The influence of body composition on therapeutic hypothermia: a prospective observational study of patients after cardiac arrest

Introduction Patients after out-of-hospital cardiac arrest (OHCA) benefit from therapeutic hypothermia for 24 hours. The time needed to reach hypothermia (target temperature of 32 degrees C to 34 degrees C) varies widely. In this study, we explore the relation between measures of body composition and the time needed to reach target temperature with hypothermia. Method We conducted a prospective observational study in patients treated with hypothermia after OHCA. Data collected included weight and height, body composition by anthropometric measures and by single-frequency body impedance, and waist-to-hip ratio. Analysis of concordance between impedance and anthropometric measures and hazard ratios of achieving target temperature (event) corrected for different body composition measures. Results Twenty-seven patients were included. The median (interquartile range) time to reach target temperature after admission to the intensive care unit was 191 (105 to 382) minutes. Intraclass correlation for total body fat (TBF) measures was 0.94 (95% confidence interval [CI] 0.89 to 0.97). Only TBF percentage (anthropometrics by the Durnin's table) appeared to be associated with time to reach target temperature: 0.93 (95% CI 0.87 to 0.99; P = 0.03). Conclusion The body composition measures from single-frequency impedance and anthropometrics appear to be very concordant. Only TBF percentage (anthropometrics) showed a significant but clinically irrelevant influence on time needed to achieve target temperature with hypothermia. We conclude that there are no indications to adjust current cooling practice toward the body composition of patient

Tracheotomy does not affect reducing sedation requirements of patients in intensive care – a retrospective study

INTRODUCTION: Translaryngeal intubated and ventilated patients often need sedation to treat anxiety, agitation and/or pain. Current opinion is that tracheotomy reduces sedation requirements. We determined sedation needs before and after tracheotomy of intubated and mechanically ventilated patients. METHODS: We performed a retrospective analysis of the use of morphine, midazolam and propofol in patients before and after tracheotomy. RESULTS: Of 1,788 patients admitted to our intensive care unit during the study period, 129 (7%) were tracheotomized. After the exclusion of patients who received a tracheotomy before or at the day of admittance, 117 patients were left for analysis. The daily dose (DD; the amount of sedatives for each day) divided by the mean daily dose (MDD; the mean amount of sedatives per day for the study period) in the week before and the week after tracheotomy was 1.07 ± 0.93 DD/MDD versus 0.30 ± 0.65 for morphine, 0.84 ± 1.03 versus 0.11 ± 0.46 for midazolam, and 0.62 ± 1.05 versus 0.15 ± 0.45 for propofol (p < 0.01). However, when we focused on a shorter time interval (two days before and after tracheotomy), there were no differences in prescribed doses of morphine and midazolam. Studying the course in DD/MDD from seven days before the placement of tracheotomy, we found a significant decline in dosage. From day -7 to day -1, morphine dosage (DD/MDD) declined by 3.34 (95% confidence interval -1.61 to -6.24), midazolam dosage by 2.95 (-1.49 to -5.29) and propofol dosage by 1.05 (-0.41 to -2.01). After tracheotomy, no further decrease in DD/MDD was observed and the dosage remained stable for all sedatives. Patients in the non-surgical and acute surgical groups received higher dosages of midazolam than patients in the elective surgical group. Time until tracheotomy did not influence sedation requirements. In addition, there was no significant difference in sedation between different patient groups. CONCLUSION: In our intensive care unit, sedation requirements were not further reduced after tracheotomy. Sedation requirements were already sharply declining before tracheotomy was performed

Advancing Administrative Supports for Research Development

Research intensive universities have raised the bar for all academic units, expecting them to increase research grants and contracts to support knowledge creation and scholarship. Similarly, performance requirements for faculty have changed, with annual reviews and tenure and promotion decisions weighting obtaining grants along with publication of scholarly products, teaching effectiveness, and service to the school, university and community. These expectations compel Deans and Directors of schools of social work to undertake new roles related to research development and administrative capacity building in order to help faculty and their units succeed. Social work schools and departments must stay or become strategically positioned in their university or college, even as the context for research development has been dramatically altered as colleges and universities invest in the nanosciences or bio- technology rather than the social sciences. A $4 billion nanoscience operation dwarfs the$20 million that a robust research enterprise that a few schools of social work enjoy. This paper highlights some of the opportunities, barriers, challenges, as well as stepping stones to success in the process of building research supports and infrastructures. Drawing upon presentations at recent meetings of the National Association of Deans and Directors of Schools of Social Work (NADD) that have been organized by the Institute of Social Work Research (IASWR), we feature several examples of approaches advancing supports for research development. Brief scenarios illustrating efforts underway at several schools depict challenging and often rewarding research capacity building endeavors. This paper presents the perspective of several Deans and Directors in the development of administrative research supports. The paper also features one model for a supportive research administration structure in the pre- and post-award environment

Non-nucleoside reverse transcriptase inhibitor-based combination antiretroviral therapy is associated with lower cell-associated hiv rna and dna levels as compared with therapy based on protease inhibitors

BACKGROUND: It remains unclear whether combination antiretroviral therapy (ART) regimens differ in their ability to fully suppress HIV replication. Here, we report the results of two crosssectional studies that compared levels of cell-associated (CA) HIV markers between individuals receiving suppressive ART containing either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI). METHODS: CA HIV unspliced RNA and total HIV DNA were quantified in two cohorts (n=100, n=124) of individuals treated with triple ART regimens consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) plus either a NNRTI or a PI. To compare CA HIV RNA and DNA levels between the regimens, we built multivariable models adjusting for age, gender, current and nadir CD4+ count, plasma viral load zenith, duration of virological suppression, NRTI backbone composition, low-level plasma HIV RNA detectability, and electronically-measured adherence to ART. RESULTS: In both cohorts, levels of CA HIV RNA and DNA strongly correlated (rho=0.70 and rho=0.54) and both markers were lower in NNRTI-treated than in PI-treated individuals. In the multivariable analysis, CA RNA in both cohorts remained significantly reduced in NNRTI-treated individuals (padj=0.02 in both cohorts), with a similar but weaker association between the ART regimen and total HIV DNA (padj=0.048 and padj=0.10). No differences in CA HIV RNA or DNA levels were observed between individual NNRTIs or individual PIs, but CA HIV RNA was lower in individuals treated with either nevirapine or efavirenz, compared to PI-treated individuals CONCLUSIONS: All current classes of antiretroviral drugs only prevent infection of new cells but do not inhibit HIV RNA transcription in long-lived reservoir cells. Therefore, these differences in CA HIV RNA and DNA levels by treatment regimen suggest that NNRTIs are more potent in suppressing HIV residual replication than PIs, which may result in a smaller viral reservoir size

Does Co-Creation of Service Recovery Create Value for Customers? The Underlying Mechanism of Motivation and the Role of Operant Resources

International audienceThis study focuses on the underlying mechanism that leads to co‐recovery behaviour and favourable co‐created value as response to a service failure. It argues that consumers’ ability to integrate their operant resources (e.g., knowledge and skills) to co‐recover from a service failure motivates them to express higher value co‐recovery in‐role behaviour and hence enjoy higher hedonic and utilitarian values. To test this claim, our study investigates the impact of consumers’ ability to co‐recover on value co‐recovery in‐role behaviour by taking into account extrinsic and intrinsic motivation as mediators. The results reveal that extrinsic motivation only partially mediates the relationship between ability to co‐recover and value co‐recovery in‐role behaviour. Furthermore, the outcomes demonstrate that value co‐recovery in‐role behaviour increases utilitarian value but decreases hedonic valu

On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study

Introduction: Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an ICU team. As the Dutch Healthcare System is organized differently and the on-ward role of hospital pharmacists in Dutch ICU teams is not well established, we conducted an intervention study to investigate whether participation of a hospital pharmacist can also be an effective approach in reducing prescribing errors and related patient harm (preventable ADEs) in this specific setting. Methods: A prospective study compared a baseline period with an intervention period. During the intervention period, an ICU hospital pharmacist reviewed medication orders for patients admitted to the ICU, noted issues related to prescribing, formulated recommendations and discussed those during patient review meetings with the attending ICU physicians. Prescribing issues were scored as prescribing errors when consensus was reached between the ICU hospital pharmacist and ICU physicians. Results: During the 8.5-month study period, medication orders for 1,173 patients were reviewed. The ICU hospital pharmacist made a total of 659 recommendations. During the intervention period, the rate of consensus between the ICU hospital pharmacist and ICU physicians was 74%. The incidence of prescribing errors during the intervention period was significantly lower than during the baseline period: 62.5 per 1,000 monitored patient-days versus 190.5 per 1,000 monitored patient-days, respectively (P < 0.001). Preventable ADEs (patient harm, National Coordinating Council for Medication Error Reporting and Prevention severity categories E and F) were reduced from 4.0 per 1,000 monitored patient-days during the baseline period to 1.0 per 1,000 monitored patient-days during the intervention period (P = 0.25). Per monitored patient-day, the intervention itself cost (sic)3, but might have saved (sic)26 to (sic)40 by preventing ADEs. Conclusions: On-ward participation of a hospital pharmacist in a Dutch ICU was associated with significant reductions in prescribing errors and related patient harm (preventable ADEs) at acceptable costs per monitored patient-da

Non-nucleoside reverse transcriptase inhibitor-based combination antiretroviral therapy is associated with lower cell-associated HIV RNA and DNA levels compared to protease inhibitor-based therapy

Background: It remains unclear whether combination antiretroviral therapy (ART) regimens differ in their ability to fully suppress human immunodeficiency virus (HIV) replication. Here, we report the results of two cross-sectional studies that compared levels of cell-associated (CA) HIV markers between individuals receiving suppressive ART containing either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI). Methods: CA HIV unspliced RNA and total HIV DNA were quantified in two cohorts (n = 100, n = 124) of individuals treated with triple ART regimens consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) plus either an NNRTI or a PI. To compare CA HIV RNA and DNA levels between the regimens, we built multivariable models adjusting for age, gender, current and nadir CD4+ count, plasma viral load zenith, duration of virological suppression, NRTI backbone composition, low-level plasma HIV RNA detectability, and electronically measured adherence to ART. Results: In both cohorts, levels of CA HIV RNA and DNA strongly correlated (rho = 0.70 and rho = 0.54) and both markers were lower in NNRTI-treated than in PI-treated individuals. In the multivariable analysis, CA RNA in both cohorts remained significantly reduced in NNRTI-treated individuals (padj = 0.02 in both cohorts), with a similar but weaker association between the ART regimen and total HIV DNA (padj = 0.048 and padj = 0.10). No differences in CA HIV RNA or DNA levels were observed between individual NNRTIs or individual PIs, but CA HIV RNA was lower in individuals treated with either nevirapine or efavirenz, compared to PI-treated individuals. Conclusions: All current classes of antiretroviral drugs only prevent infection of new cells but do not inhibit HIV RNA transcription in long-lived reservoir cells. Therefore, these differences in CA HIV RNA and DNA levels by treatment regimen suggest that NNRTIs are more potent in suppressing HIV residual replication than PIs, which may result in a smaller viral reservoir size

Nose to Tail: Using the Whole Employment Relationship to Link Worker Participation to Operational Performance

Although many employers continue to adopt various forms of worker participation or employee involvement, expected positive gains often fail to materialize. One explanation for the weak or altogether missing performance effects is that researchers rely on frameworks that focus almost exclusively on contingencies related to the workers themselves or to the set of tasks subject to participatory processes. This study is premised on the notion that a broader examination of the employment relationship within which a worker participation program is embedded reveals a wider array of factors impinging upon its success. I integrate labor relations theory into existing insights from the strategic human resource management literature to advance an alternative framework that additionally accounts for structures and processes above the workplace level — namely, the (potentially implicit) contract linking employees to the organization and the business strategies enacted by the latter. The resulting propositions suggest that the performance-enhancing impact of worker participation hinges on the presence of participatory or participation-supporting structures at all three levels of the employment relationship. I conclude with implications for participation research

Building employee relationships through corporate social responsibility: the moderating role of social cynicism and reward for application

We explore the role of deeply held beliefs, known as social axioms, in the context of employee–organization relationships. Specifically, we examine how the beliefs identified as social cynicism and reward for application moderate the relationship between employees’ work-related experiences, perceptions of CSR, attitudes, and behavioral intentions toward their firm. Utilizing a sample of 130 retail employees, we find that CSR affects more positively employees low on social cynicism and reduces distrust more so than with cynical employees. Employees exhibiting strong reward for application are less positively affected by CSR, whereas their experiences of other work-related factors are more likely to reduce distrust. Our findings suggest the need for a differentiated view of CSR in the context of employee studies and offer suggestions for future research and management practice

Water level and vegetation type control carbon fluxes in a newly-constructed soft-sediment wetland

Wetlands support unique biodiversity and play a key role in carbon cycles, but have dramatically declined in extent worldwide. Restoration is imperative yet often challenging to counteract loss of functions. Nature-based solutions such as the creation of novel ecosystems may be an alternative restoration approach. Targeted restoration strategies that account for the effects of vegetation on greenhouse gas (GHG) fluxes can accelerate the carbon sink function of such systems. We studied the relationships between vegetation, bare soil, and GHG dynamics on Marker Wadden in the Netherlands, a newly-created 700-ha freshwater wetland archipelago created for nature and recreation. We measured CO2 and CH4 fluxes, and soil microbial activity, in three-year-old soils on vegetated, with distinct species, and adjacent bare plots. Our results show that CH4 fluxes positively related to organic matter and interacted between organic matter and water table in bare soils, while CH4 fluxes positively related to plant cover in vegetated plots. Similarly, Reco in bare plots negatively related to water table, but only related positively to plant cover in vegetated plots, without differences between vegetation types. Soil microbial activity was higher in vegetated soils than bare ones, but was unaffected by substrate type. We conclude that GHG exchange of this newly-created wetland is controlled by water table and organic matter on bare soils, but the effect of vegetation is more important yet not species-specific. Our results highlight that the soil and its microbial community are still young and no functional differentiation has taken place yet and warrants longer-term monitoring