transatlantic Trade and Investment Partnership (TTIP) may not bear fruit in its current incarnation, but it certainly teaches us crucial lessons regarding the institutional dynamics of market integration beyond the state. I argue that the TTIP’s so-called ‘regulatory cooperation’, in principle a mere mechanism for ‘discussion’ and ‘exchange’ between regulators, would have had a profound impact on the regulatory culture across the Atlantic. I make this argument in three interrelated steps. First, building on insights from constitutional law and political science, I outline an analytical framework for the study of rule-making institutions beyond the state. Second, I analyse the TTIP through the lens of this framework, illustrating the mechanisms through which its model for regulatory cooperation could reform the regulatory culture in the EU. Third, I argue that this change in the EU regulatory culture would have been neither an accident, nor a result of a US-led hegemonic project. Instead, the TTIP’s regulatory cooperation is a part of the EU’s internal political struggle, intended ultimately to re-balance not only powers between the legislative and the executive in the EU, but also within the EU’s executive branch itself.