bluuebunny/crossref_metadata_2025 huggingface dataset:
The prognostic value of visually assessing enamel microcracks: Do debonding and adhesive removal contribute to their increase?
Authors: Dumbryte Irma , Jonavicius Tomas , Linkeviciene Laura , Linkevicius Tomas , Peciuliene Vytaute , Malinauskas Mangirdas
Published: August 2015

Objective: 

To find a correlation between the severity of enamel microcracks (EMCs) and their increase during debonding and residual adhesive removal (RAR).

Materials and Methods: 

Following their examination with scanning electron microscopy (SEM), 90 extracted human premolars were divided into three groups of 30: group 1, teeth having pronounced EMCs (visible with the naked eye under normal room illumination); group 2, teeth showing weak EMCs (not apparent under normal room illumination but visible by SEM); and group 3, a control group. EMCs have been classified into weak and pronounced, based on their visibility. Metal brackets (MB) and ceramic brackets (CB), 15 of each type, were bonded to all the teeth from groups 1 and 2. Debonding was performed with pliers, followed by RAR. The location, length, and width of the longest EMCs were measured using SEM before and after debonding.

Results: 

The mean overall width (Woverall) was higher for pronounced EMCs before and after debonding CB (P < .05), and after the removal of MB. Pronounced EMCs showed greater length values using both types of brackets. After debonding, the increase in Woverall of pronounced EMCs was 0.57 µm with MB (P < .05) and 0.30 µm with CB; for weak EMCs, − 0.32 µm with MB and 0.30 µm with CB.

Conclusions: 

Although the teeth having pronounced EMCs showed higher width and length values, this did not predispose to greater EMCs increase after debonding MB and CB followed by RAR.
Food plots as a habitat management tool: forage production and ungulate browsing in adjacent forest
Authors: Månsson Johan , Roberge Jean‐Michel , Edenius Lars , Bergström Roger , Nilsson Lovisa , Lidberg Maria , Komstedt Karl , Ericsson Göran
Published: August 2015

A key challenge for wildlife management is to handle competing goals. High ungulate densities may be desirable from hunting and recreational perspectives, but may come in conflict with needs to limit or reduce browsing damage. Since browsing intensity is negatively related to forage availability it may be possible to mitigate damage on forest by increasing forage availability within the landscape. A commonly used method to increase the attractiveness of a localized part of the landscape is to establish food plots. In a multiyear setup using enclosures, wildlife observations, field surveys, and controlled biomass removal, we studied food plots to document forage production, utilization by ungulates, and browsing on adjacent forests in southern Sweden. The fenced parts of the food plots produced on average 2230 to 5810 kg ha‐1 marrow‐stem kale, second‐year clover mix or early‐sown rapeseed. The biomass of target crops was generally higher within ungrazed (exclosures) compared to grazed (controls) quadrats on the food plots, which demonstrates that the crops were used as forage by ungulates. Browsing on deciduous trees in the adjacent forest was higher within 70–135 m from the food plots compared to areas further away. For wildlife management, our study shows that establishment of food plots provides substantial amounts of forage both during growing season and at the onset of the dormant season, and that a large share of this food is consumed. Finally, our study documents that forage availability for ungulates at the onset of the often‐limiting dormant season can be increased by fencing food plots throughout the growing season.
Bird quality, origin and predation level affect survival and reproduction of translocated common pheasants Phasianus colchicus
Authors: Kallioniemi Heidi , Väänänen Veli‐Matti , Nummi Petri , Virtanen Juha
Published: August 2015

We investigated the survival and breeding success of common pheasants Phasianus colchicus of two origins and in two predator densities. We translocated hand‐reared and wild pheasant hens to southern Finland (60°N, 24°E) and hand‐reared ones to central Finland (63°N, 27°E). Both groups of birds were treated similarly before release and translocated to areas with no local pheasant populations. Both areas appeared similar, the only major difference being the amount of predators. The red fox Vulpes vulpes was the major predator of pheasants present in the southern study, where it was abundant, whereas it was almost non‐existant in central Finland. In accordance with earlier studies, the wild birds survived much better than the hand‐reared ones in the area with a high red fox density. The hand‐reared birds located in the low red fox density area survived better than the hens in the area of high red fox density. However, no significant difference was observed in the survival of the hand‐reared birds in the low fox density area and wild birds in the high fox density area. Interestingly, after the first two weeks, the survival of pheasants in different groups was equal. We additionally found no significant differences between the bird‐groups in terms of hatching success when comparing hens that managed to initiate nesting. No difference was also observed between the hand‐reared birds in the low fox density area and the wild in the high fox density area in brood survival to the age of six weeks. We conclude that even hand‐reared pheasants can succeed in brood production in an area with low fox densities. We furthermore suggest that pheasants that survive the two first weeks after translocation have good chances of producing a brood whether they are wild or hand‐reared.
Diversity, abundance and the impact of hunting on large mammals in two contrasting forest sites in northern amazon
Authors: de Andrade Melo Éverton Renan , Gadelha José Ramon , de Nazaré Domingos da Silva Maria , da Silva Antonio Paulo , Pontes Antonio Rossano Mendes
Published: August 2015

A variety of Amazonian mammals serve as sources of food for its human inhabitants, but hunting can have a strong negative impact on them. Diversity, abundance, biomass, and average group size of medium‐sized and large mammals are compared across two forest areas of the northern Amazon: the Viruá National Park (protected) and the Novo Paraíso settlement (a human settlement where hunting is permitted). Hunting pressure was also characterized in Novo Paraíso. A total of 33 mammal species were recorded. There were no significant differences in the sighting rates, relative abundance and biomass, and mammal group sizes between the two areas, although the totals of all these variables were higher in Viruá due to the higher abundance of Tayassu pecari, which was not recorded at Novo Paraíso. It is suggested that T. pecari may be on the verge of local extinction, as it was the most hunted species in the settlement area. Through interviews with 50 hunters, we estimate that 541 mammals of 20 species were hunted during the study year, resulting in an estimated biomass take of 8517 kg. While the hunting intensity in Novo Paraíso may be sustainable in the short term, the reported decline of hunting efficiency, combined with the extirpation of T. pecari, suggests that mammal abundance may decline there in the near future. In the study year, 849 hunts were carried out in a hunting effort of 4575 hours, with a maximum distance travelled of 5.4 km. There was an average of 4.82 consumers for each hunt, and a per capita harvest rate of 2.24 individuals/consumer year. Hunting was not only for subsistence, but also for retaliation, although some species may not be hunted due to cultural taboos. The need for quantification of harvesting rates to maintain hunting at sustainable levels is highlighted.
Estimating nestling diet with cameras: quantifying uncertainty from unidentified food items
Authors: Robinson Barry G. , Franke Alastair , Derocher Andrew E.
Published: August 2015

Cameras at nest sites are becoming a common means for quantifying nestling diet, but there are two problems associated with this method: food items delivered to nestlings often cannot be identified, and quantification of error around diet estimates for individual nests is problematic. We present a novel method of incorporating unidentified food items into diet estimates and quantifying error around these estimates for individual nests. In our method, unidentified food items are accounted for by considering all of the possible ways in which they could be allocated among previously defined food categories (possible outcomes). We then calculate the probability of each possible outcome by assuming the probability that an unidentified food item belongs to any given category is equal to the proportion of identified items from that category. All possible outcomes, along with the probability of each, represent a probability space. We allocate the unidentified food items to each category according to the most probable outcome in the probability space when estimating the contribution of each food category to nestling diets. Confidence intervals around diet estimates for each food category are estimated by simulating many samples from this probability space and using kernel density estimation. We demonstrate the implementation of our method with data from motion‐sensitive cameras monitoring Arctic peregrine falconFalco peregrinus tundriusnests in Nunavut, Canada.
A double-blind randomized trial on the clinical effect of different shunt valve settings in idiopathic normal pressure hydrocephalus
Authors: Farahmand Dan , Sæhle Terje , Eide Per Kristian , Tisell Magnus , Hellström Per , Wikkelsö Carsten
Published: August 2015

OBJECT

The study aim was to examine the effect of gradually reducing the opening pressure on symptoms and signs in the shunt treatment of idiopathic normal pressure hydrocephalus (iNPH).

METHODS

In this prospective double-blinded, randomized, controlled, double-center study on patients with iNPH, a ventriculoperitoneal shunt with an adjustable Codman Medos Valve was implanted in 68 patients randomized into 2 groups. In 1 group (the 20–4 group) the valve setting was initially set to 20 cm H2O and gradually reduced to 4 cm H2O over the course of the 6-month study period. In the other group (the 12 group), the valve was kept at a medium level of 12 cm H2O during the whole study period. All patients were clinically evaluated using 4 tests preoperatively as well as postoperatively at 1, 2, 3, 4, and 6 months. The test scores between the 2 groups (20–4 and 12) were compared for each clinical evaluation.

RESULTS

Fifty-five patients (81%) were able to complete the study. There were no significant differences between the 2 groups (20–4 and 12) preoperatively or at any time postoperatively. Both groups exhibited significant clinical improvement after shunt insertion at all valve settings compared with the preoperative score, with the greatest improvement observed at the first postoperative evaluation. The clinical improvement was significant within the first 3 months, and thereafter no significant improvement was seen in either group.

CONCLUSIONS

Gradual reduction of the valve setting from 20 to 4 cm H2O did not improve outcome compared with a fixed valve setting of 12 cm H2O. Improvement after shunt surgery in iNPH patients was evident within 3 months, irrespective of valve setting.
Impact of maternal bifidobacteria and the mode of delivery on Bifidobacterium microbiota in infants
Authors: Sirilun S. , Takahashi H. , Boonyaritichaikij S. , Chaiyasut C. , Lertruangpanya P. , Koga Y. , Mikami K.
Published: August 2015

The aim of this study is to examine the influence of maternal intestinal and vaginal bifidobacteria on the colonisation of bifidobacteria in the gut of infants. Faecal samples from 120 healthy pregnant mothers within 1 month of delivery and from their infants at 1 month of age and 98 vaginal swabs from the mothers at the time of delivery were collected at a maternity hospital in Chiang Mai, Thailand. The faecal and vaginal samples were assayed by real-time PCR assays to detect Bifidobacterium species and to estimate the bifidobacterial copy numbers. After adjusting for the numbers of each Bifidobacterium species, delivery mode, and antibiotic use in infants by the age of 1 month, total counts of bifidobacteria in the mothers’ faeces were associated with increased copy numbers of bifidobacteria in the faeces of breastfed infants. A caesarean section was also significantly associated with a decrease in the copy numbers of bifidobacteria in the faeces of infants. No significant correlation was found between the bifidobacterial copies of the vaginal swabs and those of the infants’ faeces. The intestinal bifidobacterial status of exclusively breastfed infants was significantly positive affected by vaginal delivery and high bifidobacterial copy numbers in their mothers’ gut.
Lactobacillus fermentum NCIMB 5221 and NCIMB 2797 as cholesterol-lowering probiotic biotherapeutics: in vitro analysis
Authors: Tomaro-Duchesneau C. , Saha S. , Malhotra M. , Jones M.L. , Rodes L. , Prakash S.
Published: August 2015

Cardiovascular and coronary artery disease risk are correlated with cholesterol levels and are significant health concerns. Current cholesterol-lowering approaches includes lifestyle and diet modifications, as well as statins which presents numerous shortcomings. The probiotic bacteria, Lactobacillus fermentum NCIMB 5221 and NCIMB 2797, have demonstrated cholesterol-lowering potential in animal studies. However, there is a lack in understanding the mechanism(s) behind these observed effects. The goal of this work is to investigate, in vitro, the cholesterol-lowering mechanisms of these two strains. To determine the cholesterol-lowering mechanisms, probiotic cholesterol assimilation, colon epithelial adhesion and inhibition of cholesterol uptake by colon epithelial (Caco-2) cells were investigated. L. fermentum NCIMB 2797 (P=0.012) and NCIMB 5221 (P=0.003) assimilated cholesterol and their cell surface hydrophobicity was 70.30±8.85% and 55.60±2.59%, respectively. Both L. fermentum strains showed no significant impact (P>0.05) on Caco-2 cell viability. Of most interest, Caco-2 pre-exposure to L. fermentum NCIMB 5221 significantly decreased (P=0.015) cholesterol uptake, with 85.98±2.07% uptake compared to the untreated cells. Similarly, L. fermentum NCIMB 2797 probiotic cells significantly decreased (P=0.019) cholesterol uptake by Caco-2 cells, with 86.45±1.71% uptake observed compared to the control cells. The results demonstrate that L. fermentum NCIMB 5221 and L. fermentum NCIMB 2797 have the potential via various modes of action to lower cholesterol. Additional studies are required to understand the mechanism(s) of action behind probiotic cholesterol assimilation and behind the cholesterol uptake inhibition by colon epithelial cells.
Evaluation of viability Bifidobacterium animalis subsp. lactis LKM512 in dogs
Authors: Nakamura A. , Ohnishi Y. , Shirotori K. , Matsumoto M.
Published: August 2015

In dogs, gastric acid is not neutralised even when a meal is present in the stomach. Moreover, dogs take longer to digest their meals than humans do. Accordingly, the most important characteristic of any probiotics considered for use in dogs is high acid tolerance. The probiotic strain Bifidobacterium animalis subsp. lactis LKM512 (hereafter referred to as LKM512) not only exhibits potent acid tolerance, but also has the ability to adhere to intestinal mucin. The aim of the present study was to explore the potential of LKM512 as a probiotic in dogs. Specifically, we investigated whether LKM512 can survive in the large intestine in dogs. LKM512 preparations containing 1010 cfu were administered daily for 14 days in five dogs. Faeces were collected on the day before administration (day 0) as well as on days 7 and 14, and 7 days after administration was halted (day 21). The numbers of viable LKM512 present in faeces were determined by both culture-based techniques and molecular analysis. Changes in intestinal bacterial populations were analysed by 16S rRNA gene semiconductor sequencing using the Ion Torrent Personal Genome Machine (PGM). On days 7 and 14, the numbers of viable LKM512 that were detected in faeces by culture-based techniques and molecular analysis were greater than the original daily dosage. 16S rRNA gene sequence analysis using the PGM indicated that relative proportions of Bifidobacterium spp. and Bifidobacteriaceae were significantly higher after administration than before. The present study demonstrated that LKM512 can survive strong gastric acid, and proliferate in the large intestine of dogs. Therefore, LKM512 may be a useful canine probiotic.
Dimethylglycine supplementation in horses performing incremental treadmill exercise
Authors: de Oliveira K. , Fachiolli D.F. , Watanabe M.J. , Tsuzukibashi D. , Bittar C.M.M. , Costa C. , Poiatti M.L. , de L. Meirelles P.R.
Published: August 2015

Our objective was to verify the effect of the period of dimethylglycine (DMG) supplementation in horses subjected to incremental treadmill exercise, on the metabolic and physiologic variables and indices related to physical performance. Four adult Arabian horses with a mean age of 8±1.5 years and a mean body weight of 340±10.8 kg were used. The utilised experimental design was the 4×4 Latin square, constituted by four periods of four weeks of evaluation, intercalated with four weeks of wash-out periods. The treatments consisted of periods of DMG (30 g of commercial product) administration: without supplementation, and with supplementation for 10, 20 and 30 days. There was a significant effect of the DMG supplementation given during 30 days over the reduction in the lactate concentration after the test exercise. Alterations of V200 (speed in which the horse reaches 200 heart beats/min) and VL4 (speed which corresponds to a blood lactate of 4 mmol/l) were not observed (P>0.05), however there was a travelled distance elevation in the tests in function of the increase on the days of supplementation, by linear regression (P<0.05) analysis. It was verified that there was no effect from the DMG supplementation in horses on the heart rate and there was only a significant difference between treatments for the rectal temperature after exercise, where the supplementation for 30 days resulted in values statistically superior to the control group. Therefore, we can conclude that the equine supplementation with a DMG product in the dosage of 30 g/day for a one-month period affects the lactate metabolisms, as well as increases the travelled distance during an incremental treadmill test.
Complete nutrient content of three species of wild caught insects, pallid-winged grasshopper, rhinoceros beetles and white-lined sphinx moth
Authors: Finke M.D.
Published: August 2015

Insects serve as a major source of nutrients for many animal species, but complete nutritional information of wild insects is lacking. Wild pallid-winged grasshoppers, rhinoceros beetles and white-lined sphinx moths were caught in Rio Verde, Arizona, in the summer of 2013 (grasshoppers and beetle) or the spring of 2015 (moths). Pallid-winged grasshoppers, rhinoceros beetles and white-lined sphinx moths were analysed for moisture, crude protein, fat, ash, acid detergent fibre, minerals, amino acids, fatty acids and vitamins and values compared the nutrient requirements for both rats and poultry as reported by the National Research Council (NRC). The acid detergent fibre was also analysed for nitrogen. When compared to the nutrient requirements as established by the NRC for growing rats, grasshoppers were deficient in calcium, vitamin A, vitamin D, thiamine and vitamin B12, beetles were deficient in calcium, vitamin A, vitamin E, thiamine, pyridoxine and linoleic acid and moths were deficient in calcium, sodium, vitamin A, vitamin D, pyridoxine and vitamin B12. In contrast when compared to the nutrient requirements as established by the NRC for growing broiler chickens, grasshoppers were only deficient in calcium, manganese, and vitamin A, beetles were deficient in calcium, manganese, vitamin A, vitamin E, thiamine and linoleic acid and moths were deficient in calcium, sodium, manganese, vitamin A, vitamin D, and linoleic acid. These data show that Pallid-winged grasshoppers, Rhinoceros beetles and White-lined sphinx moths were good sources of most known nutrients including all essential amino acids, most minerals and most vitamins.
Efficacy of Mozambican bentonite and diatomaceous earth in reducing the toxic effects of aflatoxins in chicks
Authors: Anjos F.R. Dos , Ledoux D.R. , Rottinghaus G.E. , Chimonyo M.
Published: August 2015

The effectiveness of diatomaceous earth (DE) and bentonite clay (BC) in reducing the toxic effects of aflatoxin B1 (AFB1) in chicks was assessed. A total of 150 day-old male broiler chicks were assigned to six dietary treatments, with 5 replicate pens of five chicks per treatment. Dietary treatments were: (1) a positive control basal diet (BD) containing no AFB1, no BC and no DE; (2) BD + 0.50% BC but with no AFB1 and DE; (3) BD + 0.50% DE but with no AF and BC; (4) BD + 2 mg AFB1/kg diet but with no BC and DE; (5) BD + 0.50% BC + 2 mg AFB1/kg diet but with no DE; and (6) BD + 0.50% DE + 2 mg AFB1/kg diet but with no BC. Compared with controls, feed intake (FI) and body weight gain (BWG) were depressed (P<0.05) in chicks fed AFB1, with greater reduction in FI and BWG observed in birds fed the AFB1 plus 0.50% DE diet. Feed conversion ratio was similar. Chicks fed AFB1 alone had increased (P<0.05) relative liver weights compared to all other dietary treatments except for chicks fed AFB1+ DE. Chicks fed AFB1 alone and those fed AFB1+ DE had heavier (P<0.05) relative kidney weights compared to chicks fed other treatments. Compared with the control chicks, livers from birds fed dietary AFB1 and AFB1 plus DE were similar. Liver lesion score of chicks fed AFB1 plus BC was lower (P<0.05) than that of chicks fed AFB1 but higher (P<0.05) than that of control chicks. Compared to controls, serum concentrations of glucose, albumin, total protein globulin, and calcium were decreased (P<0.05) in chicks fed AFB1 alone, whereas serum concentrations of aspartate amino transferase and gamma glutamyl transferase were increased (P<0.05). It can be concluded that this concentration of BC was partially effective in reducing the toxic effects of 2 mg/kg AFB1, whereas DE at the same concentration was not effective in reducing the toxic effects of 2 mg/kg AFB1.
Deoxynivalenol and fumonisin exposure in children and adults in a family study in rural Tanzania
Authors: Gong Y.Y. , Shirima C.P. , Srey C. , Kimanya M.E. , Routledge M.N.
Published: August 2015

The relationship between child and parent exposure and excretion of deoxynivalenol (DON) and fumonisin B1 (FB1), were compared in rural Tanzania. Morning urine samples from matched child-mother-father in 50 families of the Iringa district were collected and analysed for urinary DON and FB1 using LC-MS methods. Maize intake was obtained using a seven-day food frequency questionnaire and a duplicate diet method. The urinary DON geometric means were 15.4, 45.0 and 42.0 ng/ml in children, mothers and fathers, respectively, and the urinary FB1 were 0.62, 1.25 and 1.38 ng/ml, respectively. Children had significantly lower levels of urinary DON and FB1 than their parents (P<0.001 andP=0.009, respectively) but the difference became non-significant when corrected for creatinine concentration. Both DON and FB1 were detected in urine samples from all adults and >96% of the children, respectively and were positively correlated between the child and the mother (P=0.007 and 0.02, respectively). DON or FB1 biomarkers were not correlated with maize intake. Children who were fully weaned had 3-fold higher urinary DON than those on partial breastfeeding (P=0.002). In adults, maize brew (a local produced beer) showed a strong positive correlation with both urinary DON and FB1 levels (P<0.001). The ratio of daily urinary excretion of DON between children and adult, based on assumed urine volume, was 1:2.26, but the excretion of FB1 was similar between children and adults. The study showed that DON and FB1 exposure are prevalent in rural Tanzania. Further study is required to determine the mechanism for the lower excretion of DON in children compared to adults. There is a good correlation between child and mother’s exposure levels to DON and FB1. Increased exposure risk through maize brew in adults is highlighted in this study.
A mycotoxin-dedicated total diet study in the Netherlands in 2013: Part II – occurrence
Authors: López P. , de Rijk T. , Sprong R.C. , Mengelers M.J.B. , Castenmiller J.J.M. , Alewijn M.
Published: August 2015

The occurrence of 59 natural toxins was determined in 88 composite food and drink samples of a mycotoxin-dedicated total diet study performed in the Netherlands in 2013. Composite food samples were prepared by pooling foods from a food category (as consumed, e.g. peeled, cooked, etc.) according to their consumption by population groups in the Netherlands. A multi-targeted method based on QuEChERs extraction, dilute and shoot and analysis by liquid chromatography-tandem mass spectrometry was applied to the 88 composite samples. Dedicated methods with lower detection limits for patulin, aflatoxins and trichothecenes were also applied to specific food types. Thirty samples (34%) were positive for one or more mycotoxins. Patulin, aflatoxin M1, zearalenone and plant toxins, with the exception of scopolamine in liquorice, were not detected in any of the composite samples. Aflatoxin B1 was only detected, but not at quantifiable levels, in the composites that contained peanuts. Fumonisin B1 was only found at 18 μg/kg in breakfast cereals consumed by the population group of 7-69 years, whereas ochratoxin A occurred at low levels around 1 μg/kg in liquorice, legumes and coffee. Grains and grain-based food composites were positive for ergot alkaloids, enniatins B and B1 and deoxynivalenol (DON). The levels of DON in the positive samples were lower compared to other studies, with the exception of breakfast cereals for infants with a DON concentration of 116 μg/kg. This specific composite sample may have contained an ingredient with a concentration exceeding the maximum legal limit of 200 μg/kg.Alternaria toxins (alternariol and alternariol methyl ether) were detected at levels ranging from 1.0 to 8.9 μg/kg in a number of composite samples, including tomato products, nuts, cereal products, chocolate and wine. Mycophenolic acid and roquefortine C cooccurred in mould-ripened cheese composites, while mycophenolic acid also was found in dried fruit and liquorice composite samples.
Congestion Control for Nonlinear TD-SCDMA Discrete Networks Based on TCP/IP
Authors: Liu Peng
Published: August 2015

A successive approximation approach (SAA) is developed to obtain a new congestion controller for the nonlinear TD-SCDMA network control systems based on TCP/IP. By using the successive approximation approach, the original optimal control problem is transformed into a sequence of nonhomogeneous linear two-point boundary value (TPBV) problems. The optimal control law obtained consists of an accurate linear feedback term and a nonlinear compensation term that is the limit of the solution sequence of the adjoint vector differential equations. By using the finite-time iteration of nonlinear compensation term of optimal solution sequence, we can obtain a suboptimal control law for TD-SCDMA network control systems based on TCP/IP.
Dementia and Other Neurocognitive Disorders
Authors: Galvin James E. , Kelleher Mary E.
Published: August 2015

This chapter presents a foundational overview of dementia, with a focus on Alzheimer's disease (AD), the most common cause of dementia. The authors start with an overview of mild cognitive impairment, which is often a dementia precursor, looking at symptoms and diagnostic criteria. AD is reviewed in depth, from the perspective of 2011 diagnostic guideline revisions that, for the first time, outline stages of the illness and also incorporate biomarkers to clarify diagnosis and track disease progression. Recent advances from the use of CSF tests, structural and functional imaging, and genetics are discussed. These advancements pose ethical challenges for patients and caregivers. Treatment options, including non-pharmacological strategies and medications, are reviewed.
Spiritual Factors in the Experience of Alzheimer's Disease and Other Dementias
Authors: MacKinlay Elizabeth , Trevitt Corinne
Published: August 2015

Alzheimer's disease and other dementias raise important questions of personhood and connection for those affected. Finding meaning in the face of dementia is one of the most challenging aspects of dementia; spiritual reminiscence is a way of connecting with those with dementia when their cognitive decline seems to preclude them from participating in a meaningful life. In this chapter a context for spirituality in later life is given through description of the spiritual tasks and process of ageing. This leads to presentation of work based on a mixed methods study of 113 people in residential aged care with a diagnosis of dementia who participated in either six or 24 weeks of weekly sessions of guided spiritual reminiscence (MacKinlay & Trevitt, 2012). Relationship was found to be almost synonymous with meaning for these people. Other important themes identified were vulnerability and transcendence, wisdom, hope, despair, and response to meaning.
Fragmented Existence
Authors: Svanström Rune
Published: August 2015

Drawing on prior research by the author, this chapter presents the experience of persons with dementia who lived alone and had a manifest care need. By applying the life-world perspective and the theory of intentionality to the findings, the author broadens our understanding of how people with advanced dementia experience life. More specifically, life with dementia appeared to be characterized by a gradual loss of meaning due to impaired intentionality. Participants faced increasing difficulties in understanding the meaning of the everyday objects and chores, which ultimately affected the sense of space, time, language, and the body. Our findings suggest that persons with dementia fight disturbed intentionality and try to create meaningfulness, an effort that becomes extremely difficult and strenuous over time. Home care that takes everyday objects and chores as a point of departure has the potential to help persons with dementia anchor themselves in the concrete everyday world.
The Sleep-Wake System and Alzheimer's Disease
Authors: Sharon Denise
Published: August 2015

The goal of this chapter is to raise awareness about the sleep-wake changes experienced by persons with Alzheimer's disease (AD) through a comprehensive review of the literature. The sleep-wake cycle is vital to our existence. Normal sleep is essential for restoration of the body and the brain. Sleep and wake states follow a circadian rhythm that regulates the body's internal processes. Sleep plays an important role in learning and memory consolidation, affecting wake-time cognitive functioning. The sleep-wake system is subject to aging and affected by a variety of disorders, including AD. The effect of AD on the sleep-wake cycle is magnified by comorbidities and situational factors. Disturbances of the sleep-wake cycle in AD are associated with increased caregiver burden and institutionalization and can significantly impact the affected individual's quality of life and subjective experience. Behavioral interventions designed to stabilize the sleep-wake cycle can be easily implemented.
Epidemiology of Cardiac Surgery and the Cardiac Surgical Patient
Authors: Katz Jason Neil , Sawey Edward J.
Published: August 2015

While the timeline has been relatively abbreviated, there has been significant evolution in the field of cardiac surgery. These changes have been driven by a combination of operative innovation, changing patient demographics, and novel critical care resources, all of which have allowed today's surgeons to treat a myriad of conditions among increasingly higher risk patient cohorts. At the same time, this has forced providers to expand their clinical skill sets, embrace multidisciplinary collaboration, enhance postoperative care, and intensify the rigor by which outcomes and quality are being measured. In spite of this increasing complexity, however, mortality in cardiac surgery continues to improve. In this chapter, we highlight key historical events and describe an unprecedented trajectory and evolution in care practices that have helped shape modern cardiac surgery. We also make an appeal for additional research efforts which are needed to ensure sustained and innovative growth.
Education and Training
Authors: Sandadi Jennifer , Chan June M.
Published: August 2015

Education and training has been the cornerstone of medicine from the days of the Hippocratic oath. What began as an informal apprenticeship has become a standardized curriculum, with heavy influence from the education sciences, regulatory bodies and societal demands. As an area of rigorous study in its own right, physicians have a responsibility to understand education theory and their effective application in clinical practice in order to fulfill their professional obligations. This chapter will outline past and current education theory relevant to critical care practice; introduce ideas and suggestions to implement these theories, and present new and emerging paradigms that are set to change graduate medical education in the upcoming decades.
Palliative Care
Authors: Hua May
Published: August 2015

Palliative care is a specialty of medicine that focuses on improving quality of life for patients with serious illness and their families. As the limitations of intensive care and the long-term sequelae of critical illness continue to be delimited, the role of palliative care for patients that are unable to achieve their original goals of care, as well as for survivors of critical illness, is changing and expanding. The purpose of this chapter is to introduce readers to the specialty of palliative care and its potential benefits for critically ill patients, and to present some of the issues related to the delivery of palliative care in surgical units.
Acute Coronary Syndrome
Authors: Calenda Brandon W. , Gidwani Umesh K.
Published: August 2015

Acute coronary syndrome (ACS) is a common and sometimes lethal event, usually precipitated by sudden rupture and thrombosis of an atherosclerotic plaque. Patients presenting with ACS can be rapidly risk stratified based on signs, symptoms, electrocardiogram, and biomarkers. There is a new generation of potent and reliable antiplatelet drugs, which in concert with anticoagulation and rapid revascularization, can preserve myocardium and save lives. When choosing how to revascularize, hemodynamically stable patients with diabetes mellitus and complex coronary disease benefit more from coronary artery bypass grafting rather than percutaneous coronary intervention. Despite optimal treatment, ACS can result in deadly complications such as cardiogenic shock. Supportive care is paramount, but despite its widespread use, the utility of intraaortic balloon counterpulsation is uncertain. In the future, advanced coronary imaging may enhance preventative care, novel molecular targets will help expand treatment options, and cell-based regenerative therapies may aid myocardial recovery after acute coronary syndrome.
Advanced Heart Failure Management and Selection for Advanced Therapies
Authors: Papolos Alexander , Gandhi Nishant A. , Teo Elrond , Bietry Raymond
Published: August 2015

Advancements in the field of heart failure have significantly improved both mortality and the quality of life of millions. However, heart failure generally remains a chronic disease with an insidious progression to organ failure despite optimal medical treatment. Early consideration of advanced therapies such as mechanical circulatory support and cardiac transplantation in advanced heart failure is essential. The purpose of this chapter is to assist the reader in the identification of patients with advanced heart failure that have not yet developed irreversible end-organ dysfunction, as interventions in this narrow therapeutic window results in improved post-surgical outcomes.
Perioperative Respiratory Care and Complications
Authors: Burrage Peter , Wadhwani Zinaida , Nurok Michael
Published: August 2015

Clinicians caring for patients with cardio-pulmonary disease invariably must manage the respiratory system. Doing so requires a basic understanding of physiology and the interaction of the heart and lung. The present chapter begins with rudimentary concepts of respiratory physiology, focusing on, gas exchange, pulmonary mechanics, and cardio-pulmonary interactions. These are used to develop an approach to mechanical ventilation and routine perioperative respiratory care of the patient having undergone a cardio-pulmonary procedure. The final section of this chapter addresses specific respiratory challenges encountered in caring for the critically ill cardiothoracic patient in addition to contemporary management strategies.
Cardiovascular System
Authors: Kratzert Wolf Benjamin , Boyd Eva Katherine
Published: August 2015

This chapter addresses underlying physiology, diagnostics, and management of common cardiovascular abnormalities in the patient after cardiac surgery. The goal is to provide insights into daily management, areas of controversy, and future directions in the field. After reviewing basic physiologic principles of cardiac output and circulation; problems affecting the postoperative hemodynamic state will be addressed individually. Specific topics include the low cardiac output syndrome, right ventricular failure, myocardial ischemia, diastolic dysfunction, vasodilatory syndrome, rhythm disturbances, pericardial tamponade, and cardiac arrest. Patients with postoperative open chests, or after orthotopic heart transplantation are also discussed.
Gastrointestinal Issues in the Cardiothoracic ICU
Authors: Harvey Carrie , Klein Katherine , Maile Michael
Published: August 2015

A thorough understanding of gastrointestinal issues in critical illness is necessary to optimize management of the cardiothoracic patient. Post-operatively, these patients are at increased risk of GI complications due a combination of underlying vascular disease, cardiopulmonary bypass, and low cardiac output, all of which lead to splanchnic hypoperfusion and subsequent damage to the gut mucosa. While GI complications are uncommon, they are associated with a disproportionately high rate of morbidity and mortality. Presence of unexplained fever, leukocytosis, bacteremia, hemodynamic compromise or abdominal pain or distention are concerning and require prompt assessment. Other GI management issues include delivery of adequate nutrition to counteract catabolism and promote wound healing and stress ulcer prophylaxis in patients with risk factors for upper gastrointestinal bleeding.
Surgical Management of Mitral Valve Disease
Authors: Varghese Robin
Published: August 2015

Surgery for the mitral valve has increased over the last decade, with a focus on an increasing number of valve repairs for degenerative mitral valve disease. This chapter discusses the surgical management of mitral valve disease with a focus on the pathology of mitral valve stenosis and regurgitation. With an examination into the pathophysiology of the lesions. Subsequently a discussion regarding the various surgical techniques for mitral valve surgery followed by the major and minor complications of surgery are reviewed to provide the Intensivist with an overview of possible complications. Finally a look at the future direction of the field is briefly examined.
Thoracic Aortic Disease
Authors: Worku Berhane , Girardi Leonard
Published: August 2015

Thoracic aortic disease most commonly presents in the form of aneurysmal dilation or dissection of the ascending or descending thoracic aorta, most commonly secondary to degenerative disease and hypertension. Several genetic connective tissue disorders are commonly associated as well. Treatment is focused on blood pressure control and surgical repair. Surgical repair of thoracic aortic disease presents unique risks, including neurologic injury involving the brain or spinal cord, and several adjuncts are available to mitigate against this risk. This chapter discusses commonly associated risk factors, preoperative testing, surgical repair, and postoperative management of thoracic aortic disease along with strategies for minimizing neurologic injury.
Lung Transplantation
Authors: Cheng Aaron M. , Mulligan Michael S. , Togashi Kei
Published: August 2015

Lung transplantation is a widely accepted surgical procedure for treatment of select patients suffering from end-stage lung disease. Recipients, however, require meticulous post-transplant care to preserve allograft lung function and to ensure optimal patient quality of life. In the post-operative period, these patients are predisposed to specific complications and pose unique considerations that clinicians caring for these patients in the intensive care setting should be familiar with managing. This chapter focuses on the early post-operative critical care management of the lung transplant recipient with specific emphasis on hemodynamic resuscitation; early lung graft dysfunction; and considerations regarding immunosuppression and infection. Non-pulmonary issues that affect the clinical care of these patients in the ICU setting are also discussed.
Significance of Clouds for Connected Governments
Authors: Raj Pethuru
Published: August 2015

Clouds are emerging as the core IT infrastructure for all kinds of organizations across the globe. Business and government are embarking on the cloud journey with all the clarity and confidence to tackle the associated challenges. The cloud idea represents bringing in optimization and transformation of IT infrastructures to be innately robust and resilient for the forthcoming era of knowledge. With the maturity of ICTs, governments too are keen to embrace them to deliver a bevy of people-centric services to citizens. IT vendors are also working with worldwide governments to chalk out viable plans and methodologies to enhance the service delivery assurance, competency and capability. In this chapter, we aim to discuss how the cloud paradigm is shaping up the unique requirements of connected governments. We also discuss how the Indian government is investing in cloud infrastructures to bring in the much-demanded transparency and accountability in electronic governance.
A Cloud-Based Framework for Connected Governance
Authors: Mukherjee Saswati , Geethapriya R. , Surianarayanan Suba
Published: August 2015

The advancement of various computer technologies has led to the migration of traditional governance to e-governance that enables the citizens to access the government services through Internet. Although, Information and Communication Technologies (ICT) act as backbone for e-governance in helping the government meet its citizens' needs through efficient service delivery, e-governance lacks the cross-agency communication as the e-services are offered by the government agencies independently. A better version of e-governance is c-governance (connected governance) in which the government agencies are connected and offer an integrated service to the citizens. Cloud is now a leading technology that enables collaboration across agencies and seamlessly integrated services. This chapter suggests the importance of adopting cloud technologies for c-governance and presents a discussion of the existing government clouds of Singapore and UK. A c-governance framework is also presented to illustrate how the cloud deployment and service models can be adopted for c-governance.
A Support Framework for the Migration of E-Government Services to the Cloud
Authors: Cardoso Abílio , Moreira Fernando , Simões Paulo
Published: August 2015

Public and federal agencies from countries around the world are increasingly providing information technology based services via the Internet - known as e-government. Several of the general requirements of e-government services are satisfactorily met by the emerging Cloud Computing paradigm that promises a number of benefits such as service elasticity (the ability to handle peaks and troughs of demands); optimization of costs; capacity to handle large volumes of data; and a generalized model of Internet-based access for end-users. For this reason, it is no surprise that Cloud related technologies are gradually leveraging e-government platforms. In this chapter, a support framework is outlined that complies with and extends the well-known ITIL (Information Technology Infrastructure Library) set of best practices for IT (Information Technology) service management. It is suggested that the proposed framework can be usefully deployed to assist in the process of migrating e-government services provision to the Cloud Computing environment.
An Extensible Identity Management Framework for Cloud-Based E-Government Systems
Authors: Anwar Hirra , Shibli Muhammad Awais , Habiba Umme
Published: August 2015

Numerous Cloud Identity Management (IdM) systems have been designed and implemented to meet the diverse functional and security requirements of various organizations. These requirements are subjective in nature; for instance, some government organizations require security more than efficiency while others prioritize performance and immediate response over security. However, most of the existing IdM systems are incapable of handling the user-centricity, security & technology requirements and are also domain specific. In this regard, this chapter elaborates the need to use Cloud Computing technology for enhancing the effectiveness and transparency of IdM functions and presents a comprehensive and well-structured Extensible IdM Framework for Cloud based e-government institutions. We present the design and implementation details of the proposed framework, followed by a case study which shows how government organizations of Pakistan would use the proposed framework to improve their IdM processes and achieve diverse IdM services.
Cloud Computing Applications in Education through E-Governance
Authors: Sivagurunathan S. , Swasthimathi L. S.
Published: August 2015

Cloud computing is the new style of distributed computing that aims to provide computing resources through the Internet, on a pay-per-use-basis, as a variety of services to the cloud consumers. With the emergence of newer technologies, the extensive use of ICT in every field of life is compelling the migration of e-governance services to the cloud environment. In this context, in India, the National e-Governance Plan (NeGP) has been introduced which is the flagship e-governance project. This comprises 27 Mission Mode Projects relating to Health, Education, Public Distribution System, etc. By the inclusion of education in the NeGP, the concept of effective governance of education sector is thoroughly innovated in connecting the various state governments for the effective handling of the new challenges confronting the education sector. This chapter attempts to provide a model for e-governance in the education sector using cloud computing. It is suggested that the proposed educational e-governance model can facilitate in improving transparency, providing speedy information dissemination, improving administrative efficiency, and providing public services in all aspects of the provision of education. There is no doubt that the quality of output of the education system will substantially improve if the e-governance in the education is implemented using the cloud technologies.