bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of the Sitting Upright or ‘Beachchair’ Position on Cerebral Blood Flow during Anaesthesia for Shoulder Surgery
Authors: Soeding P. F. , Wang J. , Hoy G. , Jarman P. , Phillips H. , Marks P. , Royse C. 
Published: January 2019

The sitting upright or ‘beachchair’ position is commonly used for shoulder arthroscopic surgery. There is a theoretical concern that anaesthetised patients placed in this posture are at risk of reduced cerebral blood flow (CBF), especially if there is associated hypotension. This study investigated the effect of anaesthetic-induced hypotension on estimated cerebral blood flow in patients placed in the beachchair position for shoulder surgery. Forty patients were randomised to either sedation (propofol infusion 10 to 20 mg.hour-1, n=20) or general anaesthesia using sub minimum alveolar concentration of sevoflurane (n=20). All patients received an interscalene brachial plexus regional block. Internal carotid artery blood flow was measured using the time averaged velocity of the spectral Doppler waveform, and was then used as an estimate of global CBF. Following a pre-anaesthesia study, measurement of internal carotid artery blood flow was made before and after beachchair positioning, and at five-minute intervals during surgery. Beachchair positioning during general anaesthesia significantly decreased the mean arterial pressure (34±10 mmHg) compared to sedation (4±2 mmHg, P <0.01), and vasopressor therapy was required more often. However, CBF remained constant in both anaesthetised (P=0.83) and sedated patients (P=0.68) despite beachchair positioning, and the fall in mean arterial pressure in the anaesthetised patients. There was no significant difference in CBF between groups (P=0.91). These findings indicate that in patients in the beachchair position receiving sevoflurane anaesthesia, CBF is maintained when mean arterial pressure is above 70 mmHg, consistent with intact autoregulation.
Variability in Adequacy of Ventilation during Transport of Cardiac Surgery Patients: A Cohort Study
Authors: Rajasekaram R. , Reade M. C. , Shortal B. , Hart G. K. , Shaw M. , Bellomo R. 
Published: January 2019

Inadequate ventilation of intubated patients during transport from the operating theatre to the intensive care unit with attendant hypercarbia may adversely affect haemodynamics. In a retrospective observational study, we assessed the incidence of inadequate ventilation during transport from the operating theatre to the intensive care unit in 99 consecutive cardiac surgery patients admitted to our university tertiary hospital. Demographic, clinical, arterial blood gas and haemodynamic measurements were made on arrival in the intensive care unit after cardiac surgery. The relationships between arterial carbon dioxide tension (PaCO2), mean pulmonary artery pressure (MPAP) and other relevant haemodynamic variables were explored. Overall, hypocarbia (PaCO2<35 mmHg) occurred in 18.2% of patients, while 28.3% of patients had hypercarbia (PaCO2 >45 mmHg). Pulmonary hypertension was common, with nearly half of the cohort having MPAP ≥25 mmHg and 17.2% ≥30 mmHg. However, there was no association between PaCO2 and MPAP (R2=0.0076, P=0.39). Contrary to expectation, neither hypercarbia nor high MPAP were associated with measured adverse outcomes, although this may have been because we studied an insufficient number of patients with extreme values. Associations of higher MPAP, which would be expected to compromise cardiovascular status, included acidaemia, hypoxia and the requirement for noradrenaline. These factors define a group of high-risk patients who should receive particular attention and who should be the focus of future studies.
Unrestricted Access to Sugammadex: Impact on Neuromuscular Blocking Agent Choice, Reversal Practice and Associated Healthcare Costs
Authors: Ledowski T. , Hillyard S. , Kozman A. , Johnston F. , Gillies E. , Greenaway M. , Kyle B. C. 
Published: January 2019

Sugammadex is known to rapidly and completely reverse the effects of amino-steroidal neuromuscular blocking agents. However, the high costs of sugammadex have so far prevented its introduction as the standard reversal agent in most healthcare systems. At the Royal Perth Hospital, sugammadex was recently introduced as an unrestricted alternative to neostigmine for the reversal of amino-steroidal neuromuscular blocking agents. The aim of this retrospective observational audit was to investigate the impact of this change on clinical practice and associated healthcare costs. Data from all patients intubated during a one-month period in April to May 2010 and for a similar period in 2011 were retrospectively collected and the use of neuromuscular blocking agents and reversal agents were identified and the associated costs were calculated. More steroidal neuromuscular blocking agents and sugammadex (+743%), but less glycopyrrolate and neostigmine (-48%) were used in 2011. Using the manufacturer's list price, muscle relaxation and reversal costs increased from about A$42 per case to about A$127 per case. Between the investigated time periods no differences were found for anaesthesia time, operating time or time spent in the post anaesthesia care unit. However, there was a statistically significant decrease in the time between surgery and discharge (median 2.0 vs 2.2 days). While the design of the audit was such that no inferences can be made about the cause of this change, this is an interesting observation worthy of further investigation.
Trainees’ Attitudes to Research as part of Anaesthetic Training
Authors: Kluger M. T. 
Published: January 2019

The formal project has been a requirement for the F.A.N.Z.C.A. diploma for the past few years. A questionnaire was sent to all registrars on a formal program asking questions relating to the formal project, perceived advantages, disadvantages, value of formal research teaching methodology and future career intentions. All years of training were represented. Forty-nine of the fifty-six (86%) respondents replied to the survey. Of these 15% felt the formal project had no value, 54% found it possibly useful whilst 31% perceived is as very useful. Advantages of the formal project included appreciation of research skills and the ability to critically appraise research. Disadvantages included lack of dedicated time, space and funding and production of poor quality research. A majority (63%) favoured formal teaching of research methods for the F.A.N.Z.C.A. diploma, which ideally should be taught before the Primary (30%) or in the Provisional Fellowship year (36%). Few respondents indicated a willingness to undertake a major commitment to research in the future (4%) but 46% wanted some contact with research and teaching as part of their normal work practice. A more structured teaching in research methodology, assessment of published work and presentation skills may be more suited to the longterm goals of the majority of clinical anaesthetists.
The Effect of Different Bypass Flow Rates and Low-Dose Dopamine on Gut Mucosal Perfusion and Outcome in Cardiac Surgical Patients
Authors: Schneider M. , Valentine S. , Hegde R. M. , Peacock J. , March S. , Dobb G. J. 
Published: January 2019

The aim of this double-blind, randomized, placebo-controlled trial was to investigate the effects of different cardiopulmonary bypass flow rates and low-dose dopamine on gastric mucosal pH (pHi) and outcome. We hypothesized that by minimizing gut mucosal hypoperfusion during and after cardiac surgery endotoxin translocation may be prevented, resulting in an improved clinical outcome. Four groups of 25 patients each receiving high or low flows during bypass and low-dose dopamine or saline for 24 hours after induction of anaesthesia were studied. The pHi was measured at six time intervals over 24 hours. The combination of low-dose dopamine and a low bypass flow rate was associated with a significantly greater frequency and severity of low pHi. This group also demonstrated a significantly lower vascular resistance on admission to the intensive care unit. There may be an association between low pHi and low vascular resistance.
Knowledge, Perceptions, and Patterns of Fish Oil Use in Cardiac Patients
Authors: Hilleman Daniel E. , Teply Robyn , Packard Kathleen A. 
Published: January 2019

Background: Fish oils are the most widely used nonvitamin, nonmineral dietary supplements in the United States. They are not over-the-counter medications and are neither approved nor indicated for treating disease. Patient knowledge and patterns of fish oil use are not well defined. Objective: To determine cardiac patients’ knowledge and patterns of fish oil use. Methods: One thousand consecutive patients admitted to an in-patient cardiology service (2015-2017) taking fish oil dietary supplements or prescription omega-3 fatty acids were asked to complete an anonymous questionnaire concerning product knowledge and use. Results: A total of 711 (71%) patients completed the questionnaire. Primary reasons for use included general health (34%), heart health (28%), arthritis (9%), and lipid disorders (8%). Few patients (14%) were advised to take fish oil products by a health-care provider. Only 2.5% were taking prescription omega-3 fatty acids. Only 26% knew the active ingredient in their fish oil product. Supplements were purchased through a nonpharmacy retail seller by 81% of respondents. Conclusions: Most cardiac patients consuming fish oil dietary supplements do so without medical supervision and without knowledge of the active ingredients. As most patients obtain supplements outside of a pharmacy, opportunities to monitor and educate patients remain a major challenge.
Identity-Based Othering and Collaborative Leadership: Implications of Contradictory Messages for New Administrators
Authors: Retelle Ellen , Poole Wendy 
Published: January 2019

A study of beginning administrators in a school district reveals that they receive contradictory messages about school leadership. Although the school district emphasizes collaborative, facilitative leadership through documents and orientation of new administrators, bureaucratic, political, and identity-based messages reinforce traditional hierarchical structure and the othering of teachers. The contradictions make it difficult for new administrators to develop strong, coherent identities. Those who possess a strong sense of leadership dentity at the beginning of their 1st year as administrators may have a better chance of resisting the pull of traditional leadership models. Although the findings are not generalizable, they raise important contemporary issues in the identity development of new administrators. This article examines the teacher–administrator relationship, particularly the “we–they” construction that tends to underlie the relationship. The norm of othering tends to exist whether parties perceive the teacher–administrator relationship in their particular settings to be generally positive or adversarial. The focus of this article is how vice principals in one school district, while making the transition from teaching to administration, make sense (or not) of the teacher–administrator relationship.
Creating Successful Schools for All Children: A Proven Step
Authors: Achilles C. M. , Nye B. A. , Zaharias J. B. , Fulton B. D. 
Published: January 2019

Research on class size in early primary grades (K-3) is showing the efficacy of small classes (p  .01) of 1:15. Application of these early experimental results in 17 poor counties was followed by a major rise in the average rank of the 17 systems among the state's system. Additional studies show the lasting benefits to pupils through grade 5 of having been in 1:15 classes during K-3. Professors should disseminate these results, and administrators should actively apply these—and other—research results in their quest for successful schools for all children.
Training Administrators for Culturally and Linguistically Diverse School Populations: Opinions of Expert Practitioners
Authors: Herrity Vishna A. , Glasman Naftaly S. 
Published: January 2019

Cultural and linguistic diversity has changed the social fabric of today's schools. Currently, there is a wider variety of cultural, language, and family backgrounds than ever before. As a result of the increasing numbers of language minority students with unique educational and social needs, some studies suggest that principals need specialized training to ensure that all students have equal access to an education based on academic excellence and high expectations. Yet there are limited opportunities for aspiring administrators to receive specialized training for working with culturally and linguistically diverse school populations. As a result, many school administrators may lack the necessary preparation to develop policies and implement educational programs for diverse students. This paper is based on the premise that administrator preparation programs exist within the context of school and society interactions. Changes in administrator practices in school settings require corresponding changes in university-based administrator training programs. The research study reported in this paper describes and examines the recommendations of “expert” principals for the modification of administrator preparation programs based on interactions that exist between the changes in the demographics of society, impact on the schools, and impact on administrators. The goal is that university-based training programs would play a critical role in equipping aspiring administrators with the necessary competencies to become effective instructional leaders in multiethnic schoolsettings.
Predictors of Societal Costs of Older Care-Dependent Adults Living in the Community in 11 European Countries
Authors: van Lier Lisanne I , van der Roest Henriëtte G , Oosten Babette SH , Garms-Homolová Vjenka , Onder Graziano , Finne-Soveri Harriet , V Jónsson Pálmi , Ljunggren Gunnar , Henrard Jean-Claude , Topinkova Eva , Sørbye Liv Wergeland , Bernabei Roberto , van Hout Hein PJ , Bosmans Judith E 
Published: January 2019

Background: The objective was to identify predictors of societal costs covering formal and informal care utilization by older home care clients in 11 European countries. Methods: Societal costs of 1907 older clients receiving home care for 12 months from the Aged in Home care (AdHoc) study were estimated using the InterRAI Minimum Data Set for Home Care’s (MDS-HC) resource use items. Predictors (medical, functional, and psychosocial domains) of societal costs were identified by performing univariate and multivariate generalized linear model analyses. Results: Mean societal costs per participant were €36 442, ranging from €14 865 in Denmark to €78 836 in the United Kingdom. In the final multivariate model, country, being married, activities of daily living (ADL) dependency, cognitive impairment, limitations of going out, oral conditions, number of medications, arthritis, and cerebro vascular accident (CVA) were significantly associated with societal costs. Conclusions: Of the predictors, ADL dependency and limitations of going out may be modifiable. Developing interventions targeted at improving these conditions may create opportunities to curtail societal costs.
Deaccesioning in Museums
Authors: Varner Elizabeth 
Published: January 2019

One of the paradoxes of deaccessioning is the need to dispose of tangible cultural heritage without violating the donors’ or public's trust. As the economy has declined, precipitating a need for museums to reevaluate and consolidate their collections, misinformation, confusion and public hostility towards deaccessioning has persisted. While practitioners and scholars have shown a great deal of interest in the ethical dilemmas inherent in deaccessioning, the need for deaccessioning and the practicalities and legalities of deaccessioning have been largely ignored. Refuting a blanket prohibition or bias against deaccessioning, this article highlights the legal, ethical and practical considerations of deaccessioning including a list of relevant regulations and best practices. When discussing legal considerations, this article will review restrictions on disposal, authorization to deaccession, fiduciary duties implicated by deaccessioning and standing to sue. Under ethical considerations, this article will analyze relevant provisions from the AAM, AAMD, AASLH and ICOM regarding ethical considerations as well as highlight key issues in the debate. Finally, this article will list the best practices for deaccessioning including the importance of unrestricted title to the work before sale, proper authority to approve deaccessioning, documentation needed, appropriate method, notification to donor and the use of proceeds.
Not Having Been Breastfed May Protect Chinese Women From Developing Deep Infiltrating Endometriosis: Results From Subgroup Analyses of the FEELING Study
Authors: Dai Yi , Zhang Xinmei , Xue Min , Zhou Yingfang , Sun Pengran , Leng Jinhua 
Published: January 2019

Background: This study aimed to investigate potential factors, especially early-life exposures, associated with endometrioma (OMA) and/or deep infiltrating endometriosis (DIE) in Chinese women. Methods: This is a subgroup analyses of the FEELING study, which was a case–control study that investigated the clinical, lifestyle, and environmental factors associated with OMA and/or DIE in China, Russia, and France. In this subgroup analysis, the data for the Chinese participants were further analyzed using logistic regression model. Results: All women (N = 546) had fully completed the questionnaire. The mean age of the participants was 31.8 (range: 18-41) years. Univariable analysis showed that noncyclic chronic pelvic pain, dysmenorrhea intensity class, and whether breastfed during infancy were distributed differently between patients with OMA or DIE and those with no endometriosis (non-EM) or superficial peritoneal endometriosis (SUP; P < .05). Multivariable analysis revealed that not having been breastfed was a protective factor against OMA and DIE (odds ratio [OR] = 0.33, 95% confidence interval [CI]: 0.16-0.69). Further analysis indicated not having been breastfed was a protective factor for DIE compared with non-EM (OR = 0.13, 95% CI: 0.02-0.88) and with OMA + SUP (OR = 0.19, 95% CI: 0.04-0.85) but was not a protective factor for OMA compared with non-EM (OR = 0.66, 95% CI: 0.32-1.36) and with SUP (OR = 0.63, 95% CI: 0.31-1.30). Conclusion: This is the first study suggesting that not having been breastfed might protect against DIE in Chinese women.
Hyponatremia at discharge is associated with adverse prognosis in acute heart failure syndromes with preserved ejection fraction: a report from the JASPER registry
Authors: Sato Yu , Yoshihisa Akiomi , Oikawa Masayoshi , Nagai Toshiyuki , Yoshikawa Tsutomu , Saito Yoshihiko , Yamamoto Kazuhiro , Takeishi Yasuchika , Anzai Toshihisa 
Published: January 2019

Introduction: Hyponatremia predicts adverse prognosis in patients with heart failure in particular with reduced ejection fraction. In contrast, it has recently been reported that hyponatremia on admission is not a predictor of post-discharge mortality in patients with heart failure with preserved ejection fraction. We investigated the prognostic impact of hyponatremia at discharge in patients with heart failure with preserved ejection fraction and its clinical characteristics. Methods and results: The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, prospective registration of consecutive Japanese patients hospitalised with heart failure with preserved ejection fraction and left ventricular ejection fraction of 50% or greater. Five hundred consecutive patients were enrolled in this analysis. We divided the patients into two groups based on their sodium serum levels at discharge: hyponatremia group (sodium <135 mEq/L, n=50, 10.0%) and control group (sodium ⩾135 mEq/L, n=450, 90.0%). This present analysis had two primary endpoints: all-cause death and all-cause death or rehospitalisation for heart failure. At discharge, the hyponatremia group had lower systolic blood pressure (110.0 mmHg vs. 114.5 mmHg, P=0.014) and higher levels of urea nitrogen (31.9 mg/dL vs. 24.2 mg/dL, P=0.032). In the Kaplan–Meier analysis, more patients in the hyponatremia group reached the primary endpoints than those in the control group (log rank <0.01, respectively). In the Cox proportional hazard analysis, hyponatremia at discharge was a predictor of the two endpoints (all-cause death, hazard ratio 2.708, 95% confidence interval 1.557–4.708, P<0.001; all-cause death or rehospitalisation for heart failure, hazard ratio 1.829, 95% confidence interval 1.203–2.780, P=0.005). Conclusions: Hyponatremia at discharge is associated with adverse prognosis in hospitalised patients with heart failure with preserved ejection fraction.
A novel injectable thermo‐sensitive binary hydrogels system for facilitating endoscopic submucosal dissection procedure
Authors: Zhu Yan , Xu Jia-Xin , Cheng Jing , Zhang Zhen , Zhu Bo-Qun , Chen Tian-Yin , Xu Xiao-Yue , Wang Yun , Cai Ming-Yan , Zhou Ping-Hong 
Published: January 2019

Background and aimsMaking an optimal and lasting submucosal cushion is critical for endoscopic submucosal dissection. The thermo‐sensitive binary hydrogels system composed of poloxamer 407 and poloxamer 188 might be an excellent submucosal injection solution considering the unique feature that it remains liquid at room temperature and becomes gelatinous after being injected in the submucosa of the digestive tract. The present study focuses on preparing the thermo‐sensitive binary hydrogels system and testing its capacity in mucosal lifting and its role in the endoscopic submucosal dissection procedure.MethodsVarious concentrations of poloxamer 407 and poloxamer 188 were added to normal saline. The gelation temperature viscosity of the thermo‐sensitive binary hydrogels system was measured to choose the best formula. The thermo‐sensitive binary hydrogels system and normal saline were first compared in extracted porcine stomach. For in vivo study, the thermo‐sensitive binary hydrogels system and normal saline were compared for facilitating the endoscopic submucosal dissection procedure.ResultsAmong the 46 kinds of thermo‐sensitive binary hydrogels system, gelation temperatures of the thermo‐sensitive binary hydrogels system I (poloxamer 407/poloxamer 188, 17%/0.5%, w/w) and the thermo‐sensitive binary hydrogels system II (poloxamer 407/poloxamer 188, 18%/2%, w/w) were among the ideal range of gelation temperature. The injecting pressure in vitro study of thermo‐sensitive binary hydrogels system II was significantly higher than that of thermo‐sensitive binary hydrogels system I and normal saline (p < 0.001). Sixteen gastric endoscopic submucosal dissection procedures were performed in a porcine model. The initial volume of normal saline injection (13.88 ± 3.91 ml vs 5.88 ± 3.44 ml, p = 0.001) was significantly larger than the thermo‐sensitive binary hydrogels system group. The postoperative wound showed a significant difference in the two groups (p = 0.023) indicating that the thermo‐sensitive binary hydrogels system can create a cleaner wound.ConclusionsConsidering the gelation temperature, viscosity, injection pressure, and the height of the mucosal elevation, the thermo‐sensitive binary hydrogels system I was the better submucosal injection solution.