Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis

Background

It is unknown whether a conservative approach to fluid administration or deresuscitation (active removal of fluid using diuretics or renal replacement therapy) is beneficial following haemodynamic stabilisation of critically ill patients.

Purpose

To evaluate the efficacy and safety of conservative or deresuscitative fluid strategies in adults and children with acute respiratory distress syndrome (ARDS), sepsis or systemic inflammatory response syndrome (SIRS) in the post-resuscitation phase of critical illness.

Methods

We searched Medline, EMBASE and the Cochrane central register of controlled trials from 1980 to June 2016, and manually reviewed relevant conference proceedings from 2009 to the present. Two reviewers independently assessed search results for inclusion and undertook data extraction and quality appraisal. We included randomised trials comparing fluid regimens with differing fluid balances between groups, and observational studies investigating the relationship between fluid balance and clinical outcomes.

Results

Forty-nine studies met the inclusion criteria. Marked clinical heterogeneity was evident. In a meta-analysis of 11 randomised trials (2051 patients) using a random-effects model, we found no significant difference in mortality with conservative or deresuscitative strategies compared with a liberal strategy or usual care [pooled risk ratio (RR) 0.92, 95 % confidence interval (CI) 0.82–1.02, I2 = 0 %]. A conservative or deresuscitative strategy resulted in increased ventilator-free days (mean difference 1.82 days, 95 % CI 0.53–3.10, I2 = 9 %) and reduced length of ICU stay (mean difference −1.88 days, 95 % CI −0.12 to −3.64, I2 = 75 %) compared with a liberal strategy or standard care.

Conclusions

In adults and children with ARDS, sepsis or SIRS, a conservative or deresuscitative fluid strategy results in an increased number of ventilator-free days and a decreased length of ICU stay compared with a liberal strategy or standard care. The effect on mortality remains uncertain. Large randomised trials are needed to determine optimal fluid strategies in critical illness.

Evaluation of Community-led Complementary Feeding and Learning Sessions

Thesis (Master's)--University of Washington, 2016-08

Insight assessment in psychosis and psychopathological correlates: validation of the Spanish version of the Schedule for Assessment of Insight - Expanded Version

Background and Objectives: Lack of insight is a cardinal feature of psycho­sis. Insight has been found to be a multidimensional concept, including awareness of having a mental illness, ability to relabel psychotic phenomena as abnormal and compliance with treatment., which can be measured with the Schedule for Assessment of Insight (SAI-E). The aim of this study was to validate the Spanish version of SAI-E. Methods: The SAI-E was translated into Spanish and back-translated into English, which was deemed appropriate by the original scale author. Next, the Spanish version of the SAI-E was administered to 39 patients with schizophrenia or schizoaffective disorder (DSM-IV criteria) from a North Peruvian psychiatric hospital. The Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and the Scale of Unawareness of Mental Disorder (SUMD) were also administered. Specifically, internal consistency and convergent validity were assessed. Results: Internal consistency between the 11 items of the SAI-E was found to be good to excellent (α = 0.942). Compliance items did not contribute to internal consistency (A = 0.417, B = 572). Inter-rater reliability was excellent (ICC = 0.99). Regarding concurrent validity, the SAI-E total score correlated negatively with the lack of insight and judgement item of the PANNS (r = -0.91, p <0.01) and positively with the SUMD total score (r = 0.92, p <0.001). Conclusions: The Spanish version of the SAI-E scale was demonstrated to have both excellent reliability and external validity in our sample of South American Spanish-speaking patients with schizophrenia spectrum disorders.

Towards balanced exploitation and management of the fishery resources of Uganda

A casual study of the hydrological map of Uganda would convince every serious fisherman and fisheater that he is most favoured to be in Uganda. The extent and distribution of the country's aquatic system plus the rich variety of fish species there is promises a fishery potential of considerable magnitude: The open waterways comprised by the Uganda portions of Lakes Victoria, Albert and Edward; and Lakes Kyoga, George plus minor lakes Wamala, Kijanebarora, mutanda, etc. occupy about 15% of the total surface area (91,000 m2; Depart. Land Survey, 1962). Most of the nation's fish supplies are currontly from this source. 1.2. A rich network of permanent and seasonal rivers and streams filling and/or emptying various water systems covers most of Uganda. This aquatic network is associated with a fish fauna whose immense significance as a source of protein is perhaps better appreciated by the local subsistance fisherman and consumer than by the fisheries scientist and manager in this country. Many species of this fish fauna have strong affinities with the open water systems while some are typically riverine. 1.3. Then there are wetlands composed mainly of expanses of swamp, but including some areas of bog. These cover about 2% of the country. While the variety of fish fauna found here is limited by the rather hostile nature of the environment (comparatively de-oxygenated under a canopy of dense stands of emergont vegetation) several specialised fishes e.g. Clarias spp. and Protpterus aethiopicus (Kamongo) occur here. Availability of permanent and seasonal sources of water, well distributed throughout most areas of Uganda, opens up immense potential for a variety of aquaculture practices. However, while active exploitation of much of these fishery resources is currently underway, important questions regarding the magnitudes of the various resource potentials and dynamics, and about suitable levels and modes of exploitation, are yet unanswered. These gaps in knowledge go about the fishery resources of Uganda would hinder formulation of adequate development and management schemes. This short paper examines some of the above problems and suggests some approaches towards balanced oxploitation and management of the fisheries of Uganda.

"Natural Enemies" or Intentional Allies? Teachers' & Parents' Perspectives on Middle School Boys of Color

This study examined the perspectives and “shared knowledge” of parents and teachers of boys of color. The following overarching research question guided this study: “What do parents and teachers want each other to know about their middle school son or student of color regarding academics, engagement, and behavior?” Additionally, it explored the challenges and opportunities for shared knowledge and understanding of their (respective) son’s’ or students’ academics and engagement. The methodology was qualitative in nature and the intent in conducting this case study was to describe, interpret, and explain the “shared knowledge” between these stakeholders at a predominantly minority middle school. A sample of seven parents and seven teachers from one school in a mid-Atlantic state participated in interviews and focus groups. Results indicated that parents and teachers of boys of color viewed each other as “intentional allies.” Results further showed that parents and teachers were aware of the challenges faced by boys of color in and out of school. That awareness was reflected in strategies that both groups employed to support, prepare, and protect their son/students. Lastly, the study found that teachers received no formal training in building parent-teacher partnerships, but gathered experimental knowledge on how to build those relationships. These findings have implications for teacher education programs, schools, parents, and teachers.

Effect of temperature on genomic and some biological indices during embryonic and larval development of Caspian trout Salmo trutta caspius Kessler, 1877

Since 1966 especially recent decade, Caspian trout (Salmo trutta caspius Kessler, 1877) considered as a strategic endemic species for Caspian Sea fisheries resources also coldwater aquaculture in Iran. Nowadays habitat condition effects on this subspecies during life stages, artificial breeding and incubation period noticed by research and execution sessions of fisheries in Iran. Incubation duration of Caspian trout from artificial fertilization followed by green egg and eyed egg, hatching and yolk sac absorption identified as most sensitive stages for fish and any pollution, stress and deviation by natural life conditions of embryo up to larvae could provide possible mortalities and observable or hidden alterations. Among all vital factors for Caspian trout welfare even in conservation plans and stocks rehabilitation programs or recent attempts for domestication of this fish for introduction to cold water aquaculture industry, water temperature as the most important physical factor which might conserve or induce stress to rearing environment condition is not considered yet. In hatcheries activities, the temperature for incubation and rearing Caspian trout eggs is determining by available water temperature and wide range of temperatures in governmental or private farms is using depend on the water resources availability. Also global climate change consideration and increase temperature trend accompany with group of physical and chemical factors provided by fish farm discharges and other source points entered to the migration pathway of Caspian trout in spawning season were not investigated before. Natural spawning migration pathway is upstream of Caspian tout south and south west rivers especially in Cheshmehkileh upstream in Tonekabon, Iran directed this research focus on the mentioned location. For simulation of natural spawning bed for Caspian trout, water supplied from the upstream of Daryasar branch as headwater of Cheshmehkileh River which provided REDD water condition for in vitro incubation. Green eggs treatments of wild and F1 cultured brooders both 3+ were incubated. Incubation implemented in dark, constant temperature (4, 8, 12 degree centigrade) and DO–pH–temperature digital monitoring in 3 recycling incubators ended to yolk sac absorption and entering larval stage. Hatching success, possible genome alterations by HSP70 gene expression and comet assay implemented as diagnostic tools in 3 life stages of eyed egg– Alevin and Larvae. Numbers and diameters of larvae white fiber muscles measured by histology experiment and Hematoxylin–eosine staining. Results stated significant effect of incubation temperature on hatching success, genome and white fiber muscles of wild and F1 samples. Hatching success measured as 31% and 38% for cultured and wild cold treatments, 79% and 91% for normal and 64% and 73% for warm cultured and wild treatments respectively. Considerable mortality occurred for cold treatment and 8 degree centigrade stated the best thermal condition in normal incubator according to hatching success in wild Caspian trout samples.

Maintenance or loss of dialect Andalusian features: Internal and external factors

In the last sixty years a steadily maintained process of convergence towards the Castilian national standard has been occurring in Southern Spain affecting urban middle-class speakers’ varieties, particularly phonology and lexis. As a consequence, unmarked features characterising innovative southern pronunciation have become less frequent and, at the same time, certain standard marked features have been adapted to the southern phonemic inventory. Then, urban middle-class varieties have progressively been stretching out the distance separating them from working-class and rural varieties, and bringing them closer to central Castilian varieties. Intermediate, yet incipient koineised varieties have been described including also transitional Murcia and Extremadura dialects (Hernández & Villena 2009, Villena, Vida & von Essen 2015). (1) Some of the standard phonologically marked features have spread out among southern speakers exclusively based on their mainstream social prestige and producing not only changes in obstruent phoneme inventory –i.e. acquisition of /s/ vs. /θ/ contrast, but also standstill and even reversion of old consonant push- or pull-chain shifts –e.g. /h/ or /d/ fortition, affricate /ʧ/, etc. as well as traditional lexis shift (Villena et al. 2016). Internal (grammar and word frequency) and external (stratification, network and style) factors constraining those features follow similar patterns in the Andalusian speech communities analysed so far (Granada, Malaga) but when we zoom in on central varieties, which are closer to the national standard and then more conservative, differences in frequency increase and conflict sites emerge. (2) Unmarked ‘natural’ phonological features characterising southern dialects, particularly deletion of syllable-final consonant, do not keep pace with this trend of convergence towards the standard. Thus a combination of southern innovative syllable-final and standard conservative onset-consonant features coexist. (3). The main idea is that this intermediate variety is formed through changes suggesting that Andalusian speakers look for the best way of accepting marked prestige features without altering coherence within their inventory. Either reorganisation of the innovative phonemic system in such a way that it may include Castilian and standard /s/ vs. /θ/ contrast or re-syllabification of aspirated /s/ before dental stop are excellent examples of how and why linguistic features are able to integrate intermediate varieties between the dialect-standard continuum.

Direct synthesis of β-ketophosphonates and vinyl phosphonates from alkenes or alkynes catalyzed by CuNPs/ZnO

Copper nanoparticles (CuNPs) supported on ZnO have been shown to effectively catalyze the direct synthesis of β-ketophosphonates from alkenes or alkynes, and that of vinyl phosphonates from alkynes and diethylphosphite, under air and in the absence of any additive or ligand. When using alkynes as starting materials, the selectivity proved to be dependent on the nature of the alkyne. Thus, alkynes conjugated with an aromatic ring or a carbon–carbon double bond gave β-ketophosphonates as the main reaction products, whereas aliphatic alkynes or alkynes conjugated with a carbonyl group led to the formation of the corresponding vinyl phosphonates.

Subject response rates in case-control studies of cancer : time trends, study design determinants, and quality of reporting

Objectifs: Examiner les tendances temporelles, les déterminants en lien avec le design des études et la qualité des taux de réponse rapportés dans des études cas-témoins sur le cancer publiées lors des 30 dernières années. Méthodes: Une revue des études cas-témoins sur le cancer a été menée. Les critères d'inclusion étaient la publication (i) dans l’un de 15 grands périodiques ciblés et (ii) lors de quatre périodes de publication (1984-1986, 1995, 2005 et 2013) couvrant trois décennies. 370 études ont été sélectionnées et examinées. La méthodologie en lien avec le recrutement des sujets et la collecte de données, les caractéristiques de la population, les taux de participation et les raisons de la non-participation ont été extraites de ces études. Des statistiques descriptives ont été utilisées pour résumer la qualité des taux de réponse rapportés (en fonction de la quantité d’information disponible), les tendances temporelles et les déterminants des taux de réponse; des modèles de régression linéaire ont été utilisés pour analyser les tendances temporelles et les déterminants des taux de participation. Résultats: Dans l'ensemble, les qualités des taux de réponse rapportés et des raisons de non-participation étaient très faible, particulièrement chez les témoins. La participation a diminué au cours des 30 dernières années, et cette baisse est plus marquée dans les études menées après 2000. Lorsque l'on compare les taux de réponse dans les études récentes a ceux des études menées au cours de 1971 à 1980, il y a une plus grande baisse chez les témoins sélectionnés en population générale ( -17,04%, IC 95%: -23,17%, -10,91%) que chez les cas (-5,99%, IC 95%: -11,50%, -0,48%). Les déterminants statistiquement significatifs du taux de réponse chez les cas étaient: le type de cancer examiné, la localisation géographique de la population de l'étude, et le mode de collecte des données. Le seul déterminant statistiquement significatif du taux de réponse chez les témoins hospitaliers était leur localisation géographique. Le seul déterminant statistiquement significatif du taux de participation chez les témoins sélectionnés en population générale était le type de répondant (sujet uniquement ou accompagné d’une tierce personne). Conclusion: Le taux de participation dans les études cas-témoins sur le cancer semble avoir diminué au cours des 30 dernières années et cette baisse serait plus marquée dans les études récentes. Afin d'évaluer le niveau réel de non-participation et ses déterminants, ainsi que l'impact de la non-participation sur la validité des études, il est nécessaire que les études publiées utilisent une approche normalisée pour calculer leurs taux de participation et qu’elles rapportent ceux-ci de façon transparente.

A basic interpretive study of the experiences of university students who have dropped or failed an online course

Online courses have increased in enrollments over the past few decades. As the number of students taking online courses have increased, so has the number of students who have dropped or failed an online course. According to the literature, online courses may have higher drop rates than traditional, face-to-face courses. The number of students who fail an online course is, also, of concern. As online courses may continue to grow over the next few decades, studies on persistence in online courses may benefit students, administrators, instructional designers, educators, and researchers. Although previous research studies have addressed persistence in online courses, very few examine it from the perspectives of students who were unsuccessful in their courses. These students may have unique insights about the online experience that may have related to their lack of success. The purpose of this study was to understand the experiences of university students who have failed or dropped an online course through the lenses of transactional distance theory and Kember’s model of dropout in distance education. Transactional distance theory discusses the dialog, structure, and learner autonomy involved in an online course, while, Kember’s model presents categories that may relate to dropping an online course. Together, the theory and model may help in understanding the experiences of students who have dropped or failed an online course. In this study, semi-structured interviews were conducted with 20 participants from a large Southeastern university in the United States. Based on the participants’ responses, the data was sorted and ranked according to the amount of transactional distance in their courses, as well as the categories of Kember’s model. Many of the participants who experienced low or high transactional distance have, also, expressed an issue with the goal commitment category of Kember’s model. Additionally, there were important differences in the student characteristics of those who dropped or failed an online course. Furthermore, suggestions for improving online courses were given by the participants. Some of these suggestions included more student-instructor interactions, the use of more technology tools in their online course, and for orientations to the online environment to be offered.^

Subject response rates in case-control studies of cancer : time trends, study design determinants, and quality of reporting

Objectifs: Examiner les tendances temporelles, les déterminants en lien avec le design des études et la qualité des taux de réponse rapportés dans des études cas-témoins sur le cancer publiées lors des 30 dernières années. Méthodes: Une revue des études cas-témoins sur le cancer a été menée. Les critères d'inclusion étaient la publication (i) dans l’un de 15 grands périodiques ciblés et (ii) lors de quatre périodes de publication (1984-1986, 1995, 2005 et 2013) couvrant trois décennies. 370 études ont été sélectionnées et examinées. La méthodologie en lien avec le recrutement des sujets et la collecte de données, les caractéristiques de la population, les taux de participation et les raisons de la non-participation ont été extraites de ces études. Des statistiques descriptives ont été utilisées pour résumer la qualité des taux de réponse rapportés (en fonction de la quantité d’information disponible), les tendances temporelles et les déterminants des taux de réponse; des modèles de régression linéaire ont été utilisés pour analyser les tendances temporelles et les déterminants des taux de participation. Résultats: Dans l'ensemble, les qualités des taux de réponse rapportés et des raisons de non-participation étaient très faible, particulièrement chez les témoins. La participation a diminué au cours des 30 dernières années, et cette baisse est plus marquée dans les études menées après 2000. Lorsque l'on compare les taux de réponse dans les études récentes a ceux des études menées au cours de 1971 à 1980, il y a une plus grande baisse chez les témoins sélectionnés en population générale ( -17,04%, IC 95%: -23,17%, -10,91%) que chez les cas (-5,99%, IC 95%: -11,50%, -0,48%). Les déterminants statistiquement significatifs du taux de réponse chez les cas étaient: le type de cancer examiné, la localisation géographique de la population de l'étude, et le mode de collecte des données. Le seul déterminant statistiquement significatif du taux de réponse chez les témoins hospitaliers était leur localisation géographique. Le seul déterminant statistiquement significatif du taux de participation chez les témoins sélectionnés en population générale était le type de répondant (sujet uniquement ou accompagné d’une tierce personne). Conclusion: Le taux de participation dans les études cas-témoins sur le cancer semble avoir diminué au cours des 30 dernières années et cette baisse serait plus marquée dans les études récentes. Afin d'évaluer le niveau réel de non-participation et ses déterminants, ainsi que l'impact de la non-participation sur la validité des études, il est nécessaire que les études publiées utilisent une approche normalisée pour calculer leurs taux de participation et qu’elles rapportent ceux-ci de façon transparente.

Physicochemical and antioxidant properties of the pequi (Caryocar brasiliense Camb.) almond oil obtained by handmade and cold-pressed processes.

Abstract: The aim of this study is to characterize physical and chemically and determine the antioxidant capacity of pequi almond oils (PAO) extracted by handmade and by cold-pressing. Both oils showed good quality by acid, peroxide and thiobarbituric acid values. The fatty acid (FA) profile showed a significant presence of monounsaturated FA, mainly oleic acid (53.48 to 55.41%); saturated FA, such as palmitic acid (33.30 to 35.89 %); and polyunsaturated FA (PUFA), such as linoleic acid (5.85 to 7.23%). The total phenolic (TP) and carotenoid content ranged in concentration from 87.56 to 392.00 mg GAE/100 g and 36.03 to 262.40 mg/100 g, respectively. The tocopherol and phytosterol results indicated the predominant presence of α-tocopherol (52 to 67%) and stigmasterol (63 to 68 %). The antioxidant capacity of PAO as measured using the 2,2-diphenyl-1-picrylhydrazyl (DPPH?) method oscillated from 58.48 mg/mL to 76.46 mg/mL (IC50), from 10.61 to 40.46 µmol TE/g by the 2,2′-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) (ABTS?+) method, and from 113.93 to 280.85 µmol TE/100 g and 164.49 to 277.86 µmol TE/100 g, by the lipophilic and hydrophilic oxygen radical absorbance capacity (ORAC) methods, respectively. The oils presented a good oxidative and thermal stability by Rancimat method (IP of 7.33 a 15.91 h) and curves thermogravimetric and differential scanning calorimetry (To 337-363 °C and 159-184 °C, respectively). The results confirmed the presence of compounds that conferred antioxidant capacity and oxidative and thermal resistance for PAO made by handmade or cold-pressing, indicating that these oils can potentially be used for food and non-food applications.