bluuebunny/crossref_metadata_2025 huggingface dataset:
Where is the periphery even? Capturing urban marginality in South African human rights law
Authors: Pieterse Marius
Published: March 2018

This article questions the usefulness of the notion of an ‘urban periphery’ for efforts to capture and ameliorate urban marginalisation and exclusion through human rights-based litigation. Focusing on South Africa’s Gauteng City Region, the article argues that the notion of an urban periphery fails to capture the nuances of marginal urban life and the interests of poor, marginalised urban residents in accessing the city. In the specific context of the right of access to housing, the article then grapples with South African judicial engagements with the spatial dimensions of urban marginalisation. It finds that, despite the fixation of human rights litigators, activists and commentators on housing location and the ‘urban periphery’, courts are adopting a more nuanced and balanced approach to urban marginality. It accordingly identifies interests that should be accommodated by such an approach and points to legal concepts which may more constructively respond to these.
State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis
Authors: Helmer Drew A. , Rowneki Mazhgan , Feng Xue , Tseng Chin-lin , Rose Danielle , Soroka Orysya , Fried Dennis , Jani Nisha , Pogach Leonard M. , Sambamoorthi Usha
Published: March 2018

Most Veterans who use the Veterans Health Administration (VHA) also utilize private-sector health care providers. To better inform local and regional health care planning, we assessed the association between reliance on VHA ambulatory care and total and system-specific preventable hospitalization rates (PHRs) at the state level. We conducted a retrospective dynamic cohort study using Veterans with diabetes mellitus, aged 66 years or older, and dually enrolled in VHA and Medicare parts A and B from 2004 to 2010. While controlling for median age and proportion of males, we measured the association between reliance on VHA ambulatory care and PHRs at the state level using multivariable ordinary least square regression, geographically weighted regression, and generalized additive models. We measured geospatial patterns in PHRs using global Moran’s I and univariate local indicator spatial analysis. Approximately 30% of hospitalized Veterans experienced a preventable hospitalization. Reliance on VHA ambulatory care at the state level ranged from 13.92% to 67.78% and was generally not associated with PHRs. Geospatial analysis consistently identified a cluster of western states with low PHRs from 2006 to 2010. Given the generally low reliance on VHA ambulatory care and lack of association between this reliance and PHRs, policy changes to improve Veterans’ health care outcomes should address private-sector care in addition to VHA care.
The Political Economy of the Ebola Virus Disease
Authors: Obeng-Odoom Franklin , Bockarie Matthew Marke Beckhio
Published: March 2018

Public health has much to contribute to the global understanding and action on the past, present and future of Ebola but it is currently constrained by the construction of the ‘risk’ of catching Ebola. There has been a consequential emphasis on ‘health systems’, which has deflected attention from social alienation and implosion of social ties at the family, community, national and regional levels, instead justifying a colonial top-down response strategy. Indeed, that neglects class and social relations. It follows that the response strategy has reinforced social barriers that stand in the way of the development of social medicine, collective self-reliance in Africa, empowering social ties, social protection and socially inclusive development. What is needed, then, is not public health but critical postcolonial public health to pull down these impediments and develop socially sensitive alternatives that prioritise social relations and ties, inclusivity of diversity and complexity in African societies.
Social Inequality and Institutional Deliveries
Authors: Sarkar Pinak , Tigga Nutan Shashi
Published: March 2018

Women’s maternal health is an important concern all over the world, especially in sub-Saharan Africa and Asia; this includes India, the world’s second most populous country. Despite the implementation of various programmes by the government, India has a large number of women dying because of pregnancy-related problems. Tracking the progress of the Millennium Development Goals (MDGs)-5 which specifically aim to reduce the maternal mortality ratio (MMR), one sees that India is lagging in achieving the required reduction in maternal deaths. To be sure, institutional deliveries, one of the significant interventions to reduce maternal deaths, are being promoted significantly by initiating cash transfer schemes. However, this initiative has not achieved the desired results when one compares various socio-economic groups across India. This study analyses the degree of relative deprivation by using district-level household data to examine disparity in terms of achieving institutional deliveries among different socio-economic groups by using the relative deprivation index (RDI). Examining the severity of relative deprivation, we find that illiteracy and poor economic status are major contributors in creating inequality in achieving acceptable levels of institutional delivery.
The National Committee Report on Tribal People
Authors: Srivastava Vinay Kumar
Published: March 2018

This article is a critical commentary on the report that the High-Level Committee on Socio-Economic, Health and Educational Status of Tribal Communities of India submitted to the Government of India in 2014. This is one of the most exhaustive reports on tribal societies in India, providing well analysed data on the different indices of their social and cultural life. The analysis of data on socio-economic, health and educational status is followed by a set of recommendations that the state and the institutions of civil society may examine. At the end, all these recommendations are brought together in a consolidated set and the feasibility of each of these is discussed. An important point the report makes is that the state has paid a lot of attention to issues of development in tribal areas without caring for protecting them from the elements which have been exploiting them. Development has rendered a large number of them homeless, and this makes them hugely vulnerable to different forms of oppression.
On Planning University Development: Shibboleths Versus Stylised Facts?
Authors: Tilak Jandhyala B. G.
Published: March 2018

Reflecting on the nature and pattern of development of universities in India and abroad and drawing lessons from the past and also contemporary scene, the paper highlights a few major fallacies in planning university development, contrasting them with available evidence. It has been found that the whole approach to planning university systems seems to be guided more by immediate, short term, narrow and pecuniary considerations and compulsions and by questionable presumptions and fallacious arguments rather than by long term, broad national and global considerations and theoretically sound and empirically valid research. It also emphasises the need to resurrect the idea of the ‘ideal’ university.
Book review: Mason M.S. Kim, Comparative Welfare Capitalism in East Asia: Productivist Models of Social Policy
Authors: Singh Vaishali
Published: March 2018

Mason M.S. Kim, Comparative Welfare Capitalism in East Asia: Productivist Models of Social Policy. London: Palgrave Macmillan, 2016, 172 pp., $81.80– $95.00, ISBN: 9781137471840 (Hardbound).
Book review: Richard Falk, Manoranjan Mohanty and Victor Faessel (Eds), Exploring Emerging Global Thresholds: Towards 2030
Authors: Chimni B.S.
Published: March 2018

Richard Falk, Manoranjan Mohanty and Victor Faessel (Eds), Exploring Emerging Global Thresholds: Towards 2030. Hyderabad: Orient BlackSwan, 2017, 371 pp., ₹1,050, ISBN 9789386392428.
Book review: Ashok Vajpeyi (Ed.), India Dissents: 3000 Years of Difference, Doubt and Argument
Authors: Sivaraman Satya
Published: March 2018

Ashok Vajpeyi (Ed.), India Dissents: 3000 Years of Difference, Doubt and Argument. New Delhi: Speaking Tiger Publishing Pvt. Ltd, 560 pp., ₹499, ISBN: 9789385755958 (Paperback).
Book review: Rakhshanda Jalil, Tarun K. Saint and Debjani Sengupta (Eds), Looking Back: The 1947 Partition of India, 70 Years On
Authors: Hashmi Sohail
Published: March 2018

Rakhshanda Jalil, Tarun K. Saint and Debjani Sengupta (Eds), Looking Back: The 1947 Partition of India, 70 Years On. Hyderabad: Orient BlackSwan, 2017, 355 pp., ₹1095, ISBN: 9789386689566 (Hardbound).
Book review: Tattwamasi Paltasingh and Renu Tyagi (Eds), Caring for the Elderly: Social Gerontology in the Indian Context
Authors: Dey Deblina
Published: March 2018

Tattwamasi Paltasingh and Renu Tyagi (Eds), Caring for the Elderly: Social Gerontology in the Indian Context. New Delhi: SAGE Publications India, 2015, 290 pp., ₹995, ISBN 9789351502630 (Hardcover).
Editorial
Authors: Cozzens Susan E.
Published: March 2018

It is widely thought that the state of public understanding of science in the United States, and indeed throughout much of the industrialized world, is in need of fundamental reexamination…. Regardless of its philosophical soundness, the old model of value-free science unlocking the secrets and powers of nature for man's benefit has had profound social and intellectual consequences. Today, however, there is growing resistance to this model; in various quarters, allegiance is shifting to another image, one that projects science as almost mindlessly giving virtually uncontrolled powers over nature and human life to unprepared people…. We seem to be in a crisis of reason in which commitment to rational knowledge as a source of human freedom is being seriously challenged.
Accommodations in Digital Interactive STEM Assessment Tasks
Authors: Scalise Kathleen , Irvin P. Shawn , Alresheed Fahad , Zvoch Keith , Yim-Dockery Huna , Park Sunhi , Landis Britt , Meng Paul , Kleinfelder Bren , Halladay Lauren , Partsafas Andrea
Published: March 2018

In this article, we describe current research findings on assessment accommodations and universal design within the context of emerging interactive digital assessment tasks that employ simulations such as in science, technology, engineering, and mathematics (STEM). STEM education in many classrooms now includes digitally based activities such as science simulations and virtual laboratories that have been shown in some cases to promote learning gains. When such technologies are used in STEM assessments, a major challenge is to ensure assessments are accessible so all students can show what they know and can do. Federal laws and regulations including the Individuals with Disabilities Education Act, Elementary & Secondary Education Act, and Americans with Disabilities Act require that students with disabilities (SWD) be provided an opportunity to participate in educational programing and services available to nondisabled peers. In addition to implementing principles of universal design in assessment contexts, reasonable accommodations must be afforded to ensure accessibility. This article focuses on universal design and accommodations where the STEM construct is not adjusted or modified. Here, we employ synthesis of the research literature to document accessibility recommendations and practices around interactive assessment tasks, especially in STEM. We illustrate with an example and highlight directions that future development might take. The intention is to inform educators, school administrators, state and local policy makers, and assessment developers on the availability and use of accommodations in interactive assessment contexts such as simulation, and what is needed to ensure appropriate accessibility for SWD.
Addition of an educational programme for primary caregivers to rehabilitation improves self-care and mobility in children with cerebral palsy: a randomized controlled trial
Authors: Saquetto Micheli Bernardone , de Santana Bispo Adriana , da Silva Barreto Camila , Gonçalves Katiuce Almeida , Queiroz Rodrigo Santos , da Silva Cássio Magalhães , Gomes Neto Mansueto
Published: March 2018

Objective:

To assess whether the addition of an education programme for primary caregivers to rehabilitation improves daily functioning in children with cerebral palsy.

Design:

A randomized, single-blind, controlled study.

Setting:

This study was conducted in a rehabilitation centre in Salvador, Brazil.

Participants:

A total of 63 boys and girls with cerebral palsy, at 1–12 years of age, with Gross Motor Function Classification Systems I–V, were randomly assigned to two groups: educational programme for primary caregivers and conventional rehabilitation ( n = 29) or conventional rehabilitation alone ( n = 31).

Intervention:

Each group received 12 sessions of 30 minutes of conventional rehabilitation and 12 sessions of 45 minutes to intervention group.

Measurements:

Gross Motor Function Classification System, Gross Motor Function Measure and daily functioning with the Pediatric Evaluation of Disability Inventory were assessed by a blinded assessor. The clinical outcomes were obtained at the completion of treatment (12 weeks).

Results:

Of the 63 patients included, 60 (mean ± SD age: 4.6 ± 2.74 years) completed the protocol. The combined education and rehabilitation, as compared with conventional rehabilitation alone, yielded significantly greater benefit in the self-care domain of the Functional Skills Scale (mean change 1.74 versus 5; P = 0.001), self-care (mean change 5.52 versus 13.99; P = 0.017) and the mobility domain of the Caregiver Assistance Scale of Pediatric Evaluation of Disability Inventory (mean change 0.87 versus 17.88; P = 0.002).

Conclusion:

Self-care and mobility improved in children with cerebral palsy with the addition to conventional rehabilitation of an educational programme for primary caregivers.
Who cares for the carers at hospital discharge at the end of life? A qualitative study of current practice in discharge planning and the potential value of using The Carer Support Needs Assessment Tool (CSNAT) Approach
Authors: Ewing Gail , Austin Lynn , Jones Debra , Grande Gunn
Published: March 2018

Background:

Carer factors prevent patients achieving timely and appropriate hospital discharge. There is a lack of research into interventions to support carers at hospital discharge.

Aim:

To explore whether and how family carers are currently supported during patient discharge at end of life; to assess perceived benefits, acceptability and feasibility of using The Carer Support Needs Assessment Tool (CSNAT) Approach in the hospital setting to support carers.

Design:

Qualitative.

Setting/participants:

Three National Health Service Trusts in England: focus groups with 40 hospital and community-based practitioners and 22 carer interviews about experiences of carer support during hospital discharge and views of The CSNAT Approach. Two workshops brought together 14 practitioners and five carers to discuss implementation issues. Framework analysis was conducted.

Results:

Current barriers to supporting carers at hospital discharge were an organisational focus on patients’ needs, what practitioners perceived as carers’ often ‘unrealistic expectations’ of end-of-life caregiving at home and lack of awareness of patients’ end-of-life situation. The CSNAT Approach was viewed as enabling carer support and addressing difficulties of discussing the realities of supporting someone at home towards end of life. Implementation in hospital required organisational considerations of practitioner workload and training. To enhance carer support, a two-stage process of assessment and support (hospital with community follow-up) was suggested using the CSNAT as a carer-held record to manage the transition.

Conclusion:

This study identifies a novel intervention, which expands the focus of discharge planning to include assessment of carers’ support needs at transition, potentially preventing breakdown of care at home and patient readmissions to hospital.
Liraglutide prevents metabolic side-effects and improves recognition and working memory during antipsychotic treatment in rats
Authors: Babic Ilijana , Gorak Ashleigh , Engel Martin , Sellers Dominic , Else Paul , Osborne Ashleigh L , Pai Nagesh , Huang Xu-Feng , Nealon Jessica , Weston-Green Katrina
Published: March 2018

Background:

Antipsychotic drugs (APDs), olanzapine and clozapine, do not effectively address the cognitive symptoms of schizophrenia and can cause serious metabolic side-effects. Liraglutide is a synthetic glucagon-like peptide-1 (GLP-1) receptor agonist with anti-obesity and neuroprotective properties. The aim of this study was to examine whether liraglutide prevents weight gain/hyperglycaemia side-effects and cognitive deficits when co-administered from the commencement of olanzapine and clozapine treatment.

Methods:

Rats were administered olanzapine (2 mg/kg, three times daily (t.i.d.)), clozapine (12 mg/kg, t.i.d.), liraglutide (0.2 mg/kg, twice daily (b.i.d.)), olanzapine + liraglutide co-treatment, clozapine + liraglutide co-treatment or vehicle (Control) ( n = 12/group, 6 weeks). Recognition and working memory were examined using Novel Object Recognition (NOR) and T-Maze tests. Body weight, food intake, adiposity, locomotor activity and glucose tolerance were examined.

Results:

Liraglutide co-treatment prevented olanzapine- and clozapine-induced reductions in the NOR test discrimination ratio ( p < 0.001). Olanzapine, but not clozapine, reduced correct entries in the T-Maze test ( p < 0.05 versus Control) while liraglutide prevented this deficit. Liraglutide reduced olanzapine-induced weight gain and adiposity. Olanzapine significantly decreased voluntary locomotor activity and liraglutide co-treatment partially reversed this effect. Liraglutide improved clozapine-induced glucose intolerance.

Conclusion:

Liraglutide co-treatment improved aspects of cognition, prevented obesity side-effects of olanzapine, and the hyperglycaemia caused by clozapine, when administered from the start of APD treatment. The results demonstrate a potential treatment for individuals at a high risk of experiencing adverse effects of APDs.
Dose reduction of risperidone and olanzapine can improve cognitive function and negative symptoms in stable schizophrenic patients: A single-blinded, 52-week, randomized controlled study
Authors: Zhou Yanling , Li Guannan , Li Dan , Cui Hongmei , Ning Yuping
Published: March 2018

Background:

The long-term effects of dose reduction of atypical antipsychotics on cognitive function and symptomatology in stable patients with schizophrenia remain unclear. We sought to determine the change in cognitive function and symptomatology after reducing risperidone or olanzapine dosage in stable schizophrenic patients.

Methods:

Seventy-five stabilized schizophrenic patients prescribed risperidone (≥4 mg/day) or olanzapine (≥10 mg/day) were randomly divided into a dose-reduction group ( n=37) and a maintenance group ( n=38). For the dose-reduction group, the dose of antipsychotics was reduced by 50%; for the maintenance group, the dose remained unchanged throughout the whole study. The Positive and Negative Syndrome Scale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, and Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery were measured at baseline, 12, 28, and 52 weeks. Linear mixed models were performed to compare the Positive and Negative Syndrome Scale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects and MATRICS Consensus Cognitive Battery scores between groups.

Results:

The linear mixed model showed significant time by group interactions on the Positive and Negative Syndrome Scale negative symptoms, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, speed of processing, attention/vigilance, working memory and total score of MATRICS Consensus Cognitive Battery (all p<0.05). Post hoc analyses showed significant improvement in Positive and Negative Syndrome Scale negative subscale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, speed of processing, working memory and total score of MATRICS Consensus Cognitive Battery for the dose reduction group compared with those for the maintenance group (all p<0.05).

Conclusions:

This study indicated that a risperidone or olanzapine dose reduction of 50% may not lead to more severe symptomatology but can improve speed of processing, working memory and negative symptoms in patients with stabilized schizophrenia.
Tyrosine receptor kinase B receptor activation reverses the impairing effects of acute nicotine on contextual fear extinction
Authors: Kutlu Munir Gunes , Cole Robert D , Connor David A , Natwora Brendan , Gould Thomas J
Published: March 2018

Anxiety and stress disorders have been linked to deficits in fear extinction. Our laboratory and others have demonstrated that acute nicotine impairs contextual fear extinction, suggesting that nicotine exposure may have negative effects on anxiety and stress disorder symptomatology. However, the neurobiological mechanisms underlying the acute nicotine-induced impairment of contextual fear extinction are unknown. Therefore, based on the previous studies showing that brain-derived neurotrophic factor is central for fear extinction learning and acute nicotine dysregulates brain-derived neurotrophic factor signaling, we hypothesized that the nicotine-induced impairment of contextual fear extinction may involve changes in tyrosine receptor kinase B signaling. To test this hypothesis, we systemically, intraperitoneally, injected C57BL/6J mice sub-threshold doses (2.5 and 4.0 mg/kg) of 7,8-dihydroxyflavone, a small-molecule tyrosine receptor kinase B agonist that fully mimics the effects of brain-derived neurotrophic factor, or vehicle an hour before each contextual fear extinction session. Mice also received injections, intraperitoneally, of acute nicotine (0.18 mg/kg) or saline 2–4 min before extinction sessions. While the animals that received only 7,8-dihydroxyflavone did not show any changes in contextual fear extinction, 4.0 mg/kg of 7,8-dihydroxyflavone ameliorated the extinction deficits in mice administered acute nicotine. Overall, these results suggest that acute nicotine-induced impairment of context extinction may be related to a disrupted brain-derived neurotrophic factor signaling.
The Role of Academic Skills in the Evolution of Conduct Problems and Depressive Symptoms Among Children With and Without Early Clinically Significant Conduct Problems
Authors: Poirier Martine , Temcheff Caroline E. , Déry Michèle , Toupin Jean , Verlaan Pierrette , Lemelin Jean-Pascal
Published: March 2018

Youth with conduct problems present frequently depressive symptoms. Academic skills are thought to be a mediating variable by which conduct problems could lead to depressive symptoms. No studies have longitudinally compared this model among school-aged boys and girls with different levels of conduct problems. Cascade models were tested to examine the relations between conduct problems, depressive symptoms, and academic skills over a 3-year period, and whether the severity of conduct problems and gender moderated these associations. Participants were 381 children presenting early clinically significant conduct problems (44.9% female) and 363 children with low levels of conduct problems (48.8% female). While results did not show any cascade or indirect associations, they revealed different direct links between conduct problems or depressive symptoms and academic skills in the four groups. These findings suggest that conduct problems severity and gender differences should be considered in treatment planning.
Imaginary Companions of Blind, Deaf, and Typically Developing School Children
Authors: Smith Maureen Claire
Published: March 2018

Having an imaginary companion (IC) during childhood is associated with developmental advantages. ICs also appear to persist and may serve as a coping mechanism for at-risk children. Few studies have examined imagination in blind and deaf children, two groups who may struggle with peer relationships and loneliness. This study explores the presence of ICs in a sample of 12 blind, 13 deaf, and 26 typically developing, ethnically diverse 8- to 12-year-old children. It examines teacher- and child-reports of competence potentially associated with having an IC. Results indicate that 54% of the children reported a current or prior IC, and those children engaged in more pretend play and fantasy than children without ICs. Deaf children reported the highest rates, and blind children the lowest rates, of ICs. The data suggest that having an IC may be associated with social and emotional benefits for deaf and blind children.
Aggressive Incidents in Residential Youth Care
Authors: Van den Tillaart Jantine , Eltink Ellen , Stams Geert-Jan , Van der Helm Peer , Wissink Inge
Published: March 2018

It is assumed that group climate can have an effect on aggressive behavior in adolescents living in residential facilities, but it is largely unknown whether there are climate differences between the various types of residential institutions, and whether group climate differently affects aggression incidents among adolescents placed in institutions that differ in levels of security (and openness). In current research, the differences in perception of group climate between open, semi-secure, and secure residential youth care facilities were examined as well as the association between group climate and aggression. In total, 159 adolescents (96 males, 63 females) completed the Prison Group Climate Instrument (PGCI), and (aggressive) incidents were recorded during a period of 3 months. Perception of group climate—including support from staff, group atmosphere among adolescents, possibilities for growth, and repression—did not differ between the various types of residential care, except for possibilities for growth. Adolescents in open and semi-secure institutions experienced more possibilities for growth than their peers in secure institutions. A more positive perception of group climate in open institutions proved to be related to less aggressive incidents at the living group. For semi-secure and secure institutions, no relation between group climate and aggression was found. Also, the longer adolescents stayed in residential youth care, the more aggressive incidents occurred.
The moral economy of comfortable living: Negotiating individualism and collectivism through housing in Belgrade
Authors: Johnson Charlotte E
Published: March 2018

Comfort in the home depends on material and social connections. From pipes and wires to legal and financial contracts, these connections shape expectations of what comfortable living is and how it can be achieved. These connections create a moral economy that is based on the materiality of housing, and that is revealed as individual households pursue comfortable conditions in reference to external criteria and constraints. This paper explores the moral economy of comfort through an ethnography of one apartment block in Belgrade. The building, built in the 1970s, is an archetype of the modern, consumer lifestyle that Yugoslav market socialism promised to deliver to its citizens. Today the memories of a socialist moral economy are still present in the fabric of the building and the values of the residents who struggle to maintain their homes as individual spaces of comfort within a capitalist economy. This case shows the changing legitimacy of the pursuit of comfort and the ongoing tension to manage individual and collective gain.
A New Blood Module for Continuous Renal Replacement Therapies
Authors: Ronco C. , Fecondini L. , Gavioli L. , Conz P. , Milan M. , Dell'Aquila R. , Bragantini L. , Chiaramonte S. , Brendolan A. , Crepaldi C. , Feriani M. , La Greca G.
Published: March 2018

A new blood module for continuous renal replacement therapies has been utilized to perform CVVH in critically ill patients. The features of the new module named (HP300 and manifactured by Medica srl (Medolla, Modena) are the easy installation and transportability to the bedside, the simple and safe management and the continuous measurement of the pre and post filter pressure with automatic calculation of the end-to-end pressure drop inside the filter. The last feature permits to detect early malfunctions of the filter due to fibers clotting or due to the internal coating of the hollow fibers by plasma proteins. In both cases the efficiency of the treatment can be reduced because of a significant reduction of the ultrafiltration rates or a remarkable decay of the membrane permeability and solute sieving coefficients. In many cases this reduction is only detected when important effects on solute removal have already occurred. In our experience, the new module permitted the substitution of the filters when early malfunctions were detected and maximal treatment efficiency was therefore guaranteed over extended periods of time.
Vancomycin Dosing in Haemodialysis Patients and Bayesian Estimate of Individual Pharmacokinetic Parameters
Authors: Keller F. , Hörstensmeyer C. , Looby M. , Borner K. , Pommer W. , Erdmann K. , Giehl M.
Published: March 2018

A dose reduction of vancomycin to 1000 mg once a week usually is recommended for haemodialysis patients. Our modified dosing schedule consists of a loading dose of 1000 mg and a maintenance dose of 500 mg administered 3 times a week after haemodialysis. Different vancomycin regimens were retrospectively evaluated by therapeutic drug monitoring and bayesian parameter estimates in 39 dialysis patients. The mean (± SD) trough level in 7 patients receiving only the conventional dosage regimen was significantly lower than in 17 patients strictly treated by the modified schedule (7 ± 4 versus 17 ± 8 mg/L; p = 0.001). The corresponding peaks were low in both groups and no different (23 ± 10 versus 27 ± 12 mg/L). The one week average vancomycin clearance was significantly lower in the conventional dosage group compared to the modified dosage group (6 ± 3 versus 10 ± 3 ml/min; p = 0.001). High-flux dialysers were not used in the conventional dosage group but for 30 percent of the procedures in the modified dosage group, where the vancomycin one week average elimination half-life was 66 hours (± 18) and the volume of distribution 50 litres (± 5). As compared to the bayesian programme, NONMEM calculated comparable pharmacokinetic parameters but could be applied only in 5 cases with a sufficient number of concentration measurements. Ototoxicity occurred in 1 patient, whereas vancomycin treatment was judged as ineffective against infection in 5 of the 39 patients. Their troughs were below 15 mg/L. The apparent tendency toward underdosage can be avoided by giving haemodialysis patients the modified vancomycin schedule (3 × 500 mg/week) with the higher trough levels considered therapeutic (10 - 20 mg/L).
Serum Lipoprotein (a) and Coronary Artery Disease in Uremic Patients on Chronic Hemodialysis
Authors: Docci D. , Manzoni G. , Bilancioni R. , Delvecchio C. , Capponcini C. , Baldrati L. , Neri L. , Feletti C.
Published: March 2018

There is convincing clinical and experimental evidence to support the notion that lipoprotein(a) [Lp(a)] is atherogenic. Patients undergoing chronic hemodialysis have an increased risk of atherosclerotic cardiovascular complications. In the present study, we investigated the possible relation between the alteration, if any, in serum Lp(a) and coronary artery disease in such patients. The mean serum concentration of Lp(a) tended to be higher in the 64 hemodialysis patients than in the 30 normal controls (15.1 ± 15.2 vs. 9.7 ± 10.4 mg/dl). However the difference did not reach statistical significance. The prevalence of levels above 30 mg/dl was 14% (9/64) and 10% (3/10), respectively, and the difference was also not statistically significant. Eleven hemodialysis patients with coronary artery disease had a significantly higher mean serum concentration of Lp(a) than the unaffected 53 (33.7 ± 18.4 vs. 11.1 ± 11.2 mg/dl, p < 0.001). Elevated levels were present in 63.6% (7/11) and 3.8% (2/53), respectively (p<0.01). Other parameters of lipid metabolism were not different between the two groups. We observed statistically significant positive correlations of Lp(a) to total cholesterol, LDL cholesterol and apolipoprotein B in controls, in hemodialysis patients as a whole and in those without coronary artery disease. No such correlations were obtained when hemodialysis patients with coronary artery disease were analysed separately. It is concluded that firstly, high serum levels of Lp(a) in hemodialysis patients are strongly associated with coronary artery disease, as well as in the general population; and secondly, abnormalities in the metabolism of Lp(a) may underlie atherogenesis in these patients, independently of alterations in other lipid constituents
Artificial Conditioner for Stored Organs
Authors: Kawamura A. , Meguro J. , Takahashi M. , Ikeda A. , Hirai H. , Kukita K. , Yonekawa M. , Witmanowski H. , Yokota N. , Hayashi T. , Ito K.
Published: March 2018

We have developed an artificial organ conditioning system in order not only to condition but also evaluate the viability for transplant graft of kidneys which have been stored for a long time and damaged by warm ischaemia following cardiac arrest. The conditioning system consisted of an artificial lung, a roller pump, an organ chamber and perfusate. The perfusate was prepared with electrolytes, fluorocarbon, amino acid, glucose, an oxygen scavenger and so on. Conditioning was performed by continuous perfusion under mild hypothermia at 24° C. Mildly damaged kidneys (0 and 30 minutes warm ischaemia rabbit kidneys) were well conditioned but severely damaged kidneys failed to produce urination. Our device successfully exposed the viability of stored kidneys and the successful conditioning of damaged kidneys due to warm ischaemia avoiding transplantation. By establishing our method, the harvesting of kidneys following cardiac arrest will be feasible.
Pathological Hip Fracture Due to Amyloidosis Occurring after Successful Renal Transplantation. A Case Report
Authors: Hay N.M. , Mahony J.F.
Published: March 2018

A fifty-six year old man who had been on haemodialysis for a total of seventeen years sustained a pathological fracture of the femoral neck six months after successful renal transplantation. Multiple cystic lesions were present in both hips and a bone specimen from the fracture site confirmed amyloid deposition on immunohistochemical staining. Renal transplantation may prevent further deposition of amyloid but the long-term complications of dialysis-related amyloidosis may still occur.
Effect of Aoa on Glutaraldehyde-Fixed Bioprosthetic Heart Valve Cusps and Walls: Binding and Calcification Studies
Authors: Girardot M.N. , Torrianni M. , Girardot J.M.D.
Published: March 2018

Alpha-aminooleic acid (AOA), a potent, non-toxic and biocompatible anticalcification agent, has been shown to be effective for glutaraldehyde-fixed valves in rat and juvenile sheep models, and is used for the treatment of Medtronic heart valve bioprostheses currently in clinical trials. In the pre-clinical sheep study of a stentless aortic root, the treatment with AOA prevented calcification of the cusps, but not of the wall. The experiments described in this manuscript were designed to investigate a possible relationship between the binding of AOA and the differential treatment efficacy in the cusp and the wall, and to improve the anticalcification effect of the AOA treatment in the wall. Glutaraldehyde-fixed porcine roots were treated with [14C]-AOA for binding studies, and with nonradioactive AOA for calcification studies for rat subdermal implants. The results indicate that a) the AOA treatment did reduce wall calcification, but only temporarily, b) the low efficacy of the AOA treatment on the wall was probably due to the limited penetration of AOA, and c) increasing the volume of the AOA solution during treatment significantly increased the content of AOA in the wall, and significantly decreased wall calcification. This study suggests that AOA efficacy in the wall may be hindered because of the physical characteristics of the wall, and that wall calcification may be prevented by developing methods aimed at increasing AOA penetration into the wall.
Myocardial Protection during Coronary Angioplasty with Autoperfusion and Forced Perfusion: An in vitro comparison
Authors: De Muinck E.D. , Verkerke B.J. , Rakhorst G. , Lie K.I.
Published: March 2018

During coronary angioplasty, perfusion distal to the inflated angioplasty balloon can be maintained with autoperfusion balloon catheters and coronary perfusion pumps. The blood flow rates through the autoperfusion balloon catheters and the flow rates achieved with a perfusion pump were compared in vitro with fresh human blood at 37° C. In a specially designed system, blood flow rates through Stack™ autoperfusion balloon catheters were measured at 40, 60 and 80 mmHg continuous pressure. In another system, driving pressures were measured during perfusion with the pump, through a specially designed forced perfusion catheter at 20, 40 and 60 ml/min flow. The pressure applied in the autoperfusion experiments was converted into atmospheres (atm) to facilitate comparison with the driving pressures measured during pumping (1 mmHg = 1.316 × 10−3 atm). Mean flow rates through the autoperfusion balloon catheters were: 46 ml/min at 0.05 atm, 66 ml/min at 0.09 atm and 75 ml/min at 0.1 atm. Mean pressures during pumping were: 1.8 atm at 20 ml/min, 3.5 atm at 40 ml/min, 5 atm at 60 ml/min. Due to the phasic nature of coronary blood flow, the flow through autoperfusion balloons is generally lower than the minimum required for adequate myocardial protection (= 60 ml/min). Thus, autoperfusion balloon catheters are simpler and cheaper devices than perfusion pumps, but generally they are not able to provide adequate myocardial protection.
A Miniaturized Nafion-Based Glucose Sensor: in vitro and in vivo evaluation in dogs
Authors: Moussy F. , Harrison D.J. , Rajotte R.V.
Published: March 2018

We have developed an implantable glucose sensor based on a new tri-layer membrane configuration. The needle-type sensor integrates a Pt working electrode and a Ag/AgCI reference electrode. Its size is equivalent to a 25 gauge needle (0.5 mm in diamater). Poly (o-phenylenediamine) was used as an inner coating to reduce interference by small compounds present in the body fluids, and the perfluorinated ionomer, Nation as a biocompatible, protective, outer coating. Glucose oxidase trapped in an albumin/glutaraldehyde matrix was sandwiched between these coatings. In vitro tests in buffer showed the sensors had a good selectively, a sensitivity of about 25 nA/mM, and a 90% response time of 33 s. Stabilization of the current following polarization required 10 to 30 min in vitro and 30 to 40 in vivo. Although these sensors remained stable for many weeks in saline solution, their implantation in animals resulted in the degradation of the protective Nation outer coating, which in turn, led to the failure of the incorporated reference electrode. We demonstrated that if unprotected, the AgCI layer of the reference electrode rapidly dissolves in the biological environment. However, we later showed that in vivo degradation of Nation can be prevented by heat curing. When heat cured sensors were subcutaneously implanted in dogs, the sensors' signal closely followed the plasma glucose level during glucose tolerance tests. The response of the sensors implanted in dogs was retained for 10 days.
Collagen Gel Immobilisation Provides a Suitable Cell Matrix for Long Term Human Hepatocyte Cultures in Hybrid Reactors
Authors: Koebe H.G. , Wick M. , Cramer U. , Lange V. , Schildberg F.W.
Published: March 2018

An easy to apply culture technique is presented that protects a monolayer configuration of liver cells within an extracellular matrix. The Immobilising Gel (IG)-Technique not only preserves hepatocyte morphology and supports a variety of differentiated cell functions over long term periods, but also offers higher resistance of IG-culture systems against shear forces of fluids in a hybrid reactor device, as compared to other culture techniques. Human hepatocyte cultures in IG-Technique: DNA-normalised levels for the total production of cholinesterase, albumin, urea and lactate remained high throughout the investigational period (50 days). Glutamic-Pyruvic-Transaminase (GPT) release decreased after peak values during early culture adaptation. Electron Microscopic (EM) findings after the shear forces experiment revealed undisturbed subcellular structures and a preserved intercellular morphology, including bile canaliculi and desmosomes. We conclude that the IG-technique is of considerable advantage as compared to other culture systems, especially in the field of dynamic applications, e.g. hybrid reactors for artificial organ development.
Artificial Shunting of Cerebrospinal Fluid
Authors: Hoekstra A.
Published: March 2018

A compact three-stage shunt valve system (Orbis Sigma™ Valve) which operates as a flow regulator within certain differential pressure values has been clinically evaluated in the treatment of hydrocephalus. Clinical trials were performed in 134 cases, covering 128 patients aged from 1 day to 79 years with a mean age at implantation of 11.4 years. One-third of the implants was performed to replace failed DP shunts. Using actuarial statistics, 83.9% of the shunts continued to adequately manage hydrocephalus at three years. Overdrainage occurred in 2 cases (1.5%) and insufficient drainage occurred in four cases (3%). Compared with literature for conventional DP shunts, the incidence of these phenomena is extremely low. Based on the results summarized in this paper and those already reported in the literature, the OSV appears to address the overdrainage limitations of conventional shunts.
Backdiffusion or Bicarbonate May Stimulate Complement Activation during Haemodialysis with Low-Flux Membranes
Authors: Lundberg L , Stegmayr B.G. , Wehle B.
Published: March 2018

Backdiffusion of dialysate during haemodialysis with low-flux membranes and the use of bicarbonate dialysatebase, may increase the risk for contamination. The influence on the complement system was studied by altering the flux of acetate or bicarbonate dialysate base across the membrane. Eight patients were dialysed with a transmembrane pressure of 100 mm Hg (group I) during the first 60 min to standardize the ultrafiltration (UF) and acetate as dialysate. In eight other patients (group II) the UF was “set at zero” ml during the first 60 min using an FCM 10-1 monitor (Gambro) and bicarbonate as base. The groups were dialysed three times on two hollow-fiber membranes made of Hemophan® and cellulose acetate (CA). Blood samples were taken at 0, 15, 60 and 180 min, and analysed for plasma protein, haematocrit and complement C3d. In group II there was a reduction in plasma protein concentration at 15 and 60 min (p<0.002) for Hemophan and at 60 min (p<0.01) using CA. C3d was increased at 15 min for both filters (p<0.03). The reduction of protein in group II was followed by changes in the haematocrit, indicating a backdiffusion of dialysate, which may contribute to the concomittant increase in C3d.
Preventive Equipment for Urinary Incontinence: A Device Employing Lower Abdominal Impendance Changes
Authors: Yamada A. , Fuse M. , Aoyagi T. , Hosaka H. , Toma H. , Yanagisawa H.
Published: March 2018

The object of this work was to develop a monitoring device for measuring the volume of urine in the bladder to signal, in advance, the need to urinate and thus help prevent urinary incontinence. A high-frequency electric current of 50 KHz transmitter was applied to a pair of terminals placed on the surface of a human body. The constant current was 2mA (p-p). A pair of voltage electrodes was placed in the path of the electric current to pick up high-frequency voltage signals. The best position for current electrodes was found to be on the surface of both femoral joints. Positioning the voltage electrode above the bladder on the lower abdomen was most efficient for detecting the volume of urine. New current electrodes sutured onto underpants were fitted on the surface above the femoral joints, which did not shift in the case of movement by the subjects. The reproducibility and stability were remarkably good with this electrode. The alarm level which foretold both maximum storage volume and maximum desire to void was examined. After that, when the alarm level was set within the range of impedance charge, 60% to 70%, the possibility of prediction of urination exists.
Pain Relief Mediated by Implantable Drug Delivery Devices
Authors: Hoekstra A.
Published: March 2018

Various totally implantable drug delivery systems from single access ports to micropumps are now available for administration of repeated boluses, and continuous or programmable infusions. In this respect, emphasis is given to a relatively cheap, totally implantable system for self-administering intraspinal opiates in the treatment of cancer pain. The SECOR® pump system, developed by Cordis, consists of a dual pump with refill port and safety valve. The volume of the pliable reservoir is 12 ml and refill is accomplished with a 25-G needle. The bolus delivered with each transcutaneous activation of the pumps is 0.1 ml. Clinical results demonstrated that this patient-controlled drug delivery system is safe and provides excellent pain relief associated with terminal cancer. A possible advantage of this drug delivery system over continuous infusion pumps is that patients can elect to have the morphine delivered only when they feel pain. Thus pain relief would be maximized and tolerance build-up would be minimized.
Development and Test of an Extendable Endoprosthesis for Bone Reconstruction in the Leg
Authors: Verkerke G.J. , Koops H. Schraffordt , Veth R.P.H. , Grootenboer H.J. , De Boer L.J. , Oldhoff J. , Postma A.
Published: March 2018

A malignant bone tumour may develop in the femur of a child. In the majority of cases it will be necessary to resect the bone involved, growth plate and adjacent tissues. A modular endoprosthetic system has been developed which can be extended non-invasively to bridge the defect resulting from such a resection. Elongation is achieved by using an external magnetic field. In vitro tests with a prototype showed that the lengthening element met all requirements. Six animal experiments showed that the lengthening element also functioned in vivo.
Free and Microencapsulated Adrenal Cortical Cells Produce Similar Cortisol Responses When Stimulated by Acth: An in vitro study
Authors: Abobakr A.M.
Published: March 2018

Transplantation of endocrine cells, especially when protected from immune destruction, is an attractive alternative to whole organ transplantation. The current treatment for adrenal insufficiency whether congenital or acquired is hormone replacement, which is not considered fully physiological. In this study, we isolated porcine adrenal cortical cells by collagenase digestion. The cells were microencapsulated in alginate-polylysine-alginate membranes using electrostatic droplet generator. In vitro, ACTH stimulation of both free and microencapsulated adrenal cortical cells produced comparable cortisol response. It can be concluded that the microencapsulation process is not injurious to the adrenal cortical cells and that it does not hamper their secretory function.