bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges MNCs Face in Emerging Markets: The Nestlé Experience
Authors: Pai V.S.
Published: May 2018

Maggi was the most popular instant noodles brand in India, which children in particular loved to snack on. The brand had a dominant position until suddenly in mid-2015 it got engulfed in controversy. Several state food regulators found that Maggi contained monosodium glutamate as well as lead well above the prescribed limits. Both these substances were harmful especially for children. When Nestlé India was confronted with lab test results it stuck to its position that they had a world class quality control process in place and that their products were safe for consumption. Finally, the national food regulator FSSAI, ordered a ban on the sale of Maggi including product recall. Consequently, several state governments imposed temporary ban on the sale of Maggi noodles in their respective states. The future of the company suddenly looked very bleak.

Nestlé India was slow to respond to this fast unfolding crisis. Further, their responses were very brief and not adequately culture-sensitive. This led to the feeling in several quarters that the company was probably guilty of wrongdoing. To set right things Nestlé's worldwide CEO flew into India to douse the flames of the controversy and draw up an appropriate strategy to bail out the brand. He address the media, put in place a new CEO for Nestlé India and set brand Maggi on the path of recovery. However, Nestlé India was still facing a number of critical issues. What should be done to win over the trust of its customers? How should it recover market share lost to competitors both old rivals and new entrants? What strategy should it develop to succeed with the new products, especially hot heads, launched along with the comeback strategy? Should it change its approach to dealing with government health officials to prevent confrontations in future? How should it shorten the response time and make it effective in the face of a media backed public outcry in future?
The turbulent life of the Working Time Directive
Authors: Nowak Tobias
Published: May 2018

The case of the Working Time Directive (WTD) is a prime example of a failed attempt by the Member States and the Commission to counter rulings of the European Court of Justice (CJEU) by legislative overrule. Outsourcing the decision making process to the social partners also did not deliver the desired results. After years of trying to reform the WTD, the Commission changed its strategy and issued an interpretive communication instead. However, it is doubtful that this communication will solve all that is wrong with the WTD. What were the obstacles to legislative overrule in this case? What other strategies in avoiding the consequences of CJEU rulings do the Member States apply? What will the future of WTD look like?
When Internationalization Funding Feels Tight: Satisfaction With Funding and Campus Internationalization Strategies
Authors: Glass Chris R. , Lee Jenny J.
Published: May 2018

This study investigated predictors of satisfaction with an institution’s strategy for campus internationalization among international affairs staff ( N = 1,520) and compared the varying perceptions of their institution’s funding to fulfill this mandate. This study identified factors that influenced these individuals’ sense of their institution’s internationalization strategy. Among international affairs staff who were most dissatisfied with their institution’s funding, satisfaction with how their institution managed the outsourcing of university functions, and perceived competition with other universities most influenced their perceptions of strategy. For those moderately satisfied with funding, retention of senior university leadership most influenced their perceptions of strategy. Support from senior administration, communication with faculty, and capacity to support increased student enrollment influenced perceptions of strategy for all respondents. The results of this study suggest the negotiation of the educational and entrepreneurial rationales for internationalization are far more complex—and dependent on far more factors—at institutions where international affairs staff perceive fewer human and financial resources to be available.
A Six-Step Decision-Making Process to Guide Social Skills Instruction
Authors: Stichter Janine P. , Malugen Emily C. , Davenport Mattina A.
Published: May 2018

The availability of effective research-based interventions and practices within schools is a growing concern within the field of education. There remains a lack of interventions that have been fully evaluated for use within schools and by school personnel, particularly in the area of social skills interventions. Understanding the need for social skills interventions and the long-term impact of not receiving appropriate programming is clear. Less is established on how to define the specific need and appropriate manner by which to match intervention to those needs within school settings. This article provides a six-step decision-making process designed to support educators in determining best practice social skills instruction.
Tessier Number 30 Median Mandibular Cleft With Congenital Heart Anomalies in Qena, Egypt
Authors: Ali Ahmed Ali Abdelrahim
Published: May 2018

Median cleft deformities of the lower lip and mandible are very rare congenital anomalies. Our patient had median cleft of the lower lip, mandible, and the chin with tongue duplication, ankyloglossia, and cleft strap muscles with 2 neck contracture bands. This anomaly was associated with congenital heart disease transposition of great vessels, large ventricular septal defect, and severe pulmonary stenosis. Early repair was done at 6 months to improve feeding.
Psychosocial Functioning of Children in a Craniofacial Support Group
Authors: Johns Alexis L. , Bava Laura
Published: May 2018

Objective:

To describe psychosocial functioning before and after participation in support groups for pediatric patients with craniofacial diagnoses and their families.

Design:

Baseline and postgroup outcomes and comparison to test norms.

Setting:

Urban children’s hospital.

Participants:

Patients (N = 138) were 54% female, primarily Latino (83%), aged 7 to 18 years (mean = 10.4, standard deviation = 2.8), and had public insurance (72%). Patients had isolated cleft lip/palate (54%), craniofacial syndromes (19%), craniofacial microsomia/microtia (14%), or other diagnoses (12%). Caregivers (n = 138) were mostly mothers (80%).

Intervention:

Support groups focused on peer normalization, social skills, and coping for patients with craniofacial diagnoses.

Main Outcome Measure:

Selected scales of the Behavior Assessment System for Children–Second Edition completed by patients and caregivers (51% Spanish; 49% English).

Results:

While in the average range, caregivers reported significantly higher baseline clinical concerns and patients and caregivers reported lower positive scales compared to test norms. Postgroup, patients reported significantly lower social stress than peer norms. Caregivers reported higher postgroup clinical scales, but no differences from test norms in the positive scales. In comparing pre to postgroup means, all but one scale showed significant improvement. The largest effect sizes were for higher self-reported self-esteem ( d = 0.49) and lower caregiver-reported depression ( d = 0.54) in their children.

Conclusions:

Although greater clinical concerns were reported compared to test norms, baseline and postgroup functioning was in the average range. Patients and caregivers reported significantly improved psychosocial functioning following group participation, particularly for adaptive skills and self-esteem.
Damage mechanics-based approach to studying effects of overload on fatigue life of notched specimens
Authors: Huang Jiawei , Meng Qingchun , Zhan Zhixin , Hu Weiping , Shen Fei
Published: May 2018

A continuum damage mechanics-based method is adopted to predict the fatigue life of notched specimens subjected to constant amplitude cyclic loading while containing single or multiple overloads. The residual stress and plastic damage induced by an overload are considered to be the main factors affecting the fatigue life of a specimen. The residual stress and plastic strain fields of a notched specimen are calculated using the elastic–plastic finite element method. The mean stress of the following cyclic loading is then varied by superimposing the residual stress. Meanwhile, the plastic damage is calculated based on the ductile damage model and accumulated into the total damage of the material. The quantitative effects of an overload on the damage evolution and the fatigue life are evaluated. Furthermore, the effects of the damage–overload ratio on the variation of the residual stress induced by an overload are investigated, and the effects of the occurrence time for a single overload and the occurrence frequency for multiple overloads are studied.
New Interfaces of Thyroid Hormone Actions With Blood Coagulation and Thrombosis
Authors: Davis Paul J. , Mousa Shaker A. , Schechter Geraldine P.
Published: May 2018

Substantial clinical evidence indicates hyperthyroidism enhances coagulation and increases the risk of thrombosis. In vitro and clinical evidence implicate multiple mechanisms for this risk. Genomic actions of thyroid hormone as 3,5,3′-triiodo-L-thyronine (T3) via a nuclear thyroid hormone receptor have been implicated, but recent evidence shows that nongenomic mechanisms initiated at the receptor for L-thyroxine (T4) on platelet integrin αvβ3 are prothrombotic. The T4-initiated mechanisms involve platelet activation and, in addition, cellular production of cytokines and chemokines such as CX3CL1 with procoagulatory activities. These procoagulant actions of T4 are particulary of note because within cells T4 is not seen to be functional, but to be only a prohormone for T3. Finally, it is also possible that thyroid hormone stimulates platelet-endothelial cell interaction involved in local thrombus generation. In this brief review, we survey mechanisms by which thyroid hormone is involved in coagulation and platelet functions. It is suggested that the threshold should be lowered for considering the possibility that clinically significant clotting may complicate hyperthyroidism. The value of routine measurement of partial thromboplastin time or circulating D-dimer in patients with hyperthyroid or in patients treated with thyrotropin-suppressing dosage of T4 requires clinical testing.
Methylation and Gene Expression of BCAT1 and IKZF1 in Colorectal Cancer Tissues
Authors: Jedi Maher , Young Graeme P , Pedersen Susanne K , Symonds Erin L
Published: May 2018

The genes BCAT1 and IKZF1 are hypermethylated in colorectal cancer (CRC), but little is known about how this relates to gene expression. This study assessed the relationship between methylation and gene expression of BCAT1 and IKZF1 in CRC and adjacent non-neoplastic tissues. The tissues were obtained at surgery from 36 patients diagnosed with different stages of CRC (stage I n = 8, stage II n = 13, stage III n = 10, stage IV n = 5). Methylated BCAT1 and IKZF1 were detected in 92% and 72% CRC tissues, respectively, with levels independent of stage ( P > .05). In contrast, only 31% and 3% of non-neoplastic tissues were methylated for BCAT1 and IKZF1, respectively ( P < .001). The IKZF1 messenger RNA (mRNA) expression was significantly lower in the cancer tissues compared with that of non-neoplastic tissues, whereas the BCAT1 mRNA levels were similar. The latter may be due to the BCAT1 polymerase chain reaction assay detecting more than 1 mRNA transcript. Further studies are warranted to establish the role of the epigenetic silencing of IKZF1 in colorectal oncogenesis.
Effects of Different Exercise Training Programs on Cardiorespiratory Fitness in Overweight/Obese Adults With Hypertension: A Pilot Study
Authors: Jurio-Iriarte Borja , Maldonado-Martín Sara
Published: May 2018

The goal of the study was to compare the effects of two supervised aerobic exercise programs (moderate-intensity continuous training [MICT] vs. high-intensity interval training [HIIT]) after 8-, 12-, and 16-week intervention periods on cardiorespiratory fitness (CRF) in overweight/obese adults diagnosed with hypertension. Participants ( N = 64) were divided into three intervention cohorts (control group [CG], MICT, and HIIT) and each of these, in turn, into three intervention length cohorts (8, 12, and 16 weeks). Supervised groups exercised twice a week. There were no statistical changes in postintervention periods in CG ( g < 0.1). CRF as assessed by peak oxygen uptake (mL kg−1·min−1) increased ( p < .001) in exercise groups (MICT, 3.8 ± 3.3, g = 0.6; HIIT, 4.2 ± 4.7, g = 0.7). The effect of exercise interventions compared with CG was substantial ( p < .02, g > .8) and mostly consequence of HIIT-related effects. The improvements on CRF occurred after 12 and 16 weeks in exercise interventions, rather than in the 8-week group or CG, where Hedges’s g index indicated small effect. This study may suggest that both MICT and HIIT exert cardioprotector effects on hypertension in the overweight/obese population. However, short-term training duration (<12 weeks) does not seem to improve CRF, and HIIT intervention might generate higher aerobic capacity, which seems to grow as intervention lengthens.
School-Based and Community-Based Gun Safety Educational Strategies for Injury Prevention
Authors: Holly Cheryl , Porter Sallie , Kamienski Mary , Lim Aubrianne
Published: May 2018

Background. Nearly 1,300 children in the United States die because of firearm-related injury each year and another 5,790 survive gunshot wounds, making the prevention of firearm-related unintentional injury to children of vital importance to families, health professionals, and policy makers. Objective. To systematically review the evidence on school-based and community-based gun safety programs for children aged 3 to 18 years. Study Design. Systematic review. Method. Twelve databases were searched from their earliest records to December 2016. Interventional and analytic studies were sought, including randomized controlled trials, quasi-experimental studies, as well as before-and-after studies or cohort studies with or without a control that involved an intervention. The low level of evidence, heterogeneity of studies, and lack of consistent outcome measures precluded a pooled estimate of results. A best evidence synthesis was performed. Results. Results support the premise that programs using either knowledge-based or active learning strategies or a combination of these may be insufficient for teaching gun safety skills to children. Conclusions. Gun safety programs do not improve the likelihood that children will not handle firearms in an unsupervised situation. Stronger research designs with larger samples are needed to determine the most effective way to transfer the use of the gun safety skills outside the training session and enable stronger conclusions to be drawn.
The Role of Adolescents From a Low Socioeconomic Background in Household Food Preparation: A Qualitative Study
Authors: Leak Tashara M. , Aasand Taylor A. , Vickers Zata , Reicks Marla
Published: May 2018

The purpose of this study was to understand adolescents’ from low-income households perceptions of their involvement in home food preparation, reasons underlying the extent to which they were involved, and positive and negative consequences associated with their involvement. Semistructured interviews were conducted with a convenience sample of 19 adolescents (13-18 years). Audio-recorded interviews were transcribed verbatim. Themes were identified using grounded theory and the constant comparative method. Eight adolescents described cooking as a primary responsibility due to adult work and family schedules, age, gender, and/or cultural expectations. They were typically preparing food for themselves and their family without assistance, and making decisions about what was prepared. They identified positive and negative consequences including enjoyment and satisfaction, as well as stress and less time for other activities. Eleven adolescents mostly assisted the primary food preparer, with little input in deciding what was prepared. They identified benefits such as enjoyment and family interaction. Foods prepared by many adolescents tended to be quick and easy to prepare foods. Future studies should investigate the relationship between adultified cooking responsibilities, diet quality, and health. Also, cooking education for adolescents needs to address how to prepare a healthy family meal on a budget.
Technology-Based Behavioral Interventions for Daily Activities and Supported Ambulation in People With Alzheimer’s Disease
Authors: Lancioni Giulio E. , Singh Nirbhay N. , O’Reilly Mark F. , Sigafoos Jeff , D’Amico Fiora , Laporta Dominga , Cattaneo Maria Giovanna , Scordamaglia Antonella , Pinto Katia
Published: May 2018

Objectives:

These 2 studies evaluated technology-based behavioral interventions for promoting daily activities and supported ambulation in people with mild-to-moderate and moderate-to-severe Alzheimer’s disease, respectively.

Methods:

Study 1 included 8 participants who were taught to start and carry out daily activities on their own using a tablet or smartphone device, which provided activity reminders, step instructions, and praise. Study 2 included 9 participants who were taught to engage in brief periods of ambulation using a walker combined with a tilt microswitch and a notebook computer, which monitored step responses and provided stimulation and prompts.

Results:

The participants of study 1 succeeded in starting the activities independently and carrying them out accurately. The participants of study 2 largely increased their ambulation levels and also showed signs of positive involvement (eg, smiles and verbalizations).

Conclusion:

The aforementioned technology-based interventions may represent practical means for supporting people with Alzheimer’s disease.
Research on the burst height measurement method based on the missile-borne millimeter wave detector
Authors: Cheng Cheng , Gao Min , Zhou Xiaodong , Li Jiacheng
Published: May 2018

A millimeter wave detector is applied to a novel large dynamic optional burst height proximity fuze, and it provides a higher measurement precision. In this paper, the height measurement model of the missile-borne millimeter wave detector is established to provide a theoretical basis for the measurement of burst height. A burst height measurement method based on the change rate of voltage and Doppler shift has been proposed. Compared with the traditional millimeter wave fuze continuous wave height measurement system, the proposed method shows higher measurement accuracy and faster computing speed. Through a series of digital simulation experiments, the proposed method allows the height to be estimated when the terrain reflectivity is unknown.
Adult patients’ experiences of symptom management during pulmonary exacerbations in cystic fibrosis: A thematic synthesis of qualitative research
Authors: Schmid-Mohler Gabriela , Yorke Janelle , Spirig Rebecca , Benden Christian , Caress Ann-Louise
Published: May 2018

Objective

The aim of this review was to describe how patients experience an exacerbation of cystic fibrosis in terms of symptom management.

Methods

A systematic literature search was performed in MEDLINE, CINAHL, EMBASE, PSYCINFO and ASSIA. Studies were included that contained any direct quotes or summaries of quotes from patients with cystic fibrosis aged 16 or older and were related to symptom experience and management during an exacerbation. Framework analysis, guided by Symptom Management Theory, was used to present the findings.

Results

The review included 18 qualitative studies. In addition to physiological symptoms, patients highlighted the significant role of psychological symptoms. Delayed help-seeking was a common first response. Participants choose their self-management strategies taking both physiological and psychological symptoms into account. Maintaining normality was an important short-term outcome for patients, leading to conflict with health professionals. Patients’ symptom management during exacerbation was greatly influenced by the structure of cystic fibrosis care.

Discussion

Our findings provide an initial understanding of factors influencing patient self-management during an exacerbation. The transferal of these findings into clinical practice will provide a basis for shared goal setting and intervention planning. In addition, our findings have implications for future development of patient-reported outcome measures and intervention research.
Chasing the wrong dragon: A new presentation of heroin-induced toxic leukoencephalopathy mimicking anoxic brain injury
Authors: Achamallah Natalie , Wright Robert S , Fried Jeffrey
Published: May 2018

Toxic leukoencephalopathy associated with heroin inhalation has been extensively described in the literature. This syndrome is characterized by progressive motor symptoms and dysautonomia that develop over weeks to months. We present three cases of abrupt-onset inhaled heroin-associated toxic leukoencephalopathy, a previously undescribed entity. These likely represent a subset of “found down” patients with acute neurologic changes not attributable to hypoxemic encephalopathy. All three had magnetic resonance imaging findings characteristic of toxic leukoencephalopathy, which has a relatively favorable prognosis. Prolonged unresponsiveness in patients “found down” after heroin overdose is often attributed to hypoxic brain injury. Brain magnetic resonance imaging is not generally included as part of routine workup. It should, however, be considered in patients with suspected inhaled heroin use due to the relatively favorable prognosis of toxic leukoencephalopathy. This is especially relevant in the setting of the current opioid epidemic and related increase in overdose-related intensive care unit admissions. The result may have significant impact on decisions about therapeutic options or continuation of care.
The role of dopaminergic immune cell signalling in poststroke inflammation
Authors: Talhada Daniela , Rabenstein Monika , Ruscher Karsten
Published: May 2018

Upon ischaemic stroke, brain-resident and peripheral immune cells accumulate in the central nervous system (CNS). Interestingly, these cells express pattern specific to neurotransmitter receptors and, therefore, seem to be susceptible to neurotransmitter stimulation, potentially modulating their properties and functions. One of the principal neurotransmitters in the CNS, dopamine, is involved in the regulation of processes of brain development, motor control and higher brain functions. It is constantly released in the brain and there is experimental and clinical evidence that dopaminergic signalling is involved in recovery of lost neurological function after stroke. Independent studies have revealed specific but different patterns of dopamine receptor subtypes on different populations of immune cells. Those patterns are dependent on the activation status of cells. Generally, exposure to dopamine or dopamine receptor agonists decreases detrimental actions of immune cells. In contrast, a reduction of dopaminergic inputs perpetuates a pro-inflammatory state associated with increased release of pro-inflammatory molecules. In addition, subsets of immune cells have been identified to synthesize and release dopamine, suggesting autoregulatory mechanisms. Evidence supports that inflammatory processes activated following ischaemic stroke are modulated by dopaminergic signalling.
Prevalence of chronic obstructive pulmonary disease: county-level risk factors based on the Social Ecological Model
Authors: McDaniel JT
Published: May 2018

Aims:

Chronic obstructive pulmonary disease (COPD) was the third leading cause of death among Americans in 2014. Multiple factors, ranging from proximal (i.e. biological characteristics and behaviors) to distal (i.e. environmental characteristics and policies), have been shown to predict COPD outcomes. The Social Ecological Model (SEM), which specifies that five levels of influence (i.e. intrapersonal, interpersonal, institutional, community, and public policy factors) are implicated in the development of ill health, has not been used in epidemiological studies of COPD prevalence. A better understanding of the community-level correlates of COPD prevalence may improve community health practice.

Methods:

Using several sources of county-level secondary data ( n = 646), changes in COPD prevalence from 2012 to 2014 were predicted from the five levels of the SEM using ordinary least squares (OLS) hierarchical linear regression. The geographic distribution of county-level changes in COPD prevalence was analyzed with a choropleth map.

Results:

County-level COPD prevalence increased by 4.76% between 2012 and 2014 overall; however, the greatest increases were observed among counties within the Appalachian region (i.e. counties in West Virginia). Results showed that the SEM, with five levels of influence, was a statistically significant framework for examining changes in county-level COPD prevalence, F = 10.21, p < .001, R2 = 0.28. Statistically significant county-level predictors of changes in COPD prevalence included racial composition, ethnic composition, poverty, altitude, air pollution, and smoking policy.

Conclusion:

COPD prevention may be assisted by the implementation of community-based programs rooted in a multilevel approach.
Book review: Duvvuri Subbarao. Who Moved My Interest Rate? Leading The Reserve Bank of India through Five Turbulent Years
Authors: Arora Nitin , Gill Harinder Kaur
Published: May 2018

Duvvuri Subbarao. Who Moved My Interest Rate? Leading The Reserve Bank of India through Five Turbulent Years. Penguin Books India Private Limited, 2016, pp. xxv + 323, ₹699, ISBN 978-0670088928
Does Emotional Intelligence Predict Leadership Effectiveness? An Exploration in Non-Western Context
Authors: Lone Mushtaq A. , Lone Aashiq Hussian
Published: May 2018

The study focuses on understanding the emotional intelligence and leadership linkages in a non-Western context. The study was conducted on a sample of 230 supervisors and subordinates drawn from branches of the banking sector in the state of Jammu and Kashmir, India. The study employs three-dimensional emotional intelligence model developed by Singh and Chadha. Emotional competency and emotional sensitivity were found to be significant antecedents of leadership effectiveness in the context under reference. The knowledge gained from this research is expected to increase the understanding of effective leadership and help produce powerful tools for the selection, and training and development of leaders, potentially enhancing organizational climate and performance.
Assessing externality: Successive event studies on market impacts of new housing development on an old residential neighbourhood
Authors: Tang Bo-sin , Wong Kwan To
Published: May 2018

This study assesses the externality of three new master-planned housing estate development projects on an old residential area in Hong Kong. Replicating the methodology of an event study, this paper presents the changes to the market values and the turnover of property transactions of the apartments in the existing neighbourhood before and after the successive completion of these three new projects over a period of 10 years. Our findings have identified a diverse picture about the impacts of these new housing estates on the neighbourhood. Positive externalities occur under specific circumstances related to the facility provision, spatial design and interfacing with the neighbourhood and background of the new projects. Housing externality does not depend only on the degree of geographical proximity. The policy implication is that urban planning can expand the positive spillover of infill redevelopment not only by replacing the urban dis-amenities by new buildings, but also through a responsive and beneficial integration of the new development with the existing neighbourhood.
Disruption of a GATA1-binding motif upstream of XG/PBDX abolishes Xga expression and resolves the Xg blood group system
Authors: Möller Mattias , Lee Yan Quan , Vidovic Karina , Kjellström Sven , Björkman Linda , Storry Jill R. , Olsson Martin L.
Published: May 2018

Key Points

Expression of the Xg blood group protein is governed by rs311103, and its minor allele disrupts a GATA motif to cause the Xg(a−) phenotype. These data elucidate the genetic basis of the last unresolved blood group system and make genotyping for Xga status possible.
Children in development
Authors: Bourdillon M. F.C.
Published: May 2018

Contemporary development studies have been attending to perspectives and strategies of people at the periphery of power as important actors in change. I argue that such an approach (which includes gendered actors) should extend to children, and show that they can be significant in development interventions. On the other hand, the participation of children in development processes highlights problems of competence that are intrinsic to intervention. Children illustrate both the need for participatory approaches and the problems that arise when perceptions of participants conflict with those of experts. We see that the agency of some actors can be severely curtailed.
A qualitative study assessing the feasibility of implementing a group cognitive–behavioural therapy-based intervention in Sierra Leone
Authors: Waterman Samantha , Cole Charles L. , Greenberg Neil , Rubin G. James , Beck Alison
Published: May 2018

Mental health support in Sierra Leone is sparse, and qualitative research into the feasibility of implementing psychological interventions is equally underdeveloped. Following the 2014 Ebola virus disease outbreak, South London and Maudsley NHS Trust were commissioned to develop a psychological intervention that UK clinicians could train national staff with minimal psychological experience to deliver to their peers. Following the completion of the stepped care, group-based cognitive–behavioural therapy intervention, qualitative interviews were conducted with the national team to identify key barriers and enablers to implementation of and engagement with this intervention. This article describes the key themes that came out of those interviews, and discusses the implications of these findings for future clinical teams.
Multifaceted Roles of Beige Fat in Energy Homeostasis Beyond UCP1
Authors: Sponton Carlos Henrique , Kajimura Shingo
Published: May 2018

Beige adipocytes are an inducible form of thermogenic adipose cells that emerge within the white adipose tissue in response to a variety of environmental stimuli, such as chronic cold acclimation. Similar to brown adipocytes that reside in brown adipose tissue depots, beige adipocytes are also thermogenic; however, beige adipocytes possess unique, distinguishing characteristics in their developmental regulation and biological function. This review highlights recent advances in our understanding of beige adipocytes, focusing on the diverse roles of beige fat in the regulation of energy homeostasis that are independent of the canonical thermogenic pathway via uncoupling protein 1.
Propensity Score Methods: Theory and Practice for Anesthesia Research
Authors: Schulte Phillip J. , Mascha Edward J.
Published: May 2018

Observational data are often readily available or less costly to obtain than conducting a randomized controlled trial. With observational data, investigators may statistically evaluate the relationship between a treatment or therapy and outcomes. However, inherent in observational data is the potential for confounding arising from the nonrandom assignment of treatment. In this statistical grand rounds, we describe the use of propensity score methods (ie, using the probability of receiving treatment given covariates) to reduce bias due to measured confounders in anesthesia and perioperative medicine research. We provide a description of the theory and background appropriate for the anesthesia researcher and describe statistical assumptions that should be assessed in the course of a research study using the propensity score. We further describe 2 propensity score methods for evaluating the association of treatment or therapy with outcomes, propensity score matching and inverse probability of treatment weighting, and compare to covariate-adjusted regression analysis. We distinguish several estimators of treatment effect available with propensity score methods, including the average treatment effect, the average treatment effect for the treated, and average treatment effect for the controls or untreated, and compare to the conditional treatment effect in covariate-adjusted regression. We highlight the relative advantages of the various methods and estimators, describe analysis assumptions and how to critically evaluate them, and demonstrate methods in an analysis of thoracic epidural analgesia and new-onset atrial arrhythmias after pulmonary resection.
Patient-Controlled Versus Clinician-Controlled Sedation With Propofol: Systematic Review and Meta-analysis With Trial Sequential Analyses
Authors: Kreienbühl Lukas , Elia Nadia , Pfeil-Beun Elvire , Walder Bernhard , Tramèr Martin R.
Published: May 2018

BACKGROUND:

Sedation with propofol is frequently used to facilitate diagnostic and therapeutic procedures. Propofol can be administrated by the patient (patient-controlled sedation [PCS]) or by a clinician (clinician-controlled sedation [CCS]). We aimed to compare these 2 techniques.

METHODS:

PubMed, Embase, CENTRAL, and trial registries were searched up to October 2017 for randomized controlled trials comparing PCS with CCS with propofol. The primary end points were the risks of presenting at least 1 episode of oxygen desaturation, arterial hypotension, and bradycardia, and the risk of requiring a rescue intervention (pharmacologic therapies or physical maneuvers) for sedation-related adverse events. Secondary end points were the dose of propofol administrated, operator and patient satisfaction, and the risk of oversedation. A random-effects model and an α level of .02 to adjust for multiple analyses were used throughout. Trial sequential analyses were performed for primary outcomes. Quality of evidence was assessed according to the Grades of Recommendation, Assessment, Development, and Evaluation system.

RESULTS:

Thirteen trials (1103 patients; median age, 47 years; American Society of Anesthesiologists physical status I–III) describing various diagnostic and therapeutic procedures with propofol sedation were included. PCS had no impact on the risk of oxygen desaturation (11 trials, 31/448 patients [6.9%] with PCS versus 46/481 [9.6%] with CCS; risk ratio, 0.74 [98% confidence interval, 0.35–1.56]) but decreased the risk of requiring a rescue intervention for adverse events (11 trials, 29/449 patients [6.5%] with PCS versus 74/482 [15.4%] with CCS; risk ratio, 0.45 [98% confidence interval, 0.25–0.81]). For both outcomes, Trial sequential analyses suggested that further trials were unlikely to change the results, although the quality of evidence was graded very low for all primary outcomes. For the risk of arterial hypotension and bradycardia, the required sample size for a definitive conclusion had not been reached. Analysis of secondary outcomes suggested that PCS decreased the risk of oversedation and had no impact on propofol dose administrated, or on operator or patient satisfaction.

CONCLUSIONS:

PCS with propofol, compared with CCS with propofol, had no impact on the risk of oxygen desaturation, but significantly decreased the risk of rescue interventions for sedation-related adverse events. Further high-quality trials are required to assess the risks and benefits of PCS.
Trainability of Cricoid Pressure Force Application: A Simulation-Based Study
Authors: Noll Eric , Shodhan Shivam , Varshney Arnavi , Gallagher Christopher , Diemunsch Pierre , Florence F. Barry , Romeiser Jamie , Bennett-Guerrero Elliott
Published: May 2018

BACKGROUND:

Aspiration of gastric contents is a leading cause of airway management–related mortality during anesthesia practice. Cricoid pressure (CP) is widely used during rapid sequence induction to prevent aspiration. National guidelines for CP suggest a target force of 10 N before and 30 N after loss of consciousness. However, few studies have rigorously assessed whether clinicians can be trained to consistently achieve these levels of force. We hypothesized that clinicians can be trained effectively to deliver 10–30 N during application of CP.

METHODS:

Clinicians (attending anesthesiologist, anesthesiology residents, certified registered nurse anesthetists, or operating room nurses) applied CP on a Vernier force plate simulator with measurements taken at 4 time points over 60 seconds, 2 measurements before and 2 measurements after loss of consciousness. A successful cycle required all 4 time points to be within the target range (10 ± 5 and 30 ± 5 N, respectively). After baseline assessment (n = 100 clinicians), a subset of 40 participants volunteered for education on recommended force targets, underwent self-regulated practice, and then performed 30 1-minute cycles of high-frequency simulation analyzed by cumulative sum analysis to assess their change in performance.

RESULTS:

At baseline, 5 cycles (1.3% [confidence interval {CI}, 0.3%–2.50%]) out of 400 were successful. Performance improved after education and self-regulated practice (16% successful cycles [CI, 7.8%–25%]), and performance during the last 4 of 30 cycles was 45% (CI, 33%–58%). The odds of success increased over time (odds ratio, 1.1;P< .001). By cumulative sum analysis, however, no subject crossed the h0 line, indicating that no one achieved proficiency of the predefined target forces.

CONCLUSIONS:

At baseline, performance was poor at achieving target forces specified by national guidelines. Simulation-based training improved the success rate, but no participant achieved the predefined threshold for proficiency.
A Prospective Observational Study of Technical Difficulty With GlideScope-Guided Tracheal Intubation in Children
Authors: Zhang Bin , Gurnaney Harshad G. , Stricker Paul A. , Galvez Jorge A. , Isserman Rebecca S. , Fiadjoe John E.
Published: May 2018

BACKGROUND:

The GlideScope Cobalt is one of the most commonly used videolaryngoscopes in pediatric anesthesia. Although visualization of the airway may be superior to direct laryngoscopy, users need to learn a new indirect way to insert the tracheal tube. Learning this indirect approach requires focused practice and instruction. Identifying the specific points during tube placement, during which clinicians struggle, would help with targeted education. We conducted this prospective observational study to determine the incidence and location of technical difficulties using the GlideScope, the success rates of various corrective maneuvers used, and the impact of technical difficulty on success rate.

METHODS:

We conducted this observational study at our quaternary pediatric hospital between February 2014 and August 2014. We observed 200 GlideScope-guided intubations and documented key intubation–related outcomes. Inclusion criteria for patients were <6 years of age and elective surgery requiring endotracheal intubation. We documented the number of advancement maneuvers required to intubate the trachea, the location where technical difficulty occurred, the types of maneuvers used to address difficulties, and the tracheal intubation success rate. We used a bias-corrected bootstrapping method with 300 replicates to determine the 95% confidence interval (CI) around the rate of difficulty with an intubation attempt.

RESULTS:

After excluding attempts by inexperienced clinicians, there were 225 attempts in 187 patients, 58% (131 of 225; bootstrap CI, 51.6%–64.6%]) of the attempts had technical difficulties. Technical difficulty was most likely to occur when inserting the tracheal tube between the plane of the arytenoid cartilages to just beyond the vocal cords: “zone 3.” Clockwise rotation of the tube was the most common successful corrective maneuver in zone 3. The overall tracheal intubation success rate was 98% (CI, 95%–99%); however, the first attempt success rate was only 80% (CI, 74%–86%). Patients with technical difficulty had more attempts (median [interquartile range], 2 [1–3] than those without technical difficulty median (interquartile range, 1 [1–1; P value <.01]).

CONCLUSIONS:

A variety of clinicians experience technical difficulties with the GlideScope Cobalt videolaryngoscope in children. These difficulties result in more tracheal intubation attempts, an important risk factor for intubation-associated complications. Targeted education of clinicians may reduce the incidence of technical difficulties.
Proximal Versus Distal Continuous Adductor Canal Blocks: Does Varying Perineural Catheter Location Influence Analgesia? A Randomized, Subject-Masked, Controlled Clinical Trial
Authors: Sztain Jacklynn F. , Khatibi Bahareh , Monahan Amanda M. , Said Engy T. , Abramson Wendy B. , Gabriel Rodney A. , Finneran John J. , Bellars Richard H. , Nguyen Patrick L. , Ball Scott T. , Gonzales Francis B. , Ahmed Sonya S. , Donohue Michael C. , Padwal Jennifer A. , Ilfeld Brian M.
Published: May 2018

BACKGROUND:

A continuous adductor canal block provides analgesia after surgical procedures of the knee. Recent neuroanatomic descriptions of the thigh and knee led us to speculate that local anesthetic deposited in the distal thigh close to the adductor hiatus would provide superior analgesia compared to a more proximal catheter location. We therefore tested the hypothesis that during a continuous adductor canal nerve block, postoperative analgesia would be improved by placing the perineural catheter tip 2–3 cm cephalad to where the femoral artery descends posteriorly to the adductor hiatus (distal location) compared to a more proximal location at the midpoint between the anterior superior iliac spine and the superior border of the patella (proximal location).

METHODS:

Preoperatively, subjects undergoing total knee arthroplasty received an ultrasound-guided perineural catheter inserted either in the proximal or distal location within the adductor canal in a randomized, subject-masked fashion. Subjects received a single injection of lidocaine 2% via the catheter preoperatively, followed by an infusion of ropivacaine 0.2% (8 mL/h basal, 4 mL bolus, 30 minutes lockout) for the study duration. After joint closure, the surgeon infiltrated the entire joint using 30 mL of ropivacaine (0.5%), ketorolac (30 mg), epinephrine (5 μg/mL), and tranexamic acid (2 g). The primary end point was the median level of pain as measured on a numeric rating scale (NRS) during the time period of 8:00amto 12:00Pmthe day after surgery.

RESULTS:

For the primary end point, the NRS of subjects with a catheter inserted at the proximal location (n = 24) was a median (10th, 25th–75th, 90th quartiles) of 0.5 (0.0, 0.0–3.2, 5.0) vs 3.0 (0.0, 2.0–5.4, 7.8) for subjects with a catheter inserted in the distal location (n = 26;P= .011). Median and maximum NRSs were lower in the proximal group at all other time points, but these differences did not reach statistical significance. There were no clinically relevant or statistically significant differences between the treatment groups for any other secondary end point, including opioid consumption and ambulation distance.

CONCLUSIONS:

For continuous adductor canal blocks accompanied by intraoperative periarticular local anesthetic infiltration, analgesia the day after knee arthroplasty is improved with a catheter inserted at the level of the midpoint between the anterior superior iliac spine and the superior border of the patella compared with a more distal insertion closer to the adductor hiatus.
Feasibility of Fully Automated Hypnosis, Analgesia, and Fluid Management Using 2 Independent Closed-Loop Systems During Major Vascular Surgery: A Pilot Study
Authors: Joosten Alexandre , Jame Vincent , Alexander Brenton , Chazot Thierry , Liu Ngai , Cannesson Maxime , Rinehart Joseph , Barvais Luc
Published: May 2018

Automated titration of intravenous anesthesia and analgesia using processed electroencephalography monitoring is no longer a novel concept. Closed-loop control of fluid administration to provide goal-directed fluid therapy has also been increasingly described. However, simultaneously combining 2 independent closed-loop systems together in patients undergoing major vascular surgery has not been previously detailed. The aim of this pilot study was to evaluate the clinical performance of fully automated hypnosis, analgesia, and fluid management using 2 independent closed-loop controllers in patients undergoing major vascular surgery before implementation within a larger study evaluating true patient outcomes.
KDM5B decommissions the H3K4 methylation landscape of self-renewal genes during trophoblast stem cell differentiation
Authors: Xu Jian , Kidder Benjamin L.
Published: May 2018

Trophoblast stem (TS) cells derived from the trophectoderm (TE) of mammalian embryos have the ability to self-renew indefinitely or differentiate into fetal lineages of the placenta. Epigenetic control of gene expression plays an instrumental role in dictating the fate of TS cell self-renewal and differentiation. However, the roles of histone demethylases and activating histone modifications such as methylation of histone 3 lysine 4 (H3K4me3/me2) in regulating TS cell expression programs, and in priming the epigenetic landscape for trophoblast differentiation, are largely unknown. Here, we demonstrate that the H3K4 demethylase, KDM5B, regulates the H3K4 methylome and expression landscapes of TS cells. Depletion of KDM5B resulted in downregulation of TS cell self-renewal genes and upregulation of trophoblast-lineage genes, which was accompanied by altered H3K4 methylation. Moreover, we found that KDM5B resets the H3K4 methylation landscape during differentiation in the absence of the external self-renewal signal, FGF4, by removing H3K4 methylation from promoters of self-renewal genes, and of genes whose expression is enriched in TS cells. Altogether, our data indicate an epigenetic role for KDM5B in regulating H3K4 methylation in TS cells and during trophoblast differentiation.
Galectin-3 modulates the polarized surface delivery of β1-integrin in epithelial cells
Authors: Hönig Ellena , Ringer Karina , Dewes Jenny , von Mach Tobias , Kamm Natalia , Kreitzer Geri , Jacob Ralf
Published: May 2018

Epithelial cells require a precise intracellular transport and sorting machinery to establish and maintain their polarized architecture. This machinery includes β-galactoside-binding galectins for targeting of glycoprotein to the apical membrane. Galectin-3 sorts cargo destined for the apical plasma membrane into vesicular carriers. After delivery of cargo to the apical milieu, galectin-3 recycles back into sorting organelles. We analysed the role of galectin-3 in the polarized distribution of β1-integrin in MDCK cells. Integrins are located primarily at the basolateral domain of epithelial cells. We demonstrate that a minor pool of β1-integrin interacts with galectin-3 at the apical plasma membrane. Knockdown of galectin-3 decreases apical delivery of β1-integrin. This loss is restored by supplementation with recombinant galectin-3 and galectin-3 overexpression. Our data suggest that galectin-3 targets newly synthesized β1-integrin to the apical membrane and promotes apical delivery of β1-integrin internalized from the basolateral membrane. In parallel, knockout of galectin-3 results in a reduction in cell proliferation and an impairment in proper cyst development. Our results suggest that galectin-3 modulates the surface distribution of β1-integrin and affects the morphogenesis of polarized cells.