Edward I., 1275 - 1277

ed. by Hilary Jenkinson

The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study: protocol for an international multicentre randomised controlled trial

INTRODUCTION Postoperative delirium is one of the most common complications of major surgery, affecting 10-70% of surgical patients 60 years and older. Delirium is an acute change in cognition that manifests as poor attention and illogical thinking and is associated with longer intensive care unit (ICU) and hospital stay, long-lasting cognitive deterioration and increased mortality. Ketamine has been used as an anaesthetic drug for over 50 years and has an established safety record. Recent research suggests that, in addition to preventing acute postoperative pain, a subanaesthetic dose of intraoperative ketamine could decrease the incidence of postoperative delirium as well as other neurological and psychiatric outcomes. However, these proposed benefits of ketamine have not been tested in a large clinical trial. METHODS The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study is an international, multicentre, randomised controlled trial. 600 cardiac and major non-cardiac surgery patients will be randomised to receive ketamine (0.5 or 1 mg/kg) or placebo following anaesthetic induction and prior to surgical incision. For the primary outcome, blinded observers will assess delirium on the day of surgery (postoperative day 0) and twice daily from postoperative days 1-3 using the Confusion Assessment Method or the Confusion Assessment Method for the ICU. For the secondary outcomes, blinded observers will estimate pain using the Behavioral Pain Scale or the Behavioral Pain Scale for Non-Intubated Patients and patient self-report. ETHICS AND DISSEMINATION The PODCAST trial has been approved by the ethics boards of five participating institutions; approval is ongoing at other sites. Recruitment began in February 2014 and will continue until the end of 2016. Dissemination plans include presentations at scientific conferences, scientific publications, stakeholder engagement and popular media. REGISTRATION DETAILS The study is registered at clinicaltrials.gov, NCT01690988 (last updated March 2014). The PODCAST trial is being conducted under the auspices of the Neurological Outcomes Network for Surgery (NEURONS). TRIAL REGISTRATION NUMBER NCT01690988 (last updated December 2013).

36Cl production rate from K-spallation in the European Alps (Chironico landslide, Switzerland)

The abundant production of in situ cosmogenic 36Cl from potassium renders 36Cl measurements in K-rich rocks or minerals, such as K-feldspars, potentially useful for precisely dating rock surfaces, either in single-nuclide or in multi-nuclide studies, for example combined with 10Be measurements in quartz. However, significant discrepancies in experimentally calibrated 36Cl production rates from spallation of potassium (36PK-sp), referenced to sea-level/high-latitude (SLHL), limit the accuracy of 36Cl dating from K-rich lithologies. We present a new 36Cl calibration using K-feldspars, in which K-spallation is the most dominant 36Cl production pathway (>92% of total 36Cl), thus minimizing uncertainties from the complex multi-pathway 36Cl production systematics. The samples are derived from boulders of an ∼13.4 ka-old landslide in the Swiss Alps (∼820 m, 46.43°N, 8.85°E). We obtain a local 36PK-sp of 306 ± 16 atoms 36Cl (g K)−1 a−1 and an SLHL 36PK-sp of 145.5 ± 7.7 atoms 36Cl (g K)−1 a−1, when scaled with a standard scaling protocol (‘Lm’). Applying this SLHL 36PK-sp to determine 36Cl exposure ages of K-feldspars from 10Be-dated moraine boulders yields excellent agreement, confirming the validity of the new SLHL 36PK-sp for surface exposure studies, involving 36Cl in K-feldspars, in the Alps.

Low correlation between self-report and medical record documentation of urinary tract infection symptoms.

BACKGROUND Correlations between symptom documentation in medical records and patient self-report (SR) vary depending on the condition studied. Patient symptoms are particularly important in urinary tract infection (UTI) diagnosis, and this correlation for UTI symptoms is currently unknown. METHODS This is a cross-sectional survey study in hospitalized patients with Escherichia coli bacteriuria. Patients were interviewed within 24 hours of diagnosis for the SR of UTI symptoms. We reviewed medical records for UTI symptoms documented by admitting or treating inpatient physicians (IPs), nurses (RNs), and emergency physicians (EPs). The level of agreement between groups was assessed using Cohen κ coefficient. RESULTS Out of 43 patients, 34 (79%) self-reported at least 1 of 6 primary symptoms. The most common self-reported symptoms were urinary frequency (53.5%); retention (41.9%); flank pain, suprapubic pain, and fatigue (37.2% each); and dysuria (30.2%). Correlation between SR and medical record documentation was slight to fair (κ, 0.06-0.4 between SR and IPs and 0.09-0.5 between SR and EDs). Positive agreement was highest for dysuria and frequency. CONCLUSION Correlation between self-reported UTI symptoms and health care providers' documentation was low to fair. Because medical records are a vital source of information for clinicians and researchers and symptom assessment and documentation are vital in distinguishing UTI from asymptomatic bacteriuria, efforts must be made to improve documentation.

Empowering Teachers as Leaders: A Hard Sell

Despite emphasis on preparing teachers as leaders, teacher educators realize that the transition of classroom practitioners into school leaders is fraught with many obstacles. This session addresses some of these obstacles, describes strategies and opportunities that we have used in our graduate master’s degree programs for teachers that support professionals as they make this change. The session will present evidence on the results of our efforts in terms of teachers’ performances within their programs and in the field after they graduate.

New insights into the role of the duodenal vitamin D receptor in calcium homeostasis

It is generally believed that 1,25(OH)2D3, bound to its receptor (VDR) contributes to calcium homeostasis by regulating active calcium absorption in the proximal small intestine. However, studying patients with hereditary vitamin D-resistant rickets (HVDRR) provided investigators with a better understanding of VDR's role in calcium homeostasis. HVDRR patients have inactivating mutations in the VDR, and as a consequence they develop hypocalcemia, hyperparathyroidism and severe rickets. However, these phenotypes can be corrected if the patients are given IV infusions of calcium or dietary calcium. This raises the question of what is the physiological significance of VDR-regulated active calcium absorption if calcium homeostasis can be restored independently of the VDR. ^ In order to distinguish the contribution of VDR in the proximal small intestine to overall calcium homeostasis, I generated transgenic mice expressing the human VDR (hVDR) exclusively in the proximal small intestine of mVDR-/- mice by using an hVDR-expressing transgene driven by the duodenal-specific adenosine deaminase enhancer (hVDR+/mVDR-/-). hVDR+/mVDR-/- mice expressed transcriptionally active hVDR only in the proximal small intestine and responded to 1,25(OH)2D3 by up-regulating expression of TRPV6 and calbindin D9K, genes involved in calcium absorption. Furthermore, ligated duodenal loop assays determined that calcium absorption in hVDR+/mVDR-/- mice was as responsive to 1,25(OH)2D3 as in WT mice. Despite having a functional hVDR in the proximal small intestine, hVDR+/mVDR-/- mice were hypocalcemic, had hyperparathyroidism, and were rachitic when fed a normal rodent diet at weaning, as were the mVDR-/- mice. However, when fed a high calcium, phosphorus, and lactose diet (rescue diet), the hVDR+/mVDR-/- mice responded more effectively than the mVDR-/- mice by down-regulation of parathyroid hormone production and by a greater increase in bone mineralization. Furthermore, when three-month-old rachitic mice were fed a rescue diet for 3 weeks, serum calcium and bone mineral content were normalized in hVDR+/mVDR-/- mice, but not in mVDR-/- mice. ^ In conclusion, hVDR expression enabled young mice to better use the rescue diet than mVDR-/- mice. Expression of transgenic hVDR also protected the ability of older mice to respond to the rescue diet despite the absence of the VDR elsewhere in the intestinal tract. I propose that because hVDR+/mVDR-/- mice responded better than mVDR-/- mice to the rescue diet, it is likely that VDR expression in the proximal small intestine is necessary in nutritional (insufficient dietary calcium) and physiological (age) conditions when passive calcium absorption is inadequate. ^

Childhood cancer survivor satisfaction with characteristics of clinical care

This study investigated the characteristics of a clinic that affect how satisfied survivors of childhood cancer are with their medical care. Questionnaire and interview data from the Passport for Care: Texas Implementation project collected between January 2011 to April 2012 were analyzed. Eleven clinics in Texas participated. Questionnaire respondents were childhood cancer survivor patients who had been off therapy for at least 2 years, or their parents. Interview respondents were clinical providers or research staff at the participating clinics. The outcomes evaluated were answers to a single question on satisfaction with care and a composite Percent Satisfaction Score created from seven other questionnaire items that were correlated (Spearman Rho >0.3) with the question on satisfaction. The following characteristics were also evaluated: sex, age, race, education, and type of cancer. The following clinic indicators were evaluated: type of clinic (general vs. dedicated cancer survivor clinics), number of providers, number of survivors, ratio of survivors/providers, distribution of handouts, distribution of treatment summaries, and use of Children's Oncology Group (COG) guidelines. ^ The only demographic characteristic that affected satisfaction was race. A Kruskal-Wallis test showed a statistically significant difference (Chi-square 6.129, 2 d.f., p = 0.0467). To analyze this further, Wilcoxon Rank Sum test of pairings of the three groups were performed. A Bonferroni correction for multiple testing was applied, with p = 0.017 indicating significance at alpha = 0.05. There was no significant difference between the White and Hispanic groups or between the Hispanic and "Other" groups. For the White and "Other" groups there was a significant difference for the satisfaction item (p = 0.0123) but not for the Percent Satisfaction Score (p = 0.0289). These results suggest that race may influence satisfaction and should be evaluated further in future studies. ^ None of the clinic indicators affected the Percent Satisfaction Score. Going to a clinic that distributed patient information handouts (Wilcoxon Rank Sum p = 0.048) and going to a clinic with >=100 survivors (Wilcoxon Rank Sum p = 0.021) were associated with increased satisfaction. The population of childhood cancer survivors is a growing group of individuals with special health needs. In the future survivors will likely seek medical care in a variety of clinical settings, so it is important to investigate features to improve patient satisfaction with clinical care.^

Una contribución para la comprensión del nacimiento del representacionalismo

El debate acerca del significado y del fin de la Ciencia se ha desarrollado recientemente en el ámbito de la Filosofía de la Ciencia. Uno de los temas más discutidos es la interpretación del representacionalismo en la concepción clásica de la ciencia (p. e., Rorty y Putnam). Las posibilidades de superar el representaciones dependes de su comprensión. En este trabajo se considera un aspecto del representacionalismo modernos: el modo de explicar la ciencia introducido por aristotélicos y tomistas en la Segunda Escolástica (XV – XVI), con especial mención de Cayetano. Este modo está presenta en el origen del representacionalismo.

Distribution of planktonic foraminifera in Pleistocene sediments of the New Jersey margin, NW Atlantic Ocean

Abundance records of planktonic foraminifera (>150 µm) from the upper 520 m of ODP Site 1073 (Hole 1073A, Leg 174A, 639 m water depth) have been integrated with SPECMAP-derived isotope stratigraphy, percentage of calcium carbonate, and coarse sediment fraction data in order to investigate the Pleistocene climatic history of the New Jersey margin. Six planktonic taxonomic groups dominate the foraminiferal assemblage at Site 1073: Neogloboquadrina pachyderma (d) (mean 33.8%), Turborotalita quinqueloba (18.5%), N. pachyderma (s) (18.4%), Globigerina bulloides group (11.4%), Globorotalia inflata group (9.4%), and Globigerinita glutinata (4.1%). Based on the distributions of these six foraminiferal groups, the Pleistocene section can be divided into three paleoclimatic intervals: Interval I (intermediate) corresponds to the Quaternary sediments from sequence boundary pp1 to the seafloor (79.5-0 mbsf; Emiliania huxleyi acme [85 ka] at 72 mbsf); Interval II (warm) occurs between sequence boundaries pp3 and pp1 (325-79.5 mbsf; last occurrence of Pseudoemiliania lacunosa [460 ka] at 330 mbsf); and Interval III (coldest) occurs between sequence boundaries pp4 and pp3 (520-325 mbsf; Calcareous nannofossils and dinocysts in proximity to pp4 indicate that the sedimentary record for 0.9-1.7 Ma is either missing altogether or highly condensed within the basal few meters of the section). Neogloboquadrina pachyderma (d) displays eight peaks of abundance which correlate, for the most part, with depleted delta18O values, increases in calcium carbonate percentages, low coarse fraction percentages, increased planktonic fragmentation (greater dissolution), and low N. pachyderma (s) abundances. These intervals are interpreted as representing warmer/interglacial conditions. Neogloboquadrina pachyderma (s) displays seven peaks of abundance which correlate, for the most part, with delta18O increases, decreases in calcium carbonate percentages, increases in coarse fraction percentages, and low N. pachyderma (d) abundances. These intervals are interpreted as representing cooler/glacial conditions. In Interval III, a faunal response to relative changes in sea-surface temperature is reflected by abundance peaks in Neogloboquadrina pachyderma (d), followed by Turborotalita quinqueloba and then N. pachyderma (s) (proceeding from warmest to coolest, respectively). This tripartite response is consistent with the oxygen isotope record and, although not as clear, also occurs in Intervals I and II. Six peaks/peak intervals of Globigerina bulloides abundance are closely matched by peaks in Globigerinita glutinata and occur within oxygen isotope stage (OIS) 2 (latter part) 3, 4, 5, 8, 9, 13(?), 14(?), and 15(?). We speculate that these intervals reflect increased upwelling and nutrient levels during both glacials and interglacials. Eight peak intervals of Globorotalia inflata show a general inverse correlation with G. bulloides and may reflect lowered nutrient and warmer surface waters.

Notas para el análisis estratégico de los procesos de negociación entre el FMI y los Gobiernos tomadores de créditos

¿Cómo estudiar las negociaciones entre el FMI y un Gobierno por la suscripción de un acuerdo de financiamiento? En la ponencia se presenta un esquema teórico-metodológico de análisis estratégico de los procesos de negociación entre el FMI y los Gobiernos tomadores de créditos. Primero se desarrollan los principales elementos conceptuales en los que se apoya el esquema, destacando los aportes del esquema de doble nivel de Putnam para el análisis de solución de conflictos internacionales bilaterales. Segundo, se caracterizan las variables de análisis: las estrategias de negociación, la posición negociadora y el estilo de negociación, el tipo de financiamiento y las condicionalidades que exige el organismo; luego, se desarrolla la dinámica de las negociaciones

Notas para el análisis estratégico de los procesos de negociación entre el FMI y los Gobiernos tomadores de créditos

¿Cómo estudiar las negociaciones entre el FMI y un Gobierno por la suscripción de un acuerdo de financiamiento? En la ponencia se presenta un esquema teórico-metodológico de análisis estratégico de los procesos de negociación entre el FMI y los Gobiernos tomadores de créditos. Primero se desarrollan los principales elementos conceptuales en los que se apoya el esquema, destacando los aportes del esquema de doble nivel de Putnam para el análisis de solución de conflictos internacionales bilaterales. Segundo, se caracterizan las variables de análisis: las estrategias de negociación, la posición negociadora y el estilo de negociación, el tipo de financiamiento y las condicionalidades que exige el organismo; luego, se desarrolla la dinámica de las negociaciones

Notas para el análisis estratégico de los procesos de negociación entre el FMI y los Gobiernos tomadores de créditos

¿Cómo estudiar las negociaciones entre el FMI y un Gobierno por la suscripción de un acuerdo de financiamiento? En la ponencia se presenta un esquema teórico-metodológico de análisis estratégico de los procesos de negociación entre el FMI y los Gobiernos tomadores de créditos. Primero se desarrollan los principales elementos conceptuales en los que se apoya el esquema, destacando los aportes del esquema de doble nivel de Putnam para el análisis de solución de conflictos internacionales bilaterales. Segundo, se caracterizan las variables de análisis: las estrategias de negociación, la posición negociadora y el estilo de negociación, el tipo de financiamiento y las condicionalidades que exige el organismo; luego, se desarrolla la dinámica de las negociaciones

Paleomagnetism of DSDP Leg 80 holes

Paleomagnetic results from sediments acquired from the continental margin at DSDP Sites 548, 549, 550, and 551 are described. Where possible, the results were used to construct a polarity reversal stratigraphy for the sections sampled, thus enabling the biostratigraphic dating of the sediments to be refined. Several sections in this study were found to be suitable for magnetostratigraphic work, in particular the upper Paleocene to middle Eocene sediments from Site 549, which contained rich faunal assemblages. These sediments are underlain by a thick sequence of Cretaceous sediments that formed during the Long Cretaceous normal polarity interval. Sediments that formed during the later part of this magnetically quiet interval were also recovered at Site 550. Three short reverse polarity intervals were also recovered at this site; they lie directly over basement and are thought to represent a mixed-polarity interval of late Albian age. They may therefore provide important evidence concerning the age of the earliest sediments at this site. In addition, measurements of the magnetic susceptibility and intensity of remanent magnetism proved to be of interest. A significant decrease in the susceptibility and intensity values close to the early/middle Eocene boundary was noted at Sites 548 and 549. This decrease may be correlated with the results from Holes 400A and 401, which were drilled on DSDP Leg 48 in the northeast Bay of Biscay. The decrease may represent an abrupt reduction in the supply of terrigenous material at the end of the early Eocene, reflecting, perhaps, a change in sediment transport processes at that time