bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analgesia and Sedation Protocol for Mechanically Ventilated Postsurgical Children Reduces Benzodiazepines and Withdrawal Symptoms—But Not in All Patients
Authors: Seitz Guido , Schmidt Andreas , Renk Hanna , Kumpf Matthias , Fideler Frank , Esslinger Martin , Gerbig Ines , Fuchs Jörg , Hofbeck Michael , Neunhoeffer Felix 
Published: July 2016

Background We demonstrated recently that the implementation of a nurse-driven analgesia and sedation protocol (pediatric analgesia and sedation protocol [pASP]) for mechanically ventilated nonpostsurgical patients reduces the total dose of benzodiazepines and the withdrawal symptoms significantly. It has not been investigated if these results can also be expected in the group of patients undergoing surgery.
Objectives To evaluate the effects of the pASP in mechanically ventilated postsurgical children regarding drug dosage, duration of mechanical ventilation, length of stay, and rate of withdrawal symptoms.
Methods This is a two-phase prospective observational control study. The preimplementation group was managed by the physician's order and the postimplementation group was managed with the pASP including COMFORT-B, nurse interpretation of sedation, and Sophia observation withdrawal symptoms scale scoring.
Measurements and Main Results One hundred and sixteen patients were included before and one hundred and ten patients after implementation. The pASP had no effect on length of pediatric intensive care unit stay or duration of mechanical ventilation. The protocol reduced total (5.0 mg/kg [0.5–58.0] vs 4.0 mg/kg [0.0–47.0]; p = 0.021) and daily doses (4.4 mg/kg/d [1.1–33.9] vs 2.9 mg/kg/d [0.0–9.9]; p < 0.001) of benzodiazepines significantly. No difference was observed in total and daily doses of opioids (5.0 mg/kg [0.1–67.0] vs 3.0 mg/kg [0.1–71.0]; p = 0.81) and (0.7 mg/kg/d [0.0–7.0] vs. 0.8 mg/kg/d [0.0–3.7]; p = 0.35), respectively. Rate of withdrawal symptoms was significantly lower after implementation (35.3 vs 20.0%; p = 0.01), but not in patients after solid organ transplantation or oncological patients.
Conclusion The nurse-driven analgesia and sedation protocol is an effective procedure to reduce the total doses of benzodiazepines and occurrence of withdrawal symptoms in postsurgical children, which are naïve to opioids or benzodiazepines.
Funktionelle und morphologische mikrostrukturelle Veränderungen in der SD-OCT bei der Langzeitbehandlung der neovaskulären AMD mit Ranibizumab-Monotherapie versus Kombinationstherapie mit PDT
Authors: Wand K. , Tetz K. , Fischinger I. , Lohmann C. , Maier M. , Feucht N. 
Published: July 2016

Zusammenfassung
Hintergrund: Zur Behandlung der neovaskulären altersabhängigen Makuladegeneration (nAMD) ist die intravitreale Anti-VEGF-Therapie Goldstandard. Inwiefern eine additive photodynamische Therapie (PDT) das funktionelle und strukturelle Ergebnis beeinflussen kann, wird in der Literatur kontrovers diskutiert. Ziel unserer Studie war es, den funktionellen und morphologischen Effekt der Kombinationstherapie mit PDT plus Ranibizumab im Vergleich zur Monotherapie mit Ranibizumab im Langzeitverlauf zu untersuchen.
Material und Methoden: In einer retrospektiven Studie wurden die Daten von Patienten mit nAMD ausgewertet, die für mindestens 42 Monate nachbeobachtet wurden. Patienten wurden der Gruppe A (Monotherapie mit Ranibizumab nach pro re nata [PRN]) oder der Gruppe B (Kombinationstherapie mit einmaliger PDT plus Ranibizumab nach PRN) zugeordnet. Ausgewertet wurden der beste korrigierte Visus (BCVA) zum Start- und Endzeitpunkt sowie die zentrale Retinadicke (CRT), die maximale Retinadicke (MRT) und der Durchmesser der Plaquebasis in der Spectral Domain optischen Kohärenztomografie (SD-OCT) zum 1. Mess- und zum Endzeitpunkt.
Ergebnisse: Eingeschlossen wurden in die Gruppe A 21 Augen (17 Patienten), in die Gruppe B 12 Augen (11 Patienten). Der mittlere Nachbeobachtungszeitraum von Start- bis Endpunkt betrug 64 Monate, von Erstmessung SD-OCT bis Endpunkt 47 Monate. Im Zeitraum zwischen Start- und Endpunkt erhielten die Patienten der Gruppe A 19 ± 14 intravitreale Injektionen, der Gruppe B 22 ± 10. Der BCVA zum Startpunkt betrug in der Gruppe A 0,31 ± 0,26 dezimal, in der Gruppe B 0,31 ± 0,17, zum Endpunkt in der Gruppe A 0,29 ± 0,25 (p = 0,405) und in der Gruppe B 0,25 ± 0,20 (p = 0,142). Die CRT zeigte in der Gruppe A eine Abnahme von 72 ± 178 µm (p = 0,024), in der Gruppe B eine Abnahme von 28 ± 98 (p = 0,1335). Die MRT zeigte analog in der Gruppe A eine Abnahme von 25 ± 135 µm (p = 0,166) und in der Gruppe B eine Abnahme von 2 ± 118 µm (p = 0,421). Die Plaquebasis zeigte eine Zunahme von 32 ± 1468 µm in der Gruppe A (p = 0,242) und 748 ± 1024 in der Gruppe B (p = 0,025).
Schlussfolgerung: Über einen Beobachtungszeitraum von im Mittel 5,3 Jahren zeigten Patienten mit nAMD in beiden Gruppen vergleichbare Ergebnisse mit guter Visusstabilisierung. Es kam in beiden Gruppen tendenziell zu einer Abnahme der Retinadicke sowie zu einer Zunahme der Plaquebasis. Bezüglich der SD-OCT-basierten morphologischen Kriterien zeigten Patienten der Monotherapiegruppe tendenziell ein besseres Therapieansprechen.
Epidemiologie und klinisches Erscheinungsbild der Sarkoidose
Authors: Costabel U. , Wessendorf T. , Bonella F. 
Published: July 2016

ZusammenfassungDie Sarkoidose ist eine Systemerkrankung unbekannter Ätiologie, die histologisch durch epitheloidzellige Granulome charakterisiert ist und sich immunpathologisch durch eine gesteigerte zelluläre Immunantwort vom Th1-Typ in den betroffenen Organen auszeichnet. Die Krankheit kommt weltweit vor, in nördlichen Breiten häufiger als im Süden. In Deutschland liegt die Inzidenz bei 10 pro 100 000 und die Prävalenz bei 44–48 pro 100 000. Die Erkrankung tritt meistens vor dem 50. Lebensjahr auf, kann aber prinzipiell in jedem Lebensalter, auch bei Kindern und Jugendlichen sowie im höheren Lebensalter in Erscheinung treten. Der Erkrankungsgipfel liegt zwischen 20 und 39 Jahren, Frauen sind in den meisten ethnischen Gruppen häufiger betroffen als Männer. Eine familiäre Häufung ist bekannt. Das klinische Erscheinungsbild bei Sarkoidose ist sehr vielfältig und von den einzelnen Organmanifestationen abhängig. Allgemeinsymptome sind Müdigkeit, Nachtschweiß, Gewichtsverlust, seltener auch Fieber, sowie Arthralgien und Myalgien. Organspezifische Symptome sind z. B. Husten und Luftnot beim Lungenbefall, Kopfschmerzen sowie Nervenlähmungen bei Neurosarkoidose, Herzrhythmusstörungen und Herzinsuffizienz bei kardialer Sarkoidose, vielgestaltige Hauterscheinungen bei Hautmanifestation, eine einseitige oder beidseitige Parotisschwellung bei Beteiligung der Speicheldrüsen. Man unterscheidet 2 Manifestationsformen: Eine akute, selten rezidivierende Form und eine chronische, häufiger rezidivierende Erkrankung. Das Löfgren-Syndrom, als Sonderform der akuten Sarkoidose, ist durch die Trias aus bihilärer Lymphadenopathie, Sprunggelenksarthritis und Erythema nodosum gekennzeichnet. Die chronische Sarkoidose tritt bei der Mehrzahl der Betroffenen auf, sie kann zunächst symptomarm verlaufen, trotz z. T. ausgeprägter Röntgenbildveränderungen. Man spricht von chronischer Sarkoidose, wenn nach einer Krankheitsdauer von über 2 Jahren die Krankheit noch aktiv ist. Die Prognose ist mit einer hohen Rate an Spontanremissionen insgesamt gut und hängt von den Organkomplikationen ab.
Spatial variation in giraffe demography: a test of 2 paradigms
Authors: Lee Derek E. , Bond Monica L. , Kissui Bernard M. , Kiwango Yustina A. , Bolger Douglas T. 
Published: July 2016

Abstract
Examination of spatial variation in demography among or within populations of the same species is a topic of growing interest in ecology. We examined whether spatial variation in demography of a tropical megaherbivore followed the “temporal paradigm” or the “adult survival paradigm” of ungulate population dynamics formulated from temperate-zone studies. We quantified spatial variation in demographic rates for giraffes (Giraffa camelopardalis) at regional and continental scales. Regionally, we used photographic capture-mark-recapture data from 860 adult females and 449 calves to estimate adult female survival, calf survival, and reproduction at 5 sites in the Tarangire ecosystem of Tanzania. We examined potential mechanisms for spatial variation in regional demographic rates. At the continental scale, we synthesized demographic estimates from published studies across the range of the species. We created matrix population models for all sites at both scales and used prospective and retrospective analyses to determine which vital rate was most important to variation in population growth rate. Spatial variability of demographic parameters at the continental scale was in agreement with the temporal paradigm of low variability in adult survival and more highly variable reproduction and calf survival. In contrast, at the regional scale, adult female survival had higher spatial variation, in agreement with the adult survival paradigm. At both scales, variation in adult female survival made the greatest contribution to variation in local population growth rates. Our work documented contrasting patterns of spatial variation in demographic rates of giraffes at 2 spatial scales, but at both scales, we found the same vital rate was most important. We also found anthropogenic impacts on adult females are the most likely mechanism of regional population trajectories.
Defining the risk of Zika and chikungunya virus transmission in human population centers of the eastern United States
Authors: Manore Carrie A. , Ostfeld Richard S. , Agusto Folashade B. , Gaff Holly , LaDeau Shannon L. 
Published: July 2016

AbstractThe recent spread of mosquito-transmitted viruses and associated disease to the Americas motivates a new, data-driven evaluation of risk in temperate population centers. Temperate regions are generally expected to pose low risk for significant mosquito-borne disease, however, the spread of the Asian tiger mosquito (Aedes albopictus) across densely populated urban areas has established a new landscape of risk. We use a model informed by field data to assess the conditions likely to facilitate local transmission of chikungunya and Zika viruses from an infected traveler toAe. albopictusand then to other humans in USA cities with variable human densities and seasonality.Mosquito-borne disease occurs when specific combinations of conditions maximize virus-to-mosquito and mosquito-to-human contact rates. We develop a mathematical model that captures the epidemiology and is informed by current data on vector ecology from urban sites. The model predicts that one of every two infectious travelers arriving at peak mosquito season could initiate local transmission and > 10% of the introductions could generate a disease outbreak of at least 100 people. DespiteAe. albopictuspropensity for biting non-human vertebrates, we also demonstrate that local virus transmission and human outbreaks may occur when vectors feed from humans even just 40% of the time. This work demonstrates how a conditional series of non-average events can result in local arbovirus transmission and outbreaks of disease in humans, even in temperate cities.Author SummaryZika and chikungunya viruses are transmitted byAedesmosquitoes, includingAe. albopictus, which is abundant in many temperate cities. While disease risk is lower in temperate regions where viral amplification cannot build across years, there is significant potential for localized disease outbreaks in urban populations. We use a model informed by field data to assess the conditions likely to facilitate local transmission of virus from an infected traveler toAe. albopictusand then to other humans in USA cities with variable human densities and seasonality. The model predicts that one of every two infectious travelers arriving at peak mosquito season could initiate local transmission and > 10% of the introductions could generate a disease outbreak of >100 people.Classification: Ecology
Beyond the myosin mesa: a potential unifying hypothesis on the underlying molecular basis of hyper-contractility caused by a majority of hypertrophic cardiomyopathy mutations
Authors: Nag Suman , Trivedi Darshan V. , Sarkar Saswata S. , Sutton Shirley , Ruppel Kathleen M. , Spudich James A. 
Published: July 2016

Abstract:Hypertrophic cardiomyopathy (HCM), the most commonly occurring inherited cardiovascular disease, is primarily caused by mutations in human β-cardiac myosin and myosin binding protein-C. It has been thought that such mutations in myosin increase the intrinsic force of the motor, its velocity of contraction, or its ATPase activity, giving rise to hyper-contractility. We hypothesize that while these parameters are mildly affected by most myosin HCM-causing mutations, a major effect of a majority of myosin HCM mutations is likely to involve an increase in the number of myosin heads that are functionally accessible (Na) for interaction with actin in the sarcomere. We consider a model involving three types of interactions involving the myosin mesa and the converter domain of the myosin motor that hold myosin heads in a sequestered state, likely to be released in a graded manner as the demands on the heart increase: 1) the two myosin heads binding to one another, 2) one head binding to its own coiled-coil tail, and 3) the other head binding to myosin binding protein-C. In addition there is clear evidence of interaction between the coiled-coil tail of myosin and myosin binding protein-C. Experimentally, here we focus on myosin head binding to its own coiled-coil tail and to myosin binding protein-C. We show that phosphorylation of the myosin regulatory light chain and myosin binding protein-C weaken these respective associations, consistent with known enhancements of sarcomere function by these phosphorylations. We show that these interactions are weakened as a result of myosin HCM mutations, in a manner consistent with our structural model. Our data suggests a potential unifying hypothesis for the molecular basis of hyper-contractility caused by human hypertrophic cardiomyopathy myosin mutations, whereby the mutations give rise to an increase in the number of myosin heads that are functionally accessible for interaction with actin in the sarcomere, causing the hyper-contractility observed clinically.
LARG index
Authors: Azevedo Susana Garrido , Carvalho Helena , Cruz-Machado V. 
Published: July 2016

Purpose– The purpose of this paper is to suggest a lean, agile, resilient, and green (LARG) index as a benchmarking tool to assess the leanness, agility, resilience and the greenness of the automotive companies and corresponding supply chain (SC).Design/methodology/approach– The proposed index incorporates LARG supply chain management paradigms and corresponding practices being both weighted according to their importance for the automotive SC sustainability. The Delphi technique is used to obtain the weights for each SC paradigm and a linear aggregated method is proposed. A case study approach related to the automotive SC is chosen to illustrate the LARG index application.Findings– The case study results confirmed the usefulness and ease of application of LARG index in a real world SC. The application of the suggested index to a set of companies, and consequently to their SC, makes possible to identify: the better and worst performer company in each paradigm, the LARG practices with higher levels of application among the companies, the LARG index for each company and also for the corresponding SC. This becomes an important benchmarking tool since comparative analysis regarding the LARG behaviours are possible to perform with the suggested index.Research limitations/implications– More LARG practices could be considered to improve the robustness of the index. Future studies should be conducted across more companies for improving the effectiveness of the approach, and more members should be included in the panel of Delphi technique for enhancing the validity of the suggested approach.Practical implications– SC companies will be able to assess their performance in terms of leanness, agility, resilience and greenness. A study like this could encourage all automotive companies to benchmark their organizations as regards their competitors, the best in class, and also the industry average.Originality/value– This paper contributes to the literature by introducing a new index for measuring the leanness, agility, resilience and greenness of companies and SCs. This index can be used by managers as a benchmarking tool to identify their LARG behaviour and compare it with their SC partners and seek for improvement.
Impression management and self-presentation dissimulation in Portuguese chairman’s statements
Authors: Oliveira Jonas , Azevedo Graça , Borges Fátima 
Published: July 2016

Purpose– Drawn on social psychology theory of impression management (IM), the purpose of this paper is to assess the way Portuguese managers build their narratives in chairman’s statement (CS) to manage stakeholders’ perceptions on corporate image, in a period of time of scarce resources.Design/methodology/approach– The paper’s theoretical framework draws on elements of social psychology theory of IM developed by Leary and Kowalski (1990). Through the use of the two-component model of IM (impression motivation and impression construction) the 45 CSs of Portuguese non-finance companies were content analysed to understand how managers build their voluntary communication strategies.Findings– Results indicate that organisational outcome does not influence the adoption of IM strategies. But public visibility and consumer proximity are crucial factors in explaining them. Larger companies with high consumer proximity present themselves in a favourable way, but consistent with an overall reading of the annual report. These companies show a higher level of verbosity, consistent to the argument of retrospective rationality.Originality/value– The present study goes beyond Merkl-Davieset al.(2011) work and obtains insightful knowledge on the influence of goal relevance of impression in three different perspectives: company’s public visibility, company’s dependency from debtholders, and consumer proximity. Moreover, the analysis uses a period of scarce resources and a European Latin country, with no tradition in publishing CSs, but that recently has changed its financial reporting practices from an institutional code-law logic to an institutional common-law logic. A research setting like this has not been studied hitherto.
Work-based learning
Authors: Garnett Jonathan 
Published: July 2016

Purpose
– The purpose of this paper is to show how transdisciplinarity is woven into the key curriculum components of individually negotiated work-based learning (WBL) programmes and to focus upon the performative value of knowledge in the work context.

Design/methodology/approach
– This paper draws upon WBL academic literature and the authors 22 years operational experience of WBL.

Findings
– The paper suggests that while university-level WBL can enhance the performance of organizations and individuals it is also inherently challenging and challenged by the hegemony of subject disciplines and disciplinary-based university structures. WBL is concerned with knowledge which is often unsystematic, socially constructed and is action focused in order to achieve outcomes of significance to work. This contests the supremacy of the role of the university in curriculum design, delivery and validation of knowledge and means that work-based knowledge is often seen as transdisciplinary rather than conforming to traditional subject disciplines (Boud and Solomon, 2001).

Research limitations/implications
– Central to the distinctive nature of university WBL programmes is the role of the external organization as a partner with the university and the individual learner in the planning of learning activities which are intended to have significance for the workplace. For individual knowledge to become organizational knowledge, and thus fully contribute to the intellectual capital of the organization, it must be shared and accepted by others. It follows that a key concern for organizations must be the facilitation of the recognition of knowledge and this goes beyond using a transdisciplinary lens when guiding and assessing the work of individual higher education students.

Practical implications
– The paper has practical implications for the design and facilitation of WBL programmes at higher education level.

Originality/value
– Provides an informed and sustained examination of the concept of WBL and knowledge.
Employability development opportunities (EDOs) as measures of students’ enhanced employability
Authors: Pitan Oluyomi Susan 
Published: July 2016

Purpose
– Empirical studies in relation to employability development opportunities (EDOs) and university students’ enhanced employability are few, especially in Nigeria. The purpose of this paper is to assess the extent of university students’ engagement with EDOs and to empirically establish the extent of the relationship between these EDOs and students’ enhanced employability.

Design/methodology/approach
– Data were collected from 600 final-year university students in Nigeria with the use of an adapted questionnaire. The 29 items on the questionnaire were subjected to an exploratory factor analysis in which 28 loaded under six factors which were used for further analysis.

Findings
– Results indicate that at Nigerian universities students are engaging with all the EDOs to a moderately sufficient extent. Findings also show that there is a significant positive relationship between EDOs and students’ enhanced employability. Besides, considering the relative contribution of each of the EDOs to students’ enhanced employability, real-world activities make the highest contribution. Extracurricular activities were found to have no significant relationship with students’ enhanced employability.

Research limitations/implications
– Not all the EDOs are measured in the study.

Originality/value
– Apart from empirically confirming the significant positive relationship between EDOs and university students’ enhanced employability, the study has established the relative contribution of each of these EDOs, which is a major contribution to the limited existing body of knowledge on university students’ employability.