bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal diabetes affects specific extracellular matrix components during placentation
Authors: Giachini F. R. C. , Carriel V. , Capelo L. P. , Tostes R. C. , Carvalho M. H. , Fortes Z. B. , Zorn T. M. , San Martin S.
Published: September 2010

During embryo implantation, invasive trophoblast cells mediate embryo invasion into the decidualized stroma, forming a rich network of lacunae that connect the embryonic tissues to the maternal blood vessels. Placentation is probably guided by the composition and organization of the endometrial extracellular matrix. Certain pathological conditions that occur during pregnancy, including diabetes, have been linked to abnormal placental morphology and consequent fetal morbidity. We used immunoperoxidase techniques to identify members of the collagen, proteoglycan and glycoprotein families in the various compartments of the rat placenta and to determine whether experimentally induced diabetes affects placental morphology and alters the distribution of these molecules during pregnancy. Single injections of alloxan (40 mg kg−1 i.v.) were used to induce diabetes on day 2 of pregnancy in Wistar rats. Placentas were collected on days 14, 17, and 20. Type I and III collagen, as well as the proteoglycans decorin and biglycan, were found to be distributed throughout the placentas of control and diabetic rats. In both groups, laminin expression decreased at the end of pregnancy. In contrast, fibronectin was detected in the labyrinth region of diabetic rats at all gestational stages studied, whereas it was detected only at term pregnancy in the placentas of control rats. These results show for the first time that some extracellular matrix molecules are modulated during placental development. However, as diabetic rats presented increased fibronectin deposition exclusively in the labyrinth region, we speculate that diabetes alters the microenvironment at the maternal–fetal interface, leading to developmental abnormalities in the offspring.
Human sperm anatomy: ultrastructural localization of 1α,25‐dihydroxyvitamin D3 receptor and its possible role in the human male gamete
Authors: Aquila Saveria , Guido Carmela , Perrotta Ida , Tripepi Sandro , Nastro Alfonso , Andò Sebastiano
Published: September 2010

Previous studies have suggested that 1α,25‐dihydroxyvitamin D3[1,25(OH)2D3] has a role in reproductive function. Gonadal insufficiencies were observed as a result of 1,25(OH)2D3 deficiency and in 1,25(OH)2D3 receptor (VDR) null mutant mice. To study human sperm anatomy at the molecular level, we first evaluated the ultrastructural localization of VDR by immunogold electron microscopy using a monoclonal antibody against amino acids 344–424 of human VDR, in normozoospermic samples. Intriguingly, VDR was associated predominantly with the cell nucleus. In fact, it is known that VDR is a transcription factor, and that in vitamin‐D‐depleted animals, VDR is largely localized in the cell nucleus. To assess the significance of VDR in the male gamete, we investigated the role of 1,25(OH)2D3/VDR in sperm survival and capacitation. Our results revealed that the action of 1,25(OH)2D3 depended on its concentration because although lower doses induced cholesterol efflux, protein phosphorylation and sperm survival, a higher concentration seemed to be ineffective or did not show an increased effect. These results increase our knowledge of human sperm anatomy at the molecular level and suggest that 1,25(OH)2D3/VDR may have an important role in sperm survival and the acquisition of fertilizing ability.
Stimulation of natriuretic peptide receptor C attenuates accumulation of reactive oxygen species and nitric oxide synthesis in ammonia‐treated astrocytes
Authors: Skowrońska Marta , Zielińska Magdalena , Albrecht Jan
Published: September 2010

J. Neurochem.(2010)115, 1068–1076.

Oxidative and nitrosative stress contribute to ammonia‐induced astrocytic dysfunction in hepatic encephalopathy. Treatment of cultured astrocytes with 5 mmol/L ammonium chloride (‘ammonia’) increased the production of reactive oxygen species (ROS), including the toxic NADPH oxidase reaction product, •O2−. Atrial natriuretic peptide (ANP), natriuretic peptide C and a selective natriuretic peptide receptor (NPR)‐C ligand, cANP(4–23),each decreased the total ROS content both in control cells and cells treated with ammonia. However, attenuation of •O2−accumulation by ANP and cANP(4–23),was observed in ammonia‐treated cells only and the effect of cANP(4–23)was decreased when the NADPH oxidase‐regulatory protein Giα‐2was blocked with a specific anti‐Giα‐2antibody. Although in contrast to ANP, cANP(4–23)did not elevate the cGMP content in control astrocytes, it decreased cAMP content and reduced the expression of Giα‐2, the NADPH oxidase‐regulatory protein. The results show the presence of functional NPR‐C in astrocytes, activation of which (i) attenuates basal ROS production, and (ii) prevents excessive accumulation of the toxic ROS species, •O2−by ammonia. Ammonia, ANP and cANP(4–23)added separately, each stimulated formation of NOx(nitrates + nitrites) which was associated with up‐regulation of the activity [cANP(4–23)] or/and expression (ammonia) of the endothelial isoform of nitric oxide synthase. However, the ammonia‐induced increase of NOxwas not augmented by co‐addition of ANP, and was reduced to the control level by co‐addition of cANP(4–23), indicating that activation of NPR‐C may also reduce nitrosative stress. Future hepatic encephalopathy therapy might include the use of cANP(4–23)or other NPR‐C agonists to control oxidative/nitrosative stress induced by ammonia.
Ammonium influx pathways into astrocytes and neurones of hippocampal slices
Authors: Kelly Tony , Rose Christine R.
Published: September 2010

J. Neurochem. (2010) 115, 1123–1136.

Ammonium (NH4+) is required to maintain pathways involved in shuttling metabolic precursors between astrocytes and neurones. Under hyperammonaemic conditions, increases in the cellular influx of NH4+, and accompanying changes in ion concentrations, may contribute to disruptions in metabolism and neurotransmission. We investigated mechanisms of cellular NH4+ influx in hippocampal slices by measuring acute NH4+/NH3‐evoked changes in intracellular pH (pHi) and sodium ([Na+]i). In both astrocytes and neurones, application of 5 mM NH4Cl for 30–45 min decreased pHi by 0.2–0.3 units, consistent with NH4+ influx. In astrocytes, but not neurones, acidifications were accompanied by [Na+]i increases of 25–30 mM. Glial [Na+]i increases were blocked by bumetanide, suggesting that NH4+/NH3 activated Na+‐dependent, K+, Cl− cotransport. Bumetanide also reduced NH4+/NH3‐evoked acidifications in astrocytes. Neuronal acidifications were insensitive to bumetanide and inhibition of Cl−‐dependent transport and K+ channels, but were prevented by inhibition of Na+,K+‐ATPase with ouabain. Furthermore, ouabain reduced astrocyte acidifications. Our results suggest that following rapid elevation of NH4+, Na+,K+‐ATPase is the major influx pathway for NH4+ in neurones, whereas Na+,K+‐ATPase and Na+‐dependent, K+, Cl− cotransport mediate NH4+ transport into astrocytes. The different mechanisms of NH4+ influx in astrocytes and neurones may contribute to the different susceptibility of both cell types to acute hyperammonaemic conditions.
PAPP‐A: a new anti‐aging target?
Authors: Conover Cheryl A.
Published: September 2010

This article focuses on the role of PAPP‐A in mammalian aging. It introduces PAPP‐A and a little of its history, briefly discusses the function of PAPP‐A in the insulin‐like growth factor (IGF) system and the regulators of PAPP‐A expression, and then reviews data concerning PAPP‐A in aging and age‐related diseases especially in regard to the PAPP‐A knockout (KO) mouse. The PAPP‐A KO mouse is a valuable new model to test hypotheses concerning the control of the tissue availability of IGF, independent from systemic levels, on healthspan as well as lifespan.
Acute peritonitis secondary to traumatic breeding in the bitch
Authors: Morey Deborah L.
Published: September 2010

Objective:To discuss 2 cases of acute peritonitis caused by traumatic breeding in the bitch.

Series summary:Two bitches presented with acute abdominal pain, clinical signs, and laboratory abnormalities compatible with peritonitis. Both bitches were in estrus and had been observed copulating with male dogs prior to the onset of clinical signs. Diagnostic testing revealed bacterial peritonitis in both dogs, and intracellular and extracellular spermatozoa in ascites from 1 of the dogs. Surgical exploration revealed rupture of the uterine body and generalized peritonitis in both animals. Both bitches recovered following surgical and medical treatment.

New or unique information provided:This is the first reported series of cases of peritonitis secondary to traumatic breeding. These cases introduce a unique presentation for peritonitis and acute abdominal distress. Peritonitis because of traumatic seeding of the abdominal cavity with bacteria from the urogenital tract, with or without seminoperitoneum, should be considered for bitches presenting with appropriate history, signalment, and clinical signs.
Changes in serum glucose, sodium, and tonicity in cats treated for diabetic ketosis
Authors: Kotas Stephanie , Gerber Lisa , Moore Lisa E. , Schermerhorn Thomas
Published: September 2010

Objective –To examine serum sodium, glucose, and tonicity in cats with diabetic ketosis.

Design –Retrospective study.

Setting –A university‐based referral hospital.

Animals –Cats admitted to the ICU during the period 1998 to 2002 with a diagnosis of diabetic ketosis.

Interventions –None. Routine clinical management of diabetes and associated conditions.

Measurements –Serum biochemistry assessments.

Main Results –Abnormalities of glucose, sodium and serum tonicity (ST) were common in the study group. Serum sodium but not glucose correlated closely with ST. A subset of cats treated with intravenous insulin and an isotonic sodium‐containing solution for 72 hours showed a significant decrease in glucose from admission values at 48 and 72 hours (but not at 24 hours). Serum sodium, potassium, and ST were not significantly different from admission values at any time over the 72‐hour period. However, the relative contribution of individual osmolytes varied over the course of treatment. Although glucose decreased >120% from admission values over the 72‐hour treatment period, the approximately 5% rise in serum sodium that occurred offset the osmotic effect of falling glucose and the overall ST change was <3%.

Conclusions –The incidence of osmotic‐mediated neurologic complications during treatment of cats with diabetic ketosis is low in part because the minimal fluctuation in ST during treatment likely prevents the development of osmotic gradients between serum and central nervous system tissues. The use of isotonic sodium‐containing fluids in the treatment of feline diabetes acts to minimize large osmotic shifts by adding sodium to the serum compartment as the glucose concentration falls.
A case‐based review of a simplified quantitative approach to acid‐base analysis
Authors: Hopper Kate , Haskins Steve C.
Published: September 2010

Objective
–
To present a simplified quantitative approach to acid‐base analysis and to demonstrate its clinical utility.

Data Sources
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Original research articles and textbooks.

Data Synthesis
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A simplified quantitative approach to acid‐base analysis is presented, which is derived from the Fencl‐Stewart approach and calculates the magnitude of the effect on the standardized base excess (SBE) of 5 separate variables: (1) a free water effect (marked by sodium concentration), (2) an effect marked by the chloride concentration, (3) an albumin effect, (4) a lactate effect, and (5) a phosphate effect. Six clinical cases with acid‐base abnormalities are presented in which the quantitative approach provides information that is not apparent from the traditional approach.

Conclusion
–
This simplified quantitative approach provides a comprehensive evaluation of complex acid‐base disorders, identifies individual processes and their relative influence on SBE, and aids in the development of an appropriate therapeutic plan.
Effects of fluid therapy on total protein and its influence on calculated unmeasured anions in the anesthetized dog
Authors: Valverde Alexander , Erin Hatcher M. , Stämpfli Henry R.
Published: September 2010

Objective –To determine the effects of IV lactated Ringer's solution at a rate of 10 mL/kg/h in anesthetized dogs on total protein (TP) measurement and calculation of unmeasured anions (UAs) using 2 quantitative methods of acid‐base status determination, strong ion gap, and modified base deficit.

Design –Prospective clinical study.

Animals –Forty‐three dogs, anesthetic health status I or II according to the American Society of Anesthesiologists, undergoing surgery under general anesthesia.

Interventions –Arterial blood analyses for gas tensions, acid‐base balance, electrolytes, lactate, hemoglobin (Hb), PCV, and TP were performed under general anesthesia immediately after induction and again after administration of approximately 10 mL/kg of lactated Ringer's solution (given over 1 h). UAs were determined using strong ion gap and modified base deficit.

Measurements and Main Results –Fluid replacement for 1 hour decreased TP, Hb, and PCV by 8%, 7.8%, and 8.6%, respectively. The degree of decrease in TP did not impact the calculation of UAs by quantitative methods when the prefluid administration TP value was used instead of the postfluid TP value in the calculation. Comparison of the two methods showed a low correlation (r≤0.68) and marked differences in the precision (1.96 SD).

Conclusions:The degree of decrease in TP after 1 hour of fluid replacement at approximately 10 mL/kg does not affect determination of UAs when prefluid TP is used within that time period.
Association of hyperlactatemia with age, diagnosis, and survival in equine neonates
Authors: Henderson Imogen S.F. , Franklin Robert P. , Wilkins Pamela A. , Boston Raymond C.
Published: September 2010

Objective –To investigate the association between blood lactate concentration, measured at admission and following 12–36 hours of treatment, and age, diagnosis, and survival in neonatal foals.

Design –Retrospective, observational study.

Setting –Two equine referral hospitals.

Animals –One hundred and twelve foals ≤96 hours of age were included.

Interventions –Arterial or venous blood samples were obtained from all foals at admission and surviving foals at 12–36 hours.

Measurements –The lactate concentration (LAC) was recorded at 2 time points: admission (LAC‐Admission) and 12–36 hours following treatment (LAC‐24 hours).

Main Results –LAC decreased by 0.05 mmol/L for each increased hour of age at presentation. Premature/dysmature foals demonstrated increased odds of nonsurvival of 55% for each 1 mmol/L increase in LAC‐Admission while foals with major diagnoses of neonatal encephalopathy (NE), enteritis and ‘Other’ had increased odds of nonsurvival of 52%, 113%, and 247%, respectively, for each 1.0 mmol/L increase in LAC. Blood‐culture positive foals had significantly lower LAC than blood culture negative foals. LAC‐Admission and LAC‐24 hours were significantly larger in nonsurviving foals. LAC‐Admission of >6.9 mmol/L and LAC‐24 hours >3.2 mmol/L, respectively, correctly classified 85.6% and 94.1% of cases as survivors or nonsurvivors. No differences were found when the 24‐hour change in LAC was investigated in terms of outcome, age at admission, or major diagnosis; however, LAC‐24 hours remained significantly associated with survival.

Conclusions –Admission or persistent hyperlactatemia is associated with a nonsurvival. Younger foals, premature/dysmature foals, and foals with neonatal encephalopathy had the largest LAC.
Potpourri oil toxicity in cats: 6 cases (2000–2007)
Authors: Schildt Julie C. , Jutkowitz L. Ari , Beal Matthew W.
Published: September 2010

Objective –To describe the clinical and laboratory features, treatment, and outcome of cats with a history of potpourri oil exposure.

Design –Retrospective study.

Setting –Veterinary teaching hospital.

Animals –Six client‐owned cats.

Measurements and Main Results –The medical records of animals with oral or lingual ulceration and exposure to potpourri oil from January 2000 to December 2007 were reviewed. Information obtained from the medical records included signalment, product to which the animal was exposed, clinical signs, physical examination findings, diagnostic test results, treatment, duration of hospitalization, and outcome. Six cats qualified for inclusion in the study; 3 were castrated males and 3 were spayed females. Age range was 0.3–3.6 years. All cats had severe oral and lingual ulceration. Additional clinical findings included hyperthermia, tachypnea, ptyalism, and lethargy. Treatment of these cats included IV fluids, analgesic therapy, antimicrobial therapy, and gastrointestinal protectants. Two of these cats received an esophagostomy tube for nutritional support. Duration of hospitalization was 0–5 days. All cats survived to discharge. Follow‐up for 3 cats revealed complete healing of the oral ulceration.

Conclusions –Potpourri oil toxicity should be considered as a differential diagnosis in any cat with oral and lingual ulceration. Prognosis for recovery is good with supportive care.
Pedagogy Against the State
Authors: Atkinson Dennis
Published: September 2010

The text of this article was originally presented in a public lecture in February 2008. It presents a description of earlier research on children's drawing practices which considers the ingenuity of learning and meaning‐making through drawing. Then the focus moves to the language of assess‐mentto consider how, art practices, such as drawing, as well as learner and teacher identities, are constructed and regulated within such linguistic practices (discourses). Bearing in mind the regulatory effect of such practices (and that all discourses are in some way regulatory) the final section introduces the idea of pedagogy against the state in order to think again an ethics of pedagogy concerned with becoming; an ethical imperative for pedagogy concerned with expanding our grasp of what learning is.
More than a Body's Work: Widening Cultural Participation through an International Exploration of Young People's Construction of Visual Image and Identity
Authors: Bianchi June
Published: September 2010

The article presents the rationale, methodology, and selected outcomes from More than a body's work, a collaborative, international, arts educational interactive research project. The project, taking place in both New York and England, explored the ways in which young people construct and ‘perform’ identity through the construction of their body and its appearance. The project's central intention was both to investigate diversity in young people's personal and cultural experience, and demonstrate their potential for creative engagement in mediating and expressing identity through a visual form. With its inclusive ethos, More than a body's work facilitated opportunities for young people who may not ordinarily have access to the arts to be partners in collaborative arts production, generating models of wider participation through innovative participatory approaches to visual art and interdisciplinary practice.

The ongoing project is developmental, continuing to involve young people as participants, responding to the synthesis of local, national and international influences creatively deployed within youth culture. In considering More than a body's work's significance as a model for inclusive practice within art education, the article will discuss its strategies and its potential impact in relation to current initiatives and policies within the arts, culture and education.
Contextualising Craft: Pedagogical Models for Craft Education
Authors: Pöllänen Sinikka
Published: September 2010

Craft education in Finland is, in many aspects, in a state of change. This concerns the independent position of craft as a school subject, the content of the compulsory craft courses containing textiles and technical work, the implementation of the new concept of a holistic craft process in the National Core Curriculum and so on. This bears relevance to the question of how craft should be taught at school.

This article explores the ways in which teachers can strengthen the relevance and meaningfulness of craft education at school. Teachers are challenged to provide more authentic instructional contexts and activities beyond the traditional curriculum in order to address successful living in today's society. One solution is to contextualise this teaching with the help of pedagogical models that realise the concept of holistic craft. The pedagogical models discussed in this article are based on curriculum publications, materials in print and research by other scholars.
Continuing the Journey—the Artist‐Teacher MA as a Catalyst for Critical Reflection
Authors: Parker Terry
Published: September 2010

This article discusses the personal experience of reading an Artist‐Teacher MA, both as a way of engaging with a course of study aimed specifically at art teachers and also as an attempt to explore and possibly reconcile the pedagogic issues related to the area of critical and contextual studies that had arisen within my own practice. Critical and contextual studies has grown to become an essential component of art education in schools, yet there would appear to be limited pedagogic approaches amongst art teachers or enthusiasm for alternative curriculum models other than those inferred from exemplar material provided by examination boards for assessment purposes. As a consequence of engaging with the Artist‐Teacher MA, I confronted my pedagogic practice and reconsidered my personal position within the continuum of the role of teacher and that of artist. In turn this has led me to consider the notion of the pupil‐artist and and to question the implications of this for my continuing classroom practice.
Graduate Design Education: The Case for an Accretive Model
Authors: Walliss Jillian , Greig Joan
Published: September 2010

In 2008 the University of Melbourne began implementation of the Melbourne Model, its new vision for higher education in Australia. Six broad undergraduate university degrees have been introduced and graduate schools created. Students may now progress from an undergraduate generalist degree, with major, to a professional Masters. Alternatively, graduate lateral entry is available for students to pursue a professional qualification without prior preparation. This acceleration has significant implications for design studio teaching. Students with no design background but with an undergraduate degree are now able to study architecture or landscape architecture in just three years, compared to the previous four‐to six‐year undergraduate degrees.

This article reviews and analyses the outcomes of an ‘accretive’ design studio (Christie 2002) devised for beginning Masters students which attempts to translate a new mandate of ‘acceleration’ into design pedagogy. Analysis of student focus groups, together with the work produced, revealed not only the value of the accretive model in delivering a cohesive understanding of the design process and a student engagement that exceeds the outcomes of traditional design studio but also highlights the value of an immediate immersion into a community of practice (Lave & Wenger, 1991). We argue that immersion, as distinct from conventional educational models which position education as ‘training’ for a future participation in a discipline, is central to any acceleration model, serving to position students as active definers of the discipline rather than passive observers and thereby increasing ownership of their learning experience.
Border Crossing
Authors: Allen Felicity
Published: September 2010

This paper describes a programme I have led on behalf of Tate Britain over the last five years, and sets out some initial thoughts about the impact on it of a range of different, sometimes conflicting, influences and pressures. The programme is Nahnou‐Together, which translates from the Arabic as ‘we together’ and, in this context, implies mutual learning. It is a partnership between Tate Britain, the British Council, the Adham Ismail Centre of Plastic Arts in Damascus and Darat‐al‐Funun, and the Jordan National Gallery of Fine Art in Amman, with support from the Jordan Ministry of Education.
Encounters of the Traditional Kind: Reflections on the In‐Service Teacher Training of Traditional Filipino Arts
Authors: Loza Cynthia B. , De Guzman Allan B. , Jose Regalado T.
Published: September 2010

This article presents the second segment of a qualitative study on the integration of traditional arts in tertiary level art and design education in the Philippines. It is focused on the experience of artist‐teachers as participants in an in‐service teacher training programme that aimed to prepare the teachers for the trial integration of traditional Filipino arts in art and design courses. Taking the view of the participants, journals written by the artist‐teachers were sourced for their reflections about their encounter with traditional Filipino artists during field visits. This phase of the study takes the form of action research as it involves the participants in gathering data that could inform the methods and content of the learning of traditional Filipino arts in the schools of art and design.

The findings reveal that artist‐teachers acknowledge the traditional artist as a valuable source of traditional knowledge and expertise. They also recognise their own essential role in the transmission of learning between the traditional artists and the students. The prerequisites of the course take the artist‐teachers beyond teaching in the classroom and extend their tasks to research.
Education in the New Millennium: The Case for Design‐Based Learning
Authors: Lee Hyun‐Kyung , Breitenberg Mark
Published: September 2010

This article focuses on current examples of project or design‐based learning at the secondary school level in the context of the increasing importance of creativity and innovative thinking in the twenty‐first century. The authors argue that students today learn more effectively in pedagogical practices that emphasise holistic thinking, active learning, visual media and problem‐solving.

Design‐based learning presents new ways for realising long‐term goals and learning outcomes. The purpose of this article is to investigate best practices of design education in the community and to propose instructional resource examples on design to K‐12 school teachers. This article points out the importance of systemised process for the work of design‐based teachers and learners, addresses the study of design as a subject of investigation and a mode of inquiry that engages a variety of student learning styles and makes direct connections between subjects and problem‐solving in daily life.

Our belief is that the case studies explored in this article represent the seeds of a new model of education based on creative and applied learning. The exemplar communities chosen for onsite research are the education department of the Cooper‐Hewitt National Design Museum in New York City and the Art Center College of Design in Pasadena, California, USA.
Cross‐Curricular Gallery Learning: A Phenomenological Case Study
Authors: Hickman Richard , Kiss Lauren
Published: September 2010

This article examines the strategies that can be used to enhance students' understanding of how subjects link together and whether cross‐curricular approaches, through a gallery project, have any real impact on students' understanding of the links between subjects. A substantial part of this article, however, describes the methodological aspect of the project. A phenomenological case study approach was used in order to engage fully with individual students' learning experiences. It was found that the students who were involved directly with the study felt that the links between subjects had more relevance to their learning when the teacher made such links explicit. They were unaware of the relevance of many cross‐curricular links made in lessons, but the study indicated that cross‐curricular learning can enable students to transfer skills and knowledge in order to understand concepts more fully.
Ventilator‐associated pneumonia: prevention is better than cure
Authors: Ruffell Alison , Adamcova Lenka
Published: September 2010

Background: The prevention of ventilator Assisted Pneumonia (VAP), a hospital acquired infection, among intensive care patients is a major clinical challenge. It is a condition that is associated with high rates of morbidity, mortality, length of stay and hospital costs.

Aim: The aim of this paper is to critically review the available literature and identify current evidence based nursing and medical interventions to support practitioners in preventing VAP in their patients.

Methods: A literature search using keywords, including ‘ventilator‐associated pneumonia’ were entered into a search engine. A number of highly pertinent papers relevant to the aims of the review were identified, however only a small sample came from nursing journals. Only those papers, which discussed specific strategies for managing VAP were selected for analysis and inclusion in this review.

Discussion: We identified a number of practical and evidence based strategies that nurses can incorporate into their practice to prevent VAP and to reduce its incidence. In addition, the introduction of newer techniques, advances in equipment and use of multidisciplinary care bundles can further support and improve the quality and delivery of safe patient care.

Conclusion: Targeted strategies aimed at preventing VAP, should be implemented to improve patient outcome and reduce length of intensive care unit stay and costs. Front‐line critical care nurses need to understand the factors which place their patients at risk of developing VAP and, institute evidence‐based interventions that will compromise the patients’ survival and recovery.
Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome – clinical guidelines
Authors: De Beer Karen , Michael Sindhu , Thacker Meera , Wynne Elizabeth , Pattni Caroline , Gomm Mandy , Ball Carol , Walsh Dominic , Thomlinson Andrew , Ullah Kevin
Published: September 2010

Background:  The aim of this study was to establish a standardized approach to the initial care of patients with diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar syndrome (HHS). DKA and HHS are metabolic emergencies. Effective and efficient management is the responsibility of the multidisciplinary team. The admission of patients to the intensive care unit (ICU) with DKA and HHS is rare, and management of patients’ diverse problems is prone to error because of a lack of familiarity.

Aim:  The paper’s aim is to set the developmental process of a clinical guideline following a review of the literature.

Discussion:  This clinical guideline is based on a review of the evidence available within the literature in the early phase of resuscitation. Collaborative working among the multidisciplinary team through clinical practice group was the method adopted. Management of DKA and HHS is divided into three main areas: intravenous fluid replacement, insulin therapy and electrolyte management. The controversy associated with the administration of sodium bicarbonate is discussed.

Conclusion:  Effective treatment requires a rapid initial assessment of the patient based on current medical history and clinical presentation. To this end, a quick reference algorithm and guide to management were also developed. Key criteria for evaluating the effectiveness of treatment are provided and complications of treatment are addressed. The formation of the practice development group that led to this innovation is outlined, and in conclusion, the success of the group is reflected upon.
Clinical tools for the assessment of pain in sedated critically ill adults
Authors: Cade Clare H
Published: September 2010

Aim:  This paper aims to review the evidence regarding pain assessment tools for sedated patients and to establish whether the use of a tool can be recommended in practice.

Background:  Pain assessment is a challenging area of critical care nursing practice, particularly among sedated patients. Tools to aid in assessing pain among this patient group have been developed and tested recently.

Search strategy:  In this systematic review five papers that tested pain assessment tools for sedated patients are discussed. These papers were identified via the CINAHL and MEDLINE databases using the search terms: ‘pain assessment’ and ‘sedated’ or ‘unconscious’ or ‘critically ill’ or ‘critical illness’ or ‘critical care’.

Conclusions:  The Behavioural Pain Scale (BPS) has been tested among the broadest range of patients and was found to be a reliable and valid tool in three studies. Research is needed to further demonstrate the reliability and validity of the Critical‐Care Pain Observation Tool (CPOT), as the paper of Gelinas et al. did not test its internal consistency and domain structure. The CPOT also needs testing among different critical care populations. The design of Odhner et al. study did not allow adequate testing of the Non‐verbal Pain Scale (NVPS).

Implications for practice:  The implementation of the BPS can be recommended in intensive care units and may improve the management of pain among sedated patients by providing a systematic and consistent approach to pain assessment to guide interventions. The CPOT may also prove useful in assessing pain among sedated patients, but first requires further validation. Also, further research is needed into the effects of pain assessment tools on pain management practices and patient outcomes.
P–T‐deformation‐Fe3+/Fe2+ mapping at the thin section scale and comparison with XANES mapping: application to a garnet‐bearing metapelite from the Sambagawa metamorphic belt (Japan)
Authors: VIDAL O. , DE ANDRADE V. , LEWIN E. , MUNOZ M. , PARRA T. , PASCARELLI S.
Published: September 2010

Quantitative X‐ray maps of composition from a chlorite, K‐white mica, albite, quartz and garnet bearing thin section from a Sambagawa blueschist facies metapelite were combined with a multi‐equilibrium calculation method to calculate a P–T‐Fe3+/Fe2+‐deformation map at the millimetre scale. The studied sample was chosen because elongated chlorite crystallization tails (pressure shadows) rimmed by phengite are present, which is an appropriate assemblage for the quantification of the P–T evolution. Chlorite temperature and Fe3+ content maps were calculated by successive iterations for each pixel analysis of Fe3+ until convergence of the four chlorite‐quartz‐H2O equilibria that can be written using the Fe‐ and Mg‐amesite, clinchlore, daphnite and sudoite chlorite end‐members. The calculated map of Fe2+/Fe3+ in chlorite is in good qualitative agreement with the in situ mapping of this ratio using XANES (X‐ray absorption near edge structure) techniques. The temperature map indicates that high temperature chlorite zones with low Fe3+ contents alternate with lower temperature zones and higher Fe3+ contents in the crystallization tail. Late fractures perpendicular to the elongation axis of the tail are filled by very low temperature chlorite (<250 °C) showing Fe3+/Fetotal up to 0.4. Groups of chlorite and mica pixels were then identified based on compositional and structural criteria, and a P–T‐deformation map was calculated using representative analyses of these groups. The calculated P–T‐deformation map suggests that in contrast to chlorite, the composition of most mica did not change significantly during exhumation. Mica reequilibrated in late EW shear bands only. EW shearing was already active at 0.1 GPa, 500 °C, which corresponds to the peak temperature (and probably pressure) conditions, at reduced redox conditions. The intensity of deformation probably decreased with decrease in temperature to ∼350–400 °C. At this temperature, a second main deformation event corresponding to a further EW stretching occurred and was still active below 250 °C and more oxidizing conditions. These results indicate that the scale at which P–T data can be obtained is now close to the scale of observation of structural geologists. A close link between deformation and mineral reaction is therefore possible at the microscopic scale, which provides information about the relationship between deformation and mineral reactivity, the modalities of deformation with time and the P–T conditions at which it occurred.
Origin of migmatites by deformation‐enhanced melt infiltration of orthogneiss: a new model based on quantitative microstructural analysis
Authors: HASALOVÁ P. , SCHULMANN K. , LEXA O. , ŠTÍPSKÁ P. , HROUDA F. , ULRICH S. , HALODA J. , TÝCOVÁ P.
Published: September 2010

A detailed field study reveals a gradual transition from high‐grade solid‐state banded orthogneiss via stromatic migmatite and schlieren migmatite to irregular, foliation‐parallel bodies of nebulitic migmatite within the eastern part of the Gföhl Unit (Moldanubian domain, Bohemian Massif). The orthogneiss to nebulitic migmatite sequence is characterized by progressive destruction of well‐equilibrated banded microstructure by crystallization of new interstitial phases (Kfs, Pl and Qtz) along feldspar boundaries and by resorption of relict feldspar and biotite. The grain size of all felsic phases decreases continuously, whereas the population density of new phases increases. The new phases preferentially nucleate along high‐energy like–like boundaries causing the development of a regular distribution of individual phases. This evolutionary trend is accompanied by a decrease in grain shape preferred orientation of all felsic phases. To explain these data, a new petrogenetic model is proposed for the origin of felsic migmatites by melt infiltration from an external source into banded orthogneiss during deformation. In this model, infiltrating melt passes pervasively along grain boundaries through the whole‐rock volume and changes completely its macro‐ and microscopic appearance. It is suggested that the individual migmatite types represent different degrees of equilibration between the host rock and migrating melt during exhumation. The melt topology mimicked by feldspar in banded orthogneiss forms elongate pockets oriented at a high angle to the compositional banding, indicating that the melt distribution was controlled by the deformation of the solid framework. The microstructure exhibits features compatible with a combination of dislocation creep and grain boundary sliding deformation mechanisms. The migmatite microstructures developed by granular flow accompanied by melt‐enhanced diffusion and/or melt flow. However, an AMS study and quartz microfabrics suggest that the amount of melt present did not exceed a critical threshold during the deformation to allow free movements of grains.
A case of fatal anaphylaxis in a dog associated with a dexamethasone suppression test
Authors: Schaer Michael , Ginn Pamela E. , Hanel Rita M.
Published: September 2010

Objective: To describe a case of fatal anaphylaxis in a dog associated with a ‘routine’ dexamethasone suppression test.

Case summary: An 8‐year‐old, spayed female dog, was treated with parenteral dexamethasone for a diagnosis of immune‐mediated thrombocytopenia. The dog had responded to treatment, but 9 months later was evaluated for endogenous hyperadrenocorticism, prior to surgery for a ruptured anterior cruciate ligament. A normal ACTH stimulation test was followed by a high‐dose dexamethasone suppression test. Immediately following the intravenous injection of dexamethasone, the dog developed severe anaphylactic shock and died. The postmortem examination findings supported the diagnosis of anaphylaxis.

New information provided: The anaphylaxis in this dog was fulminating and by‐passed the usual early signs of drug hypersensitivity. This is the first case in the veterinary literature reporting on dexamethasone as the cause of this dog's catastrophic event.
SUSTAINABILITY AND DECISION‐MAKING:
Authors: Farrell Alex
Published: September 2010

Sustainability has been advanced as an important societal goal which governments should adopt and implement. However, sustainability is a complex concept and one for which afirm consensus definition does not appear likely any time soon. This article briefly provides the conceptual background for a discussion of sustainability and then reviews one of the first attempts by the U.S. government to implement a policy specifically designed to promote sustainability, the Environmental Protection Agency's Sustainable Development Challenge Grant (SDCG) Program. The history for the program, the experience of it's first year are examined and a formal decision analysis of the problem facing the SDCG program managers is developed. Implications of this research for the SDCG and for other government policy‐making are discussed.
SEPARATING ANALYSIS FROM POLITICS:
Authors: Patt Anthony
Published: September 2010

Over the last twenty years, policy‐makers in Europe have attempted to solve the problem of acid rain using detailed analysis grounded in natural science and economics. The results are impressive, as Europeans have successfully implemented a number of international agreements to reduce pollution emissions, agreements that in theory achieve the greatest environmental benefit at the lowest aggregate cost across Europe. This article examines the analysis on which these policies were based. First, it finds a pattern of investigating the use of cost‐benefit analysis, together with a lack of usefulness associated with the actual results of such analysis. Second, it finds that the analytic framework that came to replace cost‐ benefit analysis—“critical loads”—contained many of the same uncertainties and political decisions that plagued cost‐benefit analysis. Nevertheless, “critical loads” analysis was seen as less value‐laden and more reliable, and contributed significantly to policy development. Desire for rapid action led policy‐makers to ignore or overlook the politics and uncertainties inherent in efforts at scientific assessment and modeling.
USING NEW APPROACHES TO ENVIRONMENTAL DECISION‐MAKING:
Authors: Mathis Mitchell L.
Published: September 2010

ABSRACT

This article examines a unique application of integrated assessment methodologies to analyze water scarcity, development and the environment in the semi‐arid Lower Rio Grande/Rio Bravo watershed. U.S. and Mexican data are analyzed to produce an integrated “baseline report” of current socio‐economic, ecological, water supply and demand, water quality, and management conditions and trends. The baseline report provides the basis for subsequent analysis of alternative future scenarios for the region. Scenarios are developed by combining demographic projections with alternatives for future water availability, irrigation technologies, and management practices. The integrated assessment methodology is evaluated as a general tool for environmental decisionmaking. Problems encountered in applying the methodology are discussed, as are possibilities for improvements. The article concludes that, despite inherent difficulties, integrated assessments can provide a powerful framework by which to analyze complex environmental issues involving different disciplines and large amounts of information.
IMPROVING ENVIRONMENTAL DECISION‐MAKING THROUGH COLLABORATIVE METHODS
Authors: Randolph John , Bauer Michael
Published: September 2010

In the past, government agencies with environmental missions rarely allowed public oversight over final decisions. However, faced with loss of control as policy and planning are increasingly carried out by Congress or the courts, some agencies, supported by businesses, communities, and environmental groups, are using collaborative methods in the decisionmaking process. This emerging paradigm for environmental decisionmaking is driven by practical necessity rather than by abstract theory.

This article will demonstrate that collaborative management is a process that broadens the influence of all entities concerned with an environmental decision, and is more likely to: (1) include the needs and opinions of affected parties; (2) bring a dialogue on normative values into the deliberative process; and (3) result in decisions that enhance environmental protection.
THE PROBLEM OF POWER:
Authors: Parsons Michael D.
Published: September 2010

The purpose of this article is to offer a methodological approach for reconstructing and reclaiming power in policy analysis and research. Positivist and post‐positivist researchers have largely abandoned the concept after failing to produce a universal definition of power. Interpretive researchers tend to produce definitions that are a function of the methodology and theory selected to guide the inquiry review earlier efforts to define power before presenting a methodology that was used to guide a study of power in the federal higher education policy arena. The methodology combines several methods with the common thread being interpretation. At the heart of this approach is Callon and Latour's (1981) sociology of translation. The claim made for this approach is that it presents a clearer field of vision unimpeded by a priori interpretations or theories of power. The meaning of power is allowed to emerge from the social setting which is being studied.
RAILROAD POLICY AND INTERMODALISM: Policy Choices after Deregulation
Authors: Plant Jeremy F.
Published: September 2010

Intermodalism is widely viewed as a promising recent development in transportation. This article examines the role played by railroads in intermodal freight transportation and the framework of public policies around whic intermodal freight movement has evolved. Intermodalism emerged because of technological, organizational, and public policy developments that contributed to its rapid growth. Deregulation of the rail industry since 1980 has led to significant restructuring through mergers and direct contracts between railroads and customers. As intermodal shipments become more important to the overall transportation system in the United States, attention will need to be given to ways in which intermodal concerns are addressed in surface transportation programs.
HIGHWAY INTERMODAL FREIGHT TRANSPORTATION: A Policy and Administration Challenge for the New Millennium
Authors: Field Mary
Published: September 2010

This article provides an overview of factors influencing highway intermodal freight transportation planning and policy in the United States. The article provides examples of state and local initiatives to manage or balance the increasing highway transportation of freight with decreasing system capacity. It also identifies important trends in commerce affecting intermodal freight generation. It concludes with a discussion of issues facing intermodal freight transportation planning and policy making at the millennium.
INTERMODALISM—A SOLUTION FOR HIGHWAY CONGESTION AT THE MILLENNIUM?
Authors: Handman Arthur L.
Published: September 2010

Highway congestion in the Northeastern U.S. is increasing beyond practical ability to obtain relief by the construction of added lanes. Single mode solutions, including HOV lanes and transit, have failed to significantly mitigate problems of highway congestion. Traditional and innovative public transportation modes using intermodal centers and enhanced transfer facilities are discussed as solutions for the congestion. Efforts in Connecticut, including projects in New Haven, Norwalk, Hartford, and New Britain are examined to show the need for coordinated transportation services that provide seamless trip options for users.
TRANSPORTATION AT THE MILLENNIUM: In Search of a Megaproject Lens
Authors: Haynes Wendy
Published: September 2010

Penetrating the complexity of publicly funded megaprojects‐ those costing in excess of $1 billion—is no small task, but it can be a rewarding one. Five tiers of rich descriptors emerge from the literature: history and purpose; context; project structure; funding; and performance measures. The five‐tier approach is used to analyze one megaproject: Boston's $14‐billion‐plus Central Artery/Tunnel Project. With time and attention, this preliminary framework could be helpful in profiling and learning from public works megaprojects generally, and transportation megaprojects particularly.