bluuebunny/crossref_metadata_2025 huggingface dataset:
Adoptive transfer of bone marrow‐derived dendritic cells decreases inhibitory and regulatory T‐cell differentiation and improves survival in murine polymicrobial sepsis
Authors: Wang Hong‐Wei , Yang Wen , Gao Lei , Kang Jia‐Rui , Qin Jia‐Jian , Liu Yue‐Ping , Lu Jiang‐Yang
Published: November 2014

A decrease in the number of dendritic cells (DCs) is a major cause of post‐sepsis immunosuppression and opportunistic infection and is closely associated with poor prognosis. Increasing the number of DCs to replenish their numbers post sepsis can improve the condition. This therapeutic approach could improve recovery after sepsis. Eighty C57BL/6 mice were subjected to sham or caecal ligation and puncture (CLP) surgery. Mice were divided into four groups: (i) Sham + vehicle, (ii) Sham + DC, (iii) CLP + vehicle, and (iv) CLP + DC. Bone‐marrow‐derived DCs (BMDCs) were administered at 6, 12 and 24 hr after surgery. After 3 days, we assessed serum indices of organ function (alanine aminotransferase, aspartate aminotransferase, creatinine, amylase and lipase), organ tissue histopathology (haematoxylin and eosin staining), cytokine [interferon‐γ (IFN‐γ), tumour necrosis factor‐α, interleukin‐12p70 (IL‐12p70), IL‐6 and IL‐10] levels in the serum, programmed death‐1 (PD‐1) expression on T cells, regulatory T‐cell differentiation in the spleen, and the survival rate (monitored for 7 days). BMDC transfer resulted in the following changes: a significant reduction in damage to the liver, kidney and pancreas in the CLP‐septic mice as well as in the pathological changes seen in the liver, lung, small intestine and pancreas; significantly elevated levels of the T helper type 1 (Th1) cytokines IFN‐γ and IL‐12p70 in the serum; decreased levels of the Th2 cytokines IL‐6 and IL‐10 in the serum; reduced expression of PD‐1 molecules on CD4+ T cells; reduced the proliferation and differentiation of splenic suppressor T cells and CD4+ CD25+ Foxp3+ regulatory T cells, and a significant increase in the survival rate of the septic animals. These results show that administration of BMDCs may have modulated the differentiation and immune function of T cells and contributed to alleviate immunosuppression, hence reducing organ damage and mortality post sepsis. Hence, the immunoregulatory effect of BMDC treatment has potential for the treatment of sepsis.
PLANNING FOR BETTER STANDARDS IN THE CARE OF THE NEUROLOGICAL SEQUELAE OF TRAUMA
Authors: Selecki B. R. , Simpson D. A. , Vanderfield G. K.
Published: November 2014

Injuries of the nervous system are common, and cause many deaths and much permanent disability. They inflict an enormous financial burden on the national economy; in Australia, adequate data are at present lacking, but a simple extrapolation from Canadian statistics suggests an estimate of more than $500,000,000 annually for the injuries resulting from road traffic accidents alone; if other causes of injury are included, the figure may reach one billion dollars.

The neurosurgeon is specifically trained to undertake the management of all forms of neurological trauma; however, in Australia, and in many other countries, only a small minority of such injuries receive neurosurgical care. This is chiefly because the number of neurosurgeons at present available is small in relation to the tasks. Many cases must therefore be in the care of general or orthopaedic surgeons, especially in country centres, and it is important that these surgeons should have some basic neurosurgical training. The Neurosurgical Society of Australasia wishes to formulate a programme to ensure that opportunities for such training are available throughout Australia. This programme should also embody a national plan for research into the treatment and prevention of neurological trauma.
THE USE OF PARENTERAL NUTRITION IN THE MANAGEMENT OF EXTERNAL GASTROINTESTINAL TRACT FISTULAE
Authors: Thomas Robert J. S. , Rosalion Alexander
Published: November 2014

Malnutrition is common in patients with gastrointestinal tract fistula, and is an important cause of the high mortality seen with this surgical complication. A prospective review of three years' experience in the management of fistulae with parenteral nutrition was undertaken, and the results obtained were compared with those in a group of patients treated prior to the introduction of this form of therapy. The use of parenteral nutrition resulted in a reduction of the mortality from 63% to 23% in unselected cases. The mortality was zero where parenteral nutrition was used in patients under 65 years of age with non‐malignant disease. With parenteral nutrition therapy, the fistulae in almost all cases closed spontaneously, in contrast with a high proportion requiring operation (20 in 38 cases) where parenteral nutrition was not used. It is concluded that all patients with significant gastrointestinal fistulae should be given appropriate parenteral nutrition as their prime mode of therapy.
JODENAL “DIVERTICULIZATION” FOR MASSIVE HAEMORRHAGE FROM PANCREATIC PSEUDOCYST
Authors: Catts P. F. , Souvlis L. , Rae R. E.
Published: November 2014

A case of massive haemorrhage into the gastrointestinal tract from a pancreatic pseudocyst is presented. The pseudocyst was a complication of acute pancreatitis, and control of the haemorrhage by operation was difficult because of the friability of the cyst wall. The surgical procedure called duodenal diverticulization is described and was found to be a useful adjunct to suture ligation for bleeding which was almost uncontrollable and when death of the patient seemed inevitable.
AVULSION OF THE AMPULLA OF VATER: AN ISOLATED INJURY FOLLOWING BLUNT ABDOMINAL TRAUMA
Authors: Parkinson S. W. , Wisniewski Z. S.
Published: November 2014

A case of avulsion of the ampulla of Vater from the duodenum due to blunt trauma is presented. In patients in whom leakage is confined to the extra peritoneal tissues, the condition can be insidious, making diagnosis difficult.
THE EFFECT OF INSULIN AND HYDROCORTISONE ON THE ISOLATED RAT LIVER
Authors: Groufsky Anne K. , Holland Robyn K. , Lee D.
Published: November 2014

Isolated rat livers were perfused at 35°C with bovine serum albumin (40 g/l) in Krebs Ringer bicarbonate buffer, or with the same solution containing insulin (0.22 × 10−6 mol/l), hydrocortisone (0.068 × 10−3 moll), or both hormones together. Observations on the synthesis of bile and on perfusate levels of potassium, aspartate aminotransferase, urea and glucose showed that the presence of insulin and/or hydrocortisone had no beneficial effect on the perfused rat liver in vitro. There is little justification, therefore, for the addition of these hormones to solutions used for preservation of the isolated liver.
THE EXPERIMENTAL ASSESSMENT OF TECHNIQUES OF MEASURING BILIARY PRESSURE*
Authors: McGlynn Michael , Jefferies Susan , Rose Margaret , Ham John
Published: November 2014

A variety of different methods have been used for the measurement of pressures during operations on the biliary tract. However, there are few data on the experimental evaluation of the methods, and there has been no controlled comparative evaluation of the most commonly used techniques.

In these eperiments, we have compared the manometric technique of Caroli, the syringe barrel method of Daniel and White et alii, and the constant infusion apparatus of Cushieri. The experiments were performed in pigs because of the similarity of their biliary tract to that of man. Resting and opening pressures were recorded, and flow into the duodenum via the ampulla was measured simultaneously.

The manometric and syringe barrel techniques gave highly reproducible measurements of resting and opening pressure, and valid measurements of opening pressure. The constant infusion apparatus gave reproducible measurements of resting pressure, but did not measure opening pressure. The manometric technique was shown to measure changes in the resistance of the choledochoduodenal junction in response to morphine and atropine.
RU 486 (MIFEPRISTONE): CLINICAL TRIALS IN CHINA
Authors: Shu‐Rong Zheng
Published: November 2014

Four multicentre clinical trials on interruption of early pregnancy (≤ 49 days of amenorrhea) using RU 486 have been conducted in China, including 2321 subjects. The data from trials 1, 2 and 4 are presented here. RU 486 (600 mg as a single dose) was given to 299 women. A further 422 women were given RU 486 (600 mg) plus a vaginal suppository containing the Chinese domestic prostaglandin PGO5 (1 mg) 36–60 hours later. Complete abortion was achieved in 63.5% of patients receiving RU 486 alone and in 94.1% of patients receiving RU 486 plus PG (p < 0.001). RU 486 given alone showed decreasing efficacy as the duration of amenorrhea increased. However, RU 486 combined with PG was equally effective at all time points studied (≤ 35 days of amenorrhea: 98.1%, 36–42 days: 92%, 42–49 days: 87.4%). When compared with RU 486 alone Ru 486 + PG also produced a shorter bleeding time and a lower volume of blood loss (n = 21, 52 ml vs n = 13, 117 ml). Two patients from the RU 486 + PG group and 4 given RU 486 alone suffered heavy bleeding, necessitating emergency curettage. No transfusions were required. The time elapsed between RU 486 intake and expulsion of the conceptus was significantly shorter in the RU 486 + PG group (n = 97, 3.1 days) than that in the RU 486 alone group (n = 95, 4.4 days). Main side effects, nausea/vomiting and headache/dizziness, were mainly due to RU 486. PG increased the incidence of diarrhea and uterine cramp. Side effects in both treatment groups were mild or moderate in character in all except four cases. Two out of four pregnancies had to be terminated with vacuum aspiration on day 6 or day 7. No serious complication was encountered in any trial. Therefore, RU 486 (600 mg in single dose) followed 36–60 hours later by vaginal administration of 1 mg PG, appears an acceptable medical alternative to vacuum aspiration for interruption of early pregnancies up to 49 days of amenorrhea (preferably below 42 days) provided that there is adequate medical follow‐up in order to monitor uterine bleeding.
Is it possible to strengthen psychiatric nursing staff's clinical supervision? RCT of a meta‐supervision intervention
Authors: Gonge Henrik , Buus Niels
Published: November 2014

Aim

To test the effects of a meta‐supervision intervention in terms of participation, effectiveness and benefits of clinical supervision of psychiatric nursing staff.

Background

Clinical supervision is regarded as a central component in developing mental health nursing practices, but the evidence supporting positive outcomes of clinical supervision in psychiatric nursing is not convincing.

Design

The study was designed as a randomized controlled trial. All permanently employed nursing staff members at three general psychiatric wards at a Danish university hospital (n = 83) were allocated to either an intervention group (n = 40) receiving the meta‐supervision in addition to attending usual supervision or to a control group (n = 43) attending usual supervision.

Methods

Self‐reported questionnaire measures of clinical supervision effectiveness and benefits were collected at base line in January 2012 and at follow‐up completed in February 2013. In addition, a prospective registration of clinical supervision participation was carried out over 3 months subsequent to the intervention.

Results

The main result was that it was possible to motivate staff in the intervention group to participate significantly more frequently in sessions of the ongoing supervision compared with the control group. However, more frequent participation was not reflected in the experienced effectiveness of the clinical supervision or in the general formative or restorative benefits.

Conclusions

The intervention had a positive effect on individuals or wards already actively engaged in clinical supervision, which suggested that individuals and wards without well‐established supervision practices may require more comprehensive interventions targeting individual and organizational barriers to clinical supervision.
The Clinical, Forensic and Treatment Outcome Factors of Patients with Autism Spectrum Disorder Treated in a Forensic Intellectual Disability Service
Authors: Esan Fola , Chester Verity , Gunaratna Ignatius J. , Hoare Sudeep , Alexander Regi T.
Published: November 2014

Background

To describe the characteristics of those with autism spectrum disorder (ASD) treated within a forensic intellectual disability hospital and to compare them with those without ASD.

Method

Service evaluation of a cohort of 138 patients treated over a 6‐year period.

Results

Of the 138, 42 had an ASD. Personality disorders and harmful use or dependence on drugs were significantly lower in the ASD group. The ASD group was less likely to be subject to criminal sections or restriction orders. Self‐harm was significantly higher in the ASD group. There were no differences in the length of stay and direction of care pathway.

Conclusions

Although the ASD and non‐ASD groups differ on clinical and forensic characteristics, their treatment outcomes appear similar. This suggests that the diagnostic category of ASD alone may be inadequate in predicting the treatment outcome. There is a case to identify distinct typologies within the ASD group.
Immunological changes after ASIT in AD allergen‐specific immunotherapy and their potential correlation with clinical response in patients with atopic dermatitis patients sensitized to house dust mite
Authors: Zhong H. , Deng X. , Song Z. , Darsow U. , Chen W. , Chen S. , Luo N. , Hao F.
Published: November 2014

Background

Allergen‐specific immunotherapy (ASIT) is the main treatment for inducing long‐term immunological and clinical tolerance in patients with IgE‐mediated allergic diseases. Recent open‐label and controlled studies on the efficacy of ASIT in patients with atopic dermatitis (AD) have provided promising results. However, data about possible relationship between the improvement of clinical symptoms and changes of serum cytokines are limited.

Methods

Seventy‐nine patients with moderate to severe AD sensitized to house dust mite (HDM) were enrolled. Fifty‐eight patients were treated with ASIT and 11 controls received only symptomatic treatment. The disease activity in AD patients was evaluated by using the patient‐oriented eczema measure (POEM) system. Serum interleukin (IL)‐4, IL‐10, interferon (IFN)‐γ, transforming growth factor (TGF) β1, total IgE, HDM‐specific IgE (s‐IgE) and HDM‐specific IgG4 (s‐IgG4) were measured before and after 2 years of therapy.

Results

The mean patient‐oriented eczema measure system (POEM) score of AD patients with ASIT significantly decreased after 2 years of treatment, compared to that in patients without ASIT. After ASIT, the serum levels of IL‐10, TGF‐β1, IFN‐γ and s‐IgG4 increased, while the level of IL‐4 decreased. The change in the POEM score was negatively correlated with changes of serum concentration of TGF‐β1, s‐IgG4 and IFN‐γ. Furthermore, s‐IgG4 levels were positively correlated with changes in the IL‐10 levels. No correlation between POEM score and serum IL‐10 or IL‐4 was observed.

Conclusion

Clinical symptoms and the quality of life of AD with HDM sensitization could be improved after 2 years of ASIT. Changes in serum IL‐10, TGF‐β1, s‐IgG4 and IFN‐γ might be considered as biomarkers to assist clinical evaluation of the therapeutic effects of ASIT in patients with AD.
Are We Testing Appropriately for Low Testosterone?: Characterization of Tested Men and Compliance with Current Guidelines
Authors: Malik Rena D. , Lapin Brittany , Wang Chihsiung E. , Lakeman Justin C. , Helfand Brian T.
Published: November 2014

Introduction

Direct-to-consumer ads for testosterone replacement therapies have significantly increased over the past several years. Subsequently, testing for low serum testosterone has correspondingly increased.

Aims

We sought to determine the testing behaviors of practitioners as well as the characteristics of men who are undergoing testing for low testosterone.

Methods

Men aged 18–85 years were queried from the institutional electronic data warehouse from 2009 to 2012. Men were considered “tested” if their serum total testosterone level had been measured for any purpose. Tested men (TM) were compared with those not tested (NT).

Main Outcome Measures

The frequency and timing of testing for low testosterone as well as patient demographics and clinical characteristics were compared between TM and NT using multivariable logistic regression models.

Results

Of the 321,674 total men, 10,133 (3.2%) underwent testing with a serum total testosterone (mean age of 55.2 ± 14.1 years). The frequency of testing increased from 2.5% to 3.6% during the study period (P < 0.001). Multivariable analysis demonstrated that TM were significantly (P < 0.001) more likely to be Caucasian and have increased body mass index. In addition, TM were significantly more likely to have comorbid conditions including decreased libido (adjusted odds ratio [aOR] 10.0, 95% confidence interval [CI] 8.5, 11.7), infertility (aOR 4.8, 95% CI 3.6, 6.6), erectile dysfunction (aOR 3.6, 95% CI 3.4, 3.8), osteoporosis (aOR 3.3, 95% CI 2.8, 3.8), depression (aOR 1.7, 95% CI 1.6, 1.8), prostate cancer (aOR 1.7, 95% CI 1.5, 1.8), hypertension (aOR 1.3. 95% CI 1.2, 1.4), chronic obstructive pulmonary disease (aOR 1.2, 95% CI 1.0, 1.4), and benign prostatic hyperplasia (aOR 1.2, 95% CI 1.1, 1.2). Among TM, only 889 (9%) men underwent testing between 7 am and 12 pm.

Conclusions

The rate of testosterone testing is increasing with most testing practices directed toward a subset of men with comorbidities that are associated with hypogonadism. Compliance of physicians obtaining early morning serum testosterone levels is low. Further education of practitioners is required to appropriately test patients for hypogonadism.
The Association of Statin Use and Gonado-Sexual Function in Women: A Retrospective Cohort Analysis
Authors: Ali Sayed K. , Reveles Kelly R. , Davis Richard , Mortensen Eric M. , Frei Christopher R. , Mansi Ishak
Published: November 2014

Introduction

It has been hypothesized that statins reduce sex hormone biosynthesis through hepatic inhibition of cholesterol synthesis, which is a precursor of androstenedione and estradiol. Such a reduction has been associated with menstrual irregularities, menopausal disorders, infertility, and low libido, but studies are conflicting. Few studies have evaluated the clinical effects of statins on gonadal-sexual function in women.

Aim

To compare the risk of gonado-sexual dysfunction in statin users vs. nonusers.

Methods

This was a retrospective cohort study of all female, adult patients (30–85 years) enrolled in the Tricare Prime/Plus San Antonio catchment area. Using 79 baseline characteristics, we created a propensity score-matched cohort of statin users and nonusers. The study duration was divided into a baseline period (October 1, 2003 to September 30, 2005) to describe patient baseline characteristics and a follow-up period (October 1, 2005 to March 1, 2012) to determine patient outcomes. Statin users were defined as those prescribed a statin for ≥3 months between October 1, 2004 and September 30, 2005. Logistic regression was used to determine the association of statin use with patient outcomes.

Main Outcome Measures

Outcomes included menstrual disorders, menopausal disorders, infertility, and ovarian/sexual dysfunction during the follow-up period. Outcomes were identified using inpatient or outpatient International Classification of Diseases, Ninth Revision, Clinical Modification codes as defined by the Agency for Healthcare Research and Quality’s Clinical Classifications Software.

Results

Of 22,706 women who met study criteria, we propensity score-matched 2,890 statin users with 2,890 nonusers; mean age 58 ± 12 years. Statin use was not significantly associated with menstrual disorders (OR 0.97; 95% CI 0.81–1.16), menopausal disorders (OR 0.92; 95% CI 0.83–1.02), infertility (OR 0.79; 95% CI 0.36–1.73), or ovarian/sexual dysfunction (OR 1.18; 95% CI 0.83–1.70).

Conclusions

Statin use was not associated with higher risk of gonado-sexual dysfunction in women.
Oral glucose solution to alleviate pain induced by intramuscular injections in preterm infants
Authors: Uzelli Derya , Yapucu Güneş Ülkü
Published: November 2014

Purpose

The purpose was to assess the effectiveness of 5% oral glucose solution in reducing pain in preterm infants during intramuscular injection.

Design and Methods

We conducted a prospective, randomized, controlled, unblinded trial to investigate the effect of glucose solution on the pain of intramuscular injection in preterm infants (N = 80).

Results

Infants who received oral glucose had significantly lower pain scores (p < .001), less crying time (p < .001), higher oxygen saturation (p < .001), and lower heart rate after compared with during the procedure (p = .02).

Practice Implications

Our results suggest that oral glucose, even if used in the lowest dose, may have a pain‐relieving effect in preterm infants if administered pre‐procedure.
Thermal stress and predation risk trigger distinct transcriptomic responses in the intertidal snail Nucella lapillus
Authors: Chu Nathaniel D. , Miller Luke P. , Kaluziak Stefan T. , Trussell Geoffrey C. , Vollmer Steven V.
Published: November 2014

Thermal stress and predation risk have profound effects on rocky shore organisms, triggering changes in their feeding behaviour, morphology and metabolism. Studies of thermal stress have shown that underpinning such changes in several intertidal species are specific shifts in gene and protein expression (e.g. upregulation of heat‐shock proteins). But relatively few studies have examined genetic responses to predation risk. Here, we use next‐generation RNA sequencing (RNA‐seq) to examine the transcriptomic (mRNA) response of the snail Nucella lapillus to thermal stress and predation risk. We found that like other intertidal species, N. lapillus displays a pronounced genetic response to thermal stress by upregulating many heat‐shock proteins and other molecular chaperones. In contrast, the presence of a crab predator (Carcinus maenas) triggered few significant changes in gene expression in our experiment, and this response showed no significant overlap with the snail's response to thermal stress. These different gene expression profiles suggest that thermal stress and predation risk could pose distinct and potentially additive challenges for N. lapillus and that genetic responses to biotic stresses such as predation risk might be more complex and less uniform across species than genetic responses to abiotic stresses such as thermal stress.
Increased detection of mild cognitive impairment with type 2 diabetes mellitus using the Japanese version of the Montreal Cognitive Assessment: A pilot study
Authors: Mori Yukiko , Futamura Akinori , Murakami Hidetomo , Kohashi Kyoko , Hirano Tsutomu , Kawamura Mitsuru
Published: November 2014

Background

Studies show that diabetes mellitus is the greatest lifestyle risk factor for dementia. Appropriate management and treatment of type 2 diabetes mellitus could prevent the onset and progression of mild cognitive impairment to dementia.

Aim

Detection of mild cognitive impairment in patients with type 2 diabetes mellitus.

Methods

Mild cognitive impairment was assessed using the Japanese version of the Montreal Cognitive Assessment. The study population was 33 non‐demented inpatients with type 2 diabetes mellitus receiving diabetes management training. The Japanese version of the Montreal Cognitive Assessment, the animal naming test and the digit‐symbol coding subtest of the Wechsler Adult Intelligence Scale were administrated in one‐to‐one interviews.

Results

The prevalence of mild cognitive impairment in diabetic patients was 72%. The background characteristics of mild cognitive impairment in diabetic patients included fewer schooling years and higher glycated hemoglobin levels in comparison to subjects without mild cognitive impairment. Neuropsychological testing showed that diabetic patients with mild cognitive impairment scored lower on the Japanese version of the Montreal Cognitive Assessment (total score, P < 0.0001), frontal lobe function (P < 0.001) and delayed recall (P < 0.05). The number of correct answers on the digit‐symbol coding subtest was also significantly lower in diabetic patients with mild cognitive impairment (P < 0.05).

Conclusion

Mild cognitive impairment with type 2 diabetes mellitus has a high prevalence. Our study suggests that mild cognitive impairment in diabetic patients can be classified into three groups: predominantly frontal lobe dysfunction, predominantly delayed recall impairment and a mixed‐type group.
CNS intravascular large cell lymphoma in a patient with autoimmune hemolytic anemia
Authors: Alexandrescu Sanda , Orengo James P. , Toossi Shahed , Perry Arie , Treseler Patrick , Hess Christopher , Margeta Marta
Published: November 2014

Intravascular large cell lymphoma (IVLCL) is a rare disease characterized by proliferation of malignant lymphocytes within the small blood vessel lumens. The association of IVLCL with autoimmune hemolytic anemia (AIHA) has been described in a single case report, but the true prevalence of this co‐occurrence is not known because of declining autopsy rates. Here, we report a case of a 41‐year‐old woman who carried a diagnosis of AIHA for 2 years, with repeated hemolytic episodes that were initially well controlled with immunomodulatory treatment. At her last presentation, the patient developed rapidly progressive neurologic symptoms and leukoencephalopathy on MRI; she died 4 weeks later with a clinical impression of thrombotic microangiopathy, a known complication of AIHA. At autopsy, the brain showed widespread platelet thrombi and intraparenchymal hemorrhages characteristic of this disorder. In addition, there was evidence of a clinically unsuspected IVLCL, most likely of B‐cell lineage. This case illustrates a potential association between IVLCL and AIHA, highlights the need for broad differential diagnosis in cases with atypical disease presentation or progression, and underlines the importance of autopsy in establishing the full cause of morbidity and mortality.
Caring until the end: a systematic literature review exploring Paediatric Intensive Care Unit end‐of‐life care
Authors: Howes Catherine
Published: November 2014

Aims and objectives

A systematic review of the literature focusing on the provision of end‐of‐life care (EOLC) on Paediatric Intensive Care Units (PICUs) and the options available to children and families within contemporary clinical practice.

Background

The death of a child is recognized as a uniquely traumatic experience for a parent. The care delivered to a child and family surrounding death can have a lasting effect on the grieving process. The majority of paediatric deaths occur within PICUs, often as a result of withdrawing or withholding treatment. Withdrawal of intensive care is becoming more common within UK PICUs, and this review will focus on the options available when a child's on‐going treatment is deemed to be futile.

Search strategies

Literature published from 2002 to 2013 was obtained from a range of sources and critically reviewed. Cormack's (2000) framework for systematic literature review was utilized to critically review literature before analysis and synthesis of the literature was undertaken within the qualitative approach.

Inclusion/exclusion criteria

Each article focused on issues surrounding the topic area, excluded adult and neonatal intensive care and was published in English.

Conclusions

Eight papers met the inclusion criteria and were suitable for review (highlighting difficulties in reviewing a small, complex subject area). Key themes identified included family views, staff views, decision‐making, medico‐legal issues and resources.

Relevance to clinical practice

Although the number of relevant articles is limited, a wide range of challenges facing children, parents and staff are highlighted, whilst generally supporting the facilitation of transferring children to their homes or hospice for withdrawal of intensive care and continuing EOLC. Further research is required, particularly regarding long‐term implications, legal issues and the effectiveness of clinical protocols.
Gross and net production during the spring bloom along the Western Antarctic Peninsula
Authors: Goldman Johanna A. L. , Kranz Sven A. , Young Jodi N. , Tortell Philippe D. , Stanley Rachel H. R. , Bender Michael L. , Morel Francois M. M.
Published: November 2014

This study explores some of the physiological mechanisms responsible for high productivity near the shelf in the Western Antarctic Peninsula despite a short growing season and cold temperature.

We measured gross and net primary production at Palmer Station during the summer of 2012/2013 via three different techniques: incubation with H218O; incubation with 14CO2; and in situ measurements of O2/Ar and triple oxygen isotope. Additional laboratory experiments were performed with the psychrophilic diatom Fragilariopsis cylindrus.

During the spring bloom, which accounted for more than half of the seasonal gross production at Palmer Station, the ratio of net‐to‐gross production reached a maximum greater than c. 60%, among the highest ever reported. The use of multiple techniques showed that these high ratios resulted from low heterotrophic respiration and very low daylight autotrophic respiration. Laboratory experiments revealed a similar ratio of net‐to‐gross O2 production in F. cylindrus and provided the first experimental evidence for an important level of cyclic electron flow (CEF) in this organism.

The low ratio of community respiration to gross primary production observed during the bloom at Palmer Station may be characteristic of high latitude coastal ecosystems and partially supported by a very active CEF in psychrophilic phytoplankton.
The Populus ARBORKNOX1 homeodomain transcription factor regulates woody growth through binding to evolutionarily conserved target genes of diverse function
Authors: Liu Lijun , Zinkgraf Matthew , Petzold H. Earl , Beers Eric P. , Filkov Vladimir , Groover Andrew
Published: November 2014

The class I KNOX homeodomain transcription factor ARBORKNOX1 (ARK1) is a key regulator of vascular cambium maintenance and cell differentiation in Populus. Currently, basic information is lacking concerning the distribution, functional characteristics, and evolution of ARK1 binding in the Populus genome.

Here, we used chromatin immunoprecipitation sequencing (ChIP‐seq) technology to identify ARK1 binding loci genome‐wide in Populus. Computational analyses evaluated the distribution of ARK1 binding loci, the function of genes associated with bound loci, the effect of ARK1 binding on transcript levels, and evolutionary conservation of ARK1 binding loci.

ARK1 binds to thousands of loci which are highly enriched proximal to the transcriptional start sites of genes of diverse functions. ARK1 target genes are significantly enriched in paralogs derived from the whole‐genome salicoid duplication event. Both ARK1 and a maize (Zea mays) homolog, KNOTTED1, preferentially target evolutionarily conserved genes. However, only a small portion of ARK1 target genes are significantly differentially expressed in an ARK1 over‐expression mutant.

This study describes the functional characteristics and evolution of DNA binding by a transcription factor in an undomesticated tree, revealing complexities similar to those shown for transcription factors in model animal species.
Tricuspid Regurgitation and Implantable Devices
Authors: AL‐BAWARDY RASHA , KRISHNASWAMY AMAR , RAJESWARAN JEEVANANTHAM , BHARGAVA MANDEEP , WAZNI OUSSAMA , WILKOFF BRUCE , TUZCU EMIN MURAT , MARTIN DAVID , THOMAS JAMES , BLACKSTONE EUGENE , KAPADIA SAMIR
Published: November 2014

Background

There are limited and conflicting data regarding the prevalence of tricuspid regurgitation (TR) after cardiac device implantation (implantable cardioverter defibrillator [ICD]; permanent pacemaker [PPM]).

Objective

The goal of this study was to assess the prevalence of TR after cardiac device implantation and determine its clinical significance.

Methods

A total of 1,596 patients, who had cardiac devices implanted between 2005 and 2011 at the Cleveland Clinic and had at least one preimplantation echocardiogram and at least one postimplantation echocardiogram were included in this study. A total of 3,566 postimplantation echocardiograms were available for the 1,596 patients (median follow‐up 10 months). The primary end point was postimplantation TR and the secondary end point was all‐cause mortality after implantation. We have used a cumulative logistic nonlinear mixed‐effects model to assess the temporal trend of TR prevalence and a parametric multiphase hazard model to assess survival.

Results

Of the 1,596 patients (mean age: 60 ± 10 years, 61% of patients were men), 985 (62%) had ICDs (including 334 patients with cardiac resynchronization therapy defibrillator) and 611 (38%) had PPMs. The prevalence of grade 3 or 4+ TR increased from 27% to 31% by 1 month and to 35% at 4 years. Accordingly, prevalence of grade 0/1+ TR decreased from 46% preimplantation to 37% at 1 month and to 32% at 4 years. Device type (ICD vs PPM) and the number of leads placed did not have an effect on postimplantation TR (P > 0.2). Right ventricular systolic pressure (RVSP) did not change over time (36 mm Hg baseline, 37.5 mm Hg by 3 months, and 37 mm Hg by 1 year). One‐year and 5‐year survival were 93% and 73%, respectively. Postimplantation TR was an independent risk factor for late death (P < 0.05).

Conclusion

Cardiac device implantation was associated with a small but significant increase in the prevalence of moderate and severe TR, both acutely and chronically after implantation. The increase in TR was similar with both ICD and PPM placement, which was not related to the number of leads implanted and not associated with a significant increase in RVSP. Postimplantation TR was associated with a higher risk of mortality.
Human rhinovirus C infections in pediatric hematology and oncology patients
Authors: Loria Carolina , Domm Jennifer A. , Halasa Natasha B. , Heitman Elizabeth , Miller E. Kathryn , Xu Meng , Saville Benjamin R. , Frangoul Haydar , Williams John V.
Published: November 2014

Children with cancer and HSCT recipients are at high risk for common viral infections. We sought to define the viral etiology of ARI and identify risk factors. Nasal wash samples were collected from pediatric hematology–oncology patients and HSCT recipients with ARI during the 2003–2005 winter seasons. Real‐time RT‐PCR was performed to detect Flu A, influenza B, RSV, PIV 1‐3, human MPV, and HRV. HRV specimens were sequenced and genotyped. Seventy‐eight samples from 62 children were included. Viruses were detected in 31 of 78 samples (40%). HRV were detected most frequently, in 16 (52%) including five HRVC; followed by seven (22%) RSV, five (16%) Flu A, four (13%) MPV, and two (6%) PIV2. There was a trend toward higher risk of viral infection for children in day care. Only 8% of the study children had received influenza vaccine. HRV, including the recently discovered HRVC, are an important cause of infection in pediatric oncology and HSCT patients. Molecular testing is superior to conventional methods and should be standard of care, as HRV are not detected by conventional methods.
Moral Judgment and Deontology: Empirical Developments
Authors: May Joshua
Published: November 2014

A traditional idea is that moral judgment involves more than calculating the consequences of actions; it also requires an assessment of the agent's intentions, the act's nature, and whether the agent uses another person as a means to her ends. I survey experimental developments suggesting that ordinary people often tacitly reason in terms of such deontological rules. It's now unclear whether we should posit a traditional form of the doctrine of double effect. However, further research suggests that a range of non‐consequentialist factors influence moral judgment, including intentions, commissions, personal harm, and agent‐centered commitments. Many, if not all, such factors appear to affect how involved the agent is in bringing about an outcome.
Patients' experiences of being mechanically ventilated in an ICU: a qualitative metasynthesis
Authors: Baumgarten Mette , Poulsen Ingrid
Published: November 2014

Background

Being a patient in an intensive care unit (ICU) and being mechanically ventilated is a scary and unpleasant experience to many patients. Qualitative studies describe these Patients' experiences, but the findings have not yet been synthesised.

Aim

The aim of this study was to gather and synthesise interpreted knowledge from qualitative studies about Patients' experiences of being mechanically ventilated in an ICU.

Method

A qualitative metasynthesis was conducted on findings from nine qualitative studies performed in the period from 1994 to 2012. The studies were critically appraised according to the method defined by Sandelowski and Barosso, and the findings were extracted, edited, grouped and abstracted. Subsequently, the abstracted findings were analysed, using the constant comparison analysis. In the analysis, we used findings from patients with home ventilation and findings from patients admitted to an ICU, while they were not ventilated.

Results

Fifteen abstracted findings appeared from the metasynthesis and led to the synthesised finding: ‘Being dependent on health professionals, without being able to communicate, causes experiences with anxiety, fear and loneliness. How intensively these feelings are experienced seems to depend on the health professionals' ability of being present with these patients. The presence of relatives can alleviate these experiences'.

Conclusion

This study shows that patients being mechanically ventilated in an ICU experience an emic vulnerability, consisting of anxiety, fear and loneliness.

Implications for practice

In future practice, it is expected that patients will be more awake during mechanical ventilation. It is therefore important that health professionals have the knowledge that their presence and their support of the relationship between the patient and his/her relatives are of great importance in the care of patients.
Person‐centred care: clarifying the concept in the context of inpatient psychiatry
Authors: Gabrielsson Sebastian , Sävenstedt Stefan , Zingmark Karin
Published: November 2014

This paper reports an analysis of the concept of person‐centred care in the context of inpatient psychiatry. It has been suggested that person‐centred care in inpatient psychiatry might differ from person‐centred care in other contexts, indicating a need to clarify the concept in this specific context. Scholarly papers from health‐related disciplines were identified following a systematic search of the electronic databases CINAHL, PUBMED and PsycINFO, covering records indexed up until March 2014. An evolutionary approach to concept analysis was applied, integrating principles for data extraction and analysis in integrative reviews. The concept of person‐centred care was defined as cultural, relational and recovery‐oriented. It aspires to improve care and calls for a transformation of inpatient psychiatry. The concept is closely related to the concepts of recovery and interpersonal nursing. The result is described in terms of attributes, antecedents, consequences and related concepts. It is concluded that the further development of the concept needs to consider the contexts of the concept at both conceptual and praxis levels. Further research should explore the nature of and relationships between context, culture, care practice and outcomes in inpatient psychiatry from a perspective of person‐centred care. The results of this analysis can provide a framework for such research.
‘Southern’ Alternatives of Urban Diffusion: Investigating Settlement Characteristics and Socio‐Economic Patterns in Three Mediterranean Regions
Authors: Di Feliciantonio Cesare , Salvati Luca
Published: November 2014

The present study investigates the relation between urban form and the socio‐economic patterns of the resident population in three southern European cities (Athens, Lisbon and Rome) featured by different processes of urban diffusion. The paper goes beyond the literature on sprawl focused on (residential, income and ethnic) segregation and the different features of the inhabitants of the suburbs and those of the inner cities residents. By integrating multivariate statistics and spatial analysis, a methodology is proposed, based on morphological and socio‐economic indicators available at a fine geographical scale. Results show how urban diffusion processes vary widely according to the context, as does the socio‐economic profile of the actors, stressing the need to think about different ‘southern European alternatives’ of sprawl.
Type Synthesis of Three-Degree-of-Freedom Translational Compliant Parallel Mechanisms
Authors: Yue Cong , Zhang Ying , Su Hai-Jun , Kong Xianwen
Published: November 2014

In this paper, we apply screw theory to type synthesis of compliant parallel mechanisms (PMs) with translational degree-of-freedom (DOF). Compliant PMs are formed by a moving platform supported by three or more limbs each of which is a serial chain of flexure joints and rigid bodies. They achieve movement through the deformation of flexure joints and have been widely used in precision machinery. As an important task in the conceptual design stage, the goal of type synthesis is to determine the chain of each limb as well as their relationship when they are assembled in parallel for a prescribed motion pattern. In our approach, we study a category of commonly used flexure primitives and flexure elements whose freedom and constraint spaces are characterized by twists and wrenches in screw theory. Following the well-studied synthesis procedure for rigid body PMs, we propose a synthesis procedure for compliant PMs via screw theory. As an example, we demonstrate the procedure for synthesizing compliant PMs with three translational DOF. Tables of limbs, types, and geometric conditions for the assemblies of these limbs are presented. The paper provides a catalog of 3DOF translational compliant PM designs. At last, we developed finite element simulation to validate one of the synthesized designs.
Imaging Thermal Transport in Graphene
Authors: Ziade Elbara , Schmidt Aaron
Published: November 2014

Frequency domain thermoreflectance (FDTR) imaging is used to create quantitative maps of both in-plane thermal conductance and cross-plane thermal boundary conductance (TBC) for graphene multilayers encased between titanium and silicon dioxide. A graphene flake is encased between a metal layer and a thermally oxidized p-type silicon wafer and a piezo stage is used to raster scan the sample for imaging. For each image pixel, a periodically modulated continuous-wave laser (the red pump beam) is focused to a Gaussian spot, less than 2 um in diameter, that locally heats the sample, while a second beam (the green probe beam) monitors the surface temperature through a proportional change in reflectivity. The pump beam is modulated simultaneously at six frequencies and the thermal properties of the graphene flake are extracted by minimizing the error between the measured probe phase lag at each frequency and an analytical solution to the heat diffusion equation in a multilayer stack of materials. Phase images at six frequencies for the sample are shown in b. Different layers of the graphene flake are clearly shown in 9.9 MHz and 11.3 MHz images. The six phase data points at every pixel are then fitted to our thermal model to generate two thermal property maps of the graphene flake: in-plane thermal conductance and TBC, shown in c. The in-plane thermal conductance map shows an increased conduction of heat in graphene with the number of layers, while the TBC map indicates a constant cross-plane conduction along the flake. Our imaging technique can be used to study thermal transport in graphene and has implications for thermal management in graphene based electronic devices.
Wettability Control of VACNT Array through Atmospheric Plasma Treatment
Authors: Ji Yulong , Li Gen , Sun Yuqing
Published: November 2014

Wetting characteristics of the vertically aligned carbon nanotube (VACNT) array surface can be modified by atmospheric plasma treatment with masks. The plasma treatment of the VACNT array surface was performed by moving an atmospheric pressure plasma jet system (Plasmatreat GmbH, Steinhagen) at a fixed speed of 0.167 m/s through a mask with holes. The hole diameter is fixed equal to 250 µm. The distance between holes varies between 0.5 mm to 3.0 mm.The Easy Drop Shape Analyzer (KRUSS GmbH) was used for contact angle measurement. Experimental results show that the wetting characteristics of the VACNT array surface can be modified from a contact angle of 140° to 0° depending on the distance between holes.
Bubble Ebullition on a Hydrophilic Surface
Authors: Sur Aritra , Lu Yi , Pascente Carmen , Ruchhoeft Paul
Published: November 2014

Nucleate boiling heat transfer depends on various aspects of the bubble ebullition, such as the bubble nucleation, growth and departure. In this work, a synchronized high-speed optical imaging and infrared (IR) thermography approach was employed to study the ebullition process of a single bubble on a hydrophilic surface. The boiling experiments were conducted at saturated temperature and atmospheric pressure conditions. De-ionized (DI) water was used as the working fluid. The boiling device was made of a 385-um thick silicon wafer. A thin film heater was deposited on one side, and the other side was used as the boiling surface. The onset of nucleate boiling (ONB) occurs at a wall superheat of ΔTsup= 12 °C and an applied heat flux of q" = 35.9 kW/m2. The evolution of the wall heat flux distribution was obtained from the IR temperature measurements, which clearly depicts the existence of the microlayer near the three-phase contact line of the nucleate bubble. The results suggest that, during the bubble growth stage, the evaporation in the microlayer region contributes dominantly to the nucleate boiling heat transfer; however, once the bubble starts to depart from the boiling surface, the microlayer quickly vanishes, and the transient conduction and the microconvection become the prevailing heat transfer mechanisms.