bluuebunny/crossref_metadata_2025 huggingface dataset:
An Assessment of Tonometry and Regional Splanchnic Blood Flow during Aortic Cross-Clamping in the Pig
Authors: Jacques T. , Morris R. , Lalak N. , Englund R. , Gibb D.
Published: January 2019

We aimed to evaluate the tonometer in the assessment of gastrointestinal ischaemia induced by an infrarenal aortic cross-clamp. Nine anaesthetized pigs were cannulated for haemodynamic monitoring and radionuclide labelled microsphere (RLM) injection. Gastric and sigmoid tonometers were positioned. After haemodynamic stabilization an infrarenal aortic cross-clamp was applied. Animals were sacrificed at the completion of the study and tissue sampled from the stomach and sigmoid colon for regional blood flow measurements. Measurements were made pre-clamp, post-clamp, pre-release and post-release. Haemodynamic parameters, gastric intramucosal pH (pHi) and blood flow did not change throughout the experiment. Arterial pH increased during cross-clamp and returned to baseline post-release. Arterial bicarbonate fell post release. Sigmoid blood flow fell during cross-clamp. The sigmoid pHi fall, delayed until pre-release, remained low post-release. Although there was a consistent fall in sigmoid pHi, 63% of post-clamp values remained within the baseline range. We conclude that maintaining haemodynamic parameters around baseline values resulted in maintenance of gastric mucosal perfusion as indicated by a steady gastric pHi. However, below the aortic cross-clamp, delay between change in sigmoid colon blood flow and change in pHi and wide variation in sigmoid pHi limits the value of an individual pHi measurement in detecting ischaemia.
Patient-Controlled Epidural Analgesia following Caesarean Delivery: A Comparison of Pethidine and Fentanyl
Authors: Goh J. L. , Evans S. F. , Pavy T. J. G.
Published: January 2019

Pethidine and fentanyl have both been used to provide patient-controlled epidural analgesia (PCEA) following caesarean delivery. Both have been compared with epidural morphine but these drugs have not been compared with each other. Patient-controlled epidural analgesia was used in a prospective, randomized, double-blind, cross-over trial to compare fentanyl and pethidine for postoperative epidural analgesia in women having elective caesarean deliveries. Two groups received either PCEA fentanyl or pethidine with a cross-over to the other drug after 24 hours. Results from 45 patients showed no difference in pain level outcomes, but pethidine scored better in all side-effects except for drowsiness at 48 hours. Patients were more satisfied with pethidine (P=0.015) and overall 65% of patients preferred pethidine. We conclude that pethidine is a suitable drug for patient-controlled epidural analgesia and leads to greater patient satisfaction than does fentanyl.
Review of Efficiencies and Patient Satisfaction in Australian and New Zealand Day Surgery Units: A Pilot Study
Authors: Rudkin G. E. , Bacon A. K. , Burrow B. , Chapman M. H. , Claxton M. , Donovan B. , Gibb D. , Weber L. S.
Published: January 2019

A pilot study was performed in eight Australasian day surgery facilities with a purpose of identifying common trends and differences. A prospective study was designed in which information was collected on 826 patients over a two-week period. Patients were well matched for age, anaesthetic type and mean surgical time. Three facility types were identified and results were statistically corrected for any differences that ASA status, age and surgical time may have made. Patient preoperative waiting time, recovery room times, delayed discharge time and unanticipated admission rates showed favourable outcome trends for free-standing facilities compared with hospital-integrated facilities where day patients had a shared recovery with inpatients. Similar trends were seen with patient opinions of waiting times and recovery periods. In summary, this pilot study has demonstrated the impact of different facility types on efficiencies and patient satisfaction both of which have important cost implications and relevance to those involved in continuous quality improvement processes in day surgery.
Attitudes and Practices of New Zealand Anaesthetists with Regard to Epidural and Subarachnoid Anaesthesia
Authors: Rodgers A. , Sage D. , Futter M. , Macmahon S.
Published: January 2019

A survey was conducted among 259 New Zealand specialist anaesthetists to assess attitudes and practices with regard to epidural or subarachnoid anaesthesia (ESA). Ninety-four per cent replied and virtually all of the respondents indicated that they performed ESA at some time. ESA was used by most anaesthetists for most patients undergoing major hip or knee surgery, abdomino-perineal resection, cystectomy, caesarean section or transurethral resection of the prostate. ESA was used in about half of patients undergoing abdominal aortic aneurysm repair, femoro-popliteal bypass or thoracotomy and there was marked variation between anaethetists in the frequency of using ESA for these procedures. There was broad consensus about the importance of a number of factors that might influence the decision to employ ESA; in particular that systemic sepsis and prolonged bleeding time were important contraindications and that patient preference and chronic lung disease were important indications. However respondents were equally divided as to whether they felt that recent myocardial infarction or congestive heart failure constituted indications or contraindications to ESA.
Inhaled Aerosolized Prostacyclin as a Selective Pulmonary Vasodilator for the Treatment of Severe Hypoxaemia
Authors: Van Heerden P. V. , Webb S. A. R. , Hee G. , Corkeron M. , Thompson W. R.
Published: January 2019

Two case reports are presented where inhaled aerosolized prostacyclin (IAP) was used to good effect as a selective pulmonary vasodilator. It was used in the treatment of a patient with severe hypoxaemia secondary to amniotic fluid embolism and for hypoxaemia secondary to the acute respiratory distress syndrome (ARDS) in a patient with acute on chronic liver failure and intra-abdominal sepsis. An apparent dose-response curve is demonstrated in the second case. A dose of IAP of 30–40 ng/kg/min produced an effect on oxygenation in the patient with liver failure equal to that seen at the maximal dose of (50 ng/kg/min). Reduction in dose below 30 ng/kg/min resulted in a deterioration in oxygenation towards baseline/pre-treatment levels. Inhaled aerosolized prostacyclin is a potent pulmonary vasodilator with little or no systemic hypotensive effect. It is simple to administer and would appear to be a viable alternative to inhaled nitric oxide.
Comparison of Patient-Controlled Epidural Analgesia with Patient-Controlled Intravenous Analgesia Using Pethidine or Fentanyl
Authors: Kee W. D. Ngan , Lam K. K. , Chen P. P. , Gin T.
Published: January 2019

We compared patient-controlled epidural analgesia (PCEA) with patient-controlled intravenous analgesia (PCIA) using pethidine or fentanyl in a randomized, double-blind crossover study of 80 patients after caesarean section. Patients received pethidine by PCEA or PCIA, or fentanyl by PCEA or PCIA, with a crossover of the route of administration at 12h.

For pethidine, pain scores were lower with PCEA vs PCIA from 4 to 16 h (P<0.05). Pethidine consumption was lower with PCEA vs PCIA from 12 to 24 h (P=0.0005). Patients preferred PCEA to PCIA (P=0.015). For fentanyl, pain scores were lower with PCEA vs PCIA at 12 h (P=0.045). Fentanyl consumption was lower with PCEA vs PCIA from 0 to 12 h (P=0.0007). Patients had similar preference for PCEA and PCIA. Pain scores and side-effects were similar between drugs. Plasma pethidine was similar between groups. Plasma fentanyl was higher with PCIA vs PCEA at 12 h (P=0.002). PCEA has advantages over PCIA and pethidine may be the preferred drug.
Mivacurium in Daycase Surgical Patients
Authors: Cade L. , Kakulas P.
Published: January 2019

Laparoscopy is commonly performed as a daycase procedure and requires satisfactory but brief and readily reversible muscle relaxation with good intubating conditions. We have examined the use of the new nondepolarizing muscle relaxant, mivacurium, in this setting and compared it with the two most commonly used such drugs in day surgery, atracurium and vecuronium, in a prospective randomized trial of 107 patients. Mivacurium provided a significantly more rapid onset and briefer duration of muscle relaxation, which was readily reversible with or without pharmacological antagonism.
Charging for Intensive Care using Direct Nursing Hours as the Cost Marker
Authors: Havill J. H. , Caspari M. , McConnell H. , Alexander M. , Montgomery C.
Published: January 2019

The hypothesis that direct nursing hours correlate with the cost of a patient stay in intensive care was tested.

One hundred and thirty-nine patients were studied and the data collected included: (a) direct nursing hours applied to each patient; (b) a daily TISS score: (c) a detailed costing of each patient (all costs are shown in N.Z.$).

There was a strong correlation between the direct nursing hours and the total cost per patient (r2=0.98) (total cost=54xdirect nursing hours+344). Also a strong correlation existed between the total TISS scores and the total costs per patient (r2=0.96) (total cost=67.13xTISS).

Direct nursing hours offer a relatively simple and logical method of allocating costs per patient.
The Role of the Anaesthetist during the Transjugular Intrahepatic Porto-Systemic Stent Shunt Procedure (TIPPS)
Authors: Kam P. C. A. , Tay T. M.
Published: January 2019

A retrospective review of the clinical experience associated with the transjugular intrahepatic porto-systemic stent shunt procedure revealed that there was a potential for life-threatening critical incidents to occur. Adequate stabilization and facilities for advanced monitoring and resuscitation by skilled personnel are essential.
Amrinone Improves Right Ventricular Ejection Fraction and Oxygen Delivery without Deterioration of Extravascular Lung Water in Canine Oleic Acid Pulmonary Injury
Authors: Ishikawa S. , Nakazawa K. , Yokoyama K. , Amaha K.
Published: January 2019

Fourteen mongrel dogs were anaesthetized and mechanically ventilated with oxygen. After oleic acid was administered intravenously, amrinone 1 mg/kg was intravenously administered to one group followed by a continuous infusion of 10 μg/kg/min for one hour (amrinone group, n = 7). Isovolumetric saline was administered to the control group (n = 7). Amrinone slightly lowered PaO2 but significantly increased oxygen delivery and improved gastric intramucosal pH (pHi) during the first 30 minutes (7.33±0.13) compared with the control group (7.21 ±0.06, P<0.05). The pHi remained higher in the amrinone group (7.30±0.15) than in the control group (7.16±0.06, P<0.05) after the drug was withdrawn. Extravascular lung water was significantly augmented after oleic acid injection and sustained in all animals for the remainder of the study.
Reinforcing a “Low Flow” Anaesthesia Policy with Feedback Can Produce a Sustained Reduction in Isoflurane Consumption
Authors: McKenzie A. J.
Published: January 2019

A three-month audit of isoflurane consumption at Palmerston North Hospital in 1994 showed an averaged vapour flow rate of approx 85 ml per minute of anaesthesia, equivalent to 1.4% isoflurane at six litres per minute. After purchasing volatile agent analysers, a program encouraging low flow anaesthesia and providing a report of the previous month's consumption rate was started in July 1996. The isoflurane averaged vapour flow rate was tracked over the following twenty-month period and fell by a sustained 65% to range around 30±5 ml/min, producing savings of approximately NZ$104,000 over this period.
Screening Tests for Predicting Difficult Intubation. A Clinical Assessment in Turkish Patients
Authors: Bilgin H. , Özyurt G.
Published: January 2019

Three methods of predicting difficult intubation were compared prospectively. Mallampati test, Wilson risk-sum and thyromental distance were determined preoperatively and laryngeal views were graded in 500 patients. The sensitivities, specificities, positive and negative predictive values of each test were calculated. The incidence of difficult intubation was found to be 8%. The sensitivities of the Mallampati test, the Wilson risk-sum and the thyromental distance were 43%, 58% and 35% respectively, and the specificities were 93%, 91% and 95% respectively. Significant differences were seen between the sensitivities of the Mallampati test and the Wilson risk-sum (P<0.001), the Wilson risk-sum and the thyromental distance (P<0.001), the Mallampati test and the thyromental distance (P<0.05). Among the different specificities, the only significant difference was observed between the Wilson risk-sum and the thyromental distance (P<0.05). There were no significant differences between the positive and negative predictive values of the three screening tests (P>0.05). In conclusion, the Wilson risk-sum was the most sensitive test and the thyromental distance has the highest positive predictive value for difficult intubation.
Effect of Nutritional Status on Vecuronium Induced Neuromuscular Blockade
Authors: Sinha S. , Jain A. K. , Bhattacharya A.
Published: January 2019

Based on simple clinical and biochemical parameters of nutritional status, seventy adult patients scheduled for elective surgery under general anaesthesia were categorized as having normal nutrition, mild, moderate or severe malnutrition or obesity Under anaesthesia, evoked responses on train-of-four nerve stimulation were recorded every 15 seconds on a mechanomyograph. Vecuronium 0.1 mg.kg-1 was used to achieve neuromuscular blockade. Compared with patients having normal nutrition, the time to onset of action was significant& prolonged in the moderate and severely malnourished groups; the time to no response on train-of-four stimulation was delayed only in severely malnourished groups (P<0.001). The duration of action of the initial dose was shorter in the moderate and severely malnourished groups. The obese group had an earlier onset of action and a longer duration of action compared with patients of normal nutrition (P<0.001). No significant difference in recovery time to a train-of-four ratio of 0.70 was observed between the malnourished and patients with normal nutrition. Malnutrition hus a marked effect on vecuronium-induced neuromuscular blockade.
Problems Associated with Nursing Staff Shortage: An Analysis of the First 3600 Incident Reports Submitted to the Australian Incident Monitoring Study (AIMS-ICU)
Authors: Beckmann U. , Baldwin I. , Durie M. , Morrison A. , Shaw L.
Published: January 2019

Although many studies have attempted to define appropriate nursing staff levels, allocation and patient dependency, minimal data is available on the effect of nursing staff shortage (NSS) on quality of care provided in intensive care. This study aimed to identify incidents associated with staff shortage as reported to the Australian Incident Monitoring Study-ICU (AIMS-ICU) project and to assess their estimated effect on patient outcome. A search of narrative keywords and contributing factors identified 89 nursing staff shortage incidents (NSS-INCIDENTS) and 373 incidents involving nursing staff shortage contributing factors (NSS-CF). NSS resulted from inappropriate rostering for current patient load (81%) and inability to respond to increased unit activity (19%). Most frequent associated incidents included problems with: drug administration/documentation (47), patient supervision (20), set-up of ventilators/ equipment (16), and accidental extubation (14). Undesirable patient outcomes included: major physiological change (22%), patient/relative dissatisfaction (12%), and physical injury (3%). This study suggests that inadequate staffing results in incidents and compromised patient safety.
Labour Ward Midwifery Staff Epidural Knowledge and Practice
Authors: Vandendriesen N. M. , Lim W. , Paech M. J.
Published: January 2019

A survey was conducted amongst labour ward midwives at our hospital to evaluate education, knowledge and attitudes toward the management of epidural analgesia in labour.

Sixty of 80 distributed forms were returned, giving a 75% response rate. Forty-two per cent of respondents had more than ten years’ practice experience. Only 51% achieved a predetermined pass score for knowledge about epidural analgesia. Though most had received formal education about epidural analgesia, 35% felt postgraduate education was insufficient.

A majority of midwives supported epidural analgesia on demand (78%), during established labour (74%), or for women at increased risk of caesarean section (82%). Midwives with lower knowledge levels were more likely to recommend epidural analgesia early in labour to multiparous women (P=0.001) and to women with either a small or a large baby (P=0.06). The majority of midwives (93%, 70% and 65%) would “almost always” top-up women with cardiac or medical diseases, multiple pregnancy or hypertensive disease, respectively.

A clear requirement for ongoing education, with input from the anaesthetic department, was identified, irrespective of personal experience. Practice patterns are discussed and recommendations made with respect to improvement of epidural analgesia management and continuing education.
Physiological Deadspace during Normocapnic Ventilation under Anaesthesia
Authors: Puri G. D. , Singh H. , Kaushik S. , Jindal S. K.
Published: January 2019

Respiratory physiological deadspace (VDphys) during normocapnic ventilation under anaesthesia was studied in 253 patients scheduled for elective non-thoracic surgery. Subjects were ventilated with SERVO 900B ventilator using CO2 analyser 930 (Siemens-Elema Sweden) to adjust minute volume sufficient to maintain end-tidal carbon dioxide fraction (FΈ CO2) around 5.5kPa with normocapnic confirmation using arterial blood gas analysis. VDphys was calculated using Enghoff's modification of Bohr's equation. VDphys and deadspace to tidal volume ratios (VD/VT) in male patients were 142.6±28.4 ml and 0.37±0.068 respectively and were significantly higher than that in females (119.4±35.6 ml and 0.36±0.067). Males had significantly higher VDphys/mass (2.5±0.68 ml.kg) compared with females (2.2±0.54 ml/kg, P<0.001) but significantly lower body mass index (BMI) (20.67±3.2 in males and 22.47±4.1 in females, P<0.001). VDphys showed positive correlation with weight, height and body surface area (BSA) but VDphys/kg showed negative correlation with BMI. Multiple regression analysis produced a best fit equation for VDphys=9.7+64.3 2BSA+13.51S where S=1 for females and 2 for males.
Incidence and Predictors of Central Venous Catheter Related Infection in Intensive Care Patients
Authors: McKinley S. , Mackenzie A. , Finfer S. , Ward R. , Penfold J.
Published: January 2019

This study investigated the incidence of and risk factors for central venous catheter (CVC) infection in intensive care. CVCs were prospectively studied in patients who had lines inserted in general or neurosurgical intensive care and were expected to have the line in situ for at least 72 hours. Catheters (n=119) were cultured for CVC-related infection (CRI; >15 colony forming units) and blood cultures done when indicated. CRI was identified in 32 (26.9%) catheters, CVC related bacteraemia in five cases (4.2%) and CVC related sepsis in none. After adjustment for duration of catheterization, independent predictors of CVC related infection were catheter insertion site, with jugular sites having the highest risk, and primary diagnosis, with neurosurgical patients at least risk.
Alfentanil Co-induction for Laryngeal Mask Insertion
Authors: Ang S. , Cheong K. F. , Ng T. I.
Published: January 2019

We assessed the effect of two different doses of alfentanil (5 and 10 μg.kg–1) on the conditions for laryngeal mask airway insertion in ASA 1 and 2 patients who received propofol for induction of anaesthesia. One hundred and fifty unpremedicated patients were randomly allocated to receive either propofol 2.5 mg.kg–1 only (Group P), alfentanil 5 μg.kg–1 and propofol 2.5 mg.kg–1 (Group A5), or alfentanil 10 μg.kg–1 and propofol 2.5 mg.kg–1 (Group A10). The addition of alfentanil to propofol resulted in a greater ease of insertion and a better quality of airway patency. Pretreatment with alfentanil also resulted in a significantly higher success rate during the first attempt at inserting the laryngeal mask airway compared with Group P (Group P 58%, Group A5 96%, Group A10 94%). Patients in Group P were apnoeic for a mean(±SD) time of 3.3(±1.9) min, 4.71(±2.2) min in Group A5, and 7.32(±4.3) min in Group A10. The use of alfentanil 10 μg.kg–1 with propofol, however, led to a significant decrease in mean arterial pressure and heart rate. We concluded that pretreatment with intravenous alfentanil 5 μg.kg–1 prior to propofol provides excellent conditions for insertion of laryngeal mask with minimal adverse haemodynamic changes.
Chronic Subdural Haematoma following Caesarean Section under Spinal Anaesthesia
Authors: Akpek E. A. , Karaaslan D. , Erol E. , Caner H. , Kayhan Z.
Published: January 2019

Intracranial subdural haematoma is a rare complication of spinal anaesthesia. This report describes the case of a 31-year-old woman who presented with post partum headache following spinal anaesthesia for caesarean section. Bilateral haematomata were evacuated via burr-holes performed under total intravenous anaesthesia and the patient made a complete and uneventful recovery. The recognized causes of subdural haematoma are discussed.
Work of Breathing Measurement in the Critically Ill Patient
Authors: French C. J.
Published: January 2019

Weaning patients from mechanical ventilation in the intensive care unit can be difficult. In patients requiring prolonged ventilatory support it has been demonstrated that conventional weaning criteria are frequently incorrect. In this group measurement of respiratory work may be of benefit. Until recently, estimation of the work of breathing in patients receiving mechanical ventilation was logistically difficult. The availability of a computerized bedside monitoring device potentially allows easier estimation of the work of breathing at the bedside. The results of preliminary studies utilizing such monitoring are provocative: they highlight the phenomenon of nosocomial respiratory failure and challenge our clinical ability to determine patient workloads and timing of extubation. The potential benefits of work of breathing measurement, in particular the avoidance of respiratory muscle fatigue, earlier extubation, reduced duration of mechanical ventilation, reduction in ICU and hospital length of stay, and most importantly, a reduction in patient morbidity are yet to be demonstrated and concerns still exist about the monitor's accuracy.
Pulmonary Mechanics in Patients with Prolonged Mechanical Ventilation Requiring Tracheostomy
Authors: Lin M. C. , Huang C. C. , Yang C. T. , Tsai Y. H. , Tsao T. C. Y.
Published: January 2019

This study was performed to assess the changes in pulmonary mechanics before and after tracheostomy in patients with prolonged mechanical ventilation and to detect pre-tracheostomy physiologic factors that predict the outcome of weaning from mechanical ventilation. Pulmonary mechanics were recorded before and after tracheostomy in 20 patients. Work of breathing, mean airway resistance and pressure/time product showed no significant differences after tracheostomy. Peak inspiratory pressure was significantly reduced (pre 33.4±11.8 vs post 28.6±9.2 mmHg). There was no difference in age or duration of mechanical ventilation between two different groups according to the outcome (weaned and not-weaned). Pre-tracheostomy intrinsic positive end expiratory pressure (PEEPi) was significantly lower in the weaned group (1.1±1.6 vs 2.7±1.4 mmHg). A significant difference was also found in pre-tracheostomy compliance (Cstatic) (47.3±36.9 vs 28.8±16.5 ml/cmH2O). We concluded that tracheostomy changed pulmonary mechanics very little except for a fall in peak inspiratory pressure. Patients who had better underlying lung mechanics (higher Cstatic and lower PEEPi) had better chances of weaning from mechanical ventilation after tracheostomy.
Obstructive Suprastomal Granulation Tissue following Percutaneous Tracheostomy
Authors: Benjamin B. , Kertesz T.
Published: January 2019

Percutaneous dilatational tracheostomy is frequently performed as an alternative to traditional surgical open tracheostomy with many reported benefits. Despite its relative safety and widespread acceptance, complications can be associated with the procedure itself or long-term. We present four cases where there was difficulty with decannulation because of exuberant obstructive granulation tissue. In each case, the percutaneous tracheostomy involved the cricoid cartilage.
A Comparison of Patient Controlled Epidural Pethidine versus Single dose Epidural Morphine for Analgesia after Caesarean Section
Authors: Fanshawe M. P.
Published: January 2019

This double-blind, randomized study of analgesia after caesarean section compared patient controlled epidural analgesia with pethidine (15 mg of a 0.25% solution and a 10 minute lockout period) versus a single bolus of epidural morphine 4 mg. Data were collected on 78 patients at 2, 6, 8, and 24 hours postoperatively and analysed using the Wilcoxon rank sum test. Satisfactory analgesia and nausea/vomiting during the first twenty-four hours did not differ between the two groups. The incidence of pruritus (P<0.001) was lower in the pethidine group at 2, 6, and 8 hours, with no difference by 24 hours. Therefore PCEA pethidine provides a useful alternative to single-dose morphine after caesarean section, particularly in those patients who have suffered severe morphine-induced pruritus previously.
Suxamethonium and Critical Illness Polyneuropathy
Authors: Hughes M. , Grant I. S. , Biccard B. , Nimmo G.
Published: January 2019

Administration of suxamethonium to patients with critical illness polyneuropathy may produce life-threatening hyper-kalaemia. A questionnaire to assess the awareness of this problem was sent to all UK intensive care units. A clinical scenario suggestive of critical illness polyneuropathy was accompanied by a list of possible drugs used to facilitate endotracheal intubation. Most respondents (68.7%) chose suxamethonium while 20.4% avoided any muscle relaxant. This result suggests a worrying lack of appreciation of the dangers of suxamethonium use in critical illness polyneuropathy.
Epidural Abscess in an Obstetric Patient
Authors: Collier C. B. , Gatt S. P.
Published: January 2019

Epidural abscess is a rare complication of epidural block and occasionally presents in the post partum period. A case is described where a thoracolumbar abscess presented with backache and headache 10 days after an apparently uneventful block for labour and caesarean section. The abscess was treated medically with a satisfactory outcome. The literature is reviewed in order to assess several recent reports of infectious complications of epidural block in obstetric patients.
Ontology-Based Knowledge Management System for Digital Highway Construction Inspection
Authors: Xu Xin , Yuan Chenxi , Zhang Yuxi , Cai Hubo , Abraham Dulcy M. , Bowman Mark D.
Published: January 2019

Inspection is critical to ensuring the quality of infrastructure construction. In recent years, state highway agencies (SHAs) have been facing the challenge of a shortage of experienced inspectors due to retirements, workforce downsizing, and resignations to take jobs in the private sector. There is a critical need to retain and manage the accumulated construction inspection knowledge (what, when, and how to inspect) and integrate this knowledge into the construction business process. This paper presents an ontological approach to managing inspection knowledge and the development of a risk-based digital inspection system integrated with the construction process. The developed system consists of five knowledge compartments: inspection activities prioritized based on risk; activity-centered pay items; inspection check items; detailed checks that include priority, frequency, object, attribute, and acceptance criteria; and training materials (optional). This risk-based system is designed to align with the construction process by connecting an activity to a pay item and that pay item to a check item, resulting in an automatically generated comprehensive inspection checklist for the activity. The optional training materials are designed to train inspectors in real time on an as-needed basis. Since risk is embedded in every knowledge compartment, this system not only automates and retains the inspection knowledge but also enables SHAs to allocate their limited resources to the most critical items. This system is currently being implemented by the Indiana Department of Transportation as a digital inspection protocol integrated in its e-construction process.
Short-term Changes After Corticosteroid Injections Into the Normal Tendons of Rabbits: A Controlled Randomized Study
Authors: Dinhane Kandir Genesio Innocenti , Godoy-Santos Alexandre Leme , Fabro Alexandre Todorovic , Moretto Maria Regina , Deprá Igor , Yoshida Winston Bonetti
Published: January 2019

Background:

Corticosteroid injections in or around tendons for the treatment of athletic injuries are a common practice among orthopaedic surgeons and are apparently efficacious in the short term, although controversies persist related to local complications.

Purpose:

This study evaluated short-term (48 hours) biomechanical, biochemical, and histological alterations after a single injection of betamethasone into the normal tendons of rabbits.

Study Design:

Controlled laboratory study.

Methods:

A total of 72 New Zealand White rabbits were randomly divided into 2 groups: the test group—in which 36 animals underwent 1 intratendinous injection of betamethasone (1.4 mg / 0.2 mL) in the right calcaneal tendon; the control group—in which the right calcaneal tendon of 36 animals was injected with saline (placebo control group) and the left calcaneal tendon was left untreated for normal standards (normal control). Forty-eight hours later, animals were euthanized and tendons were harvested. Metalloproteinase (MMP1 and MMP2) and interleukin (IL1 and IL6) expression levels, biomechanical resistance (load × elongation parameters), and histomorphometry (hematoxylin and eosin and picrosirius red stains for collagen fibers, tenocytes, and inflammatory cells) were analyzed in the tendons.

Results:

The test group had a significant reduction in MMP2 expression as compared with the control groups ( P = .027). Regarding the other parameters, there were no additional significant differences between the groups.

Conclusion:

A single injection of corticosteroid into normal calcaneal tendons did not trigger acute local morphological, structural, or biomechanical injuries at 48 hours, but it did promote a significant decrease in MMP2 levels. Additional studies are needed with increased duration of follow-up, various doses, and multiple injections and in tendinopathic models.

Clinical Relevance:

Some previous studies demonstrated early structural changes in tendons after a single corticosteroid injection, which was not corroborated by the present study. Metalloproteinase decrease is usually associated with a reduction in collagen degradation, which would be protective for the healing process. More studies are necessary to confirm the possible beneficial effect of these results in the long term and for tendinopathies.
A pilot study investigating the effect of pedalling exercise during dialysis on 6-min walking test and hand grip and pinch strength
Authors: Desai Manasi , Mohamed Ahmed , Davenport Andrew
Published: January 2019

Introduction:

Haemodialysis patients are at an increased risk of sarcopenia. Physical inactivity is now recognised as a major cause of muscle wasting in haemodialysis patients. It is unclear as to what and how much exercise is required to show benefit. We therefore performed a pilot study of cycling during haemodialysis.

Methods:

Patients underwent a progressive submaximal individualised cycling exercise, 3× a week during haemodialysis for 4 months using bed-cycle ergometers. Body composition was measured by multifrequency segmental bioimpedance and muscle function by 6-min walking test, and hand grip strength and pinch strength.

Results:

In total, 56% of patients in a dialysis centre fulfilled exercise study inclusion criteria and 13 (72.2%) of 18 patients completed the exercise programme, with the mean age of 64.0 ± 16.6 years and 76.9% being male. The 6-min walking test increased following exercise from 349 ± 105 to 398 ± 94.2 m, p < 0.05, as did both hand grip strength and pinch strength, with 20.4 ± 9.1 versus 23.4 ± 9.9 kg, p < 0.01, and 4.3 ± 1.8 versus 5.9 ± 2.4 kg, p < 0.05, respectively. There were no changes in appendicular muscle mass or other body composition detected with bioimpedance in either the exercise group, or 21 control patients, propensity matched for body composition, comorbidity and frailty. Muscle strength did not change in the control group. Haemodialysis sessional Kt/Vurea was greater at the end of the exercise programme compared to controls (1.63 ± 0.63 vs 1.21 ± 0.12, p < 0.01).

Conclusion:

The majority of dialysis centre patients met our exercise study entry criteria and could potentially benefit from cycling during haemodialysis. We found that muscle function and strength improved after a 4-month, thrice weekly cycling exercise programme.
Clinical effects of hemoadsorption with CytoSorb® in patients with severe acute pancreatitis: A case series
Authors: Tomescu Dana , Popescu Mihai , David Corina , Dima Simona
Published: January 2019

Hemoadsorption using CytoSorb® has recently gained attention as a new therapy aimed at modulating the inflammatory response syndrome in critically ill patients. The aim of our study was to assess the clinical effects of CytoSorb in patients with severe acute pancreatitis. We prospectively included 12 patients admitted to the intensive care unit for severe acute pancreatitis. After inclusion, continuous venovenous hemodiafiltration in conjunction with CytoSorb was applied. Clinical data, number of organ dysfunctions, paraclinical data, and vasopressor support were collected before and after the treatment. The use of CytoSorb was associated with a decrease in C-reactive protein from 242 (30, 300) to 180 (20, 252) mg/L (p = 0.04) and procalcitonin from 2.21 (0.01, 15.02) to 1.10 (0.01, 3.79) ng/mL (p = 0.02). The median vasopressor support was 0.1 (0, 0.9) mg/h at the beginning of the treatment and it was discontinued in all cases after the treatment. In conclusion, the use of CytoSorb in patients with severe acute pancreatitis was associated with improved hemodynamics and decreased inflammatory markers.
Emergency at sea. Wading through the chaos of emotions
Authors: Del Bono Diletta
Published: January 2019

This article draws attention to the advantages of applying the theoretical model of the experiential group in particularly critical conditions, such as those dictated by a state of emergency, as a means of addressing an urgent need by putting up a sort of decompression chamber for emotional residues derived from the difficult and sometimes extreme work situations experienced by the participants.

The shared participation in the unwholesome experience unites and creates familial bonds, and is infectious, giving back a universal language for the encounter with other cultures that are unknown to us. Not only that, the state of emergency gives rise to another form of language, the language of meaningful action, where doing as an institutional practice—acting together to save human lives—allows the structuring and consolidation of a sense of identity to which the strong ‘esprit de corps’ emerges, also told by the crew as the experiential groups bears witness.
Emotionally Engaged Civil Servants: Toward a Multilevel Theory and Multisource Analysis in Public Administration
Authors: Levitats Zehavit , Vigoda-Gadot Eran
Published: January 2019

Excellent public services build on excellent civil servants who are both emotionally intelligent and engaged in their work. This article proposes a conceptual framework for a better understanding of the relationship between public employees and their complex workplaces. We focus on the engagement of civil servants, the role of managers’ and employees’ emotional intelligence, and on employees’ public service motivation (PSM) to provide better services to citizens. We develop three major propositions: (a) the positive effect of employees’ emotional intelligence on their engagement, (b) the moderating effect of managers’ emotional intelligence on the relationship between their employees’ emotional intelligence and engagement, and (c) the moderating effect of employees’ PSM on the relationship between public servants’ emotional intelligence and their engagement. Our conceptual framework may set the stage for future research on civil servants’ engagement and emotional intelligence and their aggregate impact on the quality of government actions and services.
Work–Life Program Participation and Employee Work Attitudes: A Quasi-Experimental Analysis Using Matching Methods
Authors: Kim Sun Young , Lee David
Published: January 2019

Work–life programs (WLPs) have been widely adopted and implemented by public organizations as a means of providing employees with greater choices and flexibility in coordinating their work and personal lives. Although previous research has shown that these programs are positively related to various employee attitudes and behaviors, empirical evidence about whether and how such relationships vary by type of WLP is relatively scant. In this study, we categorize WLPs into two different types—work-oriented and life-oriented programs—and explore whether and how participating in distinct types of WLPs has varying impacts on employee work attitudes. A series of Mahalanobis distance matching is conducted using data from the 2011 Federal Employee Viewpoint Survey. The results indicate that the use of life-oriented programs has a positive and substantive impact on employee satisfaction and commitment, while the effect of participating in work-oriented programs is not statistically significant.
Factors Shaping Second Language Acquisition Among Adult Mexican Immigrants in Rural Immigrant Destinations
Authors: Albarracin Julia , Cabedo-Timmons Guadalupe , Delany-Barmann Gloria
Published: January 2019

This article investigated the intrinsic, extrinsic, and integrative orientations shaping reading and speaking English skills among adult Mexican immigrants in two gateway communities in Illinois. Intrinsic orientations refer to reasons for second language (L2) learning derived from one’s inherent pleasure and interest in the activity. Extrinsic orientations refer to reasons that are instrumental to some consequence. In turn, integrative orientation refers to social identity issues that are addressed by neither the intrinsic nor the extrinsic orientations. Findings indicated that whereas extrinsic and integrative orientations influenced English language skills, intrinsic orientations did not. More specifically, immigrants had multiple extrinsic reasons to be motivated to learn the language, including succeeding in the United States, finding (better) jobs, and communicating with health providers, bank tellers, and grocery store employees. In turn, both quantitative and qualitative analyses showed that closeness and openness toward L2 group influenced the desire to learn the language.
First In Situ Identification of Ultradian and Infradian Rhythms, and Nocturnal Locomotion Activities of Four Colonies of Red Wood Ants (Formica rufa-Group)
Authors: Berberich Gabriele M. , Berberich Martin B. , Ellison Aaron M. , Grumpe Arne , Wöhler Christian
Published: January 2019

In situ activity patterns of 2 Formica rufa-group species ( F. pratensis; F. polyctena) were continuously studied at 4 different red wood-ant nests for 6 months in each of the years 2010, 2011, 2012, and 2016 and related to weather factors and variations in the Earth’s magnetic field. The in situ activity patterns of both species were similarly periodic and exhibited ultradian, and short- and long infradian rhythms under natural LD conditions. Crepuscular and nocturnal activities shorter than or equal to 4 h were observed in both species, especially at the new moon and first quarter after the astronomical twilight in a period of darkness in fall. We hypothesize that local variability in the Earth’s magnetic field affects these long-term activity patterns, whereas humidity and temperature were more strongly associated with ultradian rhythms (less than 20 h).
Une application de la méthode d’analyse en groupe en contexte urbain burkinabé
Authors: Konaté Blahima , Berthé Abdramane , Hien Hervé M. , Tou Fatoumata , Drabo Maxime K. , Franssen Abraham
Published: January 2019

En Afrique subsaharienne, les méthodes qualitatives, de plus en plus utilisées, privilégient l’entretien individuel, le focus group, le récit de vie et l’observation. La méthode d’analyse en groupe, née en Europe, y a été récemment mise en œuvre. L’objet de cet article est de documenter une expérience d’application de cette méthode en contexte urbain burkinabè à travers l’analyse d’un récit portant sur la démence d’une personne âgée. Concrètement, après avoir décrit la méthode, nous avons d’abord examiné sa particularité. Ensuite, nous avons mis en exergue sa pertinence dans le contexte burkinabè ainsi que quelques enjeux méthodologiques. Enfin, nous avons présenté l’analyse en groupe du récit, qui soulève les enjeux liés à l’interprétation de la démence du « Vieux », à l’appréciation de l’attitude de son fils et de la femme de ce dernier à la re-cohabitation intergénérationnelle.
Clinical Trial Assessment of Intermittent and Continuous Infusion Dose of N-Acetylcysteine on Redox Status of the Body in Patients with Sepsis Admitted to the ICU
Authors: Peivandi Yazdi Arash , Razavi Majid , Sheikh Shahrzad , Boroumand Nadia , Salehi Maryam , Hashemy Seyed Isaac
Published: January 2019

Purpose:

Conflicting results exist regarding the efficacy of N-acetyl cysteine (NAC) in sepsis treatment. A pivotal factor affecting the therapeutic potency of NAC in sepsis is timing and dosing of its infusion. We aimed to assess the effect of NAC on redox status of patients with sepsis and to compare its efficacy in intermittent and continuous infusion with the objective of developing the infusion regimen and optimizing the timing.

Materials and Methods:

A prospective, randomized clinical trial was designed to compare the antioxidative effect of NAC in intermittent infusion group (IV: 25 mg/kg bolus and then 25 mg/kg/8 hours 3 times) and continuous infusion group (IV: 25 mg/kg bolus and then 75 mg/kg over 24 hours) in 60 critically ill patients with sepsis (20 patients in each group). Blood samples were collected immediately before and after intervention for total antioxidant capacity (TAC) and malondialdehyde (MDA) assessment.

Results:

N-acetyl cysteine considerably increased TAC levels in both intermittent (0.68 ± 0.60; P value = .036) and continuous (0.69 ± 0.64; P value = .015) infusion groups when compared to placebo (0.61 ± 0.10); however, the difference in TAC levels between the intermittent and the continuous infusion did not reach statistical significance ( P value = .942). Likewise, NAC treatment decreased MDA levels in both intermittent (19.45 ± 4.18; P value = 0.001) and continuous (22.47 ± 6.68; P value = .002) infusion groups when compared to placebo (31.76 ± 11.06), while the difference in MDA levels between the intermittent and the continuous infusion did not reach statistical significance ( P value = .481).

Conclusion:

Our data confirmed the antioxidative effect of NAC treatment in patients with sepsis, with no significant difference in intermittent and continuous infusion.
From Volume to Value: Helping Physicians Understand New Compensation Strategies
Authors: Flannery Thomas P.
Published: January 2019

Physician compensation is going through a fundemental transition based on changing healthcare economics, employer desires to better control outcomes of cost and quality, and third parties (insurers and benefits administrators) as well as consumer expectations. The “outcome” focus is profound and shifts risk from employers and third paries to hospitals and physicians. Redesigning of physician compensation requires significant care to ensure the proper behaviors are rewarded and physicians aligned with the desired outcomes.
On Voluntariness in Wellness: Considering Organizational Health Contingent Incentives
Authors: Terry Paul E.
Published: January 2019

Some would argue that if taking an examination to receive an incentive is not mandatory, it’s voluntary no matter the size of the monetary reward. Others have concerns with how often employers use the word “required” when communicating how employees can earn an incentive. This in spite of clear rules that indicate “health contingent” incentive designs (those based on health measures rather than on completing activities) are an either/or proposition. That is, you can either earn (this amount) by (achieving a clinical standard) or by (participating in or attaining an alternative standard). This editorial examines the merits and demerits of organizational health contingent use of incentives. It is posited that employers can best satisfy a voluntariness standard in their use of financial incentives in wellness programs when the use of incentives are well integrated into a measurably robust, organizational culture that visibly values health; and when all employees are well versed in the meaning of, and opportunities for, reasonable alternatives for earning an incentive. Concerns about the administrative burden behind this idea and other potential unintended consequences of including measures of a culture of health to meet a voluntariness standard are also presented.
The Clinical Utility of the TYM and RBANS in a One-Stop Memory Clinic in Singapore: A Pilot Study
Authors: Dong YanHong , Ling Melissa Tan Yi , Ng Kelly Ee Teng , Wang Aijing , Wan Esther Yee Shuang , Merchant Reshma A. , Venketasubramanian Narayanaswamy , Chen Christopher Li-Hsian , Mahendran Rathi , Collinson Simon Lowes
Published: January 2019

Background:

We aimed to examine the discriminant validity of a brief self-administered cognitive screening test, the Test Your Memory (TYM) and a brief neuropsychological test, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), supplemented with executive and language tests (Color Trail Test [CTT] and modified Boston Naming Test [mBNT], respectively), in detecting cognitive impairment (CI) in a one-stop memory clinic in Singapore.

Methods:

Ninety patients ≥50 years old with a diagnosis of no cognitive impairment, mild cognitive impairment, and mild Alzheimer disease were recruited from memory clinic. They received the TYM, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), RBANS, CTT, mBNT, and a gold-standard formal neuropsychological test battery.

Results:

The TYM had a significantly larger area under the curve (AUC) than MMSE (0.96 vs 0.88, P = .03) and was equivalent to MoCA in detecting CI (0.96 vs 0.95, P = .80). At the optimal cutoff points, the TYM (<38) was significantly more sensitive than the MMSE (<24) and MoCA (<20; P < .001). The RBANS had an AUC equivalent to the RBANS supplemented with CTT and mBNT (0.92 vs 0.86, P = .22) in detecting CI. The RBANS supplemented with CTT and mBNT was more sensitive than RBANS alone in detecting CI (sensitivity: 0.98 vs 0.93, P = .016) among patients screened negative using TYM.

Conclusion:

The self-administered TYM is superior to MMSE and equivalent to MoCA in detecting CI and could be implemented routinely. The RBANS supplemented with CTT and mBNT is more sensitive in detecting CI than RBANS alone therefore could be used for diagnostic purposes.