bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethical perspectives on the environmental impact of property development
Authors: Mokori A. Sentle , Cloete Chris E.
Published: August 2016

Three perspectives that can be found in ethical decision-making are explored to suggest guidelines for ethical property development: the instrumental, the intrinsic and the pluralist perspective. Given the limitations of the instrumental and the intrinsic perspectives, it is suggested that the appropriate perspective to be adopted by ethical property developers is that of pragmatism, as being a system of moral pluralism. This perspective can be utilised as a flexible toolbox which unites both traditional ethical values and the diversity of environmental ethics, as well as allowing new values to emerge without adhering to relativism.
The Way of the Mystic: The Sanjuanist stages of the spiritual path
Authors: Kourie Celia
Published: August 2016

A major conceptual dynamic in all major religious traditions is the need for purification and transformation of the individual in order to effect integration and maturation of the personality in the divine. Although the means by which this purification takes place differs according to the cultural and religious configurations of any given tradition, nevertheless a recurring image is that of an inner and outer odyssey. A major example is the threefold path of John of the Cross, which presents a psycho-spiritual journey by which ‘divine osmosis’ can be realised, passing through the ‘dark night of the soul’, and culminating in ‘spiritual marriage’. Although not accepted by many theoreticians and practitioners of mysticism, nevertheless the value of the Sanjuanist schemata still holds sway in contemporary society.
Developing Teaching Strategies in the EHR Era: A Survey of GME Experts
Authors: Atwater Amber R. , Rudd Mariah , Brown Audrey , Wiener John S. , Benjamin Robert , Lee W. Robert , Rosdahl Jullia A.
Published: August 2016

Background 

There is limited information on the impact of widespread adoption of the electronic health record (EHR) on graduate medical education (GME).

Objective 

To identify areas of consensus by education experts, where the use of EHR impacts GME, with the goal of developing strategies and tools to enhance GME teaching and learning in the EHR environment.

Methods 

Information was solicited from experienced US physician educators who use EPIC EHR following 3 steps: 2 rounds of online surveys using the Delphi technique, followed by telephone interviews. The survey contained 3 stem questions and 52 items with Likert-scale responses. Consensus was defined by predetermined cutoffs. A second survey reassessed items for which consensus was not initially achieved. Common themes to improve GME in settings with an EHR were compiled from the telephone interviews.

Results 

The panel included 19 physicians in 15 states in Round 1, 12 in Round 2, and 10 for the interviews. Ten items were found important for teaching and learning: balancing focus on EHR documentation with patient engagement achieved 100% consensus. Other items achieving consensus included adequate learning time, balancing EHR data with verbal history and physical examination, communicating clinical thought processes, hands-on EHR practice, minimizing data repetition, and development of shortcuts and templates. Teaching strategies incorporating both online software and face-to-face solutions were identified during the interviews.

Conclusions 

New strategies are needed for effective teaching and learning of residents and fellows, capitalizing on the potential of the EHR, while minimizing any unintended negative impact on medical education.
Relationship between temperature and apparent shape of pristine ice crystals
derived from polarimetric cloud radar observations during the ACCEPT campaign
Authors: Myagkov Alexander , Seifert Patric , Wandinger Ulla , Bühl Johannes , Engelmann Ronny
Published: August 2016

Abstract. This paper presents first quantitative estimations of apparent ice particle shape at the top of liquid-topped clouds. Analyzed ice particles were formed under mixed-phase conditions in the presence of supercooled water and in the temperature range from −20 to −3 °C. The estimation is based on polarizability ratios of ice particles measured by a Ka-band cloud radar MIRA-35 with hybrid polarimetric configuration. Polarizability ratio is a function of the geometrical axis ratio and the dielectric properties of the observed hydrometeors. For this study, 22 cases observed during the ACCEPT (Analysis of the Composition of Clouds with Extended Polarization Techniques) field campaign were used. Polarizability ratios retrieved for cloud layers with the cloud-top temperatures of  ∼ −5,  ∼ −8,  ∼ −15, and  ∼ −20 °C were 1.6, 0.9, 0.6, and 0.9, respectively. Such values correspond to prolate, quasi-isotropic, oblate, and quasi-isotropic particles, respectively. Data from a free-fall chamber were used for the comparison. A good agreement of detected apparent shapes with well-known shape–temperature dependencies observed in laboratories was found. Polarizability ratios used for the analysis were estimated for areas located close to the cloud top, where aggregation and riming processes do not strongly affect ice particles. We concluded that, in microwave scattering models, ice particles detected in these areas can be assumed to have pristine shapes. It was also found that even slight variations of ambient conditions at the cloud top with temperatures warmer than  ∼ −5 °C can lead to rapid changes of ice crystal shape.
Marine regime shifts in ocean biogeochemical models: a case study in the
Gulf of Alaska
Authors: Beaulieu Claudie , Cole Harriet , Henson Stephanie , Yool Andrew , Anderson Thomas R. , de Mora Lee , Buitenhuis Erik T. , Butenschön Momme , Totterdell Ian J. , Allen J. Icarus
Published: August 2016

Abstract. Regime shifts have been reported in many marine ecosystems, and are often expressed as an abrupt change occurring in multiple physical and biological components of the system. In the Gulf of Alaska, a regime shift in the late 1970s was observed, indicated by an abrupt increase in sea surface temperature and major shifts in the catch of many fish species. A thorough understanding of the extent and mechanisms leading to such regime shifts is challenged by data paucity in time and space. We investigate the ability of a suite of ocean biogeochemistry models of varying complexity to simulate regime shifts in the Gulf of Alaska by examining the presence of abrupt changes in time series of physical variables (sea surface temperature and mixed-layer depth), nutrients and biological variables (chlorophyll, primary productivity and plankton biomass) using change-point analysis. Our results show that some ocean biogeochemical models are capable of simulating the late 1970s shift, manifested as an abrupt increase in sea surface temperature followed by an abrupt decrease in nutrients and biological productivity. Models from low to intermediate complexity simulate an abrupt transition in the late 1970s (i.e. a significant shift from one year to the next) while the transition is smoother in higher complexity models. Our study demonstrates that ocean biogeochemical models can successfully simulate regime shifts in the Gulf of Alaska region. These models can therefore be considered useful tools to enhance our understanding of how changes in physical conditions are propagated from lower to upper trophic levels.
The Met Office Unified Model Global Atmosphere 6.0/6.1 and JULES Global Land 6.0/6.1 configurations
Authors: Walters David , Brooks Malcolm , Boutle Ian , Melvin Thomas , Stratton Rachel , Vosper Simon , Wells Helen , Williams Keith , Wood Nigel , Allen Thomas , Bushell Andrew , Copsey Dan , Earnshaw Paul , Edwards John , Gross Markus , Hardiman Steven , Harris Chris , Heming Julian , Klingaman Nicholas , Levine Richard , Manners James , Martin Gill , Milton Sean , Mittermaier Marion , Morcrette Cyril , Riddick Thomas , Roberts Malcolm , Sanchez Claudio , Selwood Paul , Stirling Alison , Smith Chris , Suri Dan , Tennant Warren , Vidale Pier Luigi , Wilkinson Jonathan , Willett Martin , Woolnough Steve , Xavier Prince
Published: August 2016

Abstract. We describe Global Atmosphere 6.0 and Global Land 6.0: the latest science configurations of the Met Office Unified Model and JULES land surface model developed for use across all timescales. Global Atmosphere 6.0 includes the ENDGame dynamical core, which significantly increases mid-latitude variability improving a known model bias. Alongside developments of the model’s physical parametrisations, ENDGame also increases variability in the tropics, which leads to an improved representation of tropical cyclones and other tropical phenomena. Further developments of the atmospheric and land surface parametrisations improve other aspects of model performance, including the forecasting of surface weather phenomena. We also describe Global Atmosphere 6.1 and Global Land 6.1, which include a small number of long-standing differences from our main trunk configurations that we continue to require for operational global weather prediction. Since July 2014, GA6.1/GL6.1 has been used by the Met Office for operational global NWP, whilst GA6.0/GL6.0 was implemented in its remaining global prediction systems over the following year.
Variations of deep soil moisture under different vegetation types and
influencing factors in a watershed of the Loess Plateau, China
Authors: Fang Xuening , Zhao Wenwu , Wang Lixin , Feng Qiang , Ding Jingyi , Liu Yuanxin , Zhang Xiao
Published: August 2016

Abstract. Soil moisture in deep soil layers is a relatively stable water resource for vegetation growth in the semi-arid Loess Plateau of China. Characterizing the variations in deep soil moisture and its influencing factors at a moderate watershed scale is important to ensure the sustainability of vegetation restoration efforts. In this study, we focus on analyzing the variations and factors that influence the deep soil moisture (DSM) in 80–500 cm soil layers based on a soil moisture survey of the Ansai watershed in Yan'an in Shanxi Province. Our results can be divided into four main findings. (1) At the watershed scale, higher variations in the DSM occurred at 120–140 and 480–500 cm in the vertical direction. At the comparable depths, the variation in the DSM under native vegetation was much lower than that in human-managed vegetation and introduced vegetation. (2) The DSM in native vegetation and human-managed vegetation was significantly higher than that in introduced vegetation, and different degrees of soil desiccation occurred under all the introduced vegetation types. Caragana korshinskii and black locust caused the most serious desiccation. (3) Taking the DSM conditions of native vegetation as a reference, the DSM in this watershed could be divided into three layers: (i) a rainfall transpiration layer (80–220 cm); (ii) a transition layer (220–400 cm); and (iii) a stable layer (400–500 cm). (4) The factors influencing DSM at the watershed scale varied with vegetation types. The main local controls of the DSM variations were the soil particle composition and mean annual rainfall; human agricultural management measures can alter the soil bulk density, which contributes to higher DSM in farmland and apple orchards. The plant growth conditions, planting density, and litter water holding capacity of introduced vegetation showed significant relationships with the DSM. The results of this study are of practical significance for vegetation restoration strategies, especially for the choice of vegetation types, planting zones, and proper human management measures.
Geosphere coupling and hydrothermal anomalies before the 2009 Mw 6.3 L'Aquila earthquake in Italy
Authors: Wu Lixin , Zheng Shuo , De Santis Angelo , Qin Kai , Di Mauro Rosa , Liu Shanjun , Rainone Mario Luigi
Published: August 2016

Abstract. The earthquake anomalies associated with the 6 April 2009 Mw 6.3 L'Aquila earthquake have been widely reported. Nevertheless, the reported anomalies have not been so far synergically analyzed to interpret or prove the potential lithosphere–coversphere–atmosphere coupling (LCAC) process. Previous studies on b value (a seismicity parameter from Gutenberg–Richter law) are also insufficient. In this work, the spatiotemporal evolution of several hydrothermal parameters related to the coversphere and atmosphere, including soil moisture, soil temperature, near-surface air temperature, and precipitable water, was comprehensively investigated. Air temperature and atmospheric aerosol were also statistically analyzed in time series with ground observations. An abnormal enhancement of aerosol occurred on 30 March 2009 and thus proved quasi-synchronous anomalies among the hydrothermal parameters from 29 to 31 March in particular places geo-related to tectonic thrusts and local topography. The three-dimensional (3-D) visualization analysis of b value revealed that regional stress accumulated to a high level, particularly in the L'Aquila basin and around regional large thrusts. Finally, the coupling effects of geospheres were discussed, and a conceptual LCAC mode was proposed to interpret the possible mechanisms of the multiple quasi-synchronous anomalies preceding the L'Aquila earthquake. Results indicate that CO2-rich fluids in deep crust might have played a significant role in the local LCAC process.
Soil CO2 efflux in an old-growth southern conifer forest (Agathis australis) – magnitude, components and controls
Authors: Schwendenmann Luitgard , Macinnis-Ng Cate
Published: August 2016

Abstract. Total soil CO2 efflux and its component fluxes, autotrophic and heterotrophic respiration, were measured in a native forest in northern Aotearoa–New Zealand. The forest is dominated by Agathis australis (kauri) and is on an acidic, clay rich soil. Soil CO2 efflux, volumetric soil water content and soil temperature were measured bi-weekly to monthly at 72 sampling points over 18 months. Trenching and regression analysis was used to partition total soil CO2 efflux into heterotrophic and autotrophic respiration. The effect of tree structure was investigated by calculating an index of local contribution (Ic, based on tree size and distance to the measurement location) followed by correlation analysis between Ic and total soil CO2 efflux, root biomass, litterfall and soil characteristics. The measured mean total soil CO2 efflux was 3.47 µmol m−2 s−1. Autotrophic respiration accounted for 25 % (trenching) or 28 % (regression analysis) of total soil CO2 efflux. Using uni- and bivariate models showed that soil temperature was a poor predictor of the temporal variation in total soil CO2 efflux (<  20 %). In contrast, a stronger temperature sensitivity was found for heterotrophic respiration (around 47 %). We found significant positive relationships between kauri tree size (Ic) and total soil CO2 efflux, root biomass and mineral soil CN ratio within 5–6 m of the sampling points. Using multiple regression analysis revealed that 97 % of the spatial variability in total soil CO2 efflux in this kauri-dominated stand was explained by root biomass and soil temperature. Our findings suggest that biotic factors such as tree structure should be investigated in soil carbon related studies.
Authentic Leadership In Sales Management: The Effects On Salespeople’s Task Related Outcomes
Authors: Aydin Samet , Kaya Nihat
Published: August 2016

Authentic leadership, as a new leadership concept emerging from the demand for honest and reliable leaders, has attracted the attention of the business community. The relationship between authentic leaders and their followers is being investigated across many disciplines. This study focuses on authentic leadership in sales management and explores how it affects the task-related outcomes of salespeople, such as learning orientation, customer orientation, intrinsic motivation and working hard. The data for the study were obtained from 364 salespeople and analysed using the partial least squares method. The results indicate that authentic leadership has significant positive effects upon learning orientation (β=0.251; p<0.01), customer orientation (β=0.358; p<0.01), intrinsic motivation (β=0.334; p<0.01), and working hard (β=0.251; p<0.01). As the theory suggests that authentic leadership makes important contributions to the development of followers, this study is the first to explore these contributions upon salespeople’s activities that they undertake within their sales tasks and leads to success in personal selling. Findings indicate that authentic leadership has significant positive effects upon salespeople’s individual task related outcomes.
Scale Development and Operationalization of Social Responsibility Constructs: An ISO 26000 Context
Authors: Chow Pui-Sze , Tang Ailie K.Y. , Yip Amy C.Y.
Published: August 2016

ISO 26000 is one of those prevailing guidelines on social responsibility adopted by practitioners. Despite its growing embracement, the dimensions of ISO 26000 have not been empirically operationalized. The lack of validated scales limits its compatibility in real-life practices as well as academic research on the standard. Adopting quantitative and qualitative methodology, the multidimensional scale of ISO 26000 is first operationalized through a questionnaire survey with 286 organizations in Hong Kong. The measurement items are then triangulated with industrial evidence garnered from in-depth interviews with seven organizations comprising two listed companies, two private companies, and three non-governmental organizations with operations in Hong Kong, Macau, Mainland China, Asia and the Middle East. Our measurement scale contributes to future studies of ISO 26000 in the corporate social responsibility literature. The validated scale will also be a handy guide for aligning social responsibility with the practical context and strategic implantation.
Characterization of Keratin Degrading Alkaliphiles
Authors: Elsayed Ashraf Abdelmotaleb , Mowafy Amr M. , Elrazak Ahmed Abd , Fawzy Mahmoud M. , Osman Yehia
Published: August 2016

Feather which mainly contains Keratin is one of the main poultry industry wastes and at the same time with high nutritional value if converted to soluble form.  In this study, we isolated and characterized four alkaliphilic bacteria for their ability to degrade feather under alkaline conditions. Two of the isolates have been identified as Lysinibacillus spp. and both of them are growing optimally at 30 °C and pH 9.  The others were identified as Micrococcus sp. and Nocardiopsis sp. and both of them showed optimum growth at 37 °C and pH 10.5. All the isolates are promising and potential tools that could be used for keratin degradation.
Combined Tomography and Epithelial Thickness Mapping for Diagnosis of Keratoconus
Authors: Silverman Ronald H. , Urs Raksha , RoyChoudhury Arindam , Archer Timothy J. , Gobbe Marine , Reinstein Dan Z.
Published: August 2016

Purpose

Scanning Scheimpflug provides information regarding corneal thickness and 2-surface topography while arc-scanned high-frequency ultrasound allows depiction of the epithelial and stromal thickness distributions. Both techniques are useful in detection of keratoconus. Our aim was to develop and test a keratoconus classifier combining information from both methods.

Methods

We scanned 111 normal and 30 clinical keratoconus subjects with Artemis-1 and Pentacam data. After selecting one random eye per subject, we performed stepwise linear discriminant analysis on a dataset combining parameters generated by each method to obtain classification models based on each technique alone and in combination.

Results

Discriminant analysis resulted in a 4-variable model (R2 = 0.740) based on Artemis data alone and a 4-variable model (R2 = 0.734) using Pentacam data alone. The combined model (R2 = 0.828) consisted of 3 Artemis- and 4 Pentacam-derived variables. The combined model R value was significantly higher than either model alone (p = 0.031, one-tailed). In cross-validation, Artemis had 100% sensitivity and 99.2% specificity, Pentacam had 97.3% sensitivity and 98.0% specificity, and the combined model had 97.3% sensitivity and 100% specificity.

Conclusions

Pentacam, Artemis, and combined models were all effective in distinguishing normal from clinical keratoconus subjects. From the standpoint of variance explained by the model (R2 values), the combined model was most effective. Application of the model to early and subclinical keratoconus will ultimately be required to assess the effectiveness of the combined approach.
Effect of Metabolic Acidosis on QT Intervals in Patients with Chronic Kidney Disease
Authors: Yenigun Ezgi Coskun , Aypak Cenk , Turgut Didem , Aydin Mehmet Zafer , Dede Fatih
Published: August 2016

Background

There is a strong association between chronic kidney disease (CKD) and cardiovascular events. Increased arrhythmia risk in kidney disease is one of the main predominant factors in increased mortality and sudden cardiac death. To estimate this risk, noninvasive measurement of repolarization abnormalities including QT interval and its heart rate-corrected value (QTc) with surface ECG, are commonly used parameters in clinical practice. The aim of this study is to examine the effect of CKD-related problems – mainly acidosis – on QT intervals.

Methods

30 patients with stage 3–5 CKD whose serum bicarbonate concentrations below 20 mmol/L were included in the study. Alkali therapy with oral sodium bicarbonate was used to maintain the serum bicarbonate concentration in the normal range. At the beginning all patients had sinus rhythm on surface ECG records. Kidney function tests including serum urea, serum creatinine, uric acid, blood gas analysis, and electrolytes were analyzed at the beginning and at the end of alkali treatment. All patients underwent 12 lead-ECGs, recorded simultaneously. One cardiologist examined the ECGs manually in terms of QT intervals, corrected for heart rate (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd).

Results

There were statistically significant differences in QT intervals, QTc, QTd and QTcd before and after sodium bicarbonate treatment. The correlation analyses revealed that there were significant negative correlations in pretreatment ECGs of patients between QTd and QTcd with blood pH level. Multivariate analyses between biochemical parameters and QTd-QTcd intervals have revealed that pH was related to QTd and QTc.

Conclusions

This study demonstrated that QT intervals on surface ECG are decreased after treatment of acidosis in CKD. Further studies are needed to show whether increased QT intervals cause ventricular arrhythmias in CKD.
Pre-Dialysis and Post-Dialysis Hydration Status and N-Terminal Pro-Brain Natriuretic Peptide and Survival in Haemodialysis Patients
Authors: Tangvoraphonkchai Kamonwan , Davenport Andrew
Published: August 2016

Purpose

Many dialysis centres have no formal program for assessing and adjusting post-haemodialysis (HD) target weight. Apart from clinical assessment, there are bioimpedance devices and natriuretic peptides that could potentially aid clinical management. We wished to determine whether pre- or post-HD bioimpedance assessment of extracellular water (ECW) or N terminal probrain natriuretic peptide (NT-proBNP) affected patient outcomes.

Methods

Multi-frequency bioimpedance assessments (MFBIA) were made before and after the midweek dialysis session, along with a post-dialysis NT-proBNP measurement.

Results

Data from 362 patients, median age of 63 (50–76) years, 59.7% male, 41.2% Caucasoid, with a median dialysis vintage of 31.4 (13.5–61.7) months were available for review. During a median follow-up of 49.6 (21.9–50.2) months there were 110 (30.4%) deaths. Patients who died had significantly increased ECW, as % over-hydrated both pre-HD 6.6 (5.8–7.6)% vs. survivors 5.1 (4–6.6)%, and post-HD 5.1 (4–6.6)% vs. 0.5 (-1-2.2.0, p<0.001, respectively. They also had higher NT-proBNP 325 (122–791) vs. 102 (48–342) pmol/l, p = 0.002. Using an adjusted Cox model, pre-HD ECW overhydration remained an independent factor associated with mortality (overhydration %: hazard ratio 1.15, 95% limits 1.03–1.28, p = 0.013), with a receiver operator curve (ROC) value of 0.7.

Conclusions

ECW excess is associated with increased mortality for HD patients, with ECW excess pre-dialysis being the strongest association, although these patients also had increased ECW post dialysis. Future trials are required to determine whether achieving euvolaemia as determined by bioimpedance improves patient survival.
Multiple Primary Tumors in a Family with Li-Fraumeni Syndrome with a TP53 Germline Mutation Identified by Next-Generation Sequencing
Authors: Zampiga Valentina , Danesi Rita , Tedaldi Gianluca , Tebaldi Michela , Cangini Ilaria , Pirini Francesca , Pittureri Cristina , Amaducci Elena , Guidi Luciano , Faedi Marina , Amadori Dino , Falcini Fabio , Calistri Daniele
Published: August 2016

Li-Fraumeni syndrome (LFS) is an autosomal dominant disorder occurring at a young age that predisposes individuals to multiple forms of cancer and to a heterogeneous spectrum of malignancies. We describe the clinical history of a patient who had 5 primary malignant cancers and a familiar history consistent with LFS. We analyzed the genomic DNA of the proband and her relatives by next-generation sequencing (NGS) technology using an enrichment protocol for the simultaneous sequencing of 94 genes involved in hereditary cancers. Genetic analysis of the proband revealed a TP53 germline mutation in exon 5 determining a nucleotide alteration at codon 175 (R175H), a hot spot mutation site related to LFS and a reported pathogenic mutation. The proband daughter's and brother's DNA did not carry the TP53 mutation but they had some rare variants in common with the proband, in addition to other variants with a still unclear role. In conclusion, we identified a TP53 mutation in a patient with multiple primary tumors and a family history characterized by a severe susceptibility to cancer. The genetic analysis by targeted NGS led to the identification of the genetic background and to the exclusion of a cancer risk for the family members. Targeted NGS represents an efficient approach for the identification of mutations in families with a heterogeneous phenotype.
Evidence-Based Criteria for the Choice and the Clinical use of the Most Appropriate Lock Solutions for Central Venous Catheters (Excluding Dialysis Catheters): A GAVeCeLT Consensus
Authors: Pittiruti Mauro , Bertoglio Sergio , Scoppettuolo Giancarlo , Biffi Roberto , Lamperti Massimo , Dal Molin Alberto , Panocchia Nicola , Petrosillo Nicola , Venditti Mario , Rigo Carla , DeLutio Enrico
Published: August 2016

Background

The most appropriate lock solution for central venous access devices is still to be defined. GAVeCeLT – the Italian group for venous access devices – has developed a consensus on the evidence-based criteria for the choice and the clinical use of the most appropriate lock solution for central venous catheters (excluding dialysis catheters).

Method

After the constitution of a panel of experts, a systematic collection and review of the literature has been performed, focusing on clinical studies dealing with lock solutions used for prevention of occlusion (heparin, citrate, urokinase, recombinant tissue plasminogen activator [r-TPA], normal saline) or for prevention of infection (citrate, ethanol, taurolidine, ethylene-diamine-tetra-acetic acid [EDTA], vancomycin, linezolid and other antibiotics), in both adults and in pediatric patients. Studies on central lines used for dialysis or pheresis, on peripheral venous lines and on arterial lines were excluded from this analysis. Studies on lock solutions used for treatment of obstruction or infection were not considered. The consensus has been carried out according to the Delphi method.

Results

The panel has concluded that: (a) there is no evidence supporting the heparin lock; (b) the prevention of occlusion is based on the proper flushing and locking technique with normal saline; (c) the most appropriate lock solution for infection prevention should include citrate and/or taurolidine, which have both anti-bacterial and anti-biofilm activity, with negligible undesired effects if compared to antibiotics; (d) the patient populations most likely to benefit from citrate/taurolidine lock are yet to be defined.

Conclusions

The actual value of heparinization for non-dialysis catheters should be reconsidered. Also, the use of lock with substances with anti-bacterial and anti-biofilm activity (such as citrate or taurolidine) should be taken into consideration in selected populations of patients.
Rating Scale for the Assessment of Competence in Ultrasound-guided Peripheral Vascular Access – a Delphi Consensus Study
Authors: Primdahl Stine C. , Todsen Tobias , Clemmesen Louise , Knudsen Lars , Weile Jesper
Published: August 2016

Introduction

Peripheral vascular access is vital for treatment and diagnostics of hospitalized patients. Ultrasound-guided vascular access (UGVA) is superior to the landmark technique. To ensure competence-based education, an assessment tool of UGVA competence is needed. We aimed to develop a global rating scale (RS) for assessment of UGVA competence based on opinions on the content from ultrasound experts in a modified Delphi consensus study.

Methods

We included experts from anesthesiology, emergency medicine and radiology across university hospitals in Denmark. Nine elements were drafted based on existing literature and recommendations from international societies. In a multi-round survey, the experts rated the elements on a five-point Likert scale according to importance, and suggested missing elements. The final Delphi round occurred when >80% of the experts rated all elements ≥4 on the Likert scale.

Results

Sixteen experts consented to participate in the study, one withdrew consent prior to the first Delphi round, and 14 completed all three Delphi rounds. In the first Delphi round the experts excluded one element from the scale and changed the content of two elements. In the second Delphi round, the experts excluded one element from the scale. In the third Delphi round, consensus was obtained on the eight elements: preparation of utensils, ergonomics, preparation of the ultrasound device, identification of blood vessels, anatomy, hygiene, coordination of the needle, and completion of the procedure.

Conclusions

We developed an RS for assessment of UGVA competence based on opinions of ultrasound experts through a modified Delphi consensus study.
Echo Color Doppler Ultrasound: A Valuable Diagnostic Tool in the Assessment of Arteriovenous Fistula in Hemodialysis Patients
Authors: Mudoni Anna , Caccetta Francesco , Caroppo Maurizio , Musio Fernando , Accogli Antonella , Zacheo Maria Dolores , Burzo Maria Domenica , Gallieni Maurizio , Nuzzo Vitale
Published: August 2016

A functioning vascular access is a critical requirement to improve the quality of life in hemodialysis patients, so monitoring and surveillance of vascular access play key roles in identifying all dysfunctions and reducing the huge economic cost as well as adequacy of dialysis.

In our five-year experience, a study protocol has been used and improved with the help of ultrasonography. Doppler ultrasound is an excellent and sensitive modality for hemodialysis access evaluation, one of techniques employed for arteriovenous fistulae (AVF) study, not only as a pre-operative tool, but also in post-operative monitoring of AVF maturation. In addition, the current guidelines recommend AVF surveillance by access blood flow measurement and the correction of hemodynamic stenosis in order to prolong access survival. Doppler ultrasound is readily available, directly used by nephrologists, non-invasive, safe, inexpensive, reproducible, although it requires more clinical skill and time to perform and proper equipment. Ultrasonography imaging can substantially reduce the number of subsequent invasive angiographic procedures. In our opinion, Doppler ultrasound should have a crucial place in the interdisciplinary cooperation in AVF monitoring and it should be included as part of an integrated vascular access management program.
Finding the Right Hemodialysis Vascular Access in the Elderly: A Patient-Centered Approach
Authors: Murea Mariana , Burkart John
Published: August 2016

Vascular access preparation in the elderly with advanced kidney disease needs a nuanced approach. Recent studies indicate that age, along with comorbidity, modify the outcomes associated with the type of access placed or used for hemodialysis (HD). Options ranging from permanent vascular access (arteriovenous fistula [AVF] or graft [AVG]) to tunneled central venous catheter (TCVC) or conservative medical care must be weighed on an individual basis and reassessed longitudinally. The potential benefits derived from AVF compared with AVG and TCVC are not always seen in this population. Herein, we review the literature concerning patient and vascular access outcomes in the elderly with advanced kidney disease or on HD. A multidimensional approach that takes into consideration the burden of comorbid diseases, functional status and patient-reported views on quality of life ought to be incorporated in the process of vascular access planning in the elderly.
Combined Modality Therapy for Thoracic and head and Neck Cancers: A Review of Updated Literature Based on a Consensus Meeting
Authors: Franco Pierfrancesco , Fiorentino Alba , Dionisi Francesco , Fiore Michele , Chiesa Silvia , Vagge Stefano , Cellini Francesco , Caravatta Luciana , Tombolini Mario , De Rose Fiorenza , Meattini Icro , Mortellaro Gianluca , Apicella Giuseppina , Marino Lorenza , Greto Daniela
Published: August 2016

Purpose

Combined modality therapy is a mainstay option for thoracic malignancies and head and neck cancers. The integration of different strategies is based on the multidisciplinary approach of modern clinical oncology. Radiation oncologists have to be educated, trained, and updated to provide state-of-the-art care to cancer patients and thus educational meetings are crucial.

Methods

The Italian Association of Radiation Oncology Young Members Working Group (AIRO Giovani) organized its 8th national meeting, focused on combination therapy in lung, esophageal, and head and neck cancer (with a specific focus on larynx-preservation strategies for larynx/hypopharynx tumors), involving young professionals working in Italy. The meeting was addressed to young radiation oncologists, presenting state-of-the-art knowledge, based on the latest evidence in this field. We performed a review of the current literature based on the highlights of the Congress.

Results

The multimodality approach of head and neck and thoracic malignancies includes surgery, chemotherapy, and radiotherapy, but also has to take into account new information and data coming from basic and translational research and including molecular biology, genetics, and immunology. All these aspects are crucial for the treatment of non-small-cell lung cancer and esophageal, esophagogastric junction, and larynx/hypopharynx malignancies. The integration of different treatments in the clinical decision-making process to combine therapies is crucial.

Conclusions

Combination therapy has proved to be a consolidated approach in these specific oncologic settings, highlighting the importance of multimodality management in modern clinical oncology. Dedicated meetings on specific topics are helpful to improve knowledge and skills of young professionals in radiation oncology.
Prognostic Value of Endocan in Prostate Cancer: Clinicopathologic Association between Serum Endocan Levels and Biochemical Recurrence after Radical Prostatectomy
Authors: Arslan Burak , Onuk Özkan , Hazar İsmet , Aydın Muammer , Çilesiz Nusret Can , Eroglu Ali , Nuhoglu Barış
Published: August 2016

Purpose

To assess the diagnostic capability of serum endocan level in association with clinicopathologic features and its impact on biochemical progression-free survival in patients with prostate cancer (PCa).

Methods

A total of 86 patients with localized prostate cancer were treated with open radical prostatectomy (RP). The control group included 80 patients who were referred to the urology outpatient clinic with normal rectal examination and prostate-specific antigen (PSA) levels. The patients’ characteristics, baseline PSA value, and serum endocan levels were recorded. The patients were followed up with the measurement of PSA concentration every 3 months during the first year, thereafter every 6 months until 5 years, then yearly after surgery. The primary endpoint of follow-up was the time of biochemical recurrence.

Results

The median serum endocan levels were 3.14 ng/mL in the RP group and 2.98 ng/mL in the control group (p = 0.122). A total of 86 patients who underwent RP for PCa were divided into 2 groups based on a cutoff serum endocan level of 1.8 ng/mL. The distribution of Gleason score and biochemical failure rate were significantly higher in patients with serum endocan ≥1.8 ng/mL (p = 0.031 and p = 0.047). The biochemical recurrence-free time for endocan ≥1.8 ng/mL and <1.8 ng/mL were 38 and 56 months, respectively (p = 0.041). Spearman correlation analysis showed a linear relationship between endocan expression and Gleason score (p = 0.025, p = 0.511). Multivariate analysis revealed that elevated serum endocan level (≥1.8 ng/mL) was a significant predictor of biochemical progression-free survival (hazard ratio 2.44; 95% confidence interval 1.78-3.23; p = 0.001).

Conclusions

The current study indicates that endocan has a close relationship with tumor recurrence in PCa.
Combined Therapy with Dabrafenib and Trametinib in BRAF-Mutated Metastatic Melanoma in a Real-Life Setting: The INT Milan Experience
Authors: Cavalieri Stefano , Di Guardo Lorenza , Cimminiello Carolina , Bono Aldo , Tolomio Elena , Colombetti Anna , Valeri Barbara , Di Tolla Giuseppe , de Braud Filippo , Del Vecchio Michele
Published: August 2016

Purpose

Combination therapy with dabrafenib and trametinib is safer and more effective than BRAF inhibitor-based monotherapy for metastatic melanoma.

Methods

We retrospectively analyzed BRAF-mutated metastatic melanoma patients treated at our institution with daily oral dabrafenib 300 mg and trametinib 2 mg from November 2013 to April 2016. This clinical record included both untreated and previously treated stage IV melanomas. Physical examination and laboratory examinations were performed monthly and disease re-evaluations were performed every 3 months.

Results

A total of 48 patients (24 male, 24 female) with BRAF-mutated metastatic melanoma received dabrafenib and trametinib; median age was 48 years (range 23-75). Median follow-up was 362.5 days (range 72-879). Best overall response rate consisted of 6.2% (3 patients) complete response, 64.6% (31) partial response, and 25% ( 12 ) stable disease; median time to best response was 11 weeks (range 5.7-125.5). Progression of disease was seen in 19 patients (39.6%), with median time to progression (TTP) of 26 weeks (range 8-54). A total of 15 patients (31.2%) died due to progression of disease. Median progression-free survival and median overall survival were not reached. To date, 30 patients (62.5%) are still under treatment. A total of 27 (56.2%) patients had at least one adverse event (AE); grade 3-4 AEs were seen in 4 cases (8.3%). The main toxicities were fever (25%), skin rash (14.6%), arthralgias (10.4%), and aspartate aminotransferase/alanine aminotransferase increase (8.3%). Treatment dose was reduced in 7 subjects (14.6%), with only one case of discontinuation due to AE.

Conclusions

Our data, using combined targeted therapy, are in line with the scientific literature in terms of both safety and effectiveness in a real-life setting.
The Clinical Value of PSA Increase during Intravesical Adjuvant Therapy for Nonmuscle-Invasive Bladder Cancer
Authors: Serretta Vincenzo , Gesolfo Cristina Scalici , Di Maida Fabrizio , Caruana Giovanni , Rocchini Lorenzo , Moschini Marco , Colombo Renzo , Simonato Alchiede
Published: August 2016

Introduction

Prostatic Specific Antigen (PSA), Bacillus Calmette-Guerin (BCG) increase after intravesical BCG has been reported. The need of prostate biopsy in these patients is object of debate. The aim of our study was to evaluate the effect of intravesical therapy on PSA after transurethral resection (TUR) of nonmuscle-invasive bladder cancer (NMIBC).

Materials and methods

Patients undergoing intravesical chemotherapy or immunotherapy for NMIBC were entered. PSA was measured before TUR, before the first and after the sixth instillation, 30 and 90 days after the last instillation. Patients with PSA ≥4 ng/ml or palpable prostate nodule were excluded.

Results

Out of 130 patients, 105 were evaluable. PSA increase (mean: 7.15 ng/ml) was detected after TUR and before intravesical therapy in 14 patients (13.3%). Of the remaining 91 patients, 65 (71.4%) received chemotherapy and 26 (28.6%) BCG. Median PSA before and during therapy was 1.80 and 1.97 ng/ml, with a 36% median increase in 66 patients (72.5%) (p = 0.13). No statistically significant difference emerged between chemotherapy and BCG (p = 0.22). PSA higher than 4 ng/ml was detected in six (6.3%) and two (2.1%) patients after chemotherapy and BCG, respectively, and was no more evident at 90 days.

Discussion

PSA increase due to intravesical therapy is rare and usually not clinically significant. PSA rising above 4 ng/ml during intravesical treatment was evident only in 8% of patients. PSA before TUR should be available and considered as the basal value. Elevated PSA detected during therapy should be monitored and biopsy proposed only if persisting more than 3 months after the end.
Lean in healthcare: Engagement in development, job satisfaction or exhaustion?
Authors: Lindskog Pernilla , Hemphälä Jens , Eklund Jörgen , Eriksson Andrea
Published: August 2016

Conclusions about implementing the management concept lean in healthcare are contradictory and longitudinal studies are scarce. In particular, little is known of how working conditions contribute to the sustainability of lean in healthcare. The aim of this article is to identify to what extent lean tools (visual follow-up boards, standardised work, 5S [housekeeping], and value stream mapping [VSM]) promote working conditions for employees and managers in healthcare organisations (outcomes: engagement in development, job satisfaction and exhaustion), while considering the context (i.e., job resources and job demands) and aspects of the implementation process. A longitudinal quantitative study was conducted that involved employees and managers in two hospitals and one municipality (n = 448). Applying the job demands-resources model, multiple linear regression models were used. VSM, standardised work and 5S promoted employees and managers’ working conditions when supported by job resources. When no support was provided, visual follow-up boards were inhibiting employees and managers’ job satisfaction. VSM and standardised work were seen as central lean tools. In this sample, the application of lean cannot be considered sustainable as employees and managers’ working conditions deteriorated under the implementation of lean.
A Convenção de Viena sobre Contratos de Compra e Venda Internacional: implicações no comércio eletrônico brasileiro
Authors: Teixeira Tarcisio , Sabo Isabela Cristina
Published: August 2016

A pesquisa aborda a recente adesão do Brasil à Convenção das Nações Unidas sobre Contratos de Compra e Venda Internacional de Mercadorias (CISG), bem como investiga eventuais conflitos com as leis internas quando os contratos são celebrados pelo meio eletrônico (e-commerce). Será examinado como se dá a aplicação da CISG nos contratos envolvendo empresas multinacionais que detém o domínio de seu site em diversos países, e, também, sua possível exclusão nos contratos considerados de consumo pela Teoria Finalista Mitigada. Conforme será apontado, a questão gerará maior polêmica com o Projeto de Lei do Senado n. 281/2012 (que visa a atualização do CDC), o qual amplia o viés protetivo do consumidor no âmbito internacional do comércio eletrônico.
Princípio da subsidiariedade em matéria tributária: o caso da expansão dos deveres de colaboração do contribuinte
Authors: Caliendo Paulo
Published: August 2016

O presente trabalho pretende analisar e verificar os limites de imposição de deveres acessórios aos contribuintes. Quais os limites e as possibilidades de imposição de deveres de colaboração? Pretende-se demonstrar que deve ser aplicado o princípio da subsidiariedade em matéria tributária, especialmente como um limite ao poder de impor obrigações tributárias acessórias.
Finalidades e fundamentos da moderna regulação econômica
Authors: Zarelli Renata Calheiros
Published: August 2016

Resenha sobre o Capítulo 1 da obra livro "Agências reguladoras independentes: fundamentos e seu regime jurídico" do autor Floriano de Azevedo Marques Neto (MARQUES NETO, Floriano de Azevedo. Finalidades e fundamentos da moderna regulação econômica. In: Agências reguladoras independentes: fundamentos e seu regime jurídico. Belo Horizonte: Fórum, 2005, p. 23-43).
O Estado e a atuação em parceria com a sociedade civil no desenvolvimento de ações de interesse público
Authors: Nora Luiz Fernando Zen , Arnoldi Paulo Roberto Colombo
Published: August 2016

Face às crises frequentes sofridas pelos Estados Nacionais, este artigo realiza uma reflexão sobre o papel do Estado atual frente à uma nova dinâmica econômica e social de maior vontade de participação pela sociedade civil nas ações de interesse público. Visando cortar custos, cumprirá ao Estado reduzir o tamanho da máquina pública, que em muitos casos apresenta baixa eficiência. Para tanto, deverá repensar seu papel de “executor” para “fomentador” das ações, ao mesmo tempo em que precisará garantir o bom funcionamento das diversas formas de parcerias com o particular. Conclui-se, a partir da pesquisa bibliográfica realizada, que a relação público-privada deverá tomar uma nova feição, na qual o público utiliza instrumentos privados de gestão e o privado assume cada vez mais um papel responsável em relação à comunidade. Caberá ao Estado se abrir para novas formas de participação da sociedade e, por meio da governança, estabelecer novas formas de agir e coordenar as ações em parceria, desempenhando também um papel fiscalizador, de forma a garantir que seus contratos sejam bem cumpridos.
Filosofia da linguagem e giro linguístico: implicações para os direitos autorais
Authors: Arrabal Alejandro Knaesel , Engelmann Wilson , Kuczkowski Sidnei
Published: August 2016

Este artigo propõe uma observação crítica do direto positivo em sede de Direitos Autorais, a partir das transformações contemporâneas incidentes na Filosofia da Linguagem, com especial atenção ao que se convencionou chamar “Giro Linguístico”. A partir deste marco epistemológico, o artigo explora duas possíveis implicações da “Virada Linguística” em relação os Direitos Autorais: a ressemantização das categorias “autor” e “obra” em decorrência da crítica à Metafísica Clássica e à Filosofia da Consciência.
Projetos didáticos de gênero, escrita praxiológica e desenvolvimento profissional de professores: um estudo de caso
Authors: Carnin Anderson
Published: August 2016

Este artigo apresenta uma análise do desenvolvimento profissional de uma professora participante de um curso de formação continuada pautado no trabalho com projetos didáticos de gênero (GUIMARÃES; KERSCH, 2012; 2014). Concebendo a noção de gênero de texto como instrumento psicológico (MACHADO; LOUSADA, 2010) e focalizando a dimensão praxiológica da escrita docente, o artigo discute como a apropriação de tal conceito pela docente permite que sejam desvelados índices de seu desenvolvimento profissional a partir da análise de sua escrita. Como pressuposto teórico, assume-se a perspectiva do Interacionismo Sociodiscursivo (BRONCKART, 2006; 2013; FRIEDRICH, 2012), da transposição didática (CHEVALLARD, 1985) e da didática da escrita (REUTER, 2013), a fim de analisar os modos de apropriação do conceito de gênero de texto (em uma perspectiva didática) e sua representação na escrita praxiológica do professor. Os resultados sugerem que o desenvolvimento profissional está intimamente ligado à transformação do conceito de gênero de texto em instrumento psicológico por parte da professora participante da pesquisa.