Troponin I serum levels predict the need of dialysis in incident sepsis patients with acute kidney injury in the intensive care unit

Abstract Introduction: Sepsis, an extremely prevalent condition in the intensive care unit, is usually associated with organ dysfunction, which can affect heart and kidney. Objective: To determine whether the cardiac dysfunction and the Troponin I forecast the occurrence of acute renal failure in sepsis. Methods: Cardiac dysfunction was assessed by echocardiography and by the serum troponin I levels, and renal impairment by AKIN criteria and the need of dialysis. Twenty-nine patients with incident sepsis without previous cardiac or renal dysfunction were enrolled. Results and Discussion: Patients averaged 75.3 ± 17.3 years old and 55% were male. Median APACHE II severity score at ICU admission was 16 (9.7 - 24.2) and mortality rate in 30 days was 45%. On the fifth day, 59% had ventricular dysfunction. Troponin serum levels on day 1 in the affected patients were 1.02 ± 0.6 ng/mL compared with 0.23 ± 0.18 ng/mL in patients without heart dysfunction (p = 0.01). Eighteen out of 29 patients (62%) underwent renal replacement therapy (RRT) and the percent of patients with ventricular dysfunction who required dialysis was higher (94% vs. 16%, p = 0.0001). Values of troponin at day 1 were used to develop a ROC curve to determine their ability to predict the need of dialysis. The area under the curve was 0.89 and the cutoff value was 0.4 ng/mL. Conclusion: We found that an elevation in serum troponin levels, while guarding a relationship with ventricular dysfunction, can be a precious tool to predict the need for dialysis in sepsis patients.

Social media in the purchasing of knowledge-intensive business services

The purpose of this thesis was to understand how industrial buyers utilize social media in the purchasing of knowledge-intensive business services. By combining theories from past research a theoretical framework was formed to visualize the role of the social media at the different stages of the purchasing process. The subject was approached from the industrial buyers’ perspective instead of the knowledge-intensive business firm. The research was conducted using two qualitative research methods: interviews and netnography. The selected interviewees have been involved in the decision-making unit for purchasing knowledge-intensive business services. Additionally all of them are using various social media. Based on the interviews social media is used merely to support decision-making. Some of the interviewees had also shared their own experiences about the service and collaboration with the service provider with other social media users. Based on the interviews two social media were chosen for closer examination. The findings from netnography support the results from the interviews. The outcome of knowledgeintensive business services is dependable of the professionals. Therefore the information is used during decision-making process to confirm the formed image of the service, and the professionals of the service provider. Information obtained from social media complements information provided by the supplier. Even though the interviewees had not themselves used social media to find information about the service during search process, finding from netnography suggest it to exist. Industrial buyers ask other users’ opinions and experience about the services, and receive recommendations to them. Some recommendations are given publicly, but more discreet information is shared in private conversations. Observations in social media show that industrial buyers might be exposed to triggers to promote problem recognition as well. Companies share news and successful customer cases through their social media profiles, which might affect the industrial buyers, but to confirm this requires further research. The industrial buyers’ use of social media during different purchasing processes of knowledgeintensive business services can be conceptualize based on the findings. This helps companies to create right content to their social media pages, and encourage professionals to develop their networks in social media.

Preliminary epidemiological study of latent tuberculosis in Mexican agricultural workers in the Niagara region, Canada

It is well documented that the majority of Tuberculosis (TB) cases diagnosed in Canada are related to foreign-bom persons from TB high-burden countries. The Canadian seasonal agricultural workers program (SAWP) operating with Mexico allows migrant workers to enter the country with a temporary work permit for up to 8 months. Preiimnigration screening of these workers by both clinical examination and chest X-ray (CXR) reduces the risk of introducing cases of active pulmonary TB to Canada, but screening for latent TB (LTBI) is not routinely done. Studies carried out in industrialized nations with high immigration from TBendemic countries provide data of lifetime LTBI reactivation of around 10% but little is known about reactivation rates within TB-endemic countries where new infections (or reinfections) may be impossible to distinguish from reactivation. Migrant populations like the SAWP workers who spend considerable amounts of time in both Canada and TBendemic rural areas in Mexico are a unique population in terms of TB epidemiology. However, to our knowledge no studies have been undertaken to explore either the existence of LTBI among Mexican workers, the probability of reactivation or the workers' exposure to TB cases while back in their communities before returning the following season. Being aware of their LTBI status may help workers to exercise healthy behaviours to avoid TB reactivation and therefore continue to access the SAWP. In order to assess the prevalence of LTBI and associated risk factors among Mexican migrant workers a preliminary cross sectional study was designed to involve a convenience sample of the Niagara Region's Mexican workers in 2007. Research ethics clearance was granted by Brock University. Individual questionnaires were administered to collect socio-demographic and TB-related epidemiological data as well as TB knowledge and awareness levels. Cellular immunity to M tuberculosis was assessed by both an Interferon-y release assay (lGRA), QuantiFERON -TB Gold In-Tube (QFf™) and by the tuberculin skin test (TSn using Mantoux. A total of 82 Mexican workers (out of 125 invited) completed the study. Most participants were male (80%) and their age ranged from 22 to 65 years (mean 38.5). The prevalence of LTBI was 34% using TST and 18% using QFTTM. As previously reported, TST (using ~lOmm cut-off) showed a sensitivity of 93.3% and a specificity of 79.1 %. These findings at the moment cannot predict the probability of progression to active TB; only longitudinal cohort studies of this population can ascertain this outcome. However, based on recent publications, lORA positive individuals may have up to 14% probability of reactivation within the next two years. Although according to the SA WP guidelines, all workers undergo TB screening before entering or re-entering Canada, CXR examination requirements showed to be inconsistent for this population: whereas 100% of the workers coming to Canada for the first time reported having the procedure done, only 31 % of returning participants reported having had a CXR in the past year. None of the participants reported ever having a CXR compatible with TB which was consistent with the fact that none had ever been diagnosed with active pulmonary TB and with only 3.6% reporting close contact with a person with active TB in their lifetime. Although Mexico reports that 99% of popUlation is fully immunized against TB within the first year of age, only 85.3% of participants reported receiving BOC vaccine in childhood. Conversely, even when TST is not part of the routine TB screening in endemic countries, a suqDrisingly high 25.6% reported receiving a TST in the past. In regards to TB knowledge and awareness, 74% of the studied population had previous knowledge about (active) TB, 42% correctly identified active TB symptomatology, 4.8% identified the correct route of transmission, 4.8% knew about the existence of LTBI, 3.6% knew that latent TB could reactivate and 48% recognized TB as treatable and curable. Of all variables explored as potential risk factors for LTBI, age was the only one which showed statistical significance. Significant associations could not be proven for other known variables (such as sex, TB contact, history of TB) probably because of the small sample size and the homogeneity of the sample. Screening for LTBI by TST (high sensitivity) followed by confirmation with QFT''"'^ (high specificity) suggests to be a good strategy especially for immigrants from TB high-burden countries. After educational sessions, workers positive for LTBI gained greater knowledge about the signs and symptoms of TB reactivation as well as the risk factors commonly associated with reactivation. Additionally, they were more likely to attend their annual health check up and request a CXR exam to monitor for TB reactivation.

A survey of attitudes of agricultural society leaders toward leadership development education

It was the purpose of this study to investigate attitudes toward leadership development education of one client group served by the ontario Ministry of Agriculture and Food. The survey, answered by 175 participants, attempted to answer the following questions: (a) What is a common definition of leadership?, (b) What leadership concepts are important to leadership development education? and, (c) What are client attitudes toward leadership development education? A descriptive research approach was used and the data were analyzed according to a model developed by Colaizzi. Concept maps were developed under the broad areas of: (a) Developing leader qualities; (b) Past experiences that developed leadership skills that worked on the jOb; (c) Leadership skills developed from present day positions; and (d) How leadership skills may be developed in future situations. A description of the dynamics of leadership development was written and the essential dynamics of leadership skill development in one volunteer organization was described. This study supports the linkages perspective of leadership within voluntary organizations developed by Vandenberg, Thullen and Fear (1987). The linkages perspective consists of three major components: perception, property and process. As a perception, leadership is the set of beliefs each group member holds regarding the behaviours and qualities characteristic of effective leaders. As a property, leadership represents the qualities attributed by group members to persons perceived as effectively (or potentially) influencing the goal achievement process. As a process, leadership involves the use of non-coercive influence to facilitate group accomplishment of valued goals. Leadership concepts important for development in a leadership development education program related to personal, organizational and societal development. The top five concepts in terms of rank order are communicating effectively, forming and working with groups, working creatively (tie), developing followers, managing meetings, directing projects or activities, understanding financial matters, managing negotiations (tie), developing resources and understanding and developing oneself (tie). Several recommendations are relevant for extension personnel as educators. Theoretical concepts on leadership need to be shared to extension practitioners involved in leadership development. currently used teaching materials for leadership development should be evaluated to see if they include concepts from preferrred theoretical leadership perceptions.

Vitamin D status and latent tuberculosis infection : a preliminary study in a group of healthy Mexican agricultural workers

Vitamin D metabolites are important in the regulation of bone and calcium homeostasis, but also have a more ubiquitous role in the regulation of cell differentiation and immune function. Severely low circulating 25-dihydroxyvitamin D [25(OH)D] concentrations have been associated with the onset of active tuberculosis (TB) in immigrant populations, although the association with latent TB infection (LTBI) has not received much attention. A previous study identified the prevalence of LTBI among a sample of Mexican migrant workers enrolled in Canada's Seasonal Agricultural Workers Program (SA WP) in the Niagara Region of Ontario. The aim of the present study was to determine the vitamin D status of the same sample, and identify if a relationship existed with LTBI. Studies of vitamin D deficiency and active TB are most commonly carried out among immigrant populations to non-endemic regions, in which reactivation of LTBI has occurred. Currently, there is limited knowledge of the association between vitamin D deficiency and LTBI. Entry into Canada ensured that these individuals did not have active TB, and L TBI status was established previously by an interferon-gamma release assay (IGRA) (QuantiFERON-TB Gold In-Tube®, Cellestis Ltd., Australia). Awareness of vitamin D status may enable individuals at risk of deficiency to improve their nutritional health, and those with LTBI to be aware of this risk factor for disease. Prevalence of vitamin D insufficiency among the Mexican migrant workers was determined from serum samples collected in the summer of 2007 as part of the cross sectional LTBI study. Samples were measured for concentrations of the main circulating vitamin D metabolite, 25(OH)D, with a widely used 1251 250HD RIA (DiaSorin Inc.®, Stillwater, MN), and were categorized as deficient «37.5 nmoI/L), insufficient (>37.5 nmollL, < 80 nmol/L) or sufficient (2::80 nmoI/L). Fisher's exact tests and t tests were used to determine if vitamin D status (sufficiency or insufficiency) or 25(OH)D concentrations significantly differed by sex or age categories. Predictors of vitamin D insufficiency and 25(OH)D concentrations were taken from questionnaires carried out during the previous study, and analyzed in the present study using multiple regression prediction models. Fisher's exact test and t test was used to determine if vitamin D status or 25(OH)D concentration differed by LTBI status. Strength of the relationship between interferongamma (IFN-y) concentration (released by peripheral T cells in response to TB antigens) and 25(OH)D concentration was analyzed using a Spearman correlation. Out of 87 participants included in the study (78% male; mean age 38 years), 14 were identified as LTBI positive but none had any signs or symptoms of TB reactivation. Only 30% of the participants were vitamin D sufficient, whereas 68% were insufficient and 2% were deficient. Significant independent predictors of lower 25(OH)D concentrations were sex, number of years enrolled in the SA WP and length of stay in Canada. No significant differences were found between 25(OH)D concentrations and LTBI status. There was a significant moderate correlation between IFN-y and 25(OH)D concentrations ofLTBI-positive individuals. The majority of participants presented with Vitamin D insufficiency but none were severely deficient, indicating that 25(OH)D concentrations do not decrease dramatically in populations who temporarily reside in Canada but go back to their countries of origin during the Canadian winter. This study did not find a statistical relationship between low levels of vitamin D and LTBI which suggests that in the presence of overall good health, lower than ideal levels of 2S(OH)D, may still be exerting a protective immunological effect against LTBI reactivation. The challenge remains to determine a critical 2S(OH)D concentration at which reactivation is more likely to occur.

Identifying language needs of ESL students in a Canadian university based intensive English language program

This study investigated the needs of adult ESL learners intending to pursue higher education in Canada. Its chief purpose was to enable educators and administrators to design ESL programs that would prepare students to function at optimal levels in academic and social settings during their university studies. The study adopted a mixed research method that was predominantly qualitative in its orientation and narrative in its implementation. It focused on an Intensive English Language Program (IELP) offered at an Ontario university. Using a holistic approach, the study sought to represent the various perspectives of all the participants in the program: the students, the instructors, and the administrators. Analysis of both qualitative and quantitative data gathered from 17 students, 6 instructors, and 1 administrator in the IELP showed that to a large extent the academic needs ofESL learners in the IELP were generally not being met. Most notably, the study found that learners were not receiving sufficient training in speaking and listening skills, a factor that contributed to their sense of insecurity and lack of confidence in their ability to communicate successfully in academic and social settings. The study also revealed that the solutions to many of the problems it identified lay not in the classroom but in the way the ESL program was structured administratively. One major recommendation to come out of the study is that programs like the IELP should be restructured so as to give them greater flexibility in meeting individual needs. While the study labored under certain limitations and did not achieve all of its goals, it did succeed in creating awareness ofthe problems and in establishing a methodological approach that can serve as a framework within which future research may be conducted in this somewhat neglected area.

Promoting parent-therapist collaboration in intensive behavioural intervention programs : exploring estrategies to improve teamwork

This qualitative study investigated senior level staff (Senior Therapists), front-line staff (Instructor Therapists), and parent perspectives on parent-therapist collaboration within Intensive Behavioural Intervention settings. Two senior staff interviews, two parent interviews, and a focus group with therapists were conducted to examine how parents and therapists currently interact within IBI settings, parent and therapist expectations of each other, factors that promote and barriers that impede parent-therapist collaboration, and how parent-therapist collaboration might be improved. A constant comparative analysis by question within and across cases revealed five prominent themes of 'Role Definition', 'Perspective-taking/Empathy', 'Trust', 'Open Communication', and 'Consistency'. Additional similarities and differences were discovered between parent and therapist perspectives such as the need for clear parentprofessional boundaries, the importance of maintaining client privacy, and respect. Implications of the findings and suggestions for future research are discussed.