bluuebunny/crossref_metadata_2025 huggingface dataset:
Physiologic Response to Traumatic Shock
Authors: Klein Deborah Goldenberg
Published: January 2016

Traumatic injury results in major physiologic alterations that begin at the time of injury and persist until recovery is complete. The response of the body is divided into two phases — the acute phase and the flow phase. The acute phase is characterized by shock with changes in hormone concentration. These hormones, either alone or in combination, result in lipolysis, amino acid release, gluconeogenesis, and glycolysis. The flow phase of injury is a catabolic process that is characterized by an increased protein metabolism. Hypermetabolism and increased nitrogen losses are seen. The magnitude of these alterations is directly related to the severity of injury. Tissues with the highest oxygen consumption are more susceptible to injury and death. Cellular function does not depend on oxygen alone but also on the ability of the cells to use available oxygen. If the body is unable to compensate through biochemical, hormonal, and metabolic activities, an irreversible state results unless appropriate interventions are instituted promptly
Implementation of Structure and Process Standards
Authors: Krum Glenda A.
Published: January 2016

A dilemma in critical care nursing practice is how to develop and implement a practical quality assurance program that incorporates high-quality standards of nursing care for critically ill patients and addresses those aspects of care considered important by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Standards for Nursing Care of the Critically Ill defines and describes structure and process standards and provides a comprehensive guide for the development of a program for the delivery of quality care to critically ill patients. The purpose of this chapter is to discuss practical application of the standards described by the American Association of Critical-Care Nurses (AACN) through the use of policies and procedures that support structure and process standards
The Automated Implantable Cardioverter
Authors: DeBorde Rozann , Aarons Diana , Biggs Madalyn
Published: January 2016

The automatic implantable cardioverter defibrillator (AICD) is becoming the treatment of choice for patients with ventricular tachycardia and ventricular fibrillation. The widespread use of the AICD is requiring nurses in a variety of settings to become familiar with the device and device-patient interactions. This article attempts to define specific issues and nursing interventions relative to the AICD
Family Perception: A Key to Intervention
Authors: Reeder Jean M.
Published: January 2016

A family’s perception of a critical illness or injury is a subjective experience based on coping strategies, past experiences with illness, family traditions, and the patient’s role in the family. Qualitative data from a study on families coping with serious injury is used to describe and illustrate family perception and support findings from previous family needs studies. Interventions based on family perceptions and needs are discussed
Comprehensive Assessment of Families of the Critically Ill
Authors: Lynn-McHale Debra J. , Smith Ann
Published: January 2016

The family enters the critical care unit under a significant amount of stress with many diverse and complex needs. During this crisis period, dysfunctional behavior may lead to ineffective coping. This article will present a comprehensive family assessment tool based on Myra Levine’s Principles of Conservation. The assessment tool not only will enhance the comprehensiveness of patient and family care, but will provide a method for reassuring families that they are part of their relatives’ care and recovery. This tool will also enable the critical care nurse to individually assess and meet the holistic needs of families
The Neonatal Intensive Care Unit Environment: Sources of Stress for Parents
Authors: Miles Margaret Shandor , Funk Sandra G. , Kasper Mary Ann
Published: January 2016

Many aspects of neonatal intensive care units (NICUs) are stressful to parents, including prolonged hospitalization, alterations in parenting, exposure to a technical environment, and the appearance of their small, fragile infant. To identify potential NICU stressors for parents, levels of stress these experiences engender, and their relationship to anxiety, parents of infants hospitalized in three NICUs were interviewed using the Parental Stressor Scale: NICU and the State-Trait Anxiety Inventory. Alterations in parental role caused by the infant’s illness generated the greatest stress. The second highest areas of stress were the infant’s appearance and behavior. State anxiety levels were higher than normative means and significantly related to stress scores
Auto-PEEP: An Impediment to Weaning in the Chronically Ventilated Patient
Authors: Geisman Lori Kohles , Ahrens Tom
Published: January 2016

Auto-positive end expiratory pressure (auto-PEEP) is a physiologic event that is a recently recognized phenomenon common to mechanically ventilated patients. Auto-PEEP occurs when forces exist that limit expiration and the subsequent elimination of positive pressure from the lungs. If positive pressure is retained, a potential reduction in cardiac output and increase in complications from barotrauma arise. Because of possible physiologic problems associated with it, auto-PEEP can potentially interfere with weaning from mechanical ventilation. Nursing measures that can reduce the effect of auto-PEEP during weaning are centered on improving the inspiratory/expiratory flow patterns. These efforts include manipulating mechanical ventilator settings and reducing causes of increased respiratory rates (e.g., pain and anxiety). Since auto-PEEP was only recently identified as a potential impediment to weaning from mechanical ventilation, the nurse must be aware of the need to assess for the presence of auto-PEEP in these patients
Psychosocial Concerns of the Ventilator-dependent Child in the Pediatric Intensive Care Unit
Authors: Warner Joanie , Norwood Sarah
Published: January 2016

An increasing number of infants and children suffer from respiratory and neuromuscular diseases that render them ventilator-dependent. These patients spend months in pediatric intensive care units (PICUs) until they are either extubated or are stable enough to tolerate home ventilation. The critical nature of the PICU and its emphasis on meeting short-term goals is not readily compatible with the long-term and dynamic needs of developing children. In order to prevent the delays in growth and development that often occur during prolonged hospitalizations, this article addresses the impediments to normal growth and development in the PICU and offers specific suggestions on how the environment and nursing care can be changed to support the development of ventilator-dependent children and their families
Mechanical Support beyond the Intra-aortic Balloon Pump
Authors: Rutan Peter M.
Published: January 2016

The ventricular assist device (VAD) is one of the latest tools available to help the clinician contend with severe heart failure. This article presents a historical overview of the development of the VAD and discusses the incidence and etiology of heart failure. The investigational device research process, nursing involvement, and future trends are discussed
Neuromuscular Blocking Agents in the Critically Ill Patient: Neither Sedating nor Pain Relieving
Authors: Wild Lorie Rietman
Published: January 2016

Although neuromuscular blocking agents (NMBAs), such as pancuronium bromide and succinylcholine, are widely used in the management of critically ill patients, many misconceptions regarding the agents’ clinical effects and indications persist. This article will discuss these misconceptions and review the indications for the use of NMBAs in the critically ill patient, how these potent agents work, and strategies to effectively manage critically ill patients who are receiving NMBAs as a part of their treatment regimen
The Elderly Neuroscience Patient: Implications for use Critical Care Nurse
Authors: Guin Peggy R. , Freudenberger Kathleen
Published: January 2016

The elderly patient may present to the critical care unit with neurologic deficits such as acute confusion, loss of consciousness, or signs of a cerebrovascular accident. Recognizing the normal age-related changes that occur in the nervous system enables the critical care nurse to evaluate the patient’s response to neurologic disorders. The normal neurologic changes associated with aging provide implications for assessment, response to the critical care environment, and the time needed for education and rehabilitation. Other changes, especially decreased immunity, malnutrition, and pulmonary and cardiac pathology, significantly increase the risk for morbidity and mortality after an acute neurologic event. Changes in pharmacokinetics and the likelihood of polypharmacy in the older patient greatly increase the risk for complications and side effects of the commonly used treatments. Important elements of nursing management for the elderly neuroscience patient include performing an accurate neurologic assessment, including noting changes in cognition, observing for adverse drug reactions, optimizing ventilation, and maximizing mobility and nutritional status. This article focuses on these aspects of nursing care for the elderly neuroscience patient
Wolff-Parkinson-White Syndrome
Authors: Morscher Joanne Hughes
Published: January 2016

Wolff-Parkinson-White (WPW) syndrome is a cardiac conduction disorder that presents with potentially life-threatening consequences. Wolff-Parkinson-White syndrome-induced dysrhythmias account for 20% of all supraventricular tachycardias that occur in the general population. Clinical presentations range from no symptoms to a sudden cardiac arrest. The risk of sudden death is always present with WPW syndrome, and it is the motivating force in the evaluation and treatment of this syndrome. Current diagnostic modalities are accurate in identifying patients with WPW syndrome, but lack the sensitivity to predict sudden cardiac death. This article reviews the history of WPW syndrome, as well as its general characteristics, diagnostic criteria, treatment modalities, and nursing implications
Dysrhythmias Associated with Digoxin Toxicity
Authors: Kelso Lynn A.
Published: January 2016

Digoxin is frequently prescribed for patients. With a narrow therapeutic window, toxicity can quickly occur. Nurses must quickly recognize dysrhythmias associated with digoxin toxicity to prevent life-threatening situations
Diagnoses in Opposition: Thyroid Storm and Myxedema Coma
Authors: Spittle Loretta
Published: January 2016

An overview of normal thyroid function is presented to facilitate the understanding of the pathophysiology of two life-threatening thyroid disorders: thyroid storm and myxedema coma. Signs and symptoms, medical management, nursing diagnoses and interventions, and expected patient outcomes are discussed, as is the important role of the nurse as an integral member of the management team
Pheochromocytoma: A Clinical Review
Authors: Agana-Defensor Rubi , Proch Marcella
Published: January 2016

Few disorders of endocrine function are so sudden and dramatic in their presentation as those caused by a pheochromocytoma. This chromaffin cell tumor arises within the adrenal medulla or within the sympathetic nervous system and causes wide fluctuations in blood pressure, tachydysrhythmias, and manifestations of intense anxiety. The patient experiences explosive paroxysms of catecholamine overload. The diagnoses of accelerated hypertension or panic disorder often are prematurely adopted. The condition kills, with deaths primarily attributed to irreversible cardiovascular and end-organ damage caused by profound hypertension. For those with a pheochromocytoma, the disorder caused by the tumor is a terrifying constellation of symptoms. Although pheochromocytoma is rare, it must be considered in the treatment of any patient with sudden, extreme hypertension and accompanying hypermetabolism. A cure is possible, but only with early diagnosis and treatment
Beta-adrenergic Blocking Agents: Their Current Status
Authors: Clark Barbara K.
Published: January 2016

Use of beta (β)-adrenergic blocking agents began in the 1960s and has risen dramatically since then. Newer agents offer more actions and fewer side effects. Uses for the drugs continue to increase as their safety and efficacy become increasingly apparent, β block, today, has widespread application in cardiovascular disease. In addition, these agents are used in the management of endocrine disorders, neurologic situations, psychiatric disorders, gastrointestinal problems, and sensory disorders. Many new β blockers arc still investigational, and some show even greater promise for therapeutic applications in the future
Peritoneal Dialysis in the Critically Ill Patient
Authors: Smith Linda J.
Published: January 2016

The use of peritoneal dialysis on an acute basis is increasing each year. Peritoneal dialysis pulls waste products and excess water out of the blood stream and into dialysate solution in the peritoneal cavity. When patients arc unstable hemodynamically, have severe cardiovascular disease, already require peritoneal dialysis, or are small children, peritoneal dialysis is the preferred treatment. Patients may be dialyzed using either a cycler or manual peritoneal dialysis. Patients should be monitored carefully for volume status, bowel status, and infection. Potential complications include problems with access, infection, pain, respiratory status, fluid imbalance, and potassium imbalance. Special consideration should be given to nutritional status because critically ill patients often need increased intake. Drug therapy needs modification because excretion of drugs by the kidney is delayed. Patient and family support is important because of decreased ability to understand, anxiety, loss of control, and change in body image. Treatment termination also may be an issue
Common Electrolyte Imbalances Associated with Malignancy
Authors: Hawthorne Jan L. , Schneider Susan M. , Workman M. Linda
Published: January 2016

More than one million Americans will be diagnosed with cancer during 1992, and 50% will be cured of their disease. Of those individuals not cured of the malignancy, survival time after diagnosis has increased tremendously compared to 1980. Because of advances in therapy and the increase in long-term survival, the presence of cancer patients in critical care units should no longer represent either a medical contradiction or an ethical dilemma when the condition requiring critical care is potentially reversible. Many of these individuals may become patients in critical care settings as a result of specific electrolyte imbalances caused by the malignant disease or treatment of malignancy. Although the imbalances often are temporary, they can be life-threatening without intervention. The most common temporary electrolyte imbalances associated with malignant conditions are hypercalcemia, hyperkalemia, and tumor lysis syndrome. Critical care nurses can contribute skill and knowledge in ameliorating these conditions so that the person with cancer can have better quality and longer survival time
Nurse Clinician Model of Managed Care
Authors: Ahrens Tom
Published: January 2016

Many different models of delivering nursing care have been proposed, each with specific advantages and disadvantages. One such model, the nurse clinician model, uses the strengths of advanced clinical practice as the cornerstone for improving quality in patient care. The increase in quality simultaneously produces an efficient and cost-effective system, as indicated by the results of a multiyear study at our institution. While other effective models exist, those that emphasize advanced clinical practice, such as the nurse clinician model, are most likely to achieve improved patient outcomes and conserve resource expenditures
Fundamentals of Physiologic Monitoring
Authors: Gardner Reed M. , Hujcs Marianne
Published: January 2016

For centuries, medical practitioners had no electronic medical instruments and had to rely on their senses of sight, hearing, smell, taste, and touch to obtain physiologic measurements. Although it is possible to estimate blood pressure by palpating the pulse at the radial or brachial artery, such estimates are not accurate. Determining arterial oxygen saturation of hemoglobin is more complex: how “blue” a patient appears depends on skin coloration, lighting, and the examiner’s sense of color. Finally, using radiographic images to validate pulmonary edema when clinicians suspect that there is an elevated left atrial or pulmonary artery wedge pressure also challenges human senses. However, today’s medical instruments use transducers and signal processors to convert patient information into a form that clinicians can easily perceive and understand. This article defines terms used with biomedical instrumentation and discusses the components of ideal physiologic patient monitoring systems
Respiratory Monitoring in Critical Care
Authors: Ahrens Tom
Published: January 2016

The assessment of pulmonary function, from a clinical perspective, can be performed accurately only if the clinician understands the concept ventilation/perfusion ratios of the lung. The major categories of ventilation/perfusion ratios are intrapulmonary shunting and physiologic deadspace. Virtually all pulmonary assessments and interventions arc aimed to address Qs/Qt or Vd/Vt. This chapter provides background information useful to the clinician in the assessment of intrapulmonary shunting and deadspace analysis. From this information, more thorough assessments of pulmonary function are possible
Using Continuous SVO2 to Assess Oxygen Supply/Demand Balance in the Critically Ill Patient
Authors: White Kathleen M.
Published: January 2016

To ensure that tissues arc well oxygenated, oxygen supply and demand are now targets of therapy for the critically ill patient. This chapter reviews the physiologic determinants of oxygen supply, how it is threatened by respiratory or cardiac dysfunction or by hemorrhaged or anemic states, and how it can be assessed in individual patients. Activities and conditions that increase tissue oxygen demand arc examined so that clinicians can identify those patients whose oxygen demands may be excessive and should be controlled. Failure of tissues to consume enough oxygen is explained in patients with critically low delivery or with the maldistributed blood flow state seen in sepsis. The monitoring of mixed venous oxygen saturation is examined as a method of tracking the threats to supply/demand balance and of guiding treatment that can support the adequate oxygenation of tissue
Current Challenges, Concepts, and Controversies in Chest Tube Management
Authors: Gross Stacey B.
Published: January 2016

Competent chest tube management represents the mainstay of postoperative care for the cardiothoracic patient. Patency and integrity of mediastinal and pleural catheters is crucial to preservation of cardiopulmonary performance. Despite the relatively brief period of time these catheters dwell, knowledge of their placement, function, and current research findings relevant to their care is essential for appropriate nursing interventions. This article addresses application and management of chest tubes, autotransfusion techniques, and areas for future nursing research
Hypothermia and Rewarming after Cardiac Surgery
Authors: Osguthorpe Susan G.
Published: January 2016

Ensuring adequate oxygen delivery to the tissues with respect to oxygen demand is an important operative challenge during cardiac surgery. The state of the art in myocardial preservation in the 1990s has evolved to include pre-treatment of the myocardium; intraoperative use of systemic hypothermia with cardiopulmonary bypass (CPB), topical cooling of the myocardium, cold cardioplegia, and myocardial reperfusion; and postoperative oxygen transport support. These techniques optimize myocardial preservation while providing adequate cardiac surgery operative times by decreasing the myocardial ischemic period, decreasing cellular metabolic requirements, and preserving energy stores. Awareness of the physiologic consequences of hypothermia in the postoperative cardiac patient improves nursing assessment of the hypothermic patient. Appropriate temperature monitoring and reporting support timely medical and nursing interventions for hypothermia, such as internal and external rewarming techniques or drug administration to facilitate the rewarming process and suppress or treat shivering. This article addresses the physiologic condition of hypothermia, the elective hypothermia techniques used during cardiac surgery, and the medical or nursing rewarming and management techniques for the postoperative cardiac surgery patient
Myocardial Depression after Cardiac Surgery: Pharmacologic and Mechanical Support
Authors: Ley S. Jill
Published: January 2016

Cardiovascular surgery patients may experience a low cardiac output state as a result of anesthesia, cardiopulmonary bypass, and myocardial stunning. Prompt assessment and early intervention are critical to patient survival. A variety of pharmacologic agents are available to support the failing circulation, including several promising new experimental inotropic agents. Intraaortic balloon pumps (IABP) and ventricular assist devices (VAD) are additional therapies reserved for advanced cardiac decompensation that is unresponsive to pharmacologic treatment. A review of etiologic factors precipitating postcardiotomy failure is presented, and traditional and experimental inotropic agents are discussed. An overview of mechanical cardiac support with the IABP, centrifugal and pneumatic VAD, and the Hemopump (Johnson & Johnson Interventional Systems, New Brunswick, NJ) device is presented, all of which addresses information critical to optimal patient outcomes
Pain Management in the Critically Ill: What Do We Know and How Can We Improve?
Authors: Alpen Michele A. , Titler Marita G.
Published: January 2016

Pain management in the critically ill is a challenge and a problem of great concern for critical care nurses. The authors review research on pain in the areas of pain assessment, nurses’ knowledge and attitudes, pharmacologic interventions, and nonpharmacologic interventions for the management of pain. Although the research base is not completely developed in the critically ill population, implications for practice are provided, based upon the findings in populations akin to the critically ill. Strategies are outlined for achieving improved pain control in critical care units through education, adoption of standards on pain management, and quality improvement activities
Resuscitation of Traumatic Shock
Authors: Cottingham Christine A.
Published: January 2016

Shock, or tissue hypoperfusion, is a frequent complication from traumatic injury. Despite the etiology of the shock state, there is always some component of hypovolemia. The body’s innate ability to compensate for impaired perfusion may mask clinical signs, leading to delays in treatment. This article presents an overview of these compensatory mechanisms and resuscitation strategies from the vantage point of routine hemodynamic monitoring.
Pulling It All Together
Authors: Drew Barbara J.
Published: January 2016

Advanced practice nurses and expert staff nurses are in a position to improve the way patients’ electrocardiograms (ECGs) are monitored in hospital units. Recently published practice standards recommend the best practices for arrhythmia, ischemia, and QT-interval ECG monitoring. Two case studies are presented here to illustrate how expert nurses can teach staff to incorporate the practice standards into their clinical practice. As nurses become more expert in ECG monitoring, it is expected that they will detect ECG abnormalities earlier, and patients will have more timely treatment and better outcomes.
Communication in the Intensive Care Unit About the End of Life
Authors: Treece Patsy D.
Published: January 2016

Communicating well in the intensive care unit is essential to providing quality critical care for the families of patients who are expected to die. There are many examples in the literature of how clinicians fall short of meeting these needs of families. There is also a developing body of literature describing approaches and tools that may have a positive impact on the perceived quality of end-of-life communication. The quality of clinician communication can be improved just as other skills that are important in the intensive care unit.
Withdrawal of Cardiac Medications and Devices
Authors: Wiegand Debra Lynn-McHale , Kalowes Peggy G.
Published: January 2016

Withdrawal of life-sustaining therapies such as cardiac medications, pacemakers, internal cardioverter defibrillators, and ventricular assist devices occurs in patients with advanced cardiac disease as goals of treatment transition from active to less aggressive. This article defines life-sustaining therapies and describes ethical and legal considerations related to withdrawal of cardiac medications and cardiac devices. Healthcare providers need to anticipate clinical situations in which implantable cardiac devices and medications are no longer desired by patients and/or are no longer medically appropriate. Discussions are important between patients, families, and healthcare providers that focus on each patient’s condition, prognosis, advance directives, goals of care, and treatment options. Critical care nurses support each patient and his or her family and work with other members of the healthcare team to achieve a peaceful death.
Revitalizing Academic-Service Partnerships to Resolve Nursing Faculty Shortages
Authors: Connolly Maria A. , Wilson Carol Jo
Published: January 2016

Vacancy rates of nursing faculty are on the increase as fewer educators are being prepared and nurses at the bedside are in short supply. Advanced practice nurses—uniquely suited to provide clinical education for undergraduate and graduate students—are underutilized. However, without release time, preparation as educators, ongoing support from education and administration, and remuneration for providing both evidence-based education and evidence-based patient care, they can hardly be expected to assume additional responsibilities. This article reviews academic-service partnerships, noting a general lack of published efficacy and cost-effectiveness data, and highlights 21st-century innovations for academia and service to share resources for the benefit of all stakeholders—especially patients and students.
Methodologic Challenges in the Design and Conduct of Hyperacute Stroke Research
Authors: Wojner Alexandrov Anne W.
Published: January 2016

Stroke is the third leading cause of death in the United States and the leading cause of adult disability, consistently ranking in the top 10 of leading diagnostic categories encountered by practitioners in emergency and critical care settings. Despite its prevalence and clinical significance, only tissue plasminogen activator for ischemic stroke has been shown to reduce 3-month mortality and disability in phase III clinical trials, whereas for hemorrhagic stroke, no medicinal treatment has yet to demonstrate a similar reduction in mortality or disability. This article describes challenges inherent in the design and conduct of hyperacute stroke trials. Sample heterogeneity associated with pathophysiologic stroke mechanisms, the neurovascular territory implicated, systemic and intracranial hemodynamics, risk factor profiles, and patient access to requisite healthcare services are reviewed as contributors challenging enrollment into well-designed studies. Current controversies associated with designation of endpoints are presented and strategies to enhance trial design, and subsequent enrollment, are discussed. Recommendations are made for future clinical research into phenomena associated with hyperacute stroke.
Strategies for Starting a Successful Evidence-Based Practice Program
Authors: Schulman Christine S.
Published: January 2016

Today’s nurses must provide care that is based on the best available evidence. Creating a program that supports the routine use of evidence-based practice (EBP) can seem complicated and time-consuming. This article provides a practical description of the critical elements to consider when starting an EBP program. A successful program includes built-in organizational supports for clinical inquiry, functional and efficient processes for EBP activities, and added details to sustain momentum and interest over time. Strategies for making EBP part of everyday care are identified, along with suggestions for overcoming barriers to change and ideas for acknowledging nurses for EBP work.
User Education and its Present Status in University Libraries in Sri Lanka: An Overview
Authors: Wickramanayake Lalith
Published: January 2016

The rapid development of information and communication technology (ICT), particularly internet, and the increasing development of user education forms and methods, such as new information literacy initiatives have resulted in significant changes in academic libraries. With these unprecedented changes, academic librarians in Sri Lanka have to deal with instructional processes more effectively and efficiently. The primary concern of this paper is to understand the concept ‘user education’ in the local context and its present practices in university libraries. Even more, this study intends to understand problems encountered, challenges being faced and potential new opportunities available on user education in university libraries in Sri Lanka. The total outcome of this paper is beneficial for researchers, policy makers, university authorities and academic librarians in Sri Lanka to understand the real situation which exists behind instructional activities of university libraries and to design, develop, implement policies and make strategies on pertinent subject. Journal of the University Librarians’ Association of Sri Lanka, Vol. 19, Issue 1, October 2015, Page 92-114
CTL-Promoting Effects of IL-21 Counteract Murine Lupus in the Parent→F1 Graft-versus-Host Disease Model
Authors: Nguyen Vinh , Rus Horea , Chen Ching , Rus Violeta
Published: January 2016

IL-21 promotes B cell and CTL responses in vivo, conferring IL-21 with a role in both humoral and cellular responses. Because CTL can target and eliminate autoreactive B cells, we investigated whether IL-21R signaling in CD8 T cells would alter the expansion of autoreactive B cells in an autoimmune setting. We addressed this question using the parent→F1 murine model of acute and chronic (lupus-like) graft-versus-host disease (GVHD) as models of a CTL-mediated or T-dependent B cell–mediated response, respectively. Induction of acute GVHD using IL-21R–deficient donor T cells resulted in decreased peak donor CD8 T cell numbers and decreased CTL effector function due to impaired granzyme B/perforin and Fas/Fas ligand pathways and a phenotype of low-intensity chronic GVHD with persistent host B cells, autoantibody production, and mild lupus-like renal disease. CTL effector maturation was critically dependent on IL-21R signaling in Ag-specific donor CD8, but not CD4, T cells. Conversely, treatment of DBA/2J→F1 chronic GVHD mice with IL-21 strongly promoted donor CD8 T cell expansion and rescued defective donor anti-host CTLs, resulting in host B cell elimination, decreased autoantibody levels, and attenuated renal disease, despite evidence of concurrently enhanced CD4 help for B cells and heightened B cell activation. These results demonstrate that, in the setting of lupus-like CD4 T cell–driven B cell hyperactivity, IL-21 signaling on Ag-specific donor CD8 T cells is critical for CTL effector maturation, whereas a lack of IL-21R downregulates CTL responses that would otherwise limit B cell hyperactivity and autoantibody production.
Epidemiologic trends in lung cancer over two decades in Northern Greece: an analysis of bronchoscopic data
Authors: Kontakiotis T. , Manolakoglou N. , Zoglopitis F. , Iakovidis D. , Sacas L. , Papagiannis A. , Mandrali A. , Papakosta D. , Argyropoulou P. , Bouros D.
Published: January 2016

Background and Aim. The relative frequency of histological subtypes of lung cancer in Europe has changed dramatically during the 20th century. The aim of this study was to explore the changing epidemiology of lung cancer in Northern Greece over the last two decades. Methods. From the extensive database of the Bronchoscopy Unit of the G. Papanicolaou General Hospital, Thessaloniki, Greece, we identified all patients with a histologic and/or cytologic report positive for lung cancer over two consecutive decades. Results. Between 1/1/1986 and 31/12/2005 we identified 9981 patients with specimens positive for lung cancer. A significant increase in mean patient age was observed during the second decade (64.8±9.4 vs. 62.1±8.9, p=0.001). Men developed lung cancer ten times more often than women. The predominant histological type was squamous cell cancer in males (4203 cases, 45.7%) and adenocarcinoma (418 cases, 52.6%) in females. The number of lung cancer cases was significantly higher during the second decade compared to the first decade (5766 cases [57.8%] vs. 4215 cases [42.2%], respectively, p<0.001). There was a significant decrease in the percentage of squamous cell carcinoma in males in the second decade (2317 cases [44.1%] vs. 1886 cases [48.0%], p<0.001), and an increase in adenocarcinoma (1021 cases [19.4%] vs. 609 [11.6%], p<0.001). In females, the relative incidence of adenocarcinoma was decreased and that of squamous cell carcinoma was increased, but not significantly. There was no obvious change in the incidence of small cell lung cancer. Neoplastic lesions were most often located in the upper lobes. Conclusion. The number of lung cancer cases has increased in the last decade. Squamous lung cancer appears to be decreasing in men and increasing in women. Adenocarcinoma appears to be increasing in men and decreasing in women. There appears to be no change in small cell lung cancer. During the second decade there has been a significant decrease in the male: female ratio.
Standards of care and clinical predictors in patients hospitalised for a COPD exacerbation - The Italian SOS (Stratification Observational Study)
Authors: Lusuardi M. , Blasi F. , Terzano C. , Cricelli C. , Crispino N. , Comarella L. , De Benedetto F. , Sanguinetti C.M. , Allegra L. , Donner C.F.
Published: January 2016

Background and aims. Hospitalisations for chronic obstructive pulmonary disease (COPD) exacerbations are major events in the natural history of the disease in terms of survival, quality of life and risk of further episodes of exacerbation. The aims of study were to evaluate: 1. adherence to recommended standards of care; and 2. clinical factors influencing major outcomes during hospitalisation for an episode of COPD exacerbation and within a 6-month follow-up. Methods. An observational, prospective study was conducted in 68 centres. Assessment of standards of care included diagnostic procedures (such as pulmonary function tests and microbiology) and management options (such as drug therapies, vaccinations and rehabilitation). Outcome measures relevant to the hospitalisation were: survival, need for mechanical ventilation, and length of stay (LOS). Outcomes at 6-months were: survival, exacerbations and hospitalisations for an exacerbation. Multivariate logistic regression was applied to evaluate the relation between clinical factors and outcomes. Results. 931 patients were enrolled. Only 556 patients (59.7%) were diagnosed COPD and stratified for severity with the support of spirometry (FEV1/VC ≤0.7) and were considered for outcome analysis. Among treatments, pulmonary rehabilitation and anti-smoking counselling were applied infrequently (14.5 and 8.1% of patients, respectively). Within six months 63 COPD patients (17.7%) had at least one episode of exacerbation prompting a further hospitalisation and 19 died (5.3%). Predictor of mortality was the co-morbidity Charlson index (odds ratio, OR 10.3, p=0.03 CI:1.25-84.96). A further hospitalisation was predicted by hospitalisation for an exacerbation in the previous 12 months (OR 3.59, p=0.003 CI:1.54-8.39). Conclusions. Standards of care were far lower than recommended, in particular 40% of patients were labelled as COPD without spirometry. COPD patients with a second hospitalisation in 12 months for an exacerbation had about 3 times the risk of suffering a new episode and hospitalisation in the following six months.
Central-European Jesuit Scientists in China, and Their Impact on Chinese Science
Authors: JUŽNIČ Stanislav Jože
Published: January 2016

This article describes nine Central European Jesuits from the Austrian province who embarked for China in the 17th and 18th centuries. Their European educational networks provide useful insights into the abilities of the absburg Monarchy to meet Chinese Imperial demands. The focus is on feedback of their adopted Chinese network back to their own homes. The Europeans and Chinese-based Jesuits exchanged instruments, books, artifacts, and letters. The exception was Johannes Grueber, who personally traveled back to Europe accompanied by Diestel from Carniola, and helped Athanasius Kircher to produce the appealing legend of Jesuit astronomical heroes in Beijing.The Jesuits acted as intermediate in the exchange of know-how between Europe and China. In modern Chinese eyes they were also somewhat viewed as spies, who helped European military and economic victories in the mid-19th century. Modern China is now as strong as it was in the times of Old Jesuit Society, therefore the Europocentric history of science must be rewritten from the standpoint of today’s winning Chinese economy. What kind of science will Western Civilization import from the future Chinese literati? The Jesuits’ transfer of European Sciences to the Far-Easterners caused the reverse impact from seemingly less developed centers of Far East that was felt in Jesuits’ times, but much more is to follow in the near future. We could expect the fundamental future Chinese achievements in cosmology, especially in Einstein’s general theory of relativity.
Maxillary Molar Intrusion Evaluation using Mini-implants along with Transpalatal Arch Bar
Authors: Gupta Ashish , Gupta Gaurav , Rozario Joe E , Patil Anand K , Singh Raj Kumar
Published: January 2016

Aim

The prospective clinical study was undertaken to evaluate the amount of maxillary molar intrusion achieved during orthodontic treatment using mini-implants along with transpalatal arch bar.

Materials and Methods

The treated group consisted of 10 subjects having over-erupted maxillary molars with mean age of 20.75 years. Mini-implants of 8 mm length and 1.3 mm diameter (Dentos-Absoanchor, Dentos Inc., Korea) were placed in the inter-radicular region between the second premolar and first molar on the buccal side where the molar intrusion was planned. Transpalatal arch bar was placed 5 mm away from the palate. Intrusive force of 100 to 150 gm was applied using prestretched elastic chain. Lateral cephalograms were taken before beginning of molar intrusion and 3 months after the molar intrusion. The intrusion was measured from the distobuccal cusp tip of maxillary first molar to the true vertical and rotation of the mandibular plane was assessed in relation to Go-Me and SN plane. The mean changes in the cephalometric parameters were subjected to paired t-test to determine results under statistical evaluation.

Results

Statistically significant (p < 0.001) amount of molar intrusion was achieved following the usage of mini-implant with a mean value of 1.95 mm and significant anti-clockwise rotation of the mandibular plane (Go-Me) in relation to SN plane (p < 0.001) was seen as a result of molar intrusion.

Conclusion

The study revealed that mini-implant served as an efficient source of anchorage for achieving maxillary molar intrusion in correction of malocclusion in vertical dimensions.

How to cite this article

Gupta G, Rozario JE, Patil AK, Singh RK, Kannan S, Gupta A. Maxillary Molar Intrusion Evaluation using Mini-implants along with Transpalatal Arch Bar. J Contemp Dent 2015;5(3):158-164.
Foreign Body Giant Cell Granuloma of the Mandible Subsequent to Endodontic Surgery
Authors: Rai Harishchandra , Shaila M , Ghosh Gourav , Suhasini PD
Published: January 2016

Granuloma formation is a specific type of chronic inflammation initiated by infectious and noninfectious agents with an aggregation of multinucleated giant cells. Foreign body giant cells (FBGCs) most commonly observed at the tissue/material interface where the size of foreign particulate is too large to permit macrophage phagocytosis. In this context, adherent macrophages and FBGCs constitute the foreign body reaction. Foreign-body giant cell granulomas have been reported to cause clinical symptoms from months to decades after a surgical procedure and can present with a variety of symptoms, usually on the basis of location. Foreign-body giant cell granulomas in the mandible are rare lesions, here we report a case of FBGC granuloma in the mandible that developed after endodontic treatment.

How to cite this article

Rai H, Shaila M, Ghosh G, Suhasini PD. Foreign Body Giant Cell Granuloma of the Mandible Subsequent to Endodontic Surgery. J Contemp Dent 2015;5(3):178-180.
Mobilizing New York
Authors: Carroll Tamar W.
Published: January 2016

Examining three interconnected case studies, this book demonstrates the ability of grassroots community activism to bridge racial and cultural differences and effect social change. Drawing on an array of oral histories, archival records, newspapers, films, and photographs from post-World War II New York City, the text shows how poor people transformed the antipoverty organization Mobilization for Youth and shaped the subsequent War on Poverty. Highlighting the little-known National Congress of Neighborhood Women, it reveals the significant participation of working-class white ethnic women and women of color in New York City's feminist activism. Finally, the text traces the partnership between the AIDS Coalition to Unleash Power (ACT UP) and Women's Health Action Mobilization (WHAM!), showing how gay men and feminists collaborated to create a supportive community for those affected by the AIDS epidemic, to improve health care, and to oppose homophobia and misogyny during the culture wars of the 1980s and 1990s. The book contends that social policies that encourage the political mobilization of marginalized groups and foster coalitions across identity differences are the most effective means of solving social problems and realizing democracy.
An Agrarian Republic
Authors: Dean Adam Wesley
Published: January 2016

The familiar story of the Civil War tells of a predominately agricultural South pitted against a rapidly industrializing North. However, this book argues that the Republican Party’s political ideology was fundamentally agrarian. Believing that small farms owned by families for generations led to a model society, Republicans supported a northern agricultural ideal in opposition to southern plantation agriculture, which destroyed the land’s productivity, required constant western expansion, and produced an elite landed gentry hostile to the Union. The book shows how agrarian republicanism shaped the debate over slavery’s expansion, spurred the creation of the Department of Agriculture and the passage of the Homestead Act, and laid the foundation for the development of the earliest nature parks.
Rhythms of Race
Authors: Abreu Christina D.
Published: January 2016

Among the nearly 90,000 Cubans who settled in New York City and Miami in the 1940s and 1950s were numerous musicians and entertainers, black and white, who did more than fill dance halls with the rhythms of the rumba, mambo, and cha cha chá. Presenting a history of music and race in midcentury America, this book argues that these musicians, through their work in music festivals, nightclubs, social clubs, and television and film productions, played central roles in the development of Cuban, Afro-Cuban, Latino, and Afro-Latino identities and communities. The book draws from previously untapped oral histories, cultural materials, and Spanish-language media to uncover the lives and broader social and cultural significance of these vibrant performers.
Lynched
Authors: Bailey Amy Kate , Tolnay Stewart E.
Published: January 2016

On July 9, 1883, twenty men stormed the jail in Morehouse Parish, Louisiana, kidnapped Henderson Lee, a black man charged with larceny, and hanged him. Events like this occurred thousands of times across the American South in the late nineteenth and early twentieth centuries, yet we know scarcely more about any of these other victims than we do about Henderson Lee. Drawing on new sources to provide a comprehensive portrait of the men and women lynched in the American South, this book's revealing profiles and careful analysis begin to restore the identities of—and lend dignity to—hundreds of lynching victims about whom we have known little more than their names and alleged offenses.
Soviet Soft Power in Poland
Authors: Babiracki Patryk
Published: January 2016

Concentrating on the formative years of the Cold War from 1943 to 1957, this book reveals little-known Soviet efforts to build a postwar East European empire through culture. The text argues that the Soviets involved in foreign cultural outreach tried to use “soft power” in order to galvanize broad support for the postwar order in the emerging Soviet bloc. The book shows that the Stalinist system ultimately undermined Soviet efforts to secure popular legitimacy abroad through persuasive propaganda. It also highlights the limitations and contradictions of Soviet international cultural outreach, which help explain why the Soviet empire in Eastern Europe crumbled so easily after less than a half-century of existence.
Civil War Canon
Authors: Brown Thomas J.
Published: January 2016

In this expansive history of South Carolina’s commemoration of the Civil War era, this book uses the lens of place to examine the ways that landmarks of Confederate memory have helped white southerners negotiate their shifting political, social, and economic positions. By looking at prominent sites such as Fort Sumter, Charleston’s Magnolia Cemetery, and the South Carolina statehouse, the book reveals a dynamic pattern of contestation and change. It highlights transformations of gender norms and establishes a fresh perspective on race in Civil War remembrance by emphasizing the fluidity of racial identity within the politics of white supremacy.
Defining Duty in the Civil War
Authors: Gallman J. Matthew
Published: January 2016

The Civil War thrust Americans onto unfamiliar terrain, as two competing societies mobilized for four years of bloody conflict. Concerned Northerners turned to the print media for guidance on how to be good citizens in a war that hit close to home but was fought hundreds of miles away. They read novels, short stories, poems, songs, editorials, and newspaper stories. They laughed at cartoons and satirical essays. Their spirits were stirred in response to recruiting broadsides and patriotic envelopes. This massive cultural outpouring offered a path for ordinary Americans casting around for direction. Examining the breadth of Northern popular culture, this book offers a dramatic reconsideration of how the Union’s civilians understood the meaning of duty and citizenship in wartime. Although a huge percentage of military-aged men served in the Union army, a larger group chose to stay home, even while they supported the war. This book investigates how men and women, both white and black, understood their roles in the People’s Conflict. Wartime culture created humorous and angry stereotypes ridiculing the nation’s cowards, crooks, and fools, while wrestling with the challenges faced by ordinary Americans. The book shows how thousands of authors, artists, and readers together created a new set of rules for navigating life in a nation at war.