Increasing mean arterial blood pressure in sepsis: effects on fluid balance, vasopressor load and renal function.

INTRODUCTION: The objective of this study was to evaluate the effects of two different mean arterial blood pressure (MAP) targets on needs for resuscitation, organ dysfunction, mitochondrial respiration and inflammatory response in a long-term model of fecal peritonitis. METHODS: Twenty-four anesthetized and mechanically ventilated pigs were randomly assigned (n = 8/group) to a septic control group (septic-CG) without resuscitation until death or one of two groups with resuscitation performed after 12 hours of untreated sepsis for 48 hours, targeting MAP 50-60 mmHg (low-MAP) or 75-85 mmHg (high-MAP). RESULTS: MAP at the end of resuscitation was 56 ± 13 mmHg (mean ± SD) and 76 ± 17 mmHg respectively, for low-MAP and high-MAP groups. One animal each in high- and low-MAP groups, and all animals in septic-CG died (median survival time: 21.8 hours, inter-quartile range: 16.3-27.5 hours). Norepinephrine was administered to all animals of the high-MAP group (0.38 (0.21-0.56) mcg/kg/min), and to three animals of the low-MAP group (0.00 (0.00-0.25) mcg/kg/min; P = 0.009). The high-MAP group had a more positive fluid balance (3.3 ± 1.0 mL/kg/h vs. 2.3 ± 0.7 mL/kg/h; P = 0.001). Inflammatory markers, skeletal muscle ATP content and hemodynamics other than MAP did not differ between low- and high-MAP groups. The incidence of acute kidney injury (AKI) after 12 hours of untreated sepsis was, respectively for low- and high-MAP groups, 50% (4/8) and 38% (3/8), and in the end of the study 57% (4/7) and 0% (P = 0.026). In septic-CG, maximal isolated skeletal muscle mitochondrial Complex I, State 3 respiration increased from 1357 ± 149 pmol/s/mg to 1822 ± 385 pmol/s/mg, (P = 0.020). In high- and low-MAP groups, permeabilized skeletal muscle fibers Complex IV-state 3 respiration increased during resuscitation (P = 0.003). CONCLUSIONS: The MAP targets during resuscitation did not alter the inflammatory response, nor affected skeletal muscle ATP content and mitochondrial respiration. While targeting a lower MAP was associated with increased incidence of AKI, targeting a higher MAP resulted in increased net positive fluid balance and vasopressor load during resuscitation. The long-term effects of different MAP targets need to be evaluated in further studies.

Musiktraditionen im Kontext moderner Globalisierungsprozesse und globaler Denkkonzepte

The documentation of music cultures and the research in and on “classic” regions like India, Indonesia, and Sub-Saharan Africa still plays a central role within ethnomusicological research. However, given the increasing impact of global processes, the central guiding questions of the discipline have undergone profound changes in recent years. Approaches towards globalization are highly varied: One dominant perspective – which can be described as “skeptical” – has equated globalization with musical homogenization. This perspective is still apparent in approaches in European folk music research, which focus on the preservation of “traditional” cultures. Besides hyperglobal perspectives, which perceive the emergence of global networks (hypermedia, mass media, cultural organizations) as a positive development, one can predominantly observe the emergence of transformationalist approaches in recent decades: Global interconnectedness is viewed as a (neutrally perceived) basis for the emergence of new musical structures here. The transformation of the discipline is also apparent in the shift of the historical perspective. Comparative Musicology had already developed a global-historical perspective, which, however, became problematic due to the lack of contextualization. This might explain the subsequent distanced stance taken towards global concepts. Yet the focus on oral cultures also neglected deeper analysis of the historical dimension. At present, one can observe the emergence of a – albeit highly differentiated – change of perspective. While the Anglo-American approaches encourage the development of a specifically ethnomusicological-historical methodology, this separation between ethnomusicological and historical topics is perceived as racist in countries like South Africa. Starting out with an analysis of the concept of canonization in ethnomusicology, this article not only provides an overview of the aforementioned approaches and developments, but also discusses the integration of these processes into ethnomusicologically informed music pedagogical teaching material – within both a school and university context.

Predicting Psychotherapy Dropouts: A Multilevel Approach

The role of therapeutic processes in predicting premature termination of psychotherapy has been a particular focus of recent research. The purpose of this study was to contrast outpatients who completed therapy and those who dropped out with respect to their self-reported in-session experiences of self-esteem, mastery, clarification and the therapeutic alliance. The 296 patients with mixed disorders were treated with an integrative form of cognitive–behavioural therapy without pre-determined time limit (M = 20.2 sessions). Multilevel analyses indicated that patients who did not completetreatment reported, on average, lower levels of self-esteem, mastery and clarification and lower ratings of their therapeutic alliance in treatment in contrast to patients who completed therapy. Patient-reported change in self-esteem experiences over the course of treatment turned out to be the strongest predictor of dropout from psychotherapy or successful completion. When dropout occurred before the average treatment length was reached, patients reported fewer clarifying experiences as early as the first session and their ratings of the therapeutic alliance were characterized by an absence of positive development. Both of these aspects seem to be involved in patients' decisions to leave treatment early. The findings underscore the importance of the therapeutic process in understanding the mechanisms behind treatment dropout. Copyright © 2014 John Wiley & Sons, Ltd.

Development of a potent DOTA-conjugated bombesin antagonist for targeting GRPr-positive tumours

Radiolabelled somatostatin-based antagonists show a higher uptake in tumour-bearing mouse models than agonists of similar or even distinctly higher receptor affinity. Very similar results were obtained with another family of G protein-coupled receptor ligands, the bombesin family. We describe a new conjugate, RM2, with the chelator DOTA coupled to D-Phe-Gln-Trp-Ala-Val-Gly-His-Sta-Leu-NH(2) via the cationic spacer 4-amino-1-carboxymethyl-piperidine for labelling with radiometals such as (111)In and (68)Ga.

Positive Adolescent Career Development: The Role of Intrinsic and Extrinsic Work Values

This longitudinal study of 268 Swiss adolescents, spanning across 8th grade, investigated the relation of intrinsic and extrinsic work values to positive career development in deciding, planning, and exploring. Results showed that girls reported more intrinsic and fewer extrinsic work values compared with boys. Students with an immigration background reported more extrinsic values than did students of Swiss nationality. When gender, nationality, and scholastic achievement were controlled, more general work value endorsement was a significant predictor of an above-average increase in career development over the course of the school year. Endorsement of more intrinsic but not extrinsic work values was related to positive career development.