bluuebunny/crossref_metadata_2025 huggingface dataset:
An Observational Assessment of Anesthesia Capacity in Madagascar as a Prerequisite to the Development of a National Surgical Plan
Authors: Baxter Linden S. , Ravelojaona Vaonandianina A. , Rakotoarison Hasiniaina N. , Herbert Alison , Bruno Emily , Close Kristin L. , Andean Vanessa , Andriamanjato Hery H. , Shrime Mark G. , White Michelle C.
Published: May 2017

BACKGROUND:

The global lack of anesthesia capacity is well described, but country-specific data are needed to provide country-specific solutions. We aimed to assess anesthesia capacity in Madagascar as part of the development of a Ministry of Health national surgical plan.

METHODS:

As part of a nationwide surgical safety quality improvement project, we surveyed 19 of 22 regional hospitals, representing surgical facilities caring for 75% of the total population. The assessment was divided into 3 areas: anesthesia workforce density, infrastructure and equipment, and medications. Data were obtained by semistructured interviews with Ministry of Health officials, hospital directors, technical directors, statisticians, pharmacists, and anesthesia providers and through on-site observations. Interview questions were adapted from the World Health Organization Situational Analysis Tool and the World Federation of Societies of Anaesthesiologists International Standards for Safe Practice of Anaesthesia. Additional data on workforce density were collected from the 3 remaining regions so that workforce density data are representative of all 22 regions.

RESULTS:

Anesthesia physician workforce density is 0.26 per 100,000 population and 0.19 per 100,000 outside of the capital region. Less than 50% of hospitals surveyed reported having a reliable electricity and oxygen supply. The majority of anesthesia providers work without pulse oximetry (52%) or a functioning vaporizer (52%). All the hospitals surveyed had very basic pediatric supplies, and none had a pediatric pulse oximetry probe. Ketamine is universally available but more than 50% of hospitals lack access to opioids. None of the 19 regional hospitals surveyed was able to completely meet the World Federation of Societies of Anaesthesiologists’ standards for monitoring.

CONCLUSIONS:

Improving anesthesia care is complex. Capacity assessment is a first step that would enable progress to be tracked against specific targets. In Madagascar, scale-up of the anesthesia workforce, investment in infrastructure and equipment, and improvement in medication supply-chain management are needed to attain minimal international standards. Data from this study were presented to the Ministry of Health for inclusion in the development of a national surgical plan, together with recommendations for the needed improvements in the delivery of anesthesia.
Identifying Variability in Mental Models Within and Between Disciplines Caring for the Cardiac Surgical Patient
Authors: Brown Evans K. H. , Harder Kathleen A. , Apostolidou Ioanna , Wahr Joyce A. , Shook Douglas C. , Farivar R. Saeid , Perry Tjorvi E. , Konia Mojca R.
Published: May 2017

BACKGROUND:

The cardiac operating room is a complex environment requiring efficient and effective communication between multiple disciplines. The objectives of this study were to identify and rank critical time points during the perioperative care of cardiac surgical patients, and to assess variability in responses, as a correlate of a shared mental model, regarding the importance of these time points between and within disciplines.

METHODS:

Using Delphi technique methodology, panelists from 3 institutions were tasked with developing a list of critical time points, which were subsequently assigned to pause point (PP) categories. Panelists then rated these PPs on a 100-point visual analog scale. Descriptive statistics were expressed as percentages, medians, and interquartile ranges (IQRs). We defined low response variability between panelists as an IQR ≤ 20, moderate response variability as an IQR > 20 and ≤ 40, and high response variability as an IQR > 40.

RESULTS:

Panelists identified a total of 12 PPs. The PPs identified by the highest number of panelists were (1) before surgical incision, (2) before aortic cannulation, (3) before cardiopulmonary bypass (CPB) initiation, (4) before CPB separation, and (5) at time of transfer of care from operating room (OR) to intensive care unit (ICU) staff. There was low variability among panelists’ ratings of the PP “before surgical incision,” moderate response variability for the PPs “before separation from CPB,” “before transfer from OR table to bed,” and “at time of transfer of care from OR to ICU staff,” and high response variability for the remaining 8 PPs. In addition, the perceived importance of each of these PPs varies between disciplines and between institutions.

CONCLUSIONS:

Cardiac surgical providers recognize distinct critical time points during cardiac surgery. However, there is a high degree of variability within and between disciplines as to the importance of these times, suggesting an absence of a shared mental model among disciplines caring for cardiac surgical patients during the perioperative period. A lack of a shared mental model could be one of the factors contributing to preventable errors in cardiac operating rooms.
Perioperative Use of Focused Transthoracic Cardiac Ultrasound: A Survey of Current Practice and Opinion
Authors: Conlin Frederick , Connelly Neil R. , Eaton Michael P. , Broderick Patrick J. , Friderici Jennifer , Adler Adam C.
Published: May 2017

BACKGROUND:

The advent of portable ultrasound machines in recent years has led to greater availability of focused cardiac ultrasound (FoCUS) in the perioperative and critical care setting. To our knowledge, its use in the perioperative setting among anesthesiologists remains undefined. We sought to assess the use of FoCUS by members of the Society of Cardiovascular Anesthesiologists (SCA) in clinical practice, to identify variations in its application, to outline limits to its use, and to understand the level of training of physicians using this technology.

METHODS:

A 26-question anonymous and voluntary online survey assessing the participants’ training level with FoCUS, frequency of use, and opinions regarding incorporating it into residency training and developing a pathway to basic certification. The survey was distributed to the members of the SCA via email.

RESULTS:

The survey was completed by 379 of 3660 members of the SCA (10%). Of the respondents, the majority (67%) had completed a cardiovascular anesthesiology fellowship with 58% identifying their practice as academic, while 37% stated they were in private practice, and 6% were military/Veterans Administration. Most (84%) of the respondents practiced in North America. Eighty-one percent reported familiarity with FoCUS, while 47% stated they use it in their clinical practice. Those practicing in North America were significantly less likely to utilize FoCUS in their practice as compared to other respondents. With regard to training and certification, 88% believe FoCUS education should be integrated into residency training programs and 74% believe there should be a pathway to basic certification for FoCUS.

CONCLUSIONS:

While most cardiovascular anesthesiologists are familiar with FoCUS, a minority have integrated it into their practice. Roadblocks such as lack of training, the fear of missing diagnoses, lack of resources, and the lack of a formal certification process must be addressed to allow for more widespread use of perioperative cardiac ultrasound.
Parecoxib Supplementation to Morphine Analgesia Decreases Incidence of Delirium in Elderly Patients After Hip or Knee Replacement Surgery: A Randomized Controlled Trial
Authors: Mu Dong-Liang , Zhang Da-Zhi , Wang Dong-Xin , Wang Geng , Li Chun-Jing , Meng Zhao-Ting , Li Ya-Wei , Liu Chao , Li Xue-Ying
Published: May 2017

BACKGROUND:

Severe pain and high-dose opioids are both associated with increased risk of postoperative delirium. The authors investigated whether parecoxib-supplemented IV morphine analgesia could decrease the incidence of delirium in elderly patients after total hip or knee replacement surgery.

METHODS:

In a randomized, double-blind, 2-center trial, patients of 60 years or older who underwent elective total hip or knee replacement surgery were assigned in a 1:1 ratio to receive either parecoxib (40 mg at the end of surgery and then every 12 hours for 3 days) or placebo (normal saline). All patients received combined spinal-epidural anesthesia during surgery and IV morphine for postoperative analgesia. The primary outcome was the incidence of delirium within 5 days after surgery.

RESULTS:

Between January 2011 and May 2013, 620 patients were enrolled and were included in the intention-to-treat and safety analyses. The incidence of delirium was significantly reduced from 11.0% (34/310) with placebo to 6.2% (19/310) with parecoxib (relative risk 0.56, 95% confidence interval 0.33–0.96,P= .031). The severity of pain and the cumulative consumptions of morphine at 24, 48, and 72 hours after surgery were significantly lower with parecoxib than with placebo (allP< .001), although the differences were small. There was no difference in the incidence of postoperative complications between the 2 groups (12.3% [38/310] with placebo versus 11.6% [36/310] with parecoxib;P= .80).

CONCLUSIONS:

For low-risk elderly patients undergoing elective total hip or knee replacement surgery, multidose parecoxib supplemented to IV morphine decreased the incidence of postoperative delirium without increasing adverse events.
Reduced Requirement for Prothrombin Complex Concentrate for the Restoration of Thrombin Generation in Plasma From Liver Transplant Recipients
Authors: Abuelkasem Ezeldeen , Hasan Shaheer , Mazzeffi Michael A. , Planinsic Raymond M. , Sakai Tetsuro , Tanaka Kenichi A.
Published: May 2017

BACKGROUND:

Plasma transfusion remains the mainstay hemostatic therapy during liver transplantation (LT) in most countries. However, a large volume is required for plasma to achieve clinically relevant factor increases. Prothrombin complex concentrate (PCC) is a low-volume alternative to plasma in warfarin reversal, but its efficacy has not been well studied in LT.

METHODS:

Blood samples were collected from 28 LT patients at baseline (T0) and 30 minutes after graft reperfusion (T1). Factor X and antithrombin levels were measured. Ex vivo effects of PCC (0.2 and 0.4 IU/mL) and 10% volume replacement with normal plasma were compared in LT and warfarin plasma by measuring lag time, thrombin peak, and endogenous thrombin potential (ETP) using thrombin generation (TG) assay.

RESULTS:

Coagulation status was worsened at T1 as international normalized ratio increased from 1.7 to 3.0, and factor X was decreased from 49% to 28%. TG measurements showed normal lag time and ETP at T0 and T1, but low-normal peak at T0, and below-normal peak at T1. Both doses of PCC increased peak and ETP, while 10% volume plasma had minimal effects on TG. Thrombin inhibition appears to be very slow after adding 0.4 IU/mL of PCC in LT plasma due to low antithrombin. The same doses of PCC and plasma were insufficient for warfarin reversal.

CONCLUSIONS:

Reduced TG in LT can be more effectively restored by using PCC rather than plasma. The required doses of PCC for LT patients seem to be lower than warfarin reversal due to slow thrombin inhibition.
Comparison of the Mallampati Classification in Sitting and Supine Position to Predict Difficult Tracheal Intubation: A Prospective Observational Cohort Study
Authors: Hanouz Jean-Luc , Bonnet Vincent , Buléon Clément , Simonet Thérèse , Radenac Dorothée , Zamparini Guillaume , Fischer Marc Olivier , Gérard Jean-Louis
Published: May 2017

BACKGROUND:

The Mallampati classification (MLPT) is normally evaluated in the sitting position. However, many patients cannot be evaluated in the sitting position for medical reasons. Thus, we compared the MLPT in sitting and supine positions in predicting difficult tracheal intubation (DTI). We hypothesized that the diagnostic accuracy of the MLPT performed in sitting and supine positions would differ.

METHODS:

We performed a single-center prospective observational study in adult patients who received general anesthesia and orotracheal intubation for noncardiac surgery. During the preanesthesia consultation, the MLPT in the sitting position was recorded. The day of surgery, the MLPT in the supine position and the difficulty of intubation (DTI) were recorded by an independent observer. The diagnostic performance of the MLPT for the prediction of DTI was evaluated in the sitting and supine positions through the area under the receiver operating characteristic (ROC) curve. The performance of the Naguib score in predicting DTI was calculated with the MLPT in sitting and supine positions.

RESULTS:

Among the 3036 patients, 157 (5.1%) had DTI. The area under the ROC curve for the MLPT in supine position (0.82 [0.78–0.84]) was greater than that for the MLPT in the sitting position (0.70 [0.66–0.75]; P < .001). The relationship between the sitting and supine MLPTs was moderate (Spearman rank correlation coefficient: 0.50; P < .001). The area under ROC curve for predicting DTI by the Naguib score calculated with the supine MLPT (0.78 [95% confidence interval, 0.74–0.82]) was greater than that for the Naguib score calculated with MLPT in the sitting position (0.69 [95% confidence interval, 0.63–0.74)]; P < .001).

CONCLUSIONS:

The MLPT performed in the supine position is possibly superior to that performed in the sitting position for predicting difficult intubation in adults.
Reliability of Point-of-Care Hematocrit Measurement During Liver Transplantation
Authors: Kim Won Ho , Lee Hyung-Chul , Ryu Ho-Geol , Chung Eun-Jin , Kim Borim , Jung Hoiin , Jung Chul-Woo
Published: May 2017

BACKGROUND:

Although point-of-care (POC) analyzers are commonly used during liver transplantation (LT), the accuracy of hematocrit measurement using a POC analyzer has not been evaluated. In this retrospective observational study, we aimed to evaluate the accuracy of hematocrit measurement using a POC analyzer and identify potential contributors to the measurement error and their influence on mistransfusion during LT.

METHODS:

We retrospectively collected 6461 pairs of simultaneous intraoperative hematocrit measurements using POC analyzers and laboratory devices during LTs in 901 patients. The agreement of hematocrit measurements was assessed using Bland-Altman analysis for repeated measurements, while the incidence and magnitude of hematocrit measurement error were compared among 16 different laboratory abnormality categories. A generalized estimating equation analysis was performed to identify potential contributors to falsely low-measured POC hematocrit. Additionally, we defined potential “overtransfusion” in the case when POC hematocrit was <20% and laboratory hematocrit was ≥20% and investigated its association with intraoperative transfusion.

RESULTS:

The POC hematocrit measurements were falsely lower than the laboratory hematocrit measurements in 70.3% (4541/6461) of pairs. The median (interquartile range) of hematocrit measurement error was −1.20 (−2.60 to 0.20). Bland-Altman analysis showed that 24.5% (1583/6461) of the errors were outside our a priori defined clinically acceptable limits of ±3%. The incidence of falsely low-measured hematocrit was significantly higher with the presence of concomitant hypoalbuminemia and hypoproteinemia. Hypoalbuminemia combined with hyperglycemia showed significantly larger hematocrit measurement error. Hypoalbuminemia, hypoproteinemia, and hyperglycemia were predictors of falsely low-measured hematocrit. Furthermore, the overtransfusion group showed larger amount of transfusion than the adequately transfused group, with a median difference of 2 units (95% confidence interval [0–4], P = .039), despite similar amount of blood loss.

CONCLUSIONS:

Hematocrit measured using the POC device tends to be lower than the laboratory hematocrit measured during LT. Commonly encountered laboratory abnormalities during LT include hypoalbuminemia, hypoproteinemia, and hyperglycemia, which may contribute to falsely low-measured POC hematocrit. Careful consideration of these confounders may help reduce overtransfusion that occurs due to falsely low-measured POC hematocrit.
Selective Cannabinoids for Chronic Neuropathic Pain: A Systematic Review and Meta-analysis
Authors: Meng Howard , Johnston Bradley , Englesakis Marina , Moulin Dwight E. , Bhatia Anuj
Published: May 2017

BACKGROUND:

There is a lack of consensus on the role of selective cannabinoids for the treatment of neuropathic pain (NP). Guidelines from national and international pain societies have provided contradictory recommendations. The primary objective of this systematic review and meta-analysis (SR-MA) was to determine the analgesic efficacy and safety of selective cannabinoids compared to conventional management or placebo for chronic NP.

METHODS:

We reviewed randomized controlled trials that compared selective cannabinoids (dronabinol, nabilone, nabiximols) with conventional treatments (eg, pharmacotherapy, physical therapy, or a combination of these) or placebo in patients with chronic NP because patients with NP may be on any of these therapies or none if all standard treatments have failed to provide analgesia and or if these treatments have been associated with adverse effects. MEDLINE, EMBASE, and other major databases up to March 11, 2016, were searched. Data on scores of numerical rating scale for NP and its subtypes, central and peripheral, were meta-analyzed. The certainty of evidence was classified using the Grade of Recommendations Assessment, Development, and Evaluation approach.

RESULTS:

Eleven randomized controlled trials including 1219 patients (614 in selective cannabinoid and 605 in comparator groups) were included in this SR-MA. There was variability in the studies in quality of reporting, etiology of NP, type and dose of selective cannabinoids. Patients who received selective cannabinoids reported a significant, but clinically small, reduction in mean numerical rating scale pain scores (0–10 scale) compared with comparator groups (−0.65 points; 95% confidence interval, −1.06 to −0.23 points; P = .002, I
2 = 60%; Grade of Recommendations Assessment, Development, and Evaluation: weak recommendation and moderate-quality evidence). Use of selective cannabinoids was also associated with improvements in quality of life and sleep with no major adverse effects.

CONCLUSIONS:

Selective cannabinoids provide a small analgesic benefit in patients with chronic NP. There was a high degree of heterogeneity among publications included in this SR-MA. Well-designed, large, randomized studies are required to better evaluate specific dosage, duration of intervention, and the effect of this intervention on physical and psychologic function.
Magic Mirror, on the Wall—Which Is the Right Study Design of Them All?—Part I
Authors: Vetter Thomas R.
Published: May 2017

The assessment of a new or existing treatment or intervention typically answers 1 of 3 research-related questions: (1) “Can it work?” (efficacy); (2) “Does it work?” (effectiveness); and (3) “Is it worth it?” (efficiency or cost-effectiveness). There are a number of study designs that on a situational basis are appropriate to apply in conducting research. These study designs are classified as experimental, quasi-experimental, or observational, with observational studies being further divided into descriptive and analytic categories. This first of a 2-part statistical tutorial reviews these 3 salient research questions and describes a subset of the most common types of experimental and quasi-experimental study design. Attention is focused on the strengths and weaknesses of each study design to assist in choosing which is appropriate for a given study objective and hypothesis as well as the particular study setting and available resources and data. Specific studies and papers are highlighted as examples of a well-chosen, clearly stated, and properly executed study design type.
Factors Affecting Acoustics and Speech Intelligibility in the Operating Room: Size Matters
Authors: McNeer Richard R. , Bennett Christopher L. , Horn Danielle Bodzin , Dudaryk Roman
Published: May 2017

INTRODUCTION:

Noise in health care settings has increased since 1960 and represents a significant source of dissatisfaction among staff and patients and risk to patient safety. Operating rooms (ORs) in which effective communication is crucial are particularly noisy. Speech intelligibility is impacted by noise, room architecture, and acoustics. For example, sound reverberation time (RT60) increases with room size, which can negatively impact intelligibility, while room objects are hypothesized to have the opposite effect. We explored these relationships by investigating room construction and acoustics of the surgical suites at our institution.

METHODS:

We studied our ORs during times of nonuse. Room dimensions were measured to calculate room volumes (VR). Room content was assessed by estimating size and assigning items into 5 volume categories to arrive at an adjusted room content volume (VC) metric. Psychoacoustic analyses were performed by playing sweep tones from a speaker and recording the impulse responses (ie, resulting sound fields) from 3 locations in each room. The recordings were used to calculate 6 psychoacoustic indices of intelligibility. Multiple linear regression was performed using VR and VC as predictor variables and each intelligibility index as an outcome variable.

RESULTS:

A total of 40 ORs were studied. The surgical suites were characterized by a large degree of construction and surface finish heterogeneity and varied in size from 71.2 to 196.4 m3 (average VR = 131.1 [34.2] m3). An insignificant correlation was observed between VR and VC (Pearson correlation = 0.223, P = .166). Multiple linear regression model fits and β coefficients for VR were highly significant for each of the intelligibility indices and were best for RT60 (R2 = 0.666, F(2, 37) = 39.9, P < .0001). For Dmax (maximum distance where there is <15% loss of consonant articulation), both VR and VC β coefficients were significant. For RT60 and Dmax, after controlling for VC, partial correlations were 0.825 (P < .0001) and 0.718 (P < .0001), respectively, while after controlling for VR, partial correlations were −0.322 (P = .169) and 0.381 (P < .05), respectively.

CONCLUSIONS:

Our results suggest that the size and contents of an OR can predict a range of psychoacoustic indices of speech intelligibility. Specifically, increasing OR size correlated with worse speech intelligibility, while increasing amounts of OR contents correlated with improved speech intelligibility. This study provides valuable descriptive data and a predictive method for identifying existing ORs that may benefit from acoustic modifiers (eg, sound absorption panels). Additionally, it suggests that room dimensions and projected clinical use should be considered during the design phase of OR suites to optimize acoustic performance.
Intralipid Restoration of Myocardial Contractions Following Bupivacaine-Induced Asystole: Concentration- and Time-Dependence In Vitro
Authors: Park Wyun Kon , Kim Hyun Soo , Kim Soo Hwan , Jung Ja Rang , Lynch Carl , Min Nar Hyun
Published: May 2017

BACKGROUND:

The concentration- and time-response relationships of lipid emulsion (LE; Intralipid) on the recovery of myocardial contractility following bupivacaine (BPV)-induced asystole are poorly defined.

METHODS:

After achieving asystole by 500-μM BPV, varied concentrations of LE were applied to determine the recovery of stimulated contractile responses and contractions in the cardiac tissues of guinea pigs at a 1.2-Hz stimulation rate. These experiments were performed with LE in either a recirculating (2%–16%) or washout (nonrecirculating) condition (0.05%–12%) for 60 minutes. The effect of LE itself (0.05%–12%) was examined. Oxfenicine was used to evaluate the metabolic action of LE to reverse asystole. BPV concentrations in solution and myocardial tissues were measured.

RESULTS:

In the recirculation condition, partial recovery of contractile forces was observed for 60 minutes at 4%, 8%, and 12% LE. A contracture followed after exposure to 16% LE in some asystolic muscles. In the washout experiments, following asystole, LE (0.05%–12%) had no effect on the recovery time of the first and regular contractile responses. LE (0.1%–8%) restored contractility to baseline levels after 45 minutes; partial recovery was shown with lower (0.05%) and higher (12%) concentrations. Oxfenicine did not alter the recovery of contractile forces. Contractile depression was observed with 12% LE alone. Concentration-related reduction of tissue BPV concentration by LE was observed in both circulating conditions.

CONCLUSIONS:

LE induced time- and concentration-dependent recovery of stimulated myocardial contractions from BPV-induced asystole. The lipid uptake effect, along with other undefined mechanisms of LE, seems to contribute to the recovery of contractile function; however, the LE effect on myocardial metabolism is less likely involved at this concentration (500 μM) of BPV.
Nortriptyline Enhances Morphine-Conditioned Place Preference in Neuropathic Rats: Role of the Central Noradrenergic System
Authors: Mi Wenli , Wang Shuxing , You Zerong , Lim Grewo , McCabe Michael F. , Kim Hyangin , Chen Lucy , Mao Jianren
Published: May 2017

BACKGROUND:

Combination drug therapy is commonly used to treat chronic pain conditions such as neuropathic pain, and antidepressant is often used together with opioid analgesics. While rewarding is an intrinsic property of opioid analgesics, it is unknown whether the use of an antidepressant would influence opioid reward, which may contribute to opioid addiction. In this study, we examined whether nortriptyline (a tricyclic antidepressant and a first-line medication for neuropathic pain) would enhance the morphine rewarding property in both naive and chronic constriction sciatic nerve injury (CCI) rats.

METHODS:

The rewarding effect of these drugs was assessed using conditioned place preference (CPP). The real-time polymerase chain reaction, western blot, and enzyme-linked immunosorbent assay analysis were used to investigate the function of central noradrenergic system.

RESULTS:

In naive rats, coadministration of nortriptyline with morphine did not change the acquisition of morphine-induced CPP. However, nortriptyline enhanced the acquisition, delayed the extinction, and augmented the reinstatement of morphine-induced CPP in CCI rats. In CCI rats treated with both nortriptyline and morphine, the expression of α2A-adrenergic receptors, norepinephrine transporter, and tyrosine hydroxylase was markedly decreased in the locus coeruleus, whereas the norepinephrine concentration in the nucleus accumbens was remarkably increased.

CONCLUSIONS:

These results demonstrate that nortriptyline enhanced morphine reward when both drugs were used to treat neuropathic pain in rats and that this behavioral phenotype is likely to be mediated by upregulation of the central noradrenergic system. These findings may have implications in opioid therapy commonly used for chronic pain management.
Altered feto-placental vascularization, feto-placental malperfusion, and fetal growth restriction in mice with Egfl7 loss-of-function
Authors: Lacko Lauretta A. , Hurtado Romulo , Hinds Samantha , Poulos Michael G. , Butler Jason M. , Stuhlmann Heidi
Published: May 2017

EGFL7 is a secreted, angiogenic factor produced by embryonic endothelial cells. To understand its role in placental development, we established a novel Egfl7 knockout mouse. The mutant mice have gross defects in chorioallantoic branching morphogenesis and placental vascular patterning. Microangiography and 3D imaging revealed patchy perfusion of Egfl7−/− placentas marked by impeded blood conductance through sites of narrowed vessels. Consistent with poor feto-placental perfusion, Egfl7 knockout resulted in reduced placental weight and fetal growth restriction. The placentas also showed abnormal fetal vessel patterning and >50% reduction in fetal blood space. In vitro, placental endothelial cells were deficient in migration, cord formation, and sprouting. Expression of genes involved in branching morphogenesis, Gcm1, SynA, and SynB, and patterning of the extracellular matrix, Mmrn1, were temporally dysregulated in the placentas. Egfl7 knockout did not affect expression of the microRNA embedded within intron 7. Collectively, these data reveal that Egfl7 is critical for placental vascularization and embryonic growth, and may provide insight into etiological factors underlying placental pathologies associated with intrauterine growth restriction, a significant cause of infant morbidity and mortality.
Oxygenation and adenosine deaminase support growth and proliferation of ex vivo cultured Drosophila wing imaginal discs
Authors: Strassburger Katrin , Lorbeer Franziska K. , Lutz Marilena , Graf Fabian , Boutros Michael , Teleman Aurelio A.
Published: May 2017

The Drosophila wing imaginal disc has been an important model system over the past decades for discovering novel biology related to development, signaling, and epithelial morphogenesis. Novel experimental approaches would be enabled by a culturing setup allowing ex vivo cultures of wing discs. Current setups, however, are not able to sustain both growth and cell-cycle progression of wing discs ex vivo. We discover here a setup requiring both oxygenation of the tissue and adenosine deaminase activity in the medium, which supports both growth and proliferation of wing discs for 9 hours. Nonetheless, further work will be required to extend the duration of the culturing and to enable live imaging of the cultured discs in the future.
PDGF controls contact inhibition of locomotion by regulating N-cadherin during neural crest migration
Authors: Bahm Isabel , Barriga Elias H. , Frolov Antonina , Theveneau Eric , Frankel Paul , Mayor Roberto
Published: May 2017

A fundamental property of neural crest (NC) migration is Contact inhibition of locomotion (CIL), a process by which cells change their direction of migration upon cell contact. CIL has been proven to be essential for NC migration in amphibian and zebrafish by controlling cell polarity in a cell contact dependent manner. Cell contact during CIL requires the participation of the cell adhesion molecule N-cadherin, which starts to be expressed by NC cells as a consequence of the switch between E- and N-cadherins during epithelial to mesenchymal transition (EMT). However, the mechanism that controls the upregulation of N-cadherin remains unknown. Here we show that PDGFRα and its ligand PDGF-A are co-expressed in migrating cranial NC. Inhibition of PDGF-A/PDGFRα blocks NC migration by inhibiting N-cadherin and, consequently impairing CIL. Moreover, we find PI3K/AKT as a downstream effector of the PDGFRα cellular response during CIL. Our results lead us to propose PDGF-A/PDGFRα signalling as a tissue-autonomous regulator of CIL by controlling N-cadherin upregulation during EMT. Finally, we show that once NC have undergone EMT, the same PDGF-A/PDGFRα works as NC chemoattractant guiding their directional migration.
The apical ECM preserves embryonic integrity and distributes mechanical stress during morphogenesis
Authors: Vuong-Brender Thanh Thi Kim , Suman Shashi Kumar , Labouesse Michel
Published: May 2017

Epithelia are bound by both basal and apical extracellular matrices (ECM). While the composition and function of the former have been intensively investigated, less is known about the latter. The embryonic sheath, the ECM apical to the C. elegans embryonic epidermis, has been suggested to promote its elongation. In an RNAi screen for the components of the sheath, we identified the Zona Pellucida domain proteins NOAH-1 and NOAH-2. We found that these proteins act in the same pathway, and in parallel to three other putative sheath proteins, SYM-1, LET-4 and FBN-1/Fibrillin, to ensure embryonic integrity and promote elongation. Laser nano-ablation experiments to map the stress field show that NOAH-1 and NOAH-2, together with PAK-1/p21-activated kinase, maintain and relay the actomyosin-dependent stress generated within the lateral epidermis before muscles become active. Subsequently, loss of function experiments show that apical ECM proteins are essential for muscle anchoring and for relaying the mechanical input from muscle contractions, which are essential for elongation. Hence, the apical ECM contributes to morphogenesis by maintaining embryonic integrity and relaying mechanical stress.
Amazon river dolphins (Inia geoffrensis) modify biosonar output level and directivity during prey interception in the wild
Authors: Ladegaard Michael , Jensen Frants Havmand , Beedholm Kristian , da Silva Vera Maria Ferreira , Madsen Peter Teglberg
Published: May 2017

Toothed whales have evolved to live in extremely different habitats and yet they all rely strongly on echolocation for finding and catching prey. Such biosonar based foraging involves distinct phases of searching for, approaching, and capturing prey, where echolocating animals gradually adjust sonar output to actively shape the flow of sensory information. Measuring those outputs in absolute levels requires hydrophone arrays centred on the biosonar beam axis, but this has never been done for wild toothed whales approaching and capturing prey. Rather, field studies make the assumption that toothed whales will adjust their biosonar in the same manner to arrays as they will when approaching prey. To test this assumption, we recorded wild botos (Inia geoffrensis) as they approached and captured dead fish tethered to a hydrophone in front of a star-shaped seven-hydrophone array. We demonstrate that botos gradually decrease interclick intervals and output levels during prey approaches, using stronger adjustment magnitudes than extrapolated from previous boto array data. Prey interceptions are characterised by high click rates, but although botos buzz during prey capture, they do so at lower click rates than marine toothed whales, resulting in a much more gradual transition from approach phase to buzzing. We also demonstrate for the first time that wild toothed whales broaden biosonar beamwidth when closing in on prey, as it is also seen in captive toothed whales and in bats, thus resulting in a larger ensonified volume around the prey, likely aiding prey tracking by decreasing the risk of prey evading ensonification.
Transforming Electrical Load from an Operational Constraint to a Controllable Resource
Authors: Tyagi Rajesh , Chen Weiwei , Black Jason , Tiwari Prasoon , Lecours Bernard , Shaver Jamison
Published: May 2017

Electric utilities have historically treated power demand as an uncontrollable input, requiring generation and transmission resources to maintain the supply-demand balance. In recent years, demand response (DR) has emerged as a means to manage customer loads to balance the grid. This paper presents analytic solutions to enable utilities to optimize DR programs to serve as operational resources for the grid. We developed two sets of analytics. First, we developed a clustering-based method to accurately estimate the load curtailments expected from customers during DR events. Then, we used an option value-based optimal DR event scheduling method to compute a dynamic threshold value that the utility can use to make daily decisions for triggering DR events. In extensive tests, the proposed methods show superior performance over existing approaches. We implemented these analytics in the General Electric (GE) PowerOn™ Precision Demand Response Management System, which GE offered from 2011 to 2015.
Choosing an n-Pack of Substitutable Products
Authors: Fox Edward , Norman Laura , Semple John
Published: May 2017

We develop a framework to model the shopping and consumption decisions of forward-looking consumers. Assuming that the consumer’s future utility for each product alternative can be characterized by a standard random utility model, we use dynamic programming to determine the optimal consumption policy and the maximum expected value of consuming any n substitutable products selected while shopping (an n-pack). We propose two models. In the first (canonical) model, we assume that an alternative is consumed on each successive consumption occasion and obtain a closed-form optimal policy and a closed-form value function. Given a consumer’s preferences for the product alternatives in an assortment, we then show how to identify that consumer’s optimal n-pack using a simple swapping algorithm that converges in at most n swaps. In the second (generalized) model, we introduce an outside option so that a product alternative need not be consumed on each consumption occasion. We obtain a closed-form value function for the generalized model and show that its optimal n-pack is related to that of the canonical model using a special type of majorization. Additional structural properties and implications of each model are explored, as are other applications.

The online appendix is available at https://doi.org/10.1287/mnsc.2017.2729 .

This paper was accepted by Vishal Gaur, operations management.
Student Lives in Crisis
Authors: Antonucci Lorenza
Published: May 2017

With rising levels of student debt and precarity, young people’s lives in university are not always smooth. Lorenza Antonucci has travelled across England, Italy and Sweden to understand how inequality is reproduced through university. This book provides a compelling narrative of what it means to be in university in Europe in the 21st century, not only in terms of education, but also in terms of finances, housing and well-being. Furthermore, this book shows how inequality is reproduced during university by how young people from different social classes combine family, state and labour market sources. The book identifies different profiles of young people’s experiences in university, from ‘Struggling and hopeless’ to ‘Having a great time’. Furthermore, the book discusses how the ‘welfare mixes’ present in the three countries determine different types of semi-dependence, and reinforce inequalities. The book identifies a general trend of privatisation of student support in higher education, which pushes young people to participate in the labour market and over-rely on family resources in order to sustain their participation in university. Not only does this protract young people’s semi-dependence, but it also increases inequality among different groups of young people. In addition to the current policy focus on access to higher education, and transitions to the labour market, the book calls for a greater attention on the policies that can change young people’s lives while in university.
Understanding abjection
Authors: Higgs Paul , Gilleard Chris
Published: May 2017

This chapter describes the abjection that is associated with late life frailty. Abjection refers to the collective distaste and shame associated with any devalued condition, status or position within society. Drawing upon the history of the ‘old’ abject classes, for whom the poorhouse or the workhouse served as their symbolic institution, it is argued that the successful dismantling of those institutions and the near elimination of abject or extreme poverty has since seen a ‘new’ abject class emerge, made up of the frail and most dependent persons, largely very old and very infirm people. Unlike the abject classes of the past, today’s new class of abject persons is much less able either to challenge its marginalisation or to represent itself as a collective voice. Replacing the workhouse, the nursing home is its symbolic institution where abjection is inter-woven within the networks and relations of care. Those who care and those who are cared for are alike subject to the abjection of the fourth age and the potential for abuse that flows from it.
Reconciling participation and power in international development: a case study
Authors: Newman Kate
Published: May 2017

This chapter draws on the experience of ActionAid, one of the largest INGOs originally headquartered in the UK, and now an international federation of national NGOs. The organisation transformed its form and structure in order to be more deeply rooted in national civil society and more able to involve the voices and perspectives of those living in poverty in debates that affected them. In doing this it recruited different staff and through doing this fundamentally altered the class make-up of the organisation, inadvertently recruiting staff from the elite class in various countries and thereby extending the distance between policy-makers and community organisers. The chapter argues that a lack of attention to class analysis undermined ActionAid’s theory of change and in fact moved the organisation further from the people it was hoping to represent and move closer to.
Rebuilding the family: 1940s–1950s
Authors: Hendrick Harry
Published: May 2017

The chapter examines the idea of 'the family' within the context of the so-called 'Golden Age' in social and economic affairs that was said to prevail from the late 1940s through to the early 1970s. It begins with a survey of the social democratic ideals regarding 'mental progress', as expressed in sections of Atlee's Labour Party, and of the Party's failure to convert the electorate to socialist ethics. It then goes on to provide a sustained account of the ideas and popular influence of John Bowlby and Donald Winnicott, emphasizing the significance they attributed to family, home, and the 'the bonds of love', particularly between mothers and young children, for the evolution of an emotionally mature social democracy in the post-1945 atomic age.
Narcissism and the ‘politics of recognition’: concepts of the late-modern self
Authors: Hendrick Harry
Published: May 2017

The chapter offers an overview of what it argues is the contemporary obsession with the Self - not only to the detriment of others, but also to that of the human potential for a better nature. It argues, following Hobsbawm, that the problems of values and judgment have been reduced the 'single denominator of the unrestricted freedom of the individual'. Consequently, the decline of social democracy has witnessed the failure of the socialist Left to resist the dissipation of significant Enlightenment values. The chapter is in two parts, the first of which provides brief discussions of the 'postsocialist' condition and the politics of recognition, the self and identity politics, and individualisation as 'a fate not a choice'. In the second part, several critiques of the therapeutic culture are briefly discussed, particularly with reference to what have been termed 'pure relationships' and the 'emotive will' which, it is argued, are mistakenly used to protect the self against the 'bleak coldness' of contemporary life. The chapter concludes by arguing for the jettisoning of contractual parent-child relations and renewal of the idea of parental self-sacrifice as a means of helping children to grow up.
Love, sexuality, and (non)marriage
Authors: Hill Shirley A.
Published: May 2017

Slavery, segregation, and economic disadvantage have historically undermined the functionality and resilience of African-American families, and the post-industrial turn in the economy exasperated those difficulties. This chapter looks at the health consequences of the ‘love and trouble’ tradition between black men and women, especially in terms of non-marriage, loneliness, sexuality, sexual diseases, and unwanted pregnancies.
Youth work and youth violence in a European context
Authors: Seal Mike , Harris Pete
Published: May 2017

In this chapter, the authors present an outline of the philosophical underpinnings of youth work practice and discuss how youth work is conceived, organised and delivered in different member states, and specifically in those the authors encountered in their study (Germany, Austria and the UK). They then introduce their working definition of youth violence. The authors were keen to move beyond the narrow confines of conceptualisation of youth violence as ‘gang’ violence, partly because this is a heavily populated area of enquiry, but also because they recognised that youth workers will be engaging with young people whose experience of violence falls both within and outside of the bounded and contestable phenomenon of the ‘gang’.
Responding at the existential (E) level
Authors: Seal Mike , Harris Pete
Published: May 2017

This chapter posits that existentialist philosophy may present youth workers with an alternative framework for understanding some aspects of their practice when working with young people involved in violence. An existentialist perspective on choice, relationships and personhood could help to sustain workers facing the daunting challenge of bringing about some discernible change in offenders’ behaviour and ultimately their desistance from crime and violence. Workers should also encourage young people to take some solace from small, and again, symbolic achievements. Building on Baizerman’s (2001) work, the authors explore how workers need to encourage young people to look less at the chronology of their lives or events and instead emphasise the meaning that they put on their experiences. In the process, the authors highlight the possibilities presented to workers of two theoretical trajectories within existential practice, one rooted in Christian existentialist thought, and the other, less theistic in hue, that would place an emphasis on the responsibility that radical freedom brings.
Creating policy for good practice
Authors: Seal Mike , Harris Pete
Published: May 2017

In this chapter, the author discusses the impact of current trends within policymaking at national and European level. The author then posits that policymaking around youth violence should occur at a macro (national) and micro (local) level, employing regular ‘round tables’ to discuss the contribution of youth work. Youth workers and young people should be actively involved in these as part of a culture of research and reflection. Contracting and commissioning regimes should be minimised in order to facilitate strongly collaborative (rather than competitive) partnership-working cultures and other professional training courses should include sensitisation to youth work methodologies. Policy needs to be underpinned by a recognition that youth work offers a socio-educational approach to violence prevention that can respond at all the levels outlined in our model, including the structural. Finally, the chapter explores the politics of public space, arguing that policy should formally recognise the positive value of young people’s social mixing, especially in public space, and re-evaluate policies that discourage this mixing.
Responding to structural and symbolic violence: a comparative case study
Authors: Seal Mike , Harris Pete
Published: May 2017

In the chapter, the authors identify how workers in London are struggling to combat dominant modes of structural violence and then details a street-based youth work project in Graz, Austria that specifically targets symbolic and structural violence directed at young people in public space, through the use of symbolic acts of resistance.
A sports-based response to youth violence
Authors: Seal Mike , Harris Pete
Published: May 2017

This chapter critically examines a project in Cologne, Germany that exclusively uses sport to engage with young people and employs innovative delivery methods to respond to violence, such as the use of football and, notably, street based-boxing activities. Through the use of a detailed case study, the authors illustrate how sports such as boxing can, when delivered by a reflexive youth worker, create opportunities for young people to ‘play with the moment of escalation’ and become more reflexive too, thereby opening up possibilities to construct alternative identities.
Exploring ‘confrontational pedagogy’
Authors: Seal Mike , Harris Pete
Published: May 2017

This chapter details a therapeutic method developed in Germany to illustrate some of the contested theoretical and practical issues involved in violence reduction, especially the potential pitfalls of an overly person-centred approach. Through an analysis of some of the therapeutic and educational methods employed, the authors try to provide a stimulus for further debate as to what ‘constructive confrontation’ might look like within the context of youth work practice.