Does excellence matter? The influence of potential for excellence on students’ motivation for specific collaborative tasks

It is often assumed that students with a higher potential for excellence are less motivated to collaborate. So far, the question remains whether this is actually the case. This survey study investigated the influence of business students’ (N = 389) potential for excellence on their motivation to collaborate on a business-related task. Different aspects of potential for excellence were taken into account, including intelligence, creativity, first-year grade point average (GPA), and personality. A structural equation modeling analysis was applied. The findings demonstrated that only GPA had a negative influence on students’ collaborative values, indicating that the assumption that students with a higher potential for excellence are less motivated to collaborate receives limited support. In addition, the findings showed that different aspects of potential for excellence were related to different aspects of motivation to collaborate. This indicates that the relationship between potential f

Predicting a low cortisol response to adrenocorticotrophic hormone in the critically ill: a retrospective cohort study

Introduction: Identification of risk factors for diminished cortisol response to adrenocorticotrophic hormone (ACTH) in the critically ill could facilitate recognition of relative adrenal insufficiency in these patients. Therefore, we studied predictors of a low cortisol response to ACTH. Methods: A retrospective cohort study was conducted in a general intensive care unit of a university hospital over a three year period. The study included 405 critically ill patients, who underwent a 250 μg ACTH stimulation test because of prolonged hypotension or need for vasopressor/inotropic therapy. Plasma cortisol was measured before and 30 and 60 min after ACTH injection. A low adrenal response was defined as an increase in cortisol of less than 250 nmol/l or a peak cortisol level below 500 nmol/l. Various clinical variables were collected at admission and on the test day. Results: A low ACTH response occurred in 63% of patients. Predictors, in multivariate analysis, included sepsis at admission, low platelets, low pH and bicarbonate, low albumin levels, high Sequential Organ Failure Assessment score and absence of prior cardiac surgery, and these predictors were independent of baseline cortisol and intubation with etomidate. Baseline cortisol/albumin ratios, as an index of free cortisol, were directly related and increases in cortisol/albumin were inversely related to disease severity indicators such as the Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score (Spearman r = -0.21; P < 0.0001). Conclusion: In critically ill patients, low pH/bicarbonate and platelet count, greater severity of disease and organ failure are predictors of a low adrenocortical response to ACTH, independent of baseline cortisol values and cortisol binding capacity in blood. These findings may help to delineate relative adrenal insufficiency and suggest that adrenocortical suppression occurs as a result of metabolic acidosis and coagulation disturbances

Caspofungin Weight-Based Dosing Supported by a Population Pharmacokinetic Model in Critically Ill Patients

The objective of this study was to develop a population pharmacokinetic model and to determine a dosing regimen for caspofungin in critically ill patients. Nine blood samples were drawn per dosing occasion. Fifteen patients with (suspected) invasive candidiasis had one dosing occasion and five had two dosing occasions, measured on day 3 (±1) of treatment. Pmetrics was used for population pharmacokinetic modeling and probability of target attainment (PTA). A target 24-h area under the concentration-time curve (AUC) value of 98 mg·h/liter was used as an efficacy parameter. Secondarily, the AUC/MIC targets of 450, 865, and 1,185 were used to calculate PTAs for Candida glabrata, C. albicans, and C. parapsilosis, respectively. The final 2-compartment model included weight as a covariate on volume of distribution (V). The mean V of the central compartment was 7.71 (standard deviation [SD], 2.70) liters/kg of body weight, the mean elimination constant (Ke) was 0.09 (SD, 0.04) h-1, the rate constant for the caspofungin distribution from the central to the peripheral compartment was 0.44 (SD, 0.39) h-1, and the rate constant for the caspofungin distribution from the peripheral to the central compartment was 0.46 (SD, 0.35) h-1. A loading dose of 2 mg/kg on the first day, followed by 1.25 mg/kg as a maintenance dose, was chosen. With this dose, 98% of the patients were expected to reach the AUC target on the first day and 100% of the patients on the third day. The registered caspofungin dose might not be suitable for critically ill patients who were all overweight (≥120 kg), over 80% of median weight (78 kg), and around 25% of lower weight (≤50 kg). A weight-based dose regimen might be appropriate for achieving adequate exposure of caspofungin in intensive care unit patients

Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment:A patient-level meta-analysis from randomized controlled trials

Patients with impaired kidney function have a significantly slower decrease of procalcitonin (PCT) levels during infection. Our aim was to study PCT-guided antibiotic stewardship and clinical outcomes in patients with impairments of kidney function as assessed by creatinine levels measured upon hospital admission. We pooled and analyzed individual data from 15 randomized controlled trials who were randomly assigned to receive antibiotic therapy based on a PCT-algorithms or based on standard of care. We stratified patients on the initial glomerular filtration rate (GFR, ml/min/1.73 m2) in three groups (GFR >90 [chronic kidney disease; CKD 1], GFR 15-89 [CKD 2-4] and GFR0.05). This individual patient data meta-analysis confirms that the use of PCT in patients with impaired kidney function, as assessed by admission creatinine levels, is associated with shorter antibiotic courses and lower mortality rates

Low Caspofungin Exposure in Patients in Intensive Care Units

In critically ill patients, drug exposure may be influenced by altered drug distribution and clearance. Earlier studies showed that the variability in caspofungin exposure was high in Intensive Care Unit (ICU) patients. The primary objective of this study was to determine if the standard dose of caspofungin resulted in adequate exposure in critically ill patients. A multicenter prospective study in ICU patients with (suspected) invasive candidiasis was conducted in the Netherlands, from November 2013 to October 2015. Patients received standard caspofungin treatment and the exposure was determined on day 3 of treatment. An area under the concentration-time curve over 24 hours (AUC0-24h) of 98 mg*h/L was considered adequate exposure. In case of low exposure (i.e. <79 mg*h/L; ≥20% lower AUC0-24h), the caspofungin dose was increased and the exposure re-evaluated. Twenty patients were included in the study, of which 5 had a positive blood culture. The median caspofungin AUC0-24h at day 3 was 78 mg*h/L (interquartile range (IQR), 69 - 97 mg*h/L). A low AUC0-24h (<79 mg*h/L) was seen in 10 patients. The AUC0-24h was significantly and positively correlated with the caspofungin dose in mg/kg/day (P = 0.011). The median AUC0-24h with a caspofungin dose of 1 mg/kg was estimated using a pharmacokinetic model and was 114.9 mg*h/L (IQR, 103.2 - 143.5 mg*h/L). In conclusion, the caspofungin exposure in ICU patients in this study was low compared with healthy volunteers and other (non-)critically ill patients, most likely due to a larger volume of distribution. A weight-based dose regimen is probably more suitable for patients with substantially altered drug distribution

Scaffolding in teacher-student interaction: a decade of Research

Although scaffolding is an important and frequently studied concept, much discussion exists with regard to its conceptualizations, appearances, and effectiveness. Departing from the last decade’s scaffolding literature, this review scrutinizes these three areas of scaffolding. First, contingency, fading, and transfer of responsibility are discerned in this review as the three key characteristics of scaffolding. Second, an overview is presented of the numerous descriptive studies that provided narratives on the appearances of scaffolding and classifications of scaffolding strategies. These strategies are synthesized into a framework for analysis, distinguishing between scaffolding means and intentions. Third, the small number of effectiveness studies available is discussed and the results suggest that scaffolding is effective. However, more research is needed. The main challenge in scaffolding research appears to be its measurement. Based on the encountered and described measurement problems, suggestions for future research are made