bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology and Socio-Economic Impact of Headache
Authors: Rasmussen BK
Published: November 2015

Headache disorders constitute a public-health problem of enormous proportions, with an impact on both the individual sufferer and society. Epidemiological knowledge is required to quantitate the significance of these disorders. The effects on individuals can be assessed by examining prevalence, distribution, attack frequency and duration, and headache-related disability. The socio-economic burden includes both direct costs associated with healthcare utilization and costs associated with missed work due to sickness absence or reduced efficiency. The individual and socio-economic burden of headaches is substantial. Headache disorders deserve more attention, especially concerning strategies leading to adequate primary prevention, diagnosis, and treatment.
Managers' Beliefs about the Glass Ceiling: Interpersonal and Organizational Factors
Authors: Elacqua Tina C. , Beehr Terry A. , Hansen Curtiss P. , Webster Jennica
Published: November 2015

The glass ceiling refers to the difficulty of women trying to be promoted into the top management levels. The present study examined managers' potential explanations, implicit or explicit, for why women rarely reach the top hierarchical levels in their own organization. Among 685 managers at a large Midwestern insurance company, a model was supported in which beliefs about interpersonal and situational variables in the organization were related to the perception that men and women were treated differently overall, which, in turn, was related to the belief that a glass ceiling existed. The model was not different for male and female managers, but women tended to perceive that each element of the model existed to a greater extent than men did.
Medial Patellofemoral Ligament Injuries in Children With First-Time Lateral Patellar Dislocations
Authors: Askenberger Marie , Arendt Elizabeth A. , Ekström Wilhelmina , Voss Ulrika , Finnbogason Throstur , Janarv Per-Mats
Published: November 2015

Background:

A lateral patellar dislocation (LPD) is the most common knee injury in children with traumatic knee hemarthrosis. The medial patellofemoral ligament (MPFL), the important passive stabilizer against LPDs, is injured in more than 90% of cases. The MPFL injury pattern is most often defined in adults or in mixed-age populations. The injury pattern in the skeletally immature patient may be different.

Purpose:

To describe MPFL injuries in the skeletally immature patient by magnetic resonance imaging (MRI), and to compare the results with the injury pattern found at arthroscopic surgery.

Study Design:

Case series; Level of evidence, 4.

Methods:

This was a prospective series of patients aged 9 to 14 years with acute, first-time traumatic LPDs in whom clinical examinations, radiographs, MRI, and arthroscopic surgery were performed within 2 weeks from the index injury. The MPFL injury was divided into 3 different groups according to the location: patellar site, femoral site, or multifocal. The MPFL injury site was confirmed on MRI by soft tissue edema. The length of the MPFL injury at the patellar site was measured at arthroscopic surgery, and those ≥2 cm were defined as total ruptures.

Results:

A total of 74 patients (40 girls and 34 boys; mean age, 13.1 years) were included; 73 patients (99%) had an MPFL injury according to MRI and arthroscopic surgery. The MRI scans showed an isolated MPFL injury at the patellar attachment site in 44 of 74 patients (60%), a multifocal injury in 26 patients (35%), an injury at the femoral site in 3 patients (4%), and no injury in 1 patient (1%). Arthroscopic surgery disclosed an isolated MPFL injury at the patellar site in 60 of 74 patients (81%) and a multifocal injury in 13 patients (18%); the MPFL injury at the patellar site was a total rupture in 49 patients (66%). Edema at the patellar attachment site on MRI was proven to be an MPFL rupture at the same site at arthroscopic surgery in 99% of the patients. A patellar-based injury, isolated or as part of a multifocal injury, was present on MRI in 95% (n = 70) of the patients, with a false-negative rate of 5% (n = 4) of patients compared with arthroscopic surgery.

Conclusion:

Skeletally immature children are more prone to sustaining an MPFL injury at the patellar attachment site. Arthroscopic surgery and MRI complement each other in the investigation of MPFL injuries.
Age and diabetes related changes of the retinal capillaries: An ultrastructural and immunohistochemical study
Authors: Bianchi Enrica , Ripandelli Guido , Taurone Samanta , Feher Janos , Plateroti Rocco , Kovacs Illes , Magliulo Giuseppe , Orlando Maria Patrizia , Micera Alessandra , Battaglione Ezio , Artico Marco
Published: November 2015

Normal human aging and diabetes are associated with a gradual decrease of cerebral flow in the brain with changes in vascular architecture. Thickening of the capillary basement membrane and microvascular fibrosis are evident in the central nervous system of elderly and diabetic patients. Current findings assign a primary role to endothelial dysfunction as a cause of basement membrane (BM) thickening, while retinal alterations are considered to be a secondary cause of either ischemia or exudation. The aim of this study was to reveal any initial retinal alterations and variations in the BM of retinal capillaries during diabetes and aging as compared to healthy controls. Moreover, we investigated the potential role of vascular endothelial growth factor (VEGF) and pro-inflammatory cytokines in diabetic retina.

Transmission electron microscopy (TEM) was performed on 46 enucleated human eyes with particular attention to alterations of the retinal capillary wall and Müller glial cells. Inflammatory cytokines expression in the retina was investigated by immunohistochemistry.

Our electron microscopy findings demonstrated that thickening of the BM begins primarily at the level of the glial side of the retina during aging and diabetes. The Müller cells showed numerous cytoplasmic endosomes and highly electron-dense lysosomes which surrounded the retinal capillaries. Our study is the first to present morphological evidence that Müller cells start to deposit excessive BM material in retinal capillaries during aging and diabetes. Our results confirm the induction of pro-inflammatory cytokines TNF-α and IL-1β within the retina as a result of diabetes.

These observations strongly suggest that inflammatory cytokines and changes in the metabolism of Müller glial cells rather than changes in of endothelial cells may play a primary role in the alteration of retinal capillaries BM during aging and diabetes.
Unanticipated Effects of Children with Learning Disabilities on Their Families
Authors: Dyson Lily
Published: November 2015

This study examined the unanticipated effects that children with learning disabilities have on the life of their families. Eleven parents of students aged 8 to 16 years old participated in two separate focus group interviews. Findings showed that children with learning disabilities had a range of effects on their families. These included family stress, parenting discrepancies, negative reactions from extended family members, difficulty in interacting with the school, and mixed effects upon siblings. Patterns of family coping also emerged. Recommendations for supporting families and students with learning disabilities are suggested.
Literacy Instruction, Technology, and Students with Learning Disabilities: Research We Have, Research We Need
Authors: Kennedy Michael J. , Deshler Donald D.
Published: November 2015

Technology, whether assistive (AT) or instructional (IT), has played an uneven role in the field of learning disabilities since its inception more than a half century ago. In addition, technology is in a constant state of flux; hence, researchers have been challenged to conduct appropriate experimental testing of interventions before they are outdated or made irrelevant by advances in hardware and software. As schools seek to improve learning outcomes for all students using tiered instructional models such as response to intervention (RTI), practitioners need assistance in capitalizing on AT, IT, or a combination of the two, to guide and enrich literacy instruction for students with learning disabilities. This article presents a conceptual framework for multimedia instructional design grounded in theory and empirical research. The article concludes with recommendations for how to integrate multimedia literacy instruction within RTI frameworks
Researching in Classrooms: Getting beyond “What Works”
Authors: Dudley-Marling Curt
Published: November 2015

The dominant approach to research in learning disabilities utilizes experimental and quasi-experimental designs to identify the most effective instructional strategies for students with learning disabilities. Research is always undertaken from a point of view, yet the discourse on “what works?” is generally silent on how theoretical frameworks inform all research, including intervention research in learning disabilities. This paper argues that the quality of research in learning disabilities depends on the quality of the theoretical frameworks that inform any research study, including the questions the researcher asks, the methodology employed, and the way the data are analyzed. An example of classroom language research is used to illustrate how a study informed by a sociocultural model of learning demands an alternative to the experimental and quasi-experimental methodologies that dominate research in learning disabilities.
Dual Strands in Municipal Personnel Administration: Politics and Professionalism
Authors: Stein Lana
Published: November 2015

Personnel rules are not neutral and for over a century have given preference to either political needs or the reform desire for apolitical expertise. In either case, particular interests have been served. Today's municipal personnel practices reflect both the traditional reform spirit and the changes necessitated by equal opportunity and affirmative action and the desire for greater managerial control. It is a time of transition, with as yet no dominant motif.
Dimensions of Public Sector Pay Policies in the United States and Sweden
Authors: Recascino Wise Lois
Published: November 2015

Three dimensions for analyzing public sector pay administration are used to examine central government pay administration in Sweden and the United States of America. On the first dimension, market posture, both countries are found to fall short of their espoused policy, comparability. Greater consistency is found on the second dimension, social orientation, where both countries have pursued the goal of social equality. The equilization of salary levels across society is far greater in Sweden in keeping with the socialist objectives of wage solidarity. The third dimension, reward structure, shows the greatest distance between the two countries with the struggle to implement performance-contingent pay underway in the U.S. while Swedes continue to rely on longevity for pay increases.
Tehran: Growth and Contradictions
Authors: Amirahmadi Hooshang , Kiafar Ali
Published: November 2015

Tehran, the capital and largest city of Iran, has witnessed two parallel trends: a rapid and multi-faceted socio-spatial growth, and increasing separation among social classes. The former is manifested by population increase, physical expansion, concentration of institutions, and administrative centralization. The latter is indicated by rapid accumulation of wealth and capital by a tiny layer, poverty of most of the population, and spatial segregation of social classes. These phenomena reflect the transformation from a pre-capitalist city in the 18th through the early 20th century to a transitional capitalist city in the 1920–1950 period, and to a dependent capitalist city after the 1950s.
Adapting Planning Education to Changing Student Demands
Authors: Foerster James F. , Hemmens George C.
Published: November 2015

The planning curriculum established at the University of Illinois at Chicago (UIC) in 1973 was designed to serve the needs of full-time students. Since then many changes have occurred both in the curriculum and in the composition of the student body, and now degree programs are jointly offered to both full-time and part-time students. This paper focuses upon program changes instituted over time in response to a changing student clientele, the impact of these changes on graduation rates, and suggestions for responding to changing student needs.
Conflict at Large: A National Survey of Planners and Political Conflict
Authors: Hoch Charles
Published: November 2015

Results of a national survey reveal that planners respond to the risks of political conflict with either ambivalence or a willingness to engage in political organizing and negotiating. Among the planners who encountered politically threatening conflicts, most took efforts to prevent this sort of predicament, but their efforts usually failed. Organizing allies proved to be the only coping action that exhibited a direct statistical effect on conflict outcomes. The ambivalence evident in their reports not only reveals a need for individual education to improve practitioners' strategic negotiating and organizing skills, but also the institutional vulnerability of planning and its lack of political and cultural supports.
Toxic Shock Syndrome
Authors: Dellaripa Paul F.
Published: November 2015

Toxic shock syndrome (TSS) represents a heterogeneous group of disorders that results in hypotension, multiorgan system involvement, and a characteristic rash or soft tissue infection caused by staphylococcal or streptococcal exotoxins and enterotoxins. Staphylococcal TSS emerged in the late 1970s as an illness associated with highly absorbent tampons; subsequently it has been described with postoperative infections, burns, and various viral illnesses. Although the morbidity rate associated with staphylococcal TSS may be high, the mortality rate approximates 5%. Streptococcal TSS has emerged in the 1980s and into the 1990s as a disorder that results in rapid progression of soft tissue infection in the form of cellulitis, myositis, or necrotizing fasciitis due to pyogenic streptococcal group A exotoxin. The rapidity of progression of local infection to hypotension and multiorgan failure results in a mortality rate of 30–70%. In both forms of TSS, staphylococcal and streptococcal exotoxins function as superantigens, a unique mechanism of immune activation that results in an exuberant T-cell response and profound cytokine expression. The role of antibiotics is reviewed. The use of clindamycin in streptococcal TSS and the potential therapeutic role of intravenous immunoglobulin in both forms of this disorder are discussed as well.
Serial APACHE III Scoring for Acute Renal Failure in the Intensive Care Unit
Authors: Hofmann R. Michael , Mak Rosa , Wood Kenneth E. , Heisey Dennis M. , Becker Bryan N.
Published: November 2015

Severity stratification and prediction models are important tools for gauging outcomes in critically ill patients. However, most severity scoring systems are inaccurate when attempting to predict mortality in individuals with acute renal failure (ARF), including the APACHE (Acute Physiology and Chronic Health Evaluation) II scoring system. APACHE III scoring encompasses a greater array of physiologic parameters that may better correlate with outcome in ARF. We evaluated APACHE II and APACHE III scoring in 27 individuals admitted to the intensive acre unit (ICU) with ARF requiring dialysis. We also evaluated the predictive value of serial APACHE III scoring on mortality. Sixteen of the study subjects were discharged alive from the ICU. APACHE II scores for ICU survivors versus nonsurvivors were not significantly different at the outset of dialysis treatment, though they did discriminate between survivors and nonsurvivors at 48 hours (survivors 15 ± 6.2; nonsurvivors 18.1 ± 6.9; p = 0.019). However, average APACHE III scores for survivors were significantly less than those for nonsurvivors on all days of score collection, including at the outset of dialysis (day 0 survivors 94.7 ± 22.1; nonsurvivors 106.8 ± 21.7; p = 0.03). APACHE III scores on day 2 also discriminated between those who recovered renal function (83.6 ± 16.7) compared to those who did not (105.6 ± 21.4) (p = 0.05). Serial APACHE III scoring provided rapid and reproducible scoring that differentiated between survivors and nonsurvivors in a group of critically ill patients with ARF. This study suggests that further investigations are warranted to confirm whether serial APACHE III scoring should be considered as an adjunct clinical tool in caring for individuals with ARF in the ICU.
Acute Therapy of Bacterial Meningitis
Authors: Tunkel Allan R. , Scheld W. Michael
Published: November 2015

Antimicrobial therapy for bacterial meningitis has markedly reduced mortality rates from this disorder. The efficacy of an antibiotic in meningitis depends on many factors, including its penetration into cerebrospinal fluid (CSF), the bactericidal efficacy of the antibiotic within purulent CSF, and the need for bactericidal activity in CSF because bacterial meningitis represents an infection in an area of impaired host defense. Penicillin G and ampicillin are equally efficacious for meningitis caused by Streptococcus pneumoniae or Neisseria meningitidis. This recommendation may change, however, with the emergence of strains of pneumococci or meningococci that are relatively or highly resistant to penicillin; a third-generation cephalosporin (cefotaxime or ceftriaxone) should be used for meningitis due to relatively resistant strains and vancomycin for pneumococcal meningitis caused by strains that are highly resistant to penicillin. With the high percentage of strains of Haemopbilus influenzae type b that produce β-lactamase, empiric therapy when this organism is suspected should consist of a third-generation cephalosporin; these agents are also used for meningitis caused by enteric gram-negative bacilli, and one agent, ceftazidime, is effective against Pseudomonas aeruginosa meningitis. Despite the availability of effective bactericidal antibiotics, morbidity and mortality from bacterial meningitis remains unacceptably high. Recent studies using animal models of infection have demonstrated the beneficial effect of antiinflammatory agents in attenuating the CSF inflammatory response that may lessen many of the pathophysiological consequences of meningitis. Studies of adjunctive dexamethasone therapy suggest that these agents may reduce morbidity (specifically sensorineural hearing loss) and mortality (due to S. pneumoniae) in patients with bacterial meningitis. Controversy remains, however, concerning the use of dexamethasone in all patients with bacterial meningitis and further studies are necessary. In critically ill patients with bacterial meningitis, control of increased intracranial pressure and seizures may be useful and necessary in improving outcome.
Management of Stress Gastritis
Authors: Durham Rodney M. , Shapiro Marc J.
Published: November 2015

Management of stress gastritis is primarily directed toward prevention of gastrointestinal bleeding. Antacids and H2 blockers have been the standard agents used for prophylactic therapy in critically ill patients. However, growing evidence that gastric alkalization leads to an increased incidence of nosocomial pneumonias has led to the development of other prophylactic agents that do not decrease gastric acidity. These cytoprotective agents presumably enhance gastric mucosal defenses and stimulate mucosal repair. Approximately 3% of patients bleed despite prophylactic therapy. Bleeding is usually controlled with intensive medical management, and the need for surgical intervention is rare.
Transesophageal Echocardiography
Authors: Tee Ernesto A. , Shah Pravin M.
Published: November 2015

Transesophageal echocardiography has provided a new acoustic window to the heart, the great vessels, and the mediastinum. It provides anatomical, functional hemodynamic, and blood flow information. High-quality visualization of left atrial appendage, thoracic aorta, atrial septum, and mitral valvular apparatus can be obtained readily. We discuss historical and technical aspects of transesophageal echocardiography, anatomical views, and major clinical indications for this procedure. These indications include intracardiac masses, thoracic aortic dissection, endocarditis, prosthetic and native cardiac valve function assessment, as well as its value in the detection of intracardiac source of systemic cmboli. Furthermore, the role of transesophageal echocardiography in the assessment of coronary artery and congenital heart disease and as an intraoperative diagnostic and monitoring technique is discussed.
Morbidity and Mortality in Adults With “Idiopathic” Thrombotic Thrombocytopenic Purpura/Hemolytic Uremic Syndrome
Authors: Goodnough Lawrence Tim , Strasburg David , Verbrugge Dorothea , Fisher Charles
Published: November 2015

We attempt to define the morbidity and mortality of adult patients with idiopathic (i.e., absence of known co-existent factors) thrombotic thrombocytopenic purpura/hemolytic uremia syndrome (TTP/HUS) who underwent a standard program of aggressive plasma exchange therapy. We conducted a retrospective review of patients treated with a diagnosis of TTP/HUS at a single institution over 7 years. TTP/HUS diagnosis in 52 patients was based on presence of microangiopathic, hemolytic anemia, and thrombocytopenia (< 150,000/mm3), along with 1 or more of the following: neurological abnormalities, renal dysfunction, or fever (>38°. Thirteen patients with co-existent factors of systemic lupus erythematosis, pregnancy, HIV infection, and cyclosporin or mitomycin C therapy were excluded from analysis; therefore, 39 patients treated over 7 years were studied. Interventions involved therapeutic plasma exchange of 150% plasma volume, with daily plasma replacement, until remission or death. Steroid therapy, antiplatelet therapy, or splenectomy were added at the discretion of the participating physicians. We found an overall mortality of 13 (35%) in the 39 patients. Time from onset of symptoms until initiation of therapy for all patients was 17 ± 24 days (mean ± SD). Average hospital stay was 29 ± 32 days, of which 10 ± 29 days and 12 ± 26 days were spent on the ventilator and in the intensive care unit, respectively. No differences between patients who survived and those who died were found with respect to gender, age, or blood component support (i.e., platelet, red cell transfusions) required. Six (30%) of 20 patients relapsed after attaining initial remission with medical therapy. Nine (60%) of 13 patients refractory to medical management underwent splenectomy and survived. We conclude that despite aggressive medical and surgical management, idiopathic TTP/HUS remains a syndrome with significant morbidity and mortality in otherwise young and healthy adults. Our results suggest that these patients should not be considered stable and should not undergo trial therapy with steroid or plasma infusion therapy. Earlier diagnosis and treatment with daily plasma exchange, along with consideration of surgical splenectomy in patients refractory to medical management, may be necessary if outcomes are to be improved in the management of this syndrome.
Trauma Radiology: Part II. Diagnostic Imaging of Thoracic Trauma: Review and Update
Authors: Mirvis Stuart E. , Shanmuganathan K.
Published: November 2015

Frontal chest radiographs are the principal diagnostic imaging study to detect, verify, or exclude acute thoracic injury after trauma, and they should be obtained as quickly as possible without compromising clinical assessment and resuscitation. Chest radiographs provide important information about potentially life-threatening conditions, such as tension pneumothorax, major hemothorax, and major arterial injury. In many patients, chest radiographs also provide helpful clues to the presence of such conditions as diaphragmatic rupture, pulmonary contusion/laceration, and tracheobronchial injury. In selected patients, computed tomography scans can supplement information provided by radiography, particularly for detection of mediastinal hemorrhage, aortic pseudoaneurysm, subtle pneumothorax, and delineation of complex pleuroparenchymal processes. On occasion, magnetic resonance imaging can be used to assess integrity of the hemidiaphragms and visceral herniation when other diagnostic studies are equivocal. We consider typical imaging findings associated with a variety of acute thoracic injuries, as well as the most appropriate use of available imaging techniques in different clinical scenarios.
Computers in the Intensive Care Unit: Promises Yet to Be Fulfilled
Authors: Buchman Timothy G.
Published: November 2015

Computers, whether disguised as microprocessor-controlled bedside devices or obvious as electronic patient charts, are proliferating in intensive care units. The history of the relationship between computers and intensive care units suggests that their joint development has been characterized by customization of a device or a program to automate each specific task. Failure to develop standard definitions of clinical data, standards for their interpretation, or a comprehensive model of the process of critical care retards development of computer systems beyond device-dedicated microprocessors. An agenda that gives priority to systematic examination of definitions, descriptions, and processes of critical care over additional hardware and software development is recommended.
Accurate Placement of Central Venous Catheters Using a 16-cm Catheter
Authors: McGee William T. , Moriarty Kevin P.
Published: November 2015

We determine if use of 16-cm central venous catheters (CVC) minimizes dangerous intracardiac catheter placements. We conducted a prospective study in a large community teaching hospital. Consecutive patients (n = 127) who required a CVC via either the internal jugular (IJV) or the subclavian vein (SCV) were assessed using 16 (n = 102) or 20-cm (n = 25) catheters. The main outcome measurements were (1) intracardiac placement of central venous catheters, and (2) relationship of right- or left-sided internal jugular or subclavian vein insertions to intracardiac catheter placement. Use of a 20-cm CVC resulted in 14 of 25 (56%) intracardiac placements compared with 11 of 102 (11%) using a 16-cm catheter ( p < 0.0001). All intracardiac placements with the 16-cm CVC were from right-sided approaches: IJV 7 of 38 (16%), SCV 4 of 18 (18%). Use of a 16-cm CVC to access the central circulation from either the SCV or the IJV results in a significantly greater proportion of safe catheter placements than using longer CVCs, and it should become the standard of care.
Cerebral Monitoring by Near-Infrared Spectroscopy
Authors: Tsuji Miles
Published: November 2015

Near-infrared spectroscopy (NIRS) is a noninvasive optical monitoring technology that can provide information on relative cerebral oxyhemoglobin, deoxyhemoglobin, and oxidized cytochrome aa3 concentrations. Unlike other bedside clinical monitoring technologies, NIRS provides direct information on cerebral hemoglobin oxygenation and blood volume changes. NIRS recordings have documented changes in cerebral oxygenation in fetuses during labor, critically ill premature infants, cardiopulmonary bypass patients, and adult surgical patients. This information may improve understanding of the causes of brain injury and allow detection of inadequate oxygen delivery before brain injury occurs. Future developments in NIRS technology are likely to produce practical, quantitative bedside monitors of global and regional cerebral oxygenation.
Recognition and Treatment of the Catatonic Syndrome
Authors: Fricchione Gregory , Bush George , Fozdar Manish , Francis Andrew , Fink Max
Published: November 2015

We define the catatonic syndrome and review the history of the concept of catatonia, including its recent acceptance as a syndrome. Diagnosis of the catatonic syndrome, with its associated extensive differential diagnoses related to systemic and mental disorders, is addressed. Catatonia is related to variants of the syndrome, such as lethal (malignant) catatonia and the neuroleptic malignant syndrome (NMS). Medical sequelae of these conditions are outlined. The literature on the treatment of the catatonic syndrome is reviewed, and a suggested approach to treatment and management of catatonic patients in the intensive care unit is provided. An hypothesis regarding the neuropathophysiological basis for the syndrome is also offered.
Recognition and Management of Cardiac Arrhythmias: Part I. General Principles and Supraventricular Tachyarrhythmias
Authors: Chakko Simon , Mitrani Raul
Published: November 2015

Management of cardiac arrhythmias has undergone major changes in the last few years. In the first part of this review, general principles of arrhythmia diagnosis are discussed. New techniques such as event recording and signal-averaged electrocardiography have a significant role in the clinical management of arrhythmias. Many new antiarrhythmic drugs are now available. Suppression of premature ventricular contractions to prevent malignant ventricular arrhythmias has been demonstrated to be an ineffective strategy. Implantable defibrillators and radio frequency ablation have revolutionized the treatment of arrhythmias. Differentiation of various supraventricular tachycardias has become very important since some these arrhythmias may be cured by radiofrequency ablation. Diagnosis and treatment of common supraventricular arrhythmias are discussed.
Electronic Journals: Time for a New Paradigm in Biomedical Communication
Authors: Markovitz Barry P.
Published: November 2015

Despite an exponentially increasing knowledge base in the biomedical sciences and revolutionary advances in computer technology and global networking, scientists and health care workers continue to rely on the nineteenth-century medium of print periodicals as the mainstay of information distribution. Multidisciplinary in theory and practice, practitioners of intensive care medicine are particularly in need of a modern and efficient communication and publishing medium. This discussion questions the appropriateness of the current model of commercial print publishing for biomedical communication, finding it inefficient, expensive, and overly restrictive. With the explosive recent growth of the Internet, and the platform-independent World Wide Web, scientists and clinicians now have an opportunity to forge a new paradigm of noncommercial electronic publishing. For a fraction of the cost that the biomedical community is spending currently for our antiquated system, universal access over the Internet to peer-reviewed electronic journals, sponsored jointly by universities, governments, and health care institutions, can be accomplished now.
Defining a High-Performance ICU System for the 21st Century: A Position Paper
Authors: Teres Daniel , Higgins Thomas , Steingrub Jay , Loiacono Laurie , Mcgee William , Circeo Lori , Brunton Mary , Giuliano Karen , Burns Marty , Le Gall Jean Roger , Artigas Antonio , Strosberg Martin , Lemeshow Stanley
Published: November 2015

In the fall of 1997 George D. Lundberg and John E. Wennberg wrote an editorial in JAMA calling for comprehensive quality improvement programs to become the driver of the American health care system. The suggestion came during the Second European Forum on Quality Improvement in Health Care held in Paris, France, in April 1997 and was based on comments made by Donald Berwick. The concept was to focus on an organized response to problem identification and proposed solutions to improve patient care and protect the health of the public. Critical care medicine represents a large segment of health care and is undergoing dramatic changes during our managed care revolution. General ICU severity of illness models have been developed, tested, and shown to provide a useful estimate of hospital mortality for populations of critically ill patients. These systems have captured the imagination of clinical researchers and have become an integral component of a large number of publications as well as a part of many ICU databases. These risk adjustment severity models are remarkably robust for heterogeneous patient populations but the models have not been shown to validate well in new settings. We feel that by focusing on the episode of critical illness rather than each individual ICU admission and by going beyond the traditional acute hospital discharge to determine whether the patient lives or dies, we can better evaluate critical care system performance and cost-effectiveness. The incentives for high quality/low cost should favor integrated comprehensive critical care delivery systems. Programs that score well should be identified as high quality and be honored as medallion level 1 ICUs. We challenge national and international critical care societies to evaluate and then debate the described definitions and recommendations as a call to action.
Patient-Focused Interdisciplinary Care Planning: Tools and Processes for Home Anti-Infective Therapies
Authors: Bing Caryn M. , Nowobilski-Vasilios Anna
Published: November 2015

A systematic, patient-focused approach to home care planning transcends organizational, clinical discipline and departmental boundaries. True patient-focused care planning incorporates collaborative management of the factors critical to successful patient outcomes. This article discusses operational and content issues seen in interdisciplinary care planning, as well as approaches and considerations for successful home care planning. Tools provided by the authors include a communication checklist for home anti-infective therapy and a sample interdisciplinary care plan/care coordination record. A home anti-infective therapy case illustrates the concepts, processes, and benefits of moving from the “drug related problems” approach to patient-focused interdisciplinary care planning.
Overview of Biotechnology
Authors: Bush Peggy
Published: November 2015

Modern biotechnology has advanced rapidly in the past few decades, driven largely by scientific advances which have led to the development of techniques such as recombinant DNA and hybridoma technology. The United States is a leader in the growing biotechnology field. Biotechnology has wide potential application in diverse areas including health care, chemicals, food, and waste treatment. Health care represents the largest sector in the biotechnology industry with hundreds of products in development including therapeutics, vaccines, diagnostics, devices and drug delivery systems. Unique legal, regulatory, and societal issues associated with biotechnology-derived products are being addressed as the field continues to evolve.
Pharmacotherapeutics of Biotechnology-Derived Products
Authors: Bush Peggy
Published: November 2015

Biotechnology has contributed to important advances in the healthcare field. Products include various hormones, enzymes, cytokines, vaccines, and monoclonal antibodies, with use in diverse therapeutic areas. The majority of approved biotechnology-derived therapeutic products are recombinant proteins. Many have orphan drug status and, therefore, are used in relatively small patient populations. Newer generation biotechnology products are likely to include small molecules, gene therapy products, and increased numbers of vaccines and monoclonal antibody products. Biotechnology provides the means to develop diverse, innovative, and effective approaches to the prevention, treatment, and cure of human disease.
Use of Erythropoietin Following Emergent Surgery in a Jehovah'S Witness
Authors: Barlows Theodore G. , Deitz Marisel D. , Egol Andrew B.
Published: November 2015

We report a case of a 25-year-old, female Jehovah'S Witness (JW) with severe anemia secondary to emergent salpingectomy who was treated with high dose human recombinant erythropoietin (rHu-EPO). Post-operative laboratory values were significant for a Hgb of 3.4 g/dl and a Hct 9.6%. The patient received rHu-EPO 150 u/kg IV q 12 hrs x 10 days, iron dextran, folic acid, cyanocobalamin, and fluid replacement. The patients Hgb and Hct were 6.0 g/dl and 18.9% upon discharge, increased from a nadir of 2.4 g/dl and 6.7%, respectively. The immediate administration of high dose rHu-EPO to severely anemic JW patients may decrease the period of severe anemia by accelerating erythropoiesis.
Diet Drug Disaster: The Story of Redux and Fen-Phen*
Authors: O'Donnell James
Published: November 2015

The Fen-Phen Diet combines two FDA approved drugs. Although both drugs showed significant weight loss in controlled studies, no long-term studies of safety had been performed at the time of approval. It was thought that fenfluramine and dexfenfluramine, the active racemate of fenfluramine, suppressed appetite like other amphetamine-related drugs. Phentermine was thought to act as a balance to the adverse effects of abstinence from food and irritability from CNS stimulation caused by dexfenfluramine. Primary pulmonary hypertension (PPH) was known to be a rare risk at time of approval and prompted the recommendation that use be restricted to morbidly obese patients for short periods of time (6–8 weeks). An unanticipated danger of using these two drugs in combination is that together they can produce an overdosage of serotonin. The development of cardiac valvulopathies in otherwise healthy people recalled similar pathology in response to overdosage of serotonin from other medications or from a serotonin producing tumor of the Gl (carcinoid syndrome). Serotonin pharmacology is considered to illustrate the complexity of this remarkable chemical that has properties of neurotransmitter and hormone. Since this anorexogenic epidemic affected millions of patients and because there are potential permanent residual pathologies, pharmacists will continue to be queried about the topic. A review of the Redux/Fen-Phen history, pharmacology of the anorexigenics, and interactions with serotonin agonists and antagonists is presented to provide the pharmacist with a succinct and current account of this dark chapter in pharmacotherapy.
Opioid Equivalency: A Review
Authors: McRae Aimee L. , Sonne Susan C.
Published: November 2015

Opioid analgesics are often used for the treatment of both acute and chronic pain. These agents can differ in regard to opioid receptor interactions, pharmacological actions, and side effect profiles. Furthermore, an agent can be differentiated by its relative potency and duration of action. This paper highlights the major differences between the opioid analgesics and presents a comparative table which includes equianalgesic doses for available opioid formulations. Also, guidelines for making rational prescribing decisions are discussed.
Acute Respiratory Distress Syndrome: Potential Pharmacologic Interventions
Authors: Kaufman Brian , Dhar Panchali
Published: November 2015

The mortality of the acute respiratory distress syndrome (ARDS) remains high despite advances in supportive care of ARDS and in the understanding of the pathogenesis. Numerous inflammatory mediators including reactive oxygen species, arachidonic acid metabolites, and growth factors, are present in the circulation of patients with or at risk for developing this syndrome and play a key pathophysiologic role in the development of lung injury. Pharmacologic therapy is being evaluated to: 1) support the failing lung by improving gas exchange; 2) interrupt the mediator-induced mechanisms of inflammation and injury. Although none of these experimental therapies has yet been proven to improve survival in well conducted prospective, randomized, double-blind, controlled clinical trials, many have demonstrated improvement in physiologic function. These results have helped lay the groundwork for future advances in this field.
Developing a Pharmacy Curriculum in Complementary and Alternative Medicine
Authors: Lenz Kristi L.
Published: November 2015

Complementary and alternative medicine (CAM) is gaining in popularity, with one in three Americans reporting some use. The government has taken an interest in CAM research, establishing the National Center for Complementary and Alternative Medicine. However, most conventional health care providers lack knowledge of CAM practices, due in large part to the paucity of formal education in this area. Given these trends, many colleges of pharmacy are considering re-instituting pharmacognosy courses, as well as adding CAM course work to their curricula. The literature contains very little to guide faculty in teaching pharmacy students about CAM; therefore, proposed components of a pharmacy curriculum are discussed.
Systemic Lupus Erythematosus
Authors: Scott Steven A.
Published: November 2015

Systemic lupus erythematosus (SLE) is a chronic, multiple-organ system inflammatory disorder associated with immune system dysfunction. Autoantibodies are produced that react with self-antigens in cell membranes and nuclear and cytoplasmic constituents to produce tissue damage. Commonly observed clinical manifestations include arthritis, myalgia, fever, cutaneous lesions, cytopenia, and renal, CNS, and cardiopulmonary involvement. Minor manifestations can be managed with relatively nontoxic agents such as nonsteroidal anti-inflammatory drugs, topical corticosteroids, and antimalarials. Severe disease involving the kidneys, CNS, and cardiopulmonary systems requires the aggressive use of more toxic agents such as high-dose corticosteroids, azathioprine, and cyclophosphamide. Other supportive and ancillary therapies are also required to manage the complications frequently associated with SLE.
Modelling Spray/Wall Interaction in Swirling Flows for DI Diesel Engines
Authors: Singal S K , Pundir B P , Mehta P S
Published: November 2015

A mathematical model for predicting spray/wall interaction in swirling flows of a direct-injection (DI) diesel engine is developed using a centre-line velocity vector/continuum approach. Generalization of the integral method for solving continuity and momentum equations for both free and wall regions of spray motion is demonstrated. The compression-induced swirl is estimated taking into consideration the wall friction and the exact moment of inertia of cylinder-piston assembly. The predictions are found in general agreement with the results of other workers.
Heritage ethics
Authors: Fowler Marsha D
Published: November 2015

The key to understanding the moral identity of modern nursing and the distinctiveness of nursing ethics resides in a deeper examination of the extensive nursing ethics literature and history from the late 1800s to the mid 1960s, that is, prior to the “bioethics revolution”. There is a distinctive nursing ethics, but one that falls outside both biomedical and bioethics and is larger than either. Were, there a greater corpus of research on nursing’s heritage ethics it would decidedly recondition the entire argument about a distinctive nursing ethics. It would also provide a thicker account of nursing ethics than has been afforded thus far. Such research is dependent upon identifying, locating, accessing and, more importantly, sharing these resources. A number of important heritage ethics sources are identified so that researchers might better locate them. In addition, a bibliography of heritage ethics textbooks and a transcript of the earliest known journal article on nursing ethics in the US are provided.
Globalisation, Competition and Economic Stability
Authors: Panchamukhi V. R.
Published: November 2015

The GLJP strategy is complemented by market fundamentalism, implying major emphasis on market forces and reduction in the role of the state. The systematic revolution also implies significant structural changes But the phenomenon is not without paradoxes and calls for cautious steps. Various lessons are to be learnt from the Mexican misery. The author discusses in detail about the right approach for India so that the country evades any misery. The concept of ‘Tobin Tax’ is worth examining.
Privatization and Public Regulation
Authors: Kaur Simrit , Jain S.P.
Published: November 2015

In many developing and developed countries, privatization through transfer of ownership from public to the private hands is considered as a cure for most of the problems faced by the public sector enterprises (PSEs.) However, policy makers tend to forget that both the systems – private and public – are imperfect. If market failure necessitates the need for government intervention, then failures associated with the government require more market friendly policies. This implies that at any point of time both systems will coexist i.e. privatization will go hand in hand. The present article attempts to discuss the modalities of privatization options and public regulation adopted by India.
Organisational Restructuring for the Next Millennium
Authors: Verma DR Vinnie , Misra DR Kamlesh
Published: November 2015

A major transformation is taking place in the industrial sector of the world economy. Today no organisation can remain isolated from its environment and a key aspect of managing these organisations will always be their ability to manage the inte1jace between their strategic and operational activities and what is happening in the markets and in broader cultural, financial, political and technological frameworks.

This paper attempts to highlight the major changes taking place, which have an impact on all the economies, with an emphasis on the role of technology in the restructuring process. It points out at the technology trends and its repercussions on organization structure. It also attempts to reflect upon how the functional areas like production, marketing and HR would need to be geared up to face the onslaught of change. Issues of corporate governance, e-commerce and the organisational capabilities are also discussed.
Information Technology and Education Delivery
Authors: Khurana Reema
Published: November 2015

Education in current scenario is going through a metamorphosis. With the onset of Information Technology the very concept of education delivery; has changed. The web has broken the boundaries of classroom to bring education and educator into the realms of the learner. This was earlier accomplished through televised lectures but web can be multidirectional media as against TV which was a however what have been the pros and cons of learning on the web?
Information Technology as a Strategic Tool for Attaining Success in Global Environment
Authors: Saxena DR R.P.
Published: November 2015

The emergence of global eco11omy and a global trade market has transformed the world into one massive business community. The expression “global village” is no longer a contradiction in terms. It is a reality and credit goes to the emerging Information Technology. Today, in the quality and productivity conscious, globally competitive environment, business and business people are driving the development of Information Technology and IT is providing the business opportunities that were unheard of only ten years ago.

Today, we live in a society in which information is an essential resource and where knowledge is valuable. In the present era IT has become the life giving and sustaining clement in every organisation. For survival the use of IT tools in different disciplines of management has become inevitable and there is a need to give IT a strategic orientation, as IT has emerged as a new mantra of success in today's global environment.