A 3-step therapeutic strategy for severe alveolar proteinosis.

Pulmonary alveolar proteinosis (PAP) is characterized by accumulation of lipoproteinaceous material in the terminal airways. Whole lung lavage (WLL) remains the gold standard treatment but may be particularly challenging in cases of severe hypoxemia. We present a 3-step strategy that was used in a patient with PAP-associated refractory hypoxemia and that combined venovenous extracorporeal membrane oxygenation (vvECMO), double-lumen orotracheal intubation, and bilateral multisegmental sequential lavage (MSL). The procedure was well tolerated and permitted weaning from the ventilator.

Cost-effectivness in a DRG system for two-step exchange of infected total joint arthroplasty

The costs related to the treatment of infected total joint arthroplasties represent an ever groving burden to the society. Different patient-adapted therapeutic options like débridement and retention, 1- or 2-step exchange can be used. If a 2-step exchange is used we have to consider short (2-4 weeks) or long (>4-6 weeks) interval treatment. The Swiss DRG (Diagnose related Groups) determines the reimboursement the hopsital receives for the treatment of an infected total arthroplasty. The review assesses the cost-effectiveness of hospitalisation practices linked to surgical treatment in the two-stage exchange of a prosthetic-joint infection. The aim of this retrospectiv study is to compare the economical impact between a short (2 to 4 weeks) versus a long (6 weeks and above) interval during a two-satge procedure to determine the financial impact. Retrospectiv study of the patients with a two-stage procedure for a hip or knee prosthetic joint infection at CHUV hospital Lausanne (Switzerland) between 2012 and 2013. The review analyses the correlation between the interval length and the length of the hospital stay as well as with the costs and revenues per hospital stay. In average there is a loss of 40′000 Euro per hospitalisation for the treatment of prosthetic joint infection. Revenues never cover all the costs, even with a short interval procedure. This economical loss increases with the length of the hospital stay if a long-term intervall is choosen. The review explores potential for improvement in reimbourement practices and hospitalisation practices in the current Swiss healthcare setting. There should be alternative setups to decrease the burden of medical costs by a) increase the reimboursment for the treatment of infected total joints or by b) splitting the hospital stay with partners (rapid transfer after first operation from center hospital to level 2 hospital and retransfer for second operation to center) in order to increase revenues.

An exploration of the experience of implementing the second step violence prevention curriculum in one primary general learning disabilities class /

Violence has always been a part of the human experience, and therefore, a popular topic for research. It is a controversial issue, mostly because the possible sources of violent behaviour are so varied, encompassing both biological and environmental factors. However, very little disagreement is found regarding the severity of this societal problem. Most researchers agree that the number and intensity of aggressive acts among adults and children is growing. Not surprisingly, many educational policies, programs, and curricula have been developed to address this concern. The research favours programs which address the root causes of violence and seek to prevent rather than provide consequences for the undesirable behaviour. But what makes a violence prevention program effective? How should educators choose among the many curricula on the market? After reviewing the literature surrounding violence prevention programs and their effectiveness, The Second Step Violence Prevention Curriculum surfaced as unique in many ways. It was designed to address the root causes of violence in an active, student-centred way. Empathy training, anger management, interpersonal cognitive problem solving, and behavioural social skills form the basis of this program. Published in 1992, the program has been the topic of limited research, almost entirely carried out using quantitative methodologies.The purpose of this study was to understand what happens when the Second Step Violence Prevention Curriculum is implemented with a group of students and teachers. I was not seeking a statistical correlation between the frequency of violence and program delivery, as in most prior research. Rather, I wished to gain a deeper understanding of the impact ofthe program through the eyes of the participants. The Second Step Program was taught to a small, primary level, general learning disabilities class by a teacher and student teacher. Data were gathered using interviews with the teachers, personal observations, staff reports, and my own journal. Common themes across the four types of data collection emerged during the study, and these themes were isolated and explored for meaning. Findings indicate that the program does not offer a "quick fix" to this serious problem. However, several important discoveries were made. The teachers feU that the program was effective despite a lack of concrete evidence to support this claim. They used the Second Step strategies outside their actual instructional time and felt it made them better educators and disciplinarians. The students did not display a marked change in their behaviour during or after the program implementation, but they were better able to speak about their actions, the source of their aggression, and the alternatives which were available. Although they were not yet transferring their knowledge into positive action,a heightened awareness was evident. Finally, staff reports and my own journal led me to a deeper understanding ofhow perception frames reality. The perception that the program was working led everyone to feel more empowered when a violent incident occurred, and efforts were made to address the cause rather than merely to offer consequences. A general feeling that we were addressing the problem in a productive way was prevalent among the staff and students involved. The findings from this investigation have many implications for research and practice. Further study into the realm of violence prevention is greatly needed, using a balance of quantitative and qualitative methodologies. Such a serious problem can only be effectively addressed with a greater understanding of its complexities. This study also demonstrates the overall positive impact of the Second Step Violence Prevention Curriculum and, therefore, supports its continued use in our schools.

Impact of a neonatal parenteral nutrition on the hepatic activity of methionine adenosyltransferase, a limiting step for glutathione synthesis

Problématique : Le glutathion est une molécule clé de la défense antioxydante. Chez les enfants sous nutrition parentérale (NP), particulièrement les nouveau-nés, sa concentration tissulaire est anormalement basse. Puisque la capacité de synthèse de glutathion est adéquate, un déficit en cystéine, le substrat limitant, est soupçonnée. À cause de son instabilité en solution, la cystéine est peu présente en NP; la méthionine étant le précurseur endogène de cet acide aminé. L’activité de la méthionine adénosyltransférase (MAT), une enzyme essentielle à la transformation de la méthionine en cystéine, est facilement inhibée par l’oxydation. L’hypothèse : Le faible taux de glutathion chez les enfants sous NP est causé par l’inhibition de la MAT par les peroxydes contaminant ces solutions nutritives. Objectif: Mesurer l’impact d’une infusion de NP et de H2O2 sur l’activité hépatique de MAT en relation avec le niveau de glutathion. Méthode : Un cathéter est placé dans la jugulaire droite de cobayes de trois jours de vie. Quatre groupes sont comparés:1- Témoin (animaux aucune manipulation, sans cathéter) 2)-(animaux nourris normalement et le cathéter (noué)); 3) NP (animaux nourris exclusivement par voie intraveineuse (acides aminés + dextrose + lipides + vitamines + électrolytes), cette solution génère environ 400 µM de peroxyde. 4) H2O2 (animaux nourris normalement et recevant via le cathéter 400 µM de H2O2). Après quatre jours, le foie et le sang sont prélevés pour la détermination du glutathion, potentiel redox et l’activité de MAT, glutathion peroxydase et glutathion reductase. Résultats : L’activité de MAT est plus faible dans les groupes NP et H2O2. Le potentiel redox du foie et dans le sang est plus oxydé dans le groupe NP. Tandis que la concentration de GSSG du foie est plus élevée dans le groupe NP. Ainsi la concentration de GSH dans le sang et foie est plus faible dans les NP et H2O2 Discussion: La relation entre l’inhibition de MAT et le stress oxydant observée dans le groupe NP pourrait bien expliquer la perturbation du système glutathion observée chez les nouveau-nés prématurés.

Design of a microstip fed step slot antenna for UWB communication

The design and performance of a stepped slot printed monopole antenna in the ultrawideband is presented in this article. Multiple resonances generated by the stepped slot geometry are matched in the ultrawideband using a modified microstrip feed. The impedance bandwidth (SWR < 2) of the antenna is from 3 to 11 GHz. Radiation patterns are stable and omnidirectional with appreciable gain throughout the band. Performance of the antenna is also analyzed in the time domain, which reveals good pulse handling capabilities. Compact geometry of the antenna allows easy commercial deployment.

Giant step bunching from self-organized coalescence of SrRuO3 islands

Step bunching develops in the epitaxy of SrRuO3 on vicinal SrTiO3(001) substrates. We have investigated the formation mechanisms and we show here that step bunching forms by lateral coalescence of wedgelike three-dimensional islands that are nucleated at substrate steps. After coalescence, wedgelike islands become wider and straighter with growth, forming a self-organized network of parallel step bunches with altitudes exceeding 30 unit cells, separated by atomically flat terraces. The formation mechanism of step bunching in SrRuO3, from nucleated islands, radically differs from one-dimensional models used to describe bunching in semiconducting materials. These results illustrate that growth phenomena of complex oxides can be dramatically different to those in semiconducting or metallic systems.

Bayesian Analysis of Simple Step-stress Model under Weibull Lifetimes

Department of Statistics, Cochin University of Science & Technology, Part of this work has been supported by grants from DST and CSIR, Government of India. 2Department of Mathematics and Statistics, IIT Kanpur

An incomplete step toward a banking union. CEPS Commentary, 5 July 2012

In this Commentary, Daniel Gros applauds the decision taken by Europe’s leaders at the eurozone summit at the end of June to transfer responsibility for banking supervision in the eurozone to the European Central Bank. It represents explicit recognition of the important fact that problems might originate at the national level, but, owing to monetary union, they can quickly threaten the stability of the entire eurozone banking system. In his view, the next small, incremental step, although one not yet officially acknowledged, will necessarily be the creation of a common bank rescue fund.

A stable one-step-ahead predictive control of non-linear systems

In this paper stability of one-step ahead predictive controllers based on non-linear models is established. It is shown that, under conditions which can be fulfilled by most industrial plants, the closed-loop system is robustly stable in the presence of plant uncertainties and input–output constraints. There is no requirement that the plant should be open-loop stable and the analysis is valid for general forms of non-linear system representation including the case out when the problem is constraint-free. The effectiveness of controllers designed according to the algorithm analyzed in this paper is demonstrated on a recognized benchmark problem and on a simulation of a continuous-stirred tank reactor (CSTR). In both examples a radial basis function neural network is employed as the non-linear system model.

Image fusion based on median filters and SOFM neural networks: a three-step scheme

This paper presents a new image data fusion scheme by combining median filtering with self-organizing feature map (SOFM) neural networks. The scheme consists of three steps: (1) pre-processing of the images, where weighted median filtering removes part of the noise components corrupting the image, (2) pixel clustering for each image using self-organizing feature map neural networks, and (3) fusion of the images obtained in Step (2), which suppresses the residual noise components and thus further improves the image quality. It proves that such a three-step combination offers an impressive effectiveness and performance improvement, which is confirmed by simulations involving three image sensors (each of which has a different noise structure).

A step toward the wet surface chemistry of glycine and alanine on Cu{110}: destabilization and decomposition in the presence of near-ambient water vapor

The coadsorption of water with organic molecules under near-ambient pressure and temperature conditions opens up new reaction pathways on model catalyst surfaces that are not accessible in conventional ultrahigh-vacuum surfacescience experiments. The surface chemistry of glycine and alanine at the water-exposed Cu{110} interface was studied in situ using ambient-pressure photoemission and X-ray absorption spectroscopy techniques. At water pressures above 10-5 Torr a significant pressure-dependent decrease in the temperature for dissociative desorption was observed for both amino acids, accompanied by the appearance of a newCN intermediate, which is not observed for lower pressures. The most likely reaction mechanisms involve dehydrogenation induced by O and/or OH surface species resulting from the dissociative adsorption of water. The linear relationship between the inverse decomposition temperature and the logarithm of water pressure enables determination of the activation energy for the surface reaction, between 213 and 232 kJ/mol, and a prediction of the decomposition temperature at the solidliquid interface by extrapolating toward the equilibrium vapor pressure. Such experiments near the equilibrium vapor pressure provide important information about elementary surface processes at the solidliquid interface, which can be retrieved neither under ultrahigh vacuum conditions nor from interfaces immersed in a solution.

Surface activity of surfactin recovered and purified from fermentation broth using a two-step ultrafiltration (UF) process

B. subtilis under certain types of media and fermentation conditions can produce surfactin, a biosurfactant which belongs to the lipopeptide class. Surfactin has exceptional surfactant activity, and exhibits some interesting biological characteristics such as antibacterial activity, antitumoral activity against ascites carcinoma cells, and a hypocholesterolemic activity that inhibits cAMP phosphodiesterase, as well as having anti-HIV properties. A cost effective recovery and purification of surfactin from fermentation broth using a two-step ultrafiltration (UF) process has been developed in order to reduce the cost of surfactin production. In this study, competitive adsorption of surfactin and proteins at the air-water interface was studied using surface pressure measurements. Small volumes of bovine serum albumin (BSA) and β-casein solutions were added to the air-water interface on a Langmuir trough and allowed to stabilise before the addition of surfactin to the subphase. Contrasting interfacial behaviour of proteins was observed with β-casein showing faster initial adsorption compared to BSA. On introduction of surfactin both proteins were displaced but a longer time were taken to displace β-casein. Overall the results showed surfactin were highly surface-active by forming a β-sheet structure at the air-water interface after reaching its critical micelle concentration (CMC) and were effective in removing both protein films, which can be explained following the orogenic mechanism. Results showed that the two-step UF process was effective to achieve high purity and fully functional surfactin.

Semiotic interoperability- a critical step towards systems integration

Information systems integration becomes critical in enhancing organisational competitiveness through effective use of information resource provided by the whole host of information systems. Information systems integration in its nature is a process of bringing about the capability of communication and information exchange between systems; while interoperability, often as the result of systems integration, is such a capability. However currently there is a lack of theoretical foundation for representation and measure of the interoperability in organisations. Organisational semiotics provides a theoretical foundation for systems interoperability. A notion of ‘semiotic interoperability’ is proposed in this paper as a paradigm, guiding systems integration and measuring degree of interoperability, covering aspects from physical properties, transmission structure of signs, placing emphasis on communicating meaning, intention to social consequence of information.

Identification of fractional-order transfer functions using a step excitation

This brief proposes a new method for the identification of fractional order transfer functions based on the time response resulting from a single step excitation. The proposed method is applied to the identification of a three-dimensional RC network, which can be tailored in terms of topology and composition to emulate real time systems governed by fractional order dynamics. The results are in excellent agreement with the actual network response, yet the identification procedure only requires a small number of coefficients to be determined, demonstrating that the fractional order modelling approach leads to very parsimonious model formulations.

One step forward, and two steps back: women and career progression in academia during times of uncertainty

While there is an extensive and still growing body of literature on women in academia and the challenges they encounter in career progression, there is little research on their experience specifically within a business school setting. In this study, we attempt to address this gap and examine the experiences and career development of female academics in a business school and how these are impacted by downsizing programmes. To this end, an exploratory case study is conducted. The findings of this study show that female business school academics experience numerous challenges in terms of promotion and development, networking, and the multiple and conflicting demands placed upon them. As a result, the lack of visibility seems to be a pertinent issue in terms of their career progression. Our data also demonstrates that that, paradoxically, during periods of downsizing women become more visible and thus vulnerable to layoffs as a consequence of the challenges and pressures created in their environment during this process. In this paper, we argue that this heightened visibility, and being subject to possible layoffs, further reproduces inequality regimes in academia.