Long-term transcutaneous monitoring of oxygen tension and carbon dioxide at 42 degrees C in critically ill neonates: improved performance of the tcpo2 monitor with topical metabolic inhibition.

Whereas during the last few years handling of the transcutaneous PO2 (tcPO2) and PCO2 (tcPCO2) sensor has been simplified, the high electrode temperature and the short application time remain major drawbacks. In order to determine whether the application of a topical metabolic inhibitor allows reliable measurement at a sensor temperature of 42 degrees C for a period of up to 12 h, we performed a prospective, open, nonrandomized study in a sequential sample of 20 critically ill neonates. A total of 120 comparisons (six repeated measurements per patient) between arterial and transcutaneous values were obtained. Transcutaneous values were measured with a control sensor at 44 degrees C (conventional contact medium, average application time 3 h) and a test sensor at 42 degrees C (Eugenol solution, average application time 8 h). Comparison of tcPO2 and PaO2 at 42 degrees C (Eugenol solution) showed a mean difference of +0.16 kPa (range +1.60 to -2.00 kPa), limits of agreement +1.88 and -1.56 kPa. Comparison of tcPO2 and PaO2 at 44 degrees C (control sensor) revealed a mean difference of +0.02 kPa (range +2.60 to -1.90 kPa), limits of agreement +2.12 and -2.08 kPa. Comparison of tcPCO2 and PaCO2 at 42 degrees C (Eugenol solution) showed a mean difference of +0.91 (range +2.30 to +0.10 kPa), limits of agreement +2.24 and -0.42 kPa. Comparison of tcPCO2 and PaCO2 at 44 degrees C (control sensor) revealed a mean difference of +0.63 kPa (range 1.50 to -0.30 kPa), limits of agreement +1.73 and -0.47 kPa. CONCLUSION: Our results show that the use of an Eugenol solution allows reliable measurement of tcPO2 at a heating temperature of 42 degrees C; the application time can be prolongued up to a maximum of 12 h without aggravating the skin lesions. The performance of the tcPCO2 monitor was slightly worse at 42 degrees C than at 44 degrees C suggesting that for the Eugenol solution the metabolic offset should be corrected.

Performance of an ICU ventilator and two turbin-based ventilators dedicated to non invasive ventilation (NIV) in simulated high inspiratory effort and rate: a NIV-bench-study.

INTRODUCTION. The role of turbine-based NIV ventilators (TBV) versus ICU ventilators with NIV mode activated (ICUV) to deliver NIV in case of severe respiratory failure remains debated. OBJECTIVES. To compare the response time and pressurization capacity of TBV and ICUV during simulated NIV with normal and increased respiratory demand, in condition of normal and obstructive respiratory mechanics. METHODS. In a two-chamber lung model, a ventilator simulated normal (P0.1 = 2 mbar, respiratory rate RR = 15/min) or increased (P0.1 = 6 mbar, RR = 25/min) respiratory demand. NIV was simulated by connecting the lung model (compliance 100 ml/mbar; resistance 5 or 20 l/mbar) to a dummy head equipped with a naso-buccal mask. Connections allowed intentional leaks (29 ± 5 % of insufflated volume). Ventilators to test: Servo-i (Maquet), V60 and Vision (Philips Respironics) were connected via a standard circuit to the mask. Applied pressure support levels (PSL) were 7 mbar for normal and 14 mbar for increased demand. Airway pressure and flow were measured in the ventilator circuit and in the simulated airway. Ventilator performance was assessed by determining trigger delay (Td, ms), pressure time product at 300 ms (PTP300, mbar s) and inspiratory tidal volume (VT, ml) and compared by three-way ANOVA for the effect of inspiratory effort, resistance and the ventilator. Differences between ventilators for each condition were tested by oneway ANOVA and contrast (JMP 8.0.1, p\0.05). RESULTS. Inspiratory demand and resistance had a significant effect throughout all comparisons. Ventilator data figure in Table 1 (normal demand) and 2 (increased demand): (a) different from Servo-i, (b) different from V60.CONCLUSION. In this NIV bench study, with leaks, trigger delay was shorter for TBV with normal respiratory demand. By contrast, it was shorter for ICUV when respiratory demand was high. ICUV afforded better pressurization (PTP 300) with increased demand and PSL, particularly with increased resistance. TBV provided a higher inspiratory VT (i.e., downstream from the leaks) with normal demand, and a significantly (although minimally) lower VT with increased demand and PSL.

The Identity Style Inventory (ISI-3) and the Utrecht-Management of Identity Commitments Scale (U-MICS): Factor structure, reliability, and convergent validity in French-speaking college students

The purpose of this study was to evaluate the factor structure and the reliability of the French versions of the Identity Style Inventory (ISI-3) and the Utrecht-Management of Identity Commitments Scale (U-MICS) in a sample of college students (N = 457, 18 to 25 years old). Confirmatory factor analyses confirmed the hypothesized three-factor solution of the ISI-3 identity styles (i.e. informational, normative, and diffuse-avoidant styles), the one-factor solution of the ISI-3 identity commitment, and the three-factor structure of the U-MICS (i.e. commitment, in-depth exploration, and reconsideration of commitment). Additionally, theoretically consistent and meaningful associations among the ISI-3, U-MICS, and Ego Identity Process Questionnaire (EIPQ) confirmed convergent validity. Overall, the results of the present study indicate that the French versions of the ISI-3 and UMICS are useful instruments for assessing identity styles and processes, and provide additional support to the cross-cultural validity of these tools.

Instrumental leadership: Measurement and extension of transformational-transactional leadership theory.

Leaders must scan the internal and external environment, chart strategic and task objectives, and provide performance feedback. These instrumental leadership (IL) functions go beyond the motivational and quid-pro quo leader behaviors that comprise the full-range-transformational, transactional, and laissez faire-leadership model. In four studies we examined the construct validity of IL. We found evidence for a four-factor IL model that was highly prototypical of good leadership. IL predicted top-level leader emergence controlling for the full-range factors, initiating structure, and consideration. It also explained unique variance in outcomes beyond the full-range factors; the effects of transformational leadership were vastly overstated when IL was omitted from the model. We discuss the importance of a "fuller full-range" leadership theory for theory and practice. We also showcase our methodological contributions regarding corrections for common method variance (i.e., endogeneity) bias using two-stage least squares (2SLS) regression and Monte Carlo split-sample designs.

Performance de l'estimation du poids foetal par echographie pour les foetus < or = 2000 g et les macrosomes (> or = 4000 g) [Performance of ultrasound estimation of fetal weight in fetuses weighing < or = 2000 g and more than 4000 g].

Decreasing perinatal morbidity and mortality is one of the main goals of obstetrics. Prognosis of preterm births depends on gestational age and birthweight. Multidisciplinary management is discussed with the parents according to these two parameters. In other circumstances, a suspected macrosomy will influence the management of the last weeks of pregnancy. Induction of labor or Cesarean delivery will be considered to avoid shoulder dystocia, brachial plexus injury or perinatal asphyxia. Birthweight needs to be estimated with accuracy, and this article describes the efficiency of various ultrasound weight estimation formulae for small and large fetuses.

The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women.

SUMMARY: BMD and clinical risk factors predict hip and other osteoporotic fractures. The combination of clinical risk factors and BMD provide higher specificity and sensitivity than either alone. INTRODUCTION AND HYPOTHESES: To develop a risk assessment tool based on clinical risk factors (CRFs) with and without BMD. METHODS: Nine population-based studies were studied in which BMD and CRFs were documented at baseline. Poisson regression models were developed for hip fracture and other osteoporotic fractures, with and without hip BMD. Fracture risk was expressed as gradient of risk (GR, risk ratio/SD change in risk score). RESULTS: CRFs alone predicted hip fracture with a GR of 2.1/SD at the age of 50 years and decreased with age. The use of BMD alone provided a higher GR (3.7/SD), and was improved further with the combined use of CRFs and BMD (4.2/SD). For other osteoporotic fractures, the GRs were lower than for hip fracture. The GR with CRFs alone was 1.4/SD at the age of 50 years, similar to that provided by BMD (GR = 1.4/SD) and was not markedly increased by the combination (GR = 1.4/SD). The performance characteristics of clinical risk factors with and without BMD were validated in eleven independent population-based cohorts. CONCLUSIONS: The models developed provide the basis for the integrated use of validated clinical risk factors in men and women to aid in fracture risk prediction.

Validation and performance comparison of two carbon isotope ratio methods to control the misuse of androgens in humans.

Carbon isotope ratio of androgens in urine specimens is routinely determined to exclude an abuse of testosterone or testosterone prohormones by athletes. Increasing application of gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS) in the last years for target and systematic investigations on samples has resulted in the demand for rapid sample throughput as well as high selectivity in the extraction process particularly in the case of conspicuous samples. For that purpose, we present herein the complimentary use of an SPE-based assay and an HPLC fractionation method as a two-stage strategy for the isolation of testosterone metabolites and endogenous reference compounds prior to GC/C/IRMS analyses. Assays validation demonstrated acceptable performance in terms of intermediate precision (range: 0.1-0.4 per thousand) and Bland-Altman analyses revealed no significant bias (0.2 per thousand). For further validation of this two-stage analyses strategy, all the specimens (n=124) collected during a major sport event were processed.

Analysis and quantification of vitamin D metabolites in serum by ultra-performance liquid chromatography coupled to tandem mass spectrometry and high-resolution mass spectrometry: a method comparison and validation.

RATIONALE: The aim of the work was to develop and validate a method for the quantification of vitamin D metabolites in serum using ultra-high-pressure liquid chromatography coupled to mass spectrometry (LC/MS), and to validate a high-resolution mass spectrometry (LC/HRMS) approach against a tandem mass spectrometry (LC/MS/MS) approach using a large clinical sample set. METHODS: A fast, accurate and reliable method for the quantification of the vitamin D metabolites, 25-hydroxyvitamin D2 (25OH-D2) and 25-hydroxyvitamin D3 (25OH-D3), in human serum was developed and validated. The C3 epimer of 25OH-D3 (3-epi-25OH-D3) was also separated from 25OH-D3. The samples were rapidly prepared via a protein precipitation step followed by solid-phase extraction (SPE) using an HLB μelution plate. Quantification was performed using both LC/MS/MS and LC/HRMS systems. RESULTS: Recovery, matrix effect, inter- and intra-day reproducibility were assessed. Lower limits of quantification (LLOQs) were determined for both 25OH-D2 and 25OH-D3 for the LC/MS/MS approach (6.2 and 3.4 µg/L, respectively) and the LC/HRMS approach (2.1 and 1.7 µg/L, respectively). A Passing & Bablok fit was determined between both approaches for 25OH-D3 on 662 clinical samples (1.11 + 1.06x). It was also shown that results can be affected by the inclusion of the isomer 3-epi-25OH-D3. CONCLUSIONS: Quantification of the relevant vitamin D metabolites was successfully developed and validated here. It was shown that LC/HRMS is an accurate, powerful and easy to use approach for quantification within clinical laboratories. Finally, the results here suggest that it is important to separate 3-epi-25OH-D3 from 25OH-D3. Copyright © 2012 John Wiley & Sons, Ltd.

Entrepreneur's Overconfidence, Private Benefits and the Market Performance of the Firm

Many firms around the world are managed and partially owned by entrepreneurs. These entrepreneurs hold under diversified portfolios and, therefore, bear idiosyncratic risk in addition to systematic risk. To compensate the additional risk borne, they extract private benefits. In this paper, we analyse how an entrepreneur's overconfidence affects the market performance of the firm, through the channel of private benefits. We show that two dimensions of overconfidence, namely overestimation of future cash-flows and underestimation of idiosyncratic risk (called miscalibration), have opposite effects on the private benefits extracted by the entrepreneur. As a consequence, firms managed and partially owned by overconfident entrepreneurs can deliver overperformance or underperformance, depending on the prevalence of overestimation or miscalibration of the beliefs of the entrepreneur.

THE ADULA NAPPE: STRATIGRAPHY, STRUCTURE AND KINEMATICS OF AN EXHUMED HIGH-PRESSURE NAPPE

This study analyses the stratigraphy, structure and kinematics of the northern part of the Adula nappe of the Central Alps. The Adula nappe is one of the highest basement nappes in the Lower Penninic nappe stack of the Lepontine Dome. This structural position makes possible the investigation of the transition between the Helvetic and North Penninic paleogeographic domains. The Adula nappe is principally composed of crystalline basement rocks. The investigation of the pre-Triassic basement shows that it contains several Palaeozoic detrital metasedimentary formations dated from the Cambrian to the Ordovician. These formations contain also some volcanic or intrusive magmatic rocks. Ordovician metagranites dated at ~450 Ma are also a common rock-type of the Adula basement. These formations underwent Alpine and Variscan deformation and metamorphism. Permian granites (Zervreila orthogneiss, dated at ~290 Ma) have intruded this pre-structured basement in a post-orogenic geodynamic context. Due to their age, the Zervreila orthogneiss are good markers for alpine deformation. The stratigraphy of the Mesozoic and Paleogene sedimentary cover of the Adula nappe is essential to unraveling its pre- orogenic history. The autochthonous cover is assigned to a North Penninic Triassic series that testifies for a transition between the Helvetic and Briançonnais Triassic domains. The Adula domain goes through an emersion during the Middle Jurassic, and is part of a topographic high during the first phase of the Alpine rift. The sediments of the late Middle Jurassic show a drowning phase associated with a tectonic activity and a breccia formation. In the neighbouring domains, coeval with the drowning phase in the Adula domain, a strong extensional crustal delamination and a scattered magmatic activity is associated with the main opening of the North Penninic domain. The Upper Jurassic of the Adula nappe is characterized by a carbonate formation comparable with those in the Helvetic or Subbriaçonnais domains. Flysch s.l. deposition starts probably at the end of the Cretaceous. These sediments are deposited on a large unconformity testifying for a Cretaceous sedimentary gap. The Adula nappe exhibits a very complex structure. This structure is formed by several deformation phases. Two ductile deformations are responsible for the nappe emplacement. The first deformation phase is associated with a folding compatible with a top-to-south movement at the top of the nappe. The second phase is dominant and pervasive throughout the whole nappe. It goes with a strong north vergent folding and the main nappe emplacement. These two phases cause the exhumation and emplacement of a coherent, although pre-structured, piece of continental crust. Two further deformation phases postdate the nappe emplacement. - Ce travail concerne l'étude géologique de la partie nord de la nappe de l'Adula dans les Alpes centrales. La nappe de l'Adula est l'une des nappes cristallines la plus élevée dans la pile des nappes du Pennique inférieur des Alpes lepontines. Cette position particulière permet d'étudier la transition entre les nappes des domaines helvétique et pennique inférieur. La nappe de l'Adula est principalement composée de socle cristallin : l'étude de l'histoire géologique du socle est donc l'un des thèmes de cette recherche. Ce socle contient plusieurs formations métasédimentaires paléozoïques du Cambrien à I'Ordovicien. Ces métasédiments sont issus de formations clastiques comprenant souvent des roches magmatiques volcaniques et intrusives. Ces métasédiments ont subi les cycles orogéniques varisque et alpin. La nappe de l'Adula contient plusieurs corps magmatiques granitiques métamorphisés. Les premiers métagranites sont Ordovicien et témoignent d'un environnement de marge active. Ces granites sont aussi polymétamorphiques. Les deuxièmes métagranites sont représentés par les orthogneiss de type Zervreila. Ce métagranite est d'âge permien (-290 Ma). Il est mis en place dans un contexte tectonique post-orogénique. Ce granite est un maqueur de la déformation alpine car il n'est pas affecté par les orogenèses précédentes, flippy Le contenu stratigraphique des roches mésozoïques et cénozoiques de la couverture sédimentaire de la nappe de l'Adula est'important pour en étudier son histoire pré-alpine. La couverture autochtone est composée d'une série d'âge triasique d'affinité nord-pennique, un faciès qui marque la transition entre les domaines helvétiques et briançonnais au Trias. Le domaine paléogéographique représenté dans la nappe de l'Adula connaît une émersion pendant le Jurassique moyen. Cette émersion marque le commencement du rift dans le domaine alpin. La sédimentation de la fin du Jurassique moyen est marquée par une transgression marine accompagnée par des mouvements tectoniques et la formation d'une brèche. Cette transgression est contemporaine des importants mouvements tectoniques et des manifestations magmatiques dans les unités voisines qui marquent la phase principale d'ouverture du bassin nord-pennique. Le Jurassique supérieur est caractérisé par l'instauration d'une sédimentation carbonatée comparable à celle du domaine helvétique ou subbriançonnais. Une sédimentation flyschoïde, probablement du Crétacé à Tertiaire, est déposée sur une importante discordance qui témoigne d'une lacune au Crétacé. La structure complexe de la nappe de l'Adula témoigne de nombreuses phases de déformation. Ces phases de déformation sont en partie issues de la mise en place de la nappe et de déformations plus tardives. La mise en place de la nappe produit deux phases de déformation ductile : la première produit un plissement compatible avec un cisaillement top-vers-le sud dans la partie supérieure de la nappe; la deuxième produit un intense plissement qui accompagne la mise en place de la nappe vers le nord. Ces deux phases de déformation témoignent d'un mécanisme d'exhumation par déformation ductile d'un bloc cohérent.

Diagnostic Performance of Magnetic Resonance Imaging and Computed Tomography for Advanced Retinoblastoma: A Systematic Review and Meta-analysis.

PURPOSE: To determine and compare the diagnostic performance of magnetic resonance imaging (MRI) and computed tomography (CT) for the diagnosis of tumor extent in advanced retinoblastoma, using histopathologic analysis as the reference standard. DESIGN: Systematic review and meta-analysis. PARTICIPANTS: Patients with advanced retinoblastoma who underwent MRI, CT, or both for the detection of tumor extent from published diagnostic accuracy studies. METHODS: Medline and Embase were searched for literature published through April 2013 assessing the diagnostic performance of MRI, CT, or both in detecting intraorbital and extraorbital tumor extension of retinoblastoma. Diagnostic accuracy data were extracted from included studies. Summary estimates were based on a random effects model. Intrastudy and interstudy heterogeneity were analyzed. MAIN OUTCOME MEASURES: Sensitivity and specificity of MRI and CT in detecting tumor extent. RESULTS: Data of the following tumor-extent parameters were extracted: anterior eye segment involvement and ciliary body, optic nerve, choroidal, and (extra)scleral invasion. Articles on MRI reported results of 591 eyes from 14 studies, and articles on CT yielded 257 eyes from 4 studies. The summary estimates with their 95% confidence intervals (CIs) of the diagnostic accuracy of conventional MRI at detecting postlaminar optic nerve, choroidal, and scleral invasion showed sensitivities of 59% (95% CI, 37%-78%), 74% (95% CI, 52%-88%), and 88% (95% CI, 20%-100%), respectively, and specificities of 94% (95% CI, 84%-98%), 72% (95% CI, 31%-94%), and 99% (95% CI, 86%-100%), respectively. Magnetic resonance imaging with a high (versus a low) image quality showed higher diagnostic accuracies for detection of prelaminar optic nerve and choroidal invasion, but these differences were not statistically significant. Studies reporting the diagnostic accuracy of CT did not provide enough data to perform any meta-analyses. CONCLUSIONS: Magnetic resonance imaging is an important diagnostic tool for the detection of local tumor extent in advanced retinoblastoma, although its diagnostic accuracy shows room for improvement, especially with regard to sensitivity. With only a few-mostly old-studies, there is very little evidence on the diagnostic accuracy of CT, and generally these studies show low diagnostic accuracy. Future studies assessing the role of MRI in clinical decision making in terms of prognostic value for advanced retinoblastoma are needed.