bluuebunny/crossref_metadata_2025 huggingface dataset:
Junior residents' experience and perception of handover: Implications on developing a standard handover protocol and handover training
Authors: Yang Xi Jessie , Siah Kewin T. H. , Park Taezoon , Donchin Yoel
Published: August 2015

Poor handovers contribute to medical near misses, adverse events and waste of healthcare resources. To improve handover communication, public hospitals in Singapore are among the pioneers in Asia to develop standardized handover protocols and handover training courses. This study aimed to examine junior residents’ experience and perception on clinical handovers and discuss the implications on developing a standard handover protocol and handover training. Two survey studies with 47 junior residents were conducted at the Department of Internal Medicine, National University Hospital (NUH) of Singapore in Nov 2008 and from Jan to Mar 2010 respectively. Overall, junior residents supported handover standardization. Specifically, with respect to content standardization, junior residents demonstrated a good awareness of essential topics that should be communicated during a handover, and yet follow up action and non-modifiable identifiers were poorly covered in their current practices; with respect to method standardization, they showed a strong preference for an interactive handover channel. To our surprises, the recommended verbal communication plus text message method was not highly accepted, largely due to the high workload of preparing text messages. Moreover, handover training was advocated by junior residents and they considered the early stage of physicians’ medical training to be the proper time to learn handover skills.
Medication Reconciliation: More than just a check
Authors: Grindrod Kelly , Tran Poanna , Burns Catherine
Published: August 2015

Medication reconciliation continues to be a poorly understood and poorly supported task. We conducted an exploratory study of medication reconciliation at 11 different health settings. Following the observations we used Cognitive Work Analysis to develop work domain models and decision ladder models. These models showed the complexity of medication reconciliation. Key challenges such as high demands for knowledge based behavior and inefficient information flows were identified. These areas suggest concrete ways of supporting the medication reconciliation task better.
Working with paramedics on implementing human factors improvements to their response bags
Authors: Bitan Yuval , Ramey Scott , Philp Giselle , Uukkivi Tarmo
Published: August 2015

Paramedics work in a challenging environment which can affect the health and safety of both paramedics and their patients. Our objectives in this study were to work with the paramedics on changing one of the essential tools they use on a daily bases, and to make it safer to use both for them and for their patients. Our intervention started by providing the paramedics with basic human factors knowledge, which made a revolution in the way they look at their working environment. The work with the paramedics throughout the process also assist in implementing the changes to the field, since the paramedic were involve in the change from the beginning and knew the reason for change.
Developing a Usability Ranking System for Findings in Health Information Technology Products
Authors: Cook Ashley , Herout Jennifer
Published: August 2015

Resources for addressing usability issues identified by practitioners are often limited and teams look to usability professionals for help in prioritizing the issues. Health Information Technology (HIT) products face an additional level of complexity due to the intertwined relationship between usability issues and potential patient safety issues. Human Factors Engineering (HFE) team within the Office of Informatics and Analytics of the Veterans Health Administration (VHA OIA) developed a usability ranking system, sensitive to the specific challenges of HIT products, to help teams prioritize resolution of usability findings. The system considers factors concerned with the findings themselves, including user experience impact, organizational impact, and frequency of the problem. Constructed with “checklist style” definitions for each level, the system helps practitioners more consistently select the appropriate initial ranking.
Integrating Electronic Health Records Into Clinical Workflow: An Application of Human Factors Modeling Methods to Two Specialty Care Areas
Authors: Patterson Emily S. , Gibbons Michael C. , Latkany Paul , Ramaiah Mala , Brick David , Lowry Svetlana Z.
Published: August 2015

Issues with workflow integration have contributed to slow rates of EHR adoption in specialty care settings. Based on the insights generated during collegial discussions with physician Subject Matter Experts (SMEs), we identified unique end-user needs to improve EHR workflow in two specialty outpatient care settings. These include supporting coordination between physicians and specialized technicians, data integration with specialized software and devices, following specialty-specific norms for medical terminology, and adding unique data fields. Targeted recommendations for EHR developers are made to meet these needs.
Using Comparative Cognitive Work Analysis to Identify Design Priorities in Complex Socio-Technical Systems
Authors: St-Maurice Justin , Burns Catherine M.
Published: August 2015

Health care can be categorized as a complex socio-technical system. Often, similar projects or systems experience very different outcomes during implementation. To better understand the differentiating success factors when comparing projects or systems, we argue there is a need to systematically compare complex socio-technical systems. While Cognitive Engineering offers many methods for analyzing complex socio-technical systems, such as Cognitive Work Analysis, few methods support a comparison paradigm. We propose using Cognitive Work Analysis and using it to compare two similar socio-technical systems through Comparative Cognitive Work Analysis. Through parallel phases to Cognitive Work Analysis, the comparative method allows for the identification of differentiating factors, which we call Junctions, and allows practitioners to identify design opportunities to introduce success interventions into existing designs. Future work will involve further development of this concept and its application to healthcare problems.
Mental Models and Deliberate Manipulation of Data
Authors: Koester Thomas , Jakobsen Jeanette , Brøsted Jesper Ejdorf , Bach Katrine , Petersen Olav , Kyng Morten , Rasch Sarah
Published: August 2015

Human factors risk analysis and usability tests in telemedicine contexts primarily seek to investigate how to reduce the likelihood of slips, lapses and mistakes. However, to ensure trustworthiness in e-health data, one must also be aware of more intentional patient actions which could potentially compromise patient safety and/or the integrity of the system. The pilot study in this paper set out to explore mental models and deliberate manipulation of data in a Danish telemedicine setting of home monitoring among pregnant women. Results show, that patients construct mental models of the telemedicine system – and that the patient can utilize such mental models in attempts to manipulate their data input to get a desired output from the telemedicine system.
Evaluating the Labeling-User Interface and Device Design-User Interface in Usability Validation Studies for Combination Products: Resolving the Catch-22
Authors: Davol Pamela A.
Published: August 2015

The strategy of the Center for Devices and Radiological Health (CDRH) at the Food and Drug Administration (FDA) for usability validation of medical devices is aimed at the priority of evaluating device design as a means to reduce risks through mitigation of use-errors that may present serious harms to end-users and patients. In contrast, the strategy of the Center for Drug Evaluation and Research (CDER) is aimed at evaluating product packaging and labeling to ensure end-user comprehension of drug and delivery device instructions-for-use (IFU) and other labeling as a means to minimize risks for medication errors that may result in harms to the patient or ineffective drug treatment. Although both strategies align to a common purpose, each FDA Center's requirement often presents a Catch-22, particularly when product Sponsors postpone usability evaluations and try to combine each Center's requirements for the purpose of fulfilling usability validation requirements. Although not the ideal strategy, the purpose of this presentation is to discuss and compare past-proven methods that have been successful for satisfying the usability validation testing requirements of both CDRH and CDER for combination products when Sponsors have not conducted usability evaluations throughout a product's development. This in-depth presentation will include a discussion of Centers' requirements that are in direct opposition to each other and alternative methods for usability validation testing to satisfy both Centers. Strengths and limitations of each strategy will be discussed in relation to the overall usability validation testing process. Recognizing and understanding usability validation testing strategies of CDRH and CDER that are in direct opposition of each other in advance is essential for applying a human factors usability strategy that leads to the successful validation of a combination product. Knowledge of alternative testing strategies, each with their own strengths and limitations, designed to meet expectations of both Centers allows HF usability investigators to select and/or tailor the approach that best meets the unique challenges of their investigational combination product in order to efficiently pass validation from both Centers and enter the market.
A Sentiment Analysis of Patient Safety Event Reports
Authors: Gilboa Leatt , Hoffman Daniel , Fong Allan , Ratwani Raj
Published: August 2015

Patient Safety Event (PSE) reporting systems are widely utilized by healthcare providers across the country as a method for gathering information from front-line healthcare providers about patient safety. Automated processes that utilize natural language processing (NLP) techniques have been developed and applied to analyze these reports. The objective of this study was to explore and solidify methods on how to build a sentiment analysis (SA) library specific to patient safety event reports. Our hypothesis is that application of such a library to large data sets would illuminate trends in the relationship between workplace culture and patient safety that could lead to actionable interventions by decision-makers. We examined PSE reports, gathered from a single system over a period of approximately 15 months. The analysis uncovered 36 unique keywords that vary in degree of sentiment, and can serve as a basis for a PSE-specific sentiment library, including context specific keywords such as “hung up”, “volatile”, and “throw”. SA is a useful technique that, when used in combination with other indicators, may paint a picture of an institution's safety culture.
Twelve Tips to Designing a Situation Display for the Healthcare Team
Authors: Parush Avi , Momtahan Kathryn , Kramer Chelsea , Sohmer Ben , Mastorias George , Calder Lisa
Published: August 2015

The objective of the team display is to present a current and dynamic situation picture to the healthcare team. The challenges in designing such a display are determining the relevant situational information and presenting it in a way that is timely, unobtrusive, and not overloading. The tips here focus on designing situation displays for healthcare teams during a clinical procedure (such as a surgery or a procedure in the emergency unit). These tips are based on the experience of designing two healthcare team situation displays, one for the cardiac OR team and the other for the ED/Resuscitation bay team, as well knowledge transferred from forest fire incident management.
Improving the Usability of the Nih Seniorhealth. Gov Website for Its Target Audience
Authors: Davis Kristen , Horst Dick
Published: August 2015

The NIHSeniorHealth.gov website has provided information about healthcare topics thought to be of particular interest to older adults for over ten years. The site was designed with the needs and constraints of older adult users in mind. However, realizing that the interests, expectations, and Internet proficiency of older adults continue to evolve, the National Institute on Aging (NIA), which manages the site content, and the National Library of Medicine (NLM), which implements and maintains the site, embarked on an extensive refresh of NIHSeniorHealth.gov over the last several years. An important focus of this update was the user experience (UX) of the site. The authors of this poster presentation were part of a team that supported this refresh effort by conducting a series of usability tests with representative users and offering design recommendations based on the test results as well as best practices in web user interface design. The refresh effort focused on matching the UX to needs, skills, and preferences of older adults. Since this update, the site has experienced a major resurgence of use as measured by web analytics and customer satisfaction ratings.
Usability of Incident Reporting Systems: Preliminary Results of A Case Study
Authors: Wiele Paul , Rantanen Esa
Published: August 2015

Although low participation in incident-reporting systems contributes to the problem of poor error prevention, little research has focused on improving participation. The present study is a case study of a hospital's incident reporting practices, seeking to increase both the number and quality of their incident reports by examining the usability of the reporting system itself as well as organizational factors impacting attitudes towards reporting. A snowball sample of hospital staff was recruited to identify organizational and software usability factors that both impede and promote frequent and useful incident reporting. Preliminary results suggest that time pressure is a key impediment to reporting, and that hospital staff in certain units are already attempting innovative shortcuts to cut time demands without reducing their reporting rates.
Operationalizing Sepsis Alert Design and Clinical Decision Support: Developing Enhanced Visual Display Models
Authors: Miller Kristen E. , Capan Muge , Wu Pan , Jackson Eric V. , Arnold Ryan C.
Published: August 2015

It is vital that health care providers have the tools needed for early diagnosis and treatment of sepsis to achieve improved survival outcomes. Despite advances in early warning system technology, providers still lack responsiveness in recognizing and treating septic patients. The recently introduced Centers for Medicare and Medicaid Services early management bundle for severe/septic shock highlights the need to promote bundles of care to improve guideline compliance and lower hospital mortality. Our objective is to determine the best way to provide a sepsis alert to drive compliance in the complex cognitive system that underlies the decision-making process in the dynamic and distributed health care work environment.

Alert and warning complexity is especially prevalent in health care information technology. Despite this issue, there is little consensus on how alerts and warnings should be generated and displayed to the user. Effective presentation of an alert, including how and what is displayed, may offer better cognitive support during busy patient encounters and may help providers extract information quickly. We are creating a framework to evaluate sepsis alert presentation models with enhanced visual elements integrating a textual, graphical, and figure display of the PIRO (predisposition, infection, response, organ dysfunction) classification. Our alert presentation framework is tailored to clinicians with the goal to better equip clinicians to understand their patients' data through feature extraction and visualization embedded with different asynchronous alerts.
Supporting dispatch decisions in interfacility medical transfers: Understanding the roles of uncertainty and reliability
Authors: Giang Wayne C.W. , Donmez Birsen , Zakir Areeba , Ahghari Mahvareh , MacDonald Russell D.
Published: August 2015

Efficient transfer of patients between facilities is a key component of regionalized critical care systems, but interfacility transfers pose added risks to patients. We created a decision support tool for dispatchers in medical transportation systems which provides estimates of the time to definitive care, the time between receiving the transfer request and patient handoff, which is a key component of dispatch decisions. This tool provides point-estimates of transfer times that are more accurate than the dispatchers own estimates, to support resource allocation and medical triage decisions. However, additional information about the uncertainty of these estimates may further improve dispatcher decision making. This paper describes an observational study conducted with 2 expert and 2 novice dispatchers in a medical transportation service on usage of our prototype decision support tool. In particular, we focused on whether these dispatchers use uncertainty information in their decision process, and how this information should be presented in a tool. We found that uncertainty, as represented by of the spread of possible transfer times (i.e., variability of times), is not currently considered by dispatchers. However, our observations suggest that reliability information (i.e., the trustworthiness of the tool's estimates) would be used. Expert dispatchers would use information about the reliability of estimates to build their trust in the system, while novices should use reliability information to calibrate their trust.
Engineering the Integrated Clinical Environment Organizing Information in the Intensive Care Unit (ICU)
Authors: Harris Steven D. , Bitan Yuval , North Robert A. , Ilan Roy , Howes Dan , Karn Keith S. , Burns Wes
Published: August 2015

The overarching goal of this project is to develop engineering requirements for future information resources in the ICU. We describe a method and related instrumentation for collecting data about information requirements from a clinical team in situ. Video records are collected using three consumer-grade video cameras, augmented by a wireless microphone system. We combine the video/audio recordings into a single, synchronized record. A transcript is prepared, and then coded by a professional medical records coder, using the SNOMED CT coding scheme. The resulting record represents a coded stream of verbal utterances that is sufficiently precise to support systems engineering analysis.
Tales from the Frontline: Implementing an E-Prescription Technology
Authors: Chenn Allen , Khunlertkit Adjhaporn , Winner Laura
Published: August 2015

Health Information Technology (HIT) has great potential to enhance patient care and improve efficiency of health care delivery if it is appropriately designed, implemented and used. In 2009 the Office of the National Coordinator (ONC) created Meaningful Use (MU) incentives to promote HIT adoption, which has spurred major investment in HIT, but the program has shown no reduction in use errors. Because the MU program mainly focuses on clinical process measures, with no attention to the processes of system design and implementation, many organizations encounter challenges to attain the MU. Previous studies identified lack of adequate implementation plans, lack of team support, lack of workflow analysis, and lack of dedicated resources as main barriers to MU attainment. We have identified similar concerns, and here present tales from the frontline to show perceptions of end users when our organization rushed through the implementation of e-prescription technology to meet the MU deadlines. Insufficient attention to the design and implementation process has put our organizations at risk. Reactive mitigation solutions were put in place to counteract the identifiable potential risks.
The evolutionary dynamics of tRNA-gene copy number and codon-use in E. coli.
Authors: McDonald Michael J. , Chou Chih-Hung , Swamy Krishna BS , Huang Hsien-Da , Leu Jun-Yi
Published: August 2015

Background

The introduction of foreign DNA by Lateral Gene Transfer (LGT) can quickly and drastically alter genome composition. Problems can arise if the genes introduced by LGT use codons that are not suited to the host’s translational machinery. Here we investigate compensatory adaptation of E. coli in response to the introduction of large volumes of codons that are rarely used by the host genome.

Results

We analyze genome sequences from the E. coli/Shigella complex, and find that certain tRNA genes are present in multiple copies in two pathogenic Shigella and O157:H7 subgroups of E. coli. Furthermore, we show that the codons that correspond to these multi-copy number tRNA genes are enriched in the high copy number Selfish Genetic Elements (SGE’s) in Shigella and laterally introduced genes in O157:H7. We analyze the duplicate copies and find evidence for the selective retention of tRNA genes introduced by LGT in response to the changed codon content of the genome.

Conclusion

These data support a model where the relatively rapid influx of LGT genes and SGE’s introduces a large number of genes maladapted to the host’s translational machinery. Under these conditions, it becomes advantageous for the host to retain tRNA genes that are required for the incorporation of amino acids at these codons. Subsequently, the increased number of copies of these specific tRNA genes adjusts the cellular tRNA pool to the demands set by global shifts in codon usage.
Recruitment of Dorsal Midbrain Catecholaminergic Pathways in the Recovery from Nerve Injury Evoked Disabilities
Authors: Mor David , Kang James W M , Wyllie Peter , Thirunavukarasu Vignaraja , Houlton Hayden , Austin Paul J , Keay Kevin A
Published: August 2015

Background

The periaqueductal gray region (PAG) is one of several brain areas identified to be vulnerable to structural and functional change following peripheral nerve injury. Sciatic nerve constriction injury (CCI) triggers neuropathic pain and three distinct profiles of changes in complex behaviours, which include altered social and sleep–wake behaviours as well as changes in endocrine function. The PAG encompasses subgroups of the A10 dopaminergic and A6 noradrenergic cell groups; the origins of significant ascending projections to hypothalamic and forebrain regions, which regulate sleep, complex behaviours and endocrine function. We used RT-PCR, western blots and immunohistochemistry for tyrosine hydroxylase to determine whether (1) tyrosine hydroxylase increased in the A10/A6 cells and/or; (2) de novo synthesis of tyrosine hydroxylase, in a ‘ TH-naïve’ population of ventral PAG neurons characterized rats with distinct patterns of behavioural and endocrine change co-morbid with CCI evoked-pain.

Results

Evidence for increased tyrosine hydroxylase transcription and translation in the constitutive A10/A6 cells was found in the midbrain of rats that showed an initial 2–3 day post-CCI, behavioural and endocrine change, which recovered by days 5–6 post-CCI. Furthermore these rats showed significant increases in the density of TH-IR fibres in the vPAG.

Conclusions: Our data provide evidence for

(1) potential increases in dopamine and noradrenaline synthesis in vPAG cells; and (2) increased catecholaminergic drive on vPAG neurons in rats in which transient changes in social behavior are seen following CCI. The data suggests a role for dopaminergic and noradrenergic outputs, and catecholaminergic inputs of the vPAG in the expression of one of the profiles of behavioural and endocrine change triggered by nerve injury.
Characteristics of the first metatarsophalangeal joint in gout and asymptomatic hyperuricaemia: a cross‐sectional observational study
Authors: Stewart Sarah , Dalbeth Nicola , Vandal Alain C. , Rome Keith
Published: August 2015

Background

This study aimed to identify patient‐reported outcomes and clinician‐assessed characteristics of the first metatarsophalangeal joint (1MTPJ) in people with gout and with asymptomatic hyperuricaemia by comparing them to normouricaemic controls.

Methods

Twenty four people with gout (without current symptoms of acute arthritis), 29 with asymptomatic hyperuricaemia and 34 age‐ and sex‐matched controls participated in this cross‐sectional observational study. Patient‐reported outcomes included 1MTPJ pain, foot pain and disability, body pain, lower limb function, activity limitation and overall wellbeing. Clinician‐assessed characteristics of the 1MTPJ included range of motion (ROM), plantar‐ and dorsi‐flexion force, foot posture, temperature and hallux valgus severity.

Results

Compared to controls, participants with gout reported greater 1MTPJ pain (p = 0.014), greater foot pain and disability (p < 0.001), increased odds of having disabling foot pain (odds ratio (OR) 13.4, p < 0.001), decreased lower limb function for daily living (p = 0.002) and recreational (p < 0.001) activities, increased activity limitation (p = 0.002), reduced overall wellbeing (p = 0.034), reduced ROM (p < 0.001), reduced plantarflexion force (p = 0.012), increased 1MTPJ plantar (p = 0.004), dorsal (p = 0.003) and medial (p = 0.004) temperature and had increased odds of having more severe hallux valgus (OR 0.3 p = 0.041). Compared to controls, participants with asymptomatic hyperuricaemia had increased odds of having disabling foot pain (OR 4.2, p = 0.013), increased activity limitation (p = 0.033), decreased lower limb function for daily living (p = 0.026) and recreational (p = 0.010) activities, increased 1MTPJ plantarflexion force (p = 0.004) and a more pronated foot type (p = 0.036).

Conclusions

People with gout demonstrate 1MTPJ‐specific changes indicative of subclinical inflammation, even in the absence of acute arthritis. People with asymptomatic hyperuricaemia, who exhibit no features or symptoms of gout, also report high levels of foot‐ and lower limb‐related pain and disability.
Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis
Authors: van Zanten Arthur R. H. , Dhaliwal Rupinder , Garrel Dominique , Heyland Daren K.
Published: August 2015

Introduction

Glutamine (GLN) has been suggested to have a beneficial influence on outcomes of critically ill patients. However, recent large-scale trials have suggested harm associated with GLN supplementation. Recently, systematic reviews on the use of parenteral GLN have been published; however, less information is available on the role of enteral GLN. Therefore, the aim of this systematic review was to study the effects of enteral GLN supplementation in patients with critical illness.

Methods

We identified randomized controlled trials conducted from 1980 to 2014 with enterally administered GLN in adult critically ill patients. Studies of parenteral GLN only or combined enteral-parenteral GLN were excluded. The methodological quality of studies was scored, and trial data were statistically combined. We examined a priori the treatment effects in subgroups of trials of burn and trauma patients.

Results

A total of 11 studies involving 1079 adult critically ill patients and enteral GLN supplementation were identified. Enteral GLN supplementation was not associated with a reduction of hospital mortality (risk ratio [RR] 0.94, 95 % confidence interval [CI] 0.65–1.36; p =0.74), infectious complications (RR 0.93, 95 % CI 0.79–1.10; p =0.39) or stay in the intensive care unit (weighted mean difference [WMD] −1.36 days, 95 % CI −5.51 to 2.78; p =0.52). However, there was a significant reduction in hospital stay (WMD 4.73 days, 95 % CI −8.53 to −0.90; p =0.02). In the subset of studies of patients with burns, enteral GLN supplementation was associated with significant reductions in hospital mortality (RR 0.19, 95 % 0.06–0.67; p =0.010) and hospital stay (WMD −9.16, 95 % CI −15.06 to −3.26; p =0.002). There was no effect in trauma patients.

Conclusions

Enteral GLN supplementation does not confer significant clinical benefit in critically ill patients, with the exception of reduced hospital stay. There may be a significant benefit in patients with burns, but data are sparse and larger randomized trials are warranted to confirm this effect.
Timing of antibiotics, volume, and vasoactive infusions in children with sepsis admitted to intensive care
Authors: van Paridon Bregje M. , Sheppard Cathy , G Garcia Guerra , Joffe Ari R. ,   for the Alberta Sepsis Network
Published: August 2015

Introduction

Early administration of antibiotics for sepsis, and of fluid boluses and vasoactive agents for septic shock, is recommended. Evidence for this in children is limited.

Methods

The Alberta Sepsis Network prospectively enrolled eligible children admitted to the Pediatric Intensive Care Unit (PICU) with sepsis from 04/2012-10/2014. Demographics, severity of illness, and outcomes variables were prospectively entered into the ASN database after deferred consent. Timing of interventions were determined by retrospective chart review using a study manual and case-report-form. We aimed to determine the association of intervention timing and outcome in children with sepsis. Univariate (t-test and Fisher’s Exact) and multiple linear regression statistics evaluated predictors of outcomes of PICU length of stay (LOS) and ventilation days.

Results

Seventy-nine children, age median 60 (IQR 22–133) months, 40 (51 %) female, 39 (49 %) with severe underlying co-morbidity, 44 (56 %) with septic shock, and median PRISM-III 10.5 [IQR 6.0-17.0] were enrolled. Most patients presented in an ED: 36 (46 %) at an outlying hospital ED, and 21 (27 %) at the Children’s Hospital ED. Most infections were pneumonia with/without empyema (42, 53 %), meningitis (11, 14 %), or bacteremia (10, 13 %). The time from presentation to acceptable antibiotic administration was a median of 115.0 [IQR 59.0-323.0] minutes; 20 (25 %) of patients received their antibiotics in the first hour from presentation. Independent predictors of PICU LOS were PRISM-III, and severe underlying co-morbidity, but not time to antibiotics. In the septic shock subgroup, the volume of fluid boluses given in the first 2 hours was independently associated with longer PICU LOS (effect size 0.22 days; 95 % CI 0.5, 0.38; per ml/kg). Independent predictors of ventilator days were PRISM-III score and severe underlying co-morbidity. In the septic shock subgroup, volume of fluid boluses in the first 2 hours was independently associated with more ventilator days (effect size 0.09 days; 95 % CI 0.02, 0.15; per ml/kg).

Conclusion

Higher volume of early fluid boluses in children with sepsis and septic shock was independently associated with longer PICU LOS and ventilator days. More study on the benefits and harms of fluid bolus therapy in children are needed.
Intralesional injection of adipose-derived stem cells reduces hypertrophic scarring in a rabbit ear model
Authors: Zhang Qi , Liu Li-Na , Yong Qi , Deng Jing-Cheng , Cao Wei-Gang
Published: August 2015

Introduction

Redundant collagen deposition at sites of healing dermal wounds results in hypertrophic scars. Adipose-derived stem cells (ADSCs) exhibit promise in a variety of anti-fibrosis applications by attenuating collagen deposition. The objective of this study was to explore the influence of an intralesional injection of ADSCs on hypertrophic scar formation by using an established rabbit ear model.

Methods

Twelve New Zealand albino rabbits were equally divided into three groups, and six identical punch defects were made on each ear. On postoperative day 14 when all wounds were completely re-epithelialized, the first group received an intralesional injection of ADSCs on their right ears and Dulbecco’s modified Eagle’s medium (DMEM) on their left ears as an internal control. Rabbits in the second group were injected with conditioned medium of the ADSCs (ADSCs-CM) on their right ears and DMEM on their left ears as an internal control. Right ears of the third group remained untreated, and left ears received DMEM. We quantified scar hypertrophy by measuring the scar elevation index (SEI) on postoperative days 14, 21, 28, and 35 with ultrasonography. Wounds were harvested 35 days later for histomorphometric and gene expression analysis.

Results

Intralesional injections of ADSCs or ADSCs-CM both led to scars with a far more normal appearance and significantly decreased SEI (44.04 % and 32.48 %, respectively, both P <0.01) in the rabbit ears compared with their internal controls. Furthermore, we confirmed that collagen was organized more regularly and that there was a decreased expression of alpha-smooth muscle actin (α-SMA) and collagen type Ι in the ADSC- and ADSCs-CM-injected scars according to histomorphometric and real-time quantitative polymerase chain reaction analysis. There was no difference between DMEM-injected and untreated scars.

Conclusions

An intralesional injection of ADSCs reduces the formation of rabbit ear hypertrophic scars by decreasing the α-SMA and collagen type Ι gene expression and ameliorating collagen deposition and this may result in an effective and innovative anti-scarring therapy.
Association between Serum Alkaline Phosphatase and Primary Resistance to Erythropoiesis Stimulating Agents in Chronic Kidney Disease: A Secondary Analysis of the HERO Trial
Authors: Badve Sunil V. , Zhang Lei , Coombes Jeff S. , Pascoe Elaine M. , Cass Alan , Clarke Philip , Ferrari Paolo , McDonald Stephen P. , Morrish Alicia T. , Pedagogos Eugenie , Perkovic Vlado , Reidlinger Donna , Scaria Anish , Walker Rowan , Vergara Liza A. , Hawley Carmel M. , Johnson David W.
Published: August 2015

Background:

Erythropoiesis stimulating agent (ESA)-resistant anemia is common in chronic kidney disease (CKD).

Objectives:

To evaluate the determinants of severity of ESA resistance in patients with CKD and primary ESA-resistance.

Design:

Secondary analysis of a randomized controlled trial (the Handling Erythropoietin Resistance with Oxpentifylline, HERO)

Setting and patients:

53 adult patients with CKD stage 4 or 5 and primary ESA-resistant anemia (hemoglobin ≤120 g/L, ESA resistance index [ERI] ≥1.0 IU/kg/week/gHb for erythropoietin or ≥0.005 μg/kg/week/gHb for darbepoeitin, no cause for ESA-resistance identified).

Measurements:

Iron studies, parathyroid hormone, albumin, liver enzymes, phosphate or markers of oxidative stress and inflammation.

Methods:

Participants were divided into tertiles of ERI. Multinomial logistic regression was used to analyse the determinants of ERI tertiles.

Results:

All patients, except one, were receiving dialysis for end-stage kidney disease. The mean ± SD ERI values in the low ( n = 18), medium ( n = 18) and high ( n = 17) ERI tertiles were 1.4 ± 0.3, 2.3 ± 0.2 and 3.5 ± 0.8 IU/kg/week/gHb, respectively ( P < 0.001). There were no significant differences observed in age, gender, ethnicity, cause of kidney disease, diabetes, iron studies, parathyroid hormone, albumin, liver enzymes, phosphate or markers of oxidative stress and inflammation between the ERI tertiles. The median [inter-quartile range] serum alkaline phosphatase concentrations in the low, medium and high ERI tertiles were 89 [64,121], 99 [76,134 and 148 [87,175] U/L, respectively ( P = 0.054). There was a weak but statistically significant association between ERI and serum alkaline phosphatase (R2 = 0.06, P = 0.03). Using multinomial logistic regression, the risk of being in the high ERI tertile relative to the low ERI tertile increased with increasing serum alkaline phosphatase levels ( P = 0.02). No other variables were significantly associated with ERI.

Limitations:

Small sample size; bone-specific alkaline phosphatase, other markers of bone turnover and bone biopsies not evaluated.

Conclusions:

Serum alkaline phosphatase was associated with severity of ESA resistance in ESA-resistant patients with CKD. Large prospective studies are required to confirm this association. (Trial registration: Australian New Zealand Clinical Trials Registry 12608000199314)
Probabilistic falsification of prior geologic uncertainty with seismic amplitude data: Application to a turbidite reservoir case
Authors: Scheidt Céline , Jeong Cheolkyun , Mukerji Tapan , Caers Jef
Published: August 2015

Geophysical subsurface modeling is often highly uncertain due to limited data resolution. At the same time, a wealth of geologic information, often from databases and outcrop studies, is available to state prior uncertainty on key geologic modeling parameters. In most inversion procedures, these uncertainties are ignored and only a limited number of geologic scenarios are considered. We have developed a workflow, inspired by a Popper-Bayes philosophy that aims at probabilistically updating prior geologic parameters uncertainty with data without the need for inversion or iterative data conditioning. Our approach consists of stating a wide prior model of uncertainty (in rock physics and facies), and generating a set of facies models and their corresponding geophysical responses (here the seismic response) by forward simulation. Then, a global measure of similarity is defined between any two generated seismic responses and the field data. The proposed measure, based on the wavelet transform decomposition, analyzes differences in patterns found in the seismic data and aims at comparing seismic images as a whole, avoiding any local trace-by-trace comparison. Based on this global measure of similarity, our procedure identifies the geologic interpretations that are unlikely given the observed seismic data. The proposed approach was applied and validated using seismic data from a synthetic example and an offshore reservoir in west Africa. The uncertainty included geologic parameters, such as infill channel size, proportion, and sinuosity, and geophysical parameters, such as the rock physics model and the wavelet in the forward seismic model. The synthetic example allowed for the validation of the methodology using rejection sampling. For the offshore reservoir, updated probabilities were obtained for each uncertain parameter, and some of the prior geologic interpretations were found to be inconsistent with the available seismic amplitude data cube (e.g., narrow channel width).
Diets Containing α-Linolenic (ω3) or Oleic (ω9) Fatty Acids Rescues Obese Mice From Insulin Resistance
Authors: Oliveira V. , Marinho R. , Vitorino D. , Santos G. A. , Moraes J. C. , Dragano N. , Sartori-Cintra A. , Pereira L. , Catharino R. R. , da Silva A. S. R. , Ropelle E. R. , Pauli J. R. , De Souza C. T. , Velloso L. A. , Cintra D. E.
Published: August 2015

Subclinical systemic inflammation is a hallmark of obesity and insulin resistance. The results obtained from a number of experimental studies suggest that targeting different components of the inflammatory machinery may result in the improvement of the metabolic phenotype. Unsaturated fatty acids exert antiinflammatory activity through several distinct mechanisms. Here, we tested the capacity of ω3 and ω9 fatty acids, directly from their food matrix, to exert antiinflammatory activity through the G protein-coupled receptor (GPR)120 and GPR40 pathways. GPR120 was activated in liver, skeletal muscle, and adipose tissues, reverting inflammation and insulin resistance in obese mice. Part of this action was also mediated by GPR40 on muscle, as a novel mechanism described. Pair-feeding and immunoneutralization experiments reinforced the pivotal role of GPR120 as a mediator in the response to the nutrients. The improvement in insulin sensitivity in the high-fat substituted diets was associated with a marked reduction in tissue inflammation, decreased macrophage infiltration, and increased IL-10 levels. Furthermore, improved glucose homeostasis was accompanied by the reduced expression of hepatic gluconeogenic enzymes and reduced body mass. Thus, our data indicate that GPR120 and GPR40 play a critical role as mediators of the beneficial effects of dietary unsaturated fatty acids in the context of obesity-induced insulin resistance.
Progesterone and the Repression of Myometrial Inflammation: The Roles of MKP-1 and the AP-1 System
Authors: Lei K. , Georgiou E. X. , Chen L. , Yulia A. , Sooranna S. R. , Brosens J. J. , Bennett P. R. , Johnson M. R.
Published: August 2015

Progesterone (P4) maintains uterine quiescence during pregnancy and its functional withdrawal is associated with increased prostaglandin synthesis and the onset of labor. In primary human myometrial cells, the glucocorticoid receptor (GR) rather than the P4 receptor mediates P4 antagonism of IL-1β-induced cyclooxygenase-2 (COX-2) expression, the rate-limiting enzyme in prostaglandin synthesis. We now report that P4 also acts via GR to induce MAPK phosphatase (MKP)-1 and knockdown of MKP-1 impairs the ability of P4 to repress IL-1β-dependent COX-2 induction. Microarray analysis revealed that P4 repressed preferentially activator protein-1-responsive genes in response to IL-1β. Consistent with these observations, we found that the ability of P4 to reduce c-Jun activation was lost upon GR as well as MKP-1 knockdown. Interestingly, c-Jun levels in human myometrial cells declined upon GR and MKP-1 knockdown, which suggests the presence of an activator protein-1 feedback loop. This is supported by our observation that c-Jun levels declined after an initial rise in primary myometrial cells treated with phorbol 12-myrisatate 13-acetate, a potent activator of c-Jun N-terminal kinase. Finally, we show that MKP-1 is an intermediate in P4-mediated repression of some but not all IL-1β-responsive genes. For example, P4 repression of IL11 and IRAK3 was maintained upon MKP-1 knockdown. Taken together, the data show that P4 acts via GR to drive MKP-1 expression, which in turn inhibits IL-1β-dependent c-Jun activation and COX-2 expression.
Chemotactic Amoeboid-Like Shape Change of a Vesicle under a pH Gradient
Authors: Nawa Erika , Yamamoto Daigo , Shioi Akihisa
Published: August 2015

A vesicle that exhibited the extrusion and contraction of a pseudopod-like structure under a pH gradient was studied. The vesicle is composed of oleate and oleic acid, and transforms from a double-spherical shape to a disk-like shape after numerous cyclic shape changes, including the reversal and rotation of the double-spherical vesicle. A pseudopod-like structure is extruded from the vesicle toward a pH gradient, created by NaOH diffusion, and is then contracted. This reversible motion is repeated many times. Notably, NaCl diffusion produces a monotonic and irreversible extrusion. The difference between the two systems could be explained by the cation permeability across the membrane. A mathematical model that accounted for this characteristic reproduced the experimental results semi-quantitatively. Vesicles exhibiting amoeboid-like behaviors, which may be useful in the design of amphiphilic molecular assemblies with biomimetic characteristics, have rarely been reported and are poorly understood. The present study may provide significant insight into the design of such biomimetic vesicles.
Legal Regulation of Public Private Partnership in Health Care: the Experience of the Russian Federation Subjects
Authors: Putilo Natalya , Volkova Natalya , Tsomartova Fatima
Published: August 2015

The article presents the analysis of regional practices relating to legal regulation in the field of public private partnership in health care sector. The Russian Federation recently proclaimed engagement of private business in providing public services including medical as one of the objectives of public policy. The analysis shows a tendency to use a minimum number of forms of public private partnerships in health care sector. The most appropriate forms of public private partnership as understood by regional health authorities are outsourcing, participation of private health care organizations in public health insurance system, concession agreements. The authors conclude that the development of legal regulation of public private partnership in health care requires certain specification of powers of state and local authorities in the field of public private partnership, determination of uniform terms to be used in regulating public private partnership, employment of different forms of public private partnership, clarifying obligations of the partners in implementing public private partnership agreement.
Corruption Offenses: Problematic Issues of Legal Qualification
Authors: Spyektor YEkatyerina
Published: August 2015

In this paper the author revealed the absence of uniform and clear-cut approach to the definition of the concept “corruption” and characteristic features thereof in contemporary current national and international law and science. Manipulation with such notions as corruption crime, corruption offense, misconduct, offense which creates conditions for corruption, etc. does not only bring clarity to the issues of legal qualification of the deviant act as “corruption”, but allows law enforcers to interpret broadly the true meaning and content of these concepts. The author noted that the above situation is illegal and unacceptable in terms of application the principle of analogy in “penalty law”. Lack of uniform conceptual apparatus makes it impossible to set clear limits of the legal regulation, whereby all efforts of combating the corruption become more “patchy” and not systemic. Also, it violates the principle of consistency with the existing system of legal regulation and the principle of formal certainty of law, presupposing the accuracy and clarity of the legal regulations in its capacity as the necessary guarantee to ensure the rule of law. Realizing an integrated and interdisciplinary concept of «corruption», the author proves the need for legal comprehension of said concept.
Mediation Agreement: Legal Nature and Role
Authors: Kamenkov Viktor
Published: August 2015

The article gives a legal description of a mediation agreement; it discloses its legal nature and its role in reconciling the conflicting parties. It is important to understand a mediation agreement as a complex legal instrument of an interdisciplinary nature. It shows the advantages of mediation as compared with judicial settlement. The author analyses the respective mediation institutions and norms of Russia, Belarus and Kazakhstan. By way of concluding it is stated that mediation agreement, the very nature thereof is much broader than the scope of relationships it is deemed to regulate.
Information Security of the Bodies of Executive Power at the Present Stage
Authors: Tyeryeyenko Lyudmila , Tiunov Olyeg
Published: August 2015

The national security of the Russian Federation depends essentially on information security. The article is devoted to the issues of information security of executive bodies at the present stage. The notion of information security and the meaning of information security regime with regard to executive bodies are hereby considered by the author along with the analysis of its elements, the ways to ensure information security in the light of changing situation, new challenges and threats. The author concludes that information security of executive bodies includes the provision of their information needs within their competence and frameworks which are necessary to fulfill the tasks assigned to them; Also necessary for security of information and information resources; security of telecommunications and information exchange.