bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of insufflation pressure on pulmonary mechanics in infants during laparoscopic surgical procedures
Authors: Bannister Carolyn F. , Brosius Keith K. , Wulkan Mark 
Published: November 2003

SummaryBackground Few studies have reported objective measurements of pulmonary changes under controlled conditions in infants undergoing laparoscopic procedures. We objectively measured the pulmonary effects of laparoscopically‐induced pneumoperitoneum in infants less than 1 year of age undergoing surgical procedures under general anaesthesia.Methods Nineteen ASA I‐II patients less than 1 year of age were enrolled in this direct observational study. Anaesthetic technique included inhalation induction using sevoflurane/O2/air and neuromuscular blockade. Infants were ventilated using 10–15 ml·kg−1 tidal volume at a respiratory rate sufficient to achieve normocarbia [PECO2 4.6–5.8 kPa (35–45 mmHg)]. Opioids and regional anaesthesia techniques were used when appropriate. Peak inspiratory pressure (PIP), expiratory tidal volume (Vt), endtidal carbon dioxide concentration (PECO2) and dynamic compliance (COMPdyn) were recorded at baseline, 5, 10 mmHg and maximal insufflation pressure (Pmax). Pmax was limited to 12 mmHg for infants <5 kg, 15 mmHg for infants >5 kg. At steady state Pmax, ventilator changes were implemented to restore Vt and PECO2 to within 10% of baseline. Each patient served as his own control.Results At Pmax, average PIP increased 18%, average Vt decreased 33%, average PECO2 concentration increased 13%, average COMPdyn decreased 48%; O2 saturation fell in 41% of patients. Twenty ventilator adjustments were required; one patient experienced no changes in measured pulmonary mechanics, requiring no ventilator changes.Conclusions Pulmonary mechanics in infants change significantly during laparoscopic CO2 pneumoperitoneum; the magnitude of change correlates directly with intraperitoneal pressure. Greater than 90% of infants required at least one ventilatory intervention to restore baseline Vt and PECO2.
Pretreatment with intravenous ketamine reduces propofol injection pain
Authors: Barbi E. , Marchetti F. , Gerarduzzi T. , Neri E. , Gagliardo A. , Sarti A. , Ventura A. 
Published: November 2003

SummaryBackground Paediatric procedural sedation using propofol has been shown to be safe and effective and is widely used. Pain at the injection site is a frequent complaint and can be particularly distressing for children, especially for those undergoing repeated procedures. Ketamine has analgesic properties and can diminish the incidence of propofol infusion pain in adults. The aim of the study was to investigate whether pretreatment with ketamine would reduce infusion line pain in propofol sedation in children.Methods We performed a prospective, randomized, double‐blind trial in a paediatric sedation unit of a tertiary referral teaching hospital. A total of 122 children admitted for gastroscopy were randomly allocated into two groups. Group 1 received atropine and ketamine before propofol infusion. Group 2 received atropine, normal saline solution, and a mixture of propofol with lidocaine. The main outcome measure evaluated was pain associated with the infusion and secondary outcome measures were mean medium arterial pressure decrease and desaturation.Results The incidence of pain of the infusion was significantly lower in patients pretreated with ketamine (8% vs 37%, P = 0.0001).Conclusions Pretreatment with ketamine (0.5 mg·kg−1) is very effective in preventing propofol infusion pain.
Methadone dosage for prevention of opioid withdrawal in children
Authors: Siddappa Rajashekhar , Fletcher James E. , Heard Andrew M.B. , Kielma Donna , Cimino Michael , Heard Christopher M.B. 
Published: November 2003

SummaryBackground Opioids are frequently used for sedation in the Paediatric Intensive Care Unit (PICU). With time the dosing often increases because of tolerance. On cessation of the sedation there is a risk of the opioid withdrawal syndrome. The aim of our study was to evaluate methadone dosing as a risk factor for opioid withdrawal and to determine optimal dose and efficacy of methadone to prevent withdrawal.Method We undertook a clinical, retrospective, chart review study. Data were analysed from the quality improvement initiative database of a tertiary‐care 18 bed PICU.Results Data from 30 children who received an opioid infusion for ≥7 days and subsequently received methadone for opioid withdrawal (between January 2000 and July 2001) were analysed. Nurses documented the presence or absence of withdrawal signs daily. Our unit protocol has recommended converting the patient's opioid dose into fentanyl equivalents and a dose of methadone equal to the total daily dose of fentanyl to be given three times a day. Twenty patients had no or minimal withdrawal symptoms and 10 experienced significant withdrawal. Age, weight, PRISM score, lorazepam dose, muscle relaxant use and fentanyl dose were not statistically significantly between these groups. Receiver Operator Characteristics analysis showed that 80% of the suggested methadone dose was effective in minimizing withdrawal symptoms. The odds ratio for withdrawal with <80% of the predicted methadone dose was 21.Conclusions Inadequate methadone is a risk factor for opioid withdrawal. A daily starting methadone dose equivalent to 2.5 times the daily fentanyl dose is effective in minimizing withdrawal symptoms.
Regional Blocs and Foreign Direct Investment
Authors: Donnenfeld Shabtai 
Published: November 2003

AbstractThe paper examines the impact of the emergence of regional blocs on the patterns of interbloc and intrabloc trade when firms have the option to engage in foreign direct investment (FDI). For exogenously given external tariffs, when firms have the option to engage in FDI, all interbloc trade may cease—complete trade diversion that is replaced by interbloc FDI investment creation. In such an event the volume of world trade declines but this is more than offset by the increase in world output due to direct investment. The paper also investigates the optimal tariff that a trading bloc levies on imports from nonmember countries. The tariffs are restricted by the option to engage in two‐way direct investment; hence, the regional blocs are hampered from mutually harming one another through an escalation in the tariff war. Finally, the formation of two regional blocs enhances the welfare of all countries.
Evaluation of a consultation skills workshop using the Consultation Assessment and Improvement Instrument for Nurses
Authors: Hastings Adrian M. , Lennon Mariane , Redsell Sarah A. , Cheater Francine M. 
Published: November 2003

AbstractThe aim of this work was to evaluate the impact of training in the use of the Consultation Assessment and Improvement Instrument for Nurses (CAIIN) in the context of expanding roles for primary care nurses. To achieve this, 10 experienced primary care nurses undertook a 3‐day workshop in using the CAIIN to evaluate videotaped consultations between nurses and patients, and consultations between course participants and simulated patients. The impact of the workshop was assessed by questionnaire and semistructured interview. All participants found the CAIIN to be an acceptable approach to analyse and improve the consultation performance of themselves and others. They believed that it would further improve their existing skills, and provided a useful framework for learning those aspects of consultation competence in which they had less confidence. Several found role‐play with simulated patients stressful. Concerns about the role of nurses in clinical problem‐solving were reduced, but remained significant. The CAIIN was considered to have good potential as a learning tool as part of continuing professional development and clinical supervision. In conclusion, the rapidly expanding roles of primary care nurses requires serious consideration to be given to assessing and improving their consultation skills. The CAIIN provides an acceptable method of doing so. However, learning to use the instrument effectively requires expertise amongst teachers and significant protected learning time for nurses who become assessors or mentors of their peers.
The need for information and research skills training to support evidence‐based social care: a literature review and survey
Authors: Booth Sonja H. , Booth Andrew , Falzon Louise J. 
Published: November 2003

AbstractThe integration of health and social care services, and the move towards a professionalized social care workforce, has stimulated interest in evidence‐based social care. A literature review reveals a workforce, poorly equipped by professional education, relying heavily on personal communication and ‘gut instinct’ to deliver packages of care. A workplace culture of action, not reflection, and the absence of information resources and skills, make social care practitioners less likely to consult research to improve their practice. This study aimed to discover whether training in information and research skills training, as currently delivered in healthcare, is of interest to social care practitioners. A postal questionnaire was sent to 595 social care practitioners in the Trent region to determine their attitudes to evidence‐based practice, access to information and their training requirements. Twenty‐seven practitioners were subsequently interviewed to gain further insight into these issues. Seventy‐one per cent of questionnaire respondents had taken a qualification during their career, and less than 50% of the respondents had received training in using research findings or the Internet. Even fewer had been taught to interpret research findings. Around 75% had had no instruction on searching literature databases. Just over 50% of respondents favoured evidence‐based practice within social care, but many had reservations regarding its success. Three of the five most popular topics for professional development had an existing health equivalent. Interest decreased as topics moved from practical skills towards methodologies and research skills. The study concludes that training should be pitched at a pragmatic rather than an academic level, should support existing work activities, and be targeted at a diploma‐equivalent educational level. Provision should also be made for those without a professional qualification.
Examining the relationships between individual, team and organizational learning in an Australian hospital
Authors: Chan Christopher C. A. 
Published: November 2003

AbstractThe concept of organizational learning has continued to capture the interests of scholars and practitioners. At the core of this notion is the belief that organizational learning provides a number of advantages. Some of these advantages include improved team performance, enhanced service quality, better quality‐of‐work life and, ultimately, competitive advantage. Hence, not surprisingly, there is a sustained upsurge in the interest of organizational learning. Moreover, there is widespread acceptance that learning could occur at the individual, team and organizational levels. Understanding of learning orientations at these three levels has the capacity to advance the current knowledge and practice of organizational learning. In spite of an outpouring of literature on learning, empirical research on organizational learning is still scarce. Thus, the three linkages addressed in this current study include: individual learning and organizational learning; team learning and organizational learning; and individual learning and team learning. These linkages were examined in a field study of an Australian hospital, where 189 respondents participated in an organization‐wide survey. Interestingly, individual learning was not significantly related to organizational learning. However, individual learning was a significant predictor of team learning. Team learning was significantly related to organizational learning. The implications of the research findings are discussed.
RENAL RESEARCH INSTITUTE SYMPOSIUM: Continuous Peritoneal Dialysis‐Associated Peritonitis: A Review and Current Concepts
Authors: Troidle Laura , Gorban‐Brennan Nancy , Kliger Alan , Finkelstein Fredric O. 
Published: November 2003

AbstractThe percentage of end‐stage renal disease (ESRD) patients in the United States maintained on continuous peritoneal dialysis (CPD) therapy is decreasing. Complications from CPD therapy, including peritonitis, may be the reason for the decline. Improvements in CPD technology and a better understanding of the risk factors that predispose patients to the development of peritonitis have been responsible for a decline in the rate of peritonitis. Yet peritonitis remains a significant cause of patient morbidity and mortality and the overall outcome of peritonitis is not acceptable. Factors that have limited our ability to lessen the impact of peritonitis include a lack of data on dosing antibiotics in patients on continuous cycling peritoneal dialysis (CCPD) therapy, a lack of knowledge concerning the biology of bacterial biofilm, and the development of resistance to the current prophylactic antibiotic protocols. Further studies are needed concerning the optimal management of the peritoneal catheter and whether it is feasible to resume CPD therapy after catheter removal.
RENAL RESEARCH INSTITUTE SYMPOSITUM: Characteristics and Effects of Inflammation in End‐Stage Renal Disease
Authors: Kaysen George A. , Eiserich Jason P. 
Published: November 2003

AbstractMalnutrition and cardiovascular disease are associated with end‐stage renal disease (ESRD) and both are closely associated with one another, both in cross‐sectional analysis and when the courses of individual patients are followed over time. Inflammation, by suppressing synthesis of albumin, transferrin, and other negative acute‐phase proteins and increasing their catabolic rates, either combines with modest malnutrition or mimics malnutrition, resulting in decreased levels of these proteins in dialysis patients. Inflammation also leads to reduced muscle mass by increasing muscle protein catabolism and blocking synthesis of muscle protein. More importantly, inflammation alters plasma protein composition and endothelial structure and function so as to promote vascular disease. Markers of inflammation, C‐reactive protein (CRP), and interleukin (IL)‐6 powerfully predict death from all causes and from cardiovascular disease in dialysis patients as well as progression of vascular injury. The causes of inflammation are likely multifactorial, including oxidative modification of plasma proteins, interaction of blood with nonbiocompatible membranes and lipopolysaccharides in dialysate, subclinical infection of vascular access materials, oxidative catabolism of endothelium‐derived nitric oxide, and other infectious processes. Treatment should be focused on identifying potential causes of inflammation, if obvious, and reduction of other risk factor for cardiovascular disease.
Analysis of Highly Expressed Genes in Monocytes from Atopic Dermatitis Patients
Authors: Nagata Naoko , Oshida Tadahilo , Yoshida Ning Lu , Yuyama Noriko , Sugita Yuji , Tsujimoto Gozoh , Katsunuma Toshio , Akasawa Akira , Saito Hirohisa 
Published: November 2003

<i>Background:</i> Monocytes, macrophages, and antigen-presenting cells (APCs) are key effectors of both innate and acquired immune responses. Such cells have been implicated in the pathogenesis of some inflammatory diseases. Differential gene expression in CD14-positive cells from patients with atopic dermatitis (AD) was studied using real-time quantitative RT-PCR to measure transcription levels of selected genes. <i>Methods:</i> PBMCs were prepared by Ficoll gradient separation from 30 AD patients (the anti-mite-specific IgE RAST score: 0.75 to >100 UA/ml) and 10 healthy adult individuals (the RAST score: <0.34–0.37 UA/ml) and CD14-positive cells were selected. A total of 64 genes was selected for study from groups of genes with different molecular function. <i>Results:</i> Genes involved in MHC class I antigen presentation, such as β<sub>2</sub>-microglobulin, subunits of an immunoproteasome and ATP-binding cassette transporter TAP2 were expressed at higher levels in the AD patients than in the healthy controls. The genes for Toll-like receptors, CD36 and IFNγ receptor were also upregulated in the AD patients. These genes are involved in MHC class I antigen presentation, recognition of bacterial pathogens and apoptotic cells. <i>Conclusions:</i> The upregulation of genes suggests that circulating monocytes in AD patients may be primed to differentiate into effector cells by conditions associated with AD. The upregulation of genes may prove to be a useful marker for AD.
Genome Sharing in Large Pedigrees: Multiple Imputation of <i>ibd</i> for Linkage Detection
Authors: Thompson Elizabeth , Basu Saonli 
Published: November 2003

Our objective is the development of robust methods for assessment of evidence for linkage of loci affecting a complex trait to a marker linkage group, using data on extended pedigrees. Using Markov chain Monte Carlo (MCMC) methods, it is possible to sample realizations from the distribution of gene identity by descent (<i>ibd</i>) patterns on a pedigree, conditional on observed data Y<sub><i>M</i></sub> at multiple marker loci. Measures of gene <i>ibd</i><i>W</i> which capture joint genome sharing in extended pedigrees often have unknown and highly skewed distributions, particularly when conditioned on marker data. MCMC provides a direct estimate of the distribution of such measures. Let <i>W</i> be the <i>ibd</i> measure from data <i>Y</i><sub><i>M</i></sub>, and <i>W</i><sup>*</sup> the <i>ibd</i> measure from pseudo-data <i>Y</i><sup>*</sup><sub><i>M</i></sub> simulated with the same data availability and genetic marker model as the true data <i>Y</i><sub><i>M</i></sub>, but in the absence of linkage. Then measures of the difference in distributions of <i>W</i> and <i>W</i><sup>*</sup> provide evidence for linkage. This approach extracts more information from the data <i>Y</i><sub><i>M</i></sub> than either comparison to the pedigree prior distribution of <i>W</i> or use of statistics that are expectations of <i>W</i> given the data <i>Y</i><sub><i>M</i></sub>. A small example is presented.
Morphological Features of Rat Gastric Mucosa after Acute and Chronic Treatment with Amtolmetin Guacyl: Comparison with Non-Selective and COX-2-Selective NSAIDs
Authors: Morini Giuseppina , Guaita Elena , Lazzaretti Mirka , Grandi Daniela , Coruzzi Gabriella 
Published: November 2003

<i>Background/Aims:</i> The compound amtolmetin guacyl (AMG) has been characterized in both animal and human studies as a novel non-selective non-steroidal anti-inflammatory drug (NSAID) endowed with lower ulcerogenicity in comparison with traditional NSAIDs due to a unique mechanism of action, namely the increase in endogenous production of gastric nitric oxide. <i>Methods:</i> Conscious rats were treated either acutely (4 h) or chronically (3 and 14 days) with intragastric AMG (50 and 150 mg/kg), the non-selective NSAID tolmetin (TOL, 30 and 100 mg/kg) or the COX-2-selective NSAID celecoxib (CXIB, 20 and 60 mg/kg). Macroscopically visible and histologic lesions were evaluated. The ultrastructure of mucosal microvasculature was assessed. <i>Results:</i> (1) TOL and CXIB caused quantitatively greater endothelial damage and inflammatory cell infiltration than that induced by AMG; (2) AMG and CXIB, unlike TOL, did not cause epithelial damage after acute or chronic treatment, and (3) gastric lesions induced by TOL underwent adaptation during chronic treatment. <i>Conclusion:</i> Endothelial cell damage in the gastric microvasculature is an early event following both non-selective and COX-2-selective inhibitors. The low gastric mucosal toxicity of AMG is confirmed after acute and chronic treatment.
Success and Failure in Saudi-American Negotiations: American Views
Authors: Al-Ghamdi  
Published: November 2003

AbstractThis article draws on prior research studies and comparable measures to empirically investigate American views on what constitutes critical success and failure factors in negotiating with the Saudis. The findings from this new venue of research indicate that the Americans consider non-personal factors, such as technical expertise and financing terms, as more important than personal factors in successful negotiations with the Saudis. Moreover, among the failure factors studied, none were rated high in importance. Yet, from a Saudi viewpoint, Americans should not necessarily ignore these factors in their negotiations with the Saudis. Personal relationships may be important in generating pre-negotiation contacts, and cultural factors, linked to patience, language, and social customs, may help to prevent breakdowns in the negotiation process. Based on these conclusions, the study provides implications and draws some parallels with previous research on American perceptions.
Approaches to Water Dispute Resolution: Applications to Arab-Israeli Negotiations
Authors: Shmueli  
Published: November 2003

AbstractIncreasing and competing demands among countries for water is a major cause of international disputes. This article builds on research of negotiation processes and institutional frameworks of international river basin management. Its focus is the search for effective approaches that can be applied to the resolution of Arab-Israeli water disputes. While every dispute is unique, the Arab-Israeli situation is not the only case with stubborn and long-standing enmities, shortages of water resources, political and economic power imbalances, absences from negotiations of vital riparians, and rapidly changing political climates. In the Arab-Israeli water dispute, there are both parallels and lessons to be learned from the situations in other river basins.The treaties that have thus far emerged from Arab-Israeli negotiations are briefly reviewed, as is the potential for future regional agreements. The history of other river basin negotiations is useful in charting the future directions of the Arab-Israeli water conflict. Issues include options and modes of negotiation, information and technology sharing, the importance of the geopolitical climate, comprehensive versus incremental agreements, linkage of water agreements to environmental and other issues, the power balance among participants, cost-sharing strategies, and institutions, and the capacity for implementation.Although the strained political relations between Arabs and Israelis have worsened in the past year and one-half, the water treaties do not seem endangered for the most part. Indeed, water negotiations may again become one of the confidence-building measures that can facilitate other more general negotiations, after the current stalemate is broken.
The Kuhse-Singer Euthanasia Survey: Why it Fails to Undermine the Slippery Slope Argument — Comparing Apples and Apples
Authors: Bagaric  
Published: November 2003

AbstractA survey published in the Medical Journal of Australia in 1997 showed that the incidence of non-voluntary euthanasia in Australia was higher than in the Netherlands. Euthanasia is illegal in Australia, while it is openly practiced in the Netherlands. It has been suggested that the results of the survey undermine the slippery slope argument against legalising euthanasia. This is wrong. Although at the time of the survey, euthanasia was formally prohibited by the law in Australia, the medical and legal culture was such that doctors could practice euthanasia with impunity — in certain circumstances euthanasia by doctors was effectively condoned. This is in fact supported by the findings of the survey. The survey suggests that there were approximately 6,700 cases of euthanasia in Australia in the year from July 1994 to June 1995 — not one of which was prosecuted, let alone resulted in a conviction. Ultimately the survey merely shows that in a climate where voluntary euthanasia is tolerated, wide scale abuses (in the form of non-voluntary euthanasia) occur. Paradoxically the results of the survey give further support to the slippery slope argument.