Vocal cord dysfunction: dealing with aggressivity

QUESTIONS UNDER STUDY: Vocal cord dysfunction (VCD) is characterised by recurrent attacks of paradoxical adduction of the vocal cords during inspiration, accompanied clinically by dyspnoea attacks with inspiratory stridor lasting between minutes and hours. The aim of the study is to evaluate the self-perception of patients suffering from VCD and how they deal with aggressivity. METHODS: The Giessen Test (GT) and the Picture Frustration Test (PFT) were used on 6 patients with VCD. RESULTS: Five variables show significant differences between the patients with VCD and the values of the normative groups. VCD-patients show an idealized image of themselves, ie relaxed, open, sociable, and capable of devotion. They do not reject accusations against them by others and rarely make self-criticism. In conflicts they behave passively, thus blocking their expression of aggressivity. CONCLUSIONS: In many cases organic disposition and trigger stimuli are thought to be responsible for provoking dyspnoea attacks in VCD. However, the self-perception of patients and their way of dealing with aggressivity strongly suggests that psychosocial factors play a great role in the development of VCD. This requires not only symptom-orientated therapy but also psychological counselling.

Parental influence on sibling rivalry in great tit, Parus major, nests

Sibling and parente-offspring conflicts arise mainly over the amount and distribution of parental care, especially food. In altricial bird species where the young depend on parents for obtaining food, parents may control sibling competition by the choice of their respective provisioning locations. In great tits, the parents use fixed provisioning positions on the nest rim that are determined early in the breeding cycle and maintained until. edging. The two parents may choose positions that are close to each other, or far apart, and thereby increase or relax the pressure for optimal feeding positioning among nestlings. As an inspiration to this study we previously found that the two parents provide food from closer positions if the nest is infested by ectoparasites. Here, we tested the hypothesis that the parental choice of relative provisioning locations could be strategically used to control nestling competition. We forced parents to feed from either one or two provisioning locations and assessed the induced change in nestling movement, weight gain, and food distribution among siblings. We show that the angular distance between male and female locations influences the level of behavioural competition and affects nestling weight gain and food distribution. It is the first evidence for hole-nesting birds, where it was assumed that the nestling closest to the entrance hole was fed first, that the apparent choice of feeding positions by parents could be a way of controlling sibling competition and thereby also taking partial control over the outcome of parente-offspring conflict. (c) 2007 The Association for the Study of Animal Behaviour. Published by Elsevier Ltd. All rights reserved.

Population pharmacokinetics of sevoflurane in conjunction with the AnaConDa: toward target-controlled infusion of volatiles into the breathing system

BACKGROUND: The Anesthetic Conserving Device (AnaConDa) uncouples delivery of a volatile anesthetic (VA) from fresh gas flow (FGF) using a continuous infusion of liquid volatile into a modified heat-moisture exchanger capable of adsorbing VA during expiration and releasing adsorbed VA during inspiration. It combines the simplicity and responsiveness of high FGF with low agent expenditures. We performed in vitro characterization of the device before developing a population pharmacokinetic model for sevoflurane administration with the AnaConDa, and retrospectively testing its performance (internal validation). MATERIALS AND METHODS: Eighteen females and 20 males, aged 31-87, BMI 20-38, were included. The end-tidal concentrations were varied and recorded together with the VA infusion rates into the device, ventilation and demographic data. The concentration-time course of sevoflurane was described using linear differential equations, and the most suitable structural model and typical parameter values were identified. The individual pharmacokinetic parameters were obtained and tested for covariate relationships. Prediction errors were calculated. RESULTS: In vitro studies assessed the contribution of the device to the pharmacokinetic model. In vivo, the sevoflurane concentration-time courses on the patient side of the AnaConDa were adequately described with a two-compartment model. The population median absolute prediction error was 27% (interquartile range 13-45%). CONCLUSION: The predictive performance of the two-compartment model was similar to that of models accepted for TCI administration of intravenous anesthetics, supporting open-loop administration of sevoflurane with the AnaConDa. Further studies will focus on prospective testing and external validation of the model implemented in a target-controlled infusion device.

EU trade agreements and their impacts on human rights: study commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ)

The European Union’s (EU) trade policy has a strong influence on economic development and the human rights situation in the EU’s partner countries, particularly in developing countries. The present study was commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ) as a contribution to further developing appropriate methodologies for assessing human rights risks in development-related policies, an objective set in the BMZ’s 2011 strategy on human rights. The study offers guidance for stakeholders seeking to improve their knowledge of how to assess, both ex ante and ex post, the impact of Economic Partnership Agreements on poverty reduction and the right to food in ACP countries. Currently, human rights impacts are not yet systematically addressed in the trade sustainability impact assessments (trade SIAs) that the European Commission conducts when negotiating trade agreements. Nor do they focus specifically on disadvantaged groups or include other benchmarks relevant to human rights impact assessments (HRIAs). The EU itself has identified a need for action in this regard. In June 2012 it presented an Action Plan on Human Rights and Democracy that calls for the inclusion of human rights in all impact assessments and in this context explicitly refers to trade agreements. Since then, the EU has begun to slightly adapt its SIA methodology and is working to define more adequate human rights–consistent procedures. It is hoped that readers of this study will find inspiration to help contribute to this process and help improve human rights consistency of future trade options.

La figure de la sorcière dans la littérature du XIXe siècle (Jules Michelet, George Sand, Eliza Orzeszkowa)

The nineteenth century uncovered and analysed the tragic episodes of witch-hunting and ‘witch’ trials common in Renaissance Europe. Fascinating not only to historians, this subject also inspired men of letters who popularized the image of the witch as an old, ugly and evil person, who thus deserved her lot. Jules Michelet’s La sorcière of 1862 takes a very different approach. Simultaneously a literary and historical work, the book proved scandalous as it rehabilitated the figure of the witch, shedding favourable light on her image: it was the witch who was able to save a last spark of humanity in moments of despair; it was she who acted as comforter and healer to the people. In the context of nineteenth-century literature, certain works by female authors that focused on ‘witches,’ stand out. Whilst certain male authors (Michelet included) presented the witch as a figure from the past, who had finally perished in the 17th century, texts such as George Sand’s La petite Fadette (1848) or Eliza Orzeszkowa’s Dziurdziowie (1885), suggest that the end of witch trials did not imply an end to accusations, persecutions, and even executions of ‘witches’ – and, that in terms of culture, witchcraft or sorcery had not disappeared from the societies they knew.

Traktaty pedagogiczne Honoraty z Wiśniowskich Zapovej i Klementyny z Tańskich Hoffmanowej – inspiracja czy przeróbka?

As is well know, the long-lasting influence in Poland of Hoffmanowa’s conservative pedagogical treatise « Keepsake of a Good Mother » (1819) was criticized by more progressive Polish women writers of the 19th century, such as Narcyza Żmichowska and Eliza Orzeszkowa. But the unexpected success of that book in other Slav countries later in the 19th century, especially in Bohemia, is less well known. Honorata z Wiśniowskich Zapová (1825-1856), a member of the Galician Polish szlachta who moved to Prague after her marriage in 1841 to the Czech writer K. V. Zap, has been recently exhumed as a Czech writer by Czech and Polish literary criticism: apart from her essays in Czech journals on her native country, much emphasis has been laid on the value of her most important work, Nezabudky, dar našim pannám (Forget-me-not: A Gift to Our Young Ladies, published in 1859), which was the first book of pedagogy dedicated to the instruction of young women in Bohemia. In her preface to this book, Zapová mentions Hoffmanowa as being one of her many sources of inspiration. Wishing to know more about what exactly Zapová owes to Hoffmanowa, in this article I compare Hoffmanowa’s book of pedagogy with Zapová’s. I am astonished to discover that Zapová’s book is in fact an almost literal translation from Polish to Czech of „Keepsake of a Good Mother” – in other words, that it is a plagiarism of Hoffmanowa’s book. The main question I ask here is : why did no one until now, either in 19th-century criticism or in our contemporary criticism, mention this literary fraud before?

A lung-on-chip array with an integrated bio-inspired respiration mechanism

We report about a lung-on-chip array that mimics the pulmonary parenchymal environment, including the thin, alveolar barrier and the three-dimensional cyclic strain induced by the breathing movements. A micro-diaphragm used to stretch the alveolar barrier is inspired by the in-vivo diaphragm, the main muscle responsible for inspiration. The design of this device aims not only at best reproducing the in-vivo conditions found in the lung parenchyma, but also at making its handling easy and robust. An innovative concept, based on the reversible bonding of the device, is presented that enables to accurately control the concentration of cells cultured on the membrane by easily accessing both sides of the membranes. The functionality of the alveolar barrier could be restored by co-culturing epithelial and endothelial cells that formed tight monolayers on each side of a thin, porous and stretchable membrane. We showed that cyclic stretch significantly affects the permeability properties of epithelial cell layers. Furthermore, we could also demonstrate that the strain influences the metabolic activity and the cytokine secretion of primary human pulmonary alveolar epithelial cells obtained from patients. These results demonstrate the potential of this device and confirm the importance of the mechanical strain induced by the breathing in pulmonary research.

Novel radiotherapy techniques for involved-field and involved-node treatment of mediastinal Hodgkin lymphoma: when should they be considered and which questions remain open?

PURPOSE Hodgkin lymphoma (HL) is a highly curable disease. Reducing late complications and second malignancies has become increasingly important. Radiotherapy target paradigms are currently changing and radiotherapy techniques are evolving rapidly. DESIGN This overview reports to what extent target volume reduction in involved-node (IN) and advanced radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT) and proton therapy-compared with involved-field (IF) and 3D radiotherapy (3D-RT)- can reduce high doses to organs at risk (OAR) and examines the issues that still remain open. RESULTS Although no comparison of all available techniques on identical patient datasets exists, clear patterns emerge. Advanced dose-calculation algorithms (e.g., convolution-superposition/Monte Carlo) should be used in mediastinal HL. INRT consistently reduces treated volumes when compared with IFRT with the exact amount depending on the INRT definition. The number of patients that might significantly benefit from highly conformal techniques such as IMRT over 3D-RT regarding high-dose exposure to organs at risk (OAR) is smaller with INRT. The impact of larger volumes treated with low doses in advanced techniques is unclear. The type of IMRT used (static/rotational) is of minor importance. All advanced photon techniques result in similar potential benefits and disadvantages, therefore only the degree-of-modulation should be chosen based on individual treatment goals. Treatment in deep inspiration breath hold is being evaluated. Protons theoretically provide both excellent high-dose conformality and reduced integral dose. CONCLUSION Further reduction of treated volumes most effectively reduces OAR dose, most likely without disadvantages if the excellent control rates achieved currently are maintained. For both IFRT and INRT, the benefits of advanced radiotherapy techniques depend on the individual patient/target geometry. Their use should therefore be decided case by case with comparative treatment planning.

Heart-lung interactions during neurally adjusted ventilatory assist

Introduction Assist in unison to the patient’s inspiratory neural effort and feedback-controlled limitation of lung distension with neurally adjusted ventilatory assist (NAVA) may reduce the negative effects of mechanical ventilation on right ventricular function. Methods Heart–lung interaction was evaluated in 10 intubated patients with impaired cardiac function using esophageal balloons, pulmonary artery catheters and echocardiography. Adequate NAVA level identified by a titration procedure to breathing pattern (NAVAal), 50% NAVAal, and 200% NAVAal and adequate pressure support (PSVal, defined clinically), 50% PSVal, and 150% PSVal were implemented at constant positive end-expiratory pressure for 20 minutes each. Results NAVAal was 3.1 ± 1.1cmH2O/μV and PSVal was 17 ± 2 cmH20. For all NAVA levels negative esophageal pressure deflections were observed during inspiration whereas this pattern was reversed during PSVal and PSVhigh. As compared to expiration, inspiratory right ventricular outflow tract velocity time integral (surrogating stroke volume) was 103 ± 4%, 109 ± 5%, and 100 ± 4% for NAVAlow, NAVAal, and NAVAhigh and 101 ± 3%, 89 ± 6%, and 83 ± 9% for PSVlow, PSVal, and PSVhigh, respectively (p < 0.001 level-mode interaction, ANOVA). Right ventricular systolic isovolumetric pressure increased from 11.0 ± 4.6 mmHg at PSVlow to 14.0 ± 4.6 mmHg at PSVhigh but remained unchanged (11.5 ± 4.7 mmHg (NAVAlow) and 10.8 ± 4.2 mmHg (NAVAhigh), level-mode interaction p = 0.005). Both indicate progressive right ventricular outflow impedance with increasing pressure support ventilation (PSV), but no change with increasing NAVA level. Conclusions Right ventricular performance is less impaired during NAVA compared to PSV as used in this study. Proposed mechanisms are preservation of cyclic intrathoracic pressure changes characteristic of spontaneous breathing and limitation of right-ventricular outflow impedance during inspiration, regardless of the NAVA level.

Determination of respiratory gas flow by electrical impedance tomography in an animal model of mechanical ventilation

Background A recent method determines regional gas flow of the lung by electrical impedance tomography (EIT). The aim of this study is to show the applicability of this method in a porcine model of mechanical ventilation in healthy and diseased lungs. Our primary hypothesis is that global gas flow measured by EIT can be correlated with spirometry. Our secondary hypothesis is that regional analysis of respiratory gas flow delivers physiologically meaningful results. Methods In two sets of experiments n = 7 healthy pigs and n = 6 pigs before and after induction of lavage lung injury were investigated. EIT of the lung and spirometry were registered synchronously during ongoing mechanical ventilation. In-vivo aeration of the lung was analysed in four regions-of-interest (ROI) by EIT: 1) global, 2) ventral (non-dependent), 3) middle and 4) dorsal (dependent) ROI. Respiratory gas flow was calculated by the first derivative of the regional aeration curve. Four phases of the respiratory cycle were discriminated. They delivered peak and late inspiratory and expiratory gas flow (PIF, LIF, PEF, LEF) characterizing early or late inspiration or expiration. Results Linear regression analysis of EIT and spirometry in healthy pigs revealed a very good correlation measuring peak flow and a good correlation detecting late flow. PIFEIT = 0.702 · PIFspiro + 117.4, r2 = 0.809; PEFEIT = 0.690 · PEFspiro-124.2, r2 = 0.760; LIFEIT = 0.909 · LIFspiro + 27.32, r2 = 0.572 and LEFEIT = 0.858 · LEFspiro-10.94, r2 = 0.647. EIT derived absolute gas flow was generally smaller than data from spirometry. Regional gas flow was distributed heterogeneously during different phases of the respiratory cycle. But, the regional distribution of gas flow stayed stable during different ventilator settings. Moderate lung injury changed the regional pattern of gas flow. Conclusions We conclude that the presented method is able to determine global respiratory gas flow of the lung in different phases of the respiratory cycle. Additionally, it delivers meaningful insight into regional pulmonary characteristics, i.e. the regional ability of the lung to take up and to release air.

Finding a voice - Nollywood inspired filmmaking practices in Switzerland

Under the name Nollywood a unique video film industry has developed in Nigeria in the last few decades, which now forms one of the world’s biggest entertainment industries. With its focus on stories reflecting „the values, desires and fears” (Haynes 2007: 133) of African viewers and its particular way of production, Nollywood brings „lived practices and its representation together in ways that make the films deeply accessible and entirely familiar to their audience“ (Marston et al. 2007: 57). In doing so, Nollywood shows its spectators new postcolonial forms of performative self‐expression and becomes a point of reference for a wide range of people. However, Nollywood not only excites a large number of viewers inside and outside Nigeria, it also inspires some of them to become active themselves and make their own films. This effect of Nigerian filmmaking can be found in many parts of sub‐Saharan Africa as well as in African diasporas all over the world – including Switzerland (Mooser 2011: 63‐66). As a source of inspiration, Nollywood and its unconventional ways of filmmaking offer African migrants a benchmark that meets their wish to express themselves as minority group in a foreign country. As Appadurai (1996: 53), Ginsburg (2003: 78) and Marks (2000: 21) assume, filmmakers with a migratory background have a specific need to express themselves through media. As minority group members in their country of residence they not only wish to reflect upon their situation within the diaspora and illustrate their everyday struggles as foreigners, but to also express their own views and ideas in order to challenge dominant public opinion (Ginsburg 2003: 78). They attempt to “talk back to the structures of power” (2003: 78) they live in. In this process, their audio-visual works become a means of response and “an answering echo to a previous presentation or representation” (Mitchell 1994: 421). The American art historian Mitchell, therefore, suggests interpreting representation as “the relay mechanism in exchange of power, value, and publicity” (1994: 420). This desire of interacting with the local public has also been expressed during a film project of African, mainly Nigerian, first-generation migrants in Switzerland I am currently partnering in. Several cast and crew members have expressed feelings of being under-represented, even misrepresented, in the dominant Swiss media discourse. In order to create a form of exchange and give themselves a voice, they consequently produce a Nollywood inspired film and wish to present it to the society they live in. My partnership in this on‐going film production (which forms the foundation of my PhD field study) allows me to observe and experience this process. By employing qualitative media anthropological methods and in particular Performance Ethnography, I seek to find out more about the ways African migrants represent themselves as a community through audio‐visual media and the effect the transnational use of Nollywood has on their form of self‐representations as well as the ways they express themselves.

Die Gletscher des Welterbes Jungfrau-Aletsch im Spiegel der Zeit

Die Gletscher der Region Jungfrau-Aletsch und deren einzigartige Schönheit waren während Jahrhunderten nicht nur Inspiration für Besucher und Einheimische, sondern auch entscheidende Kriterien für die Auszeichnung des Gebietes mit dem UNESCO-Welterbe-Label. Mit 167 kleinen und grossen Gletschern liegt die Region zu 42% unter Eis und umfasst die grösste zusammenhängende Eisfläche der Alpen. Im Zuge der Klimaerwärmung ziehen sich die Gletscher jedoch kontinuierlich zurück und stellen die Menschen im Alpenraum vor vielfältige Herausforderungen. Wie präsentiert sich die Situation im Welterbe-Gebiet?