The Effect of Music Listening on Anxiety and Agitation in Adult Mechanically Ventilated Patients: A Systematic Review

Mechanical ventilation causes anxiety and agitation in patients in intensive care units, which increases risk for complications and prolonged hospital stays. Since pharmacological interventions have adverse effects and are not always effective at reducing anxiety and agitation, nonpharmacological interventions, such as music listening, could be considered. The purpose of this systematic review is to identify, review, and critically appraise the evidence from studies that examined the effect of music listening, compared with standard care, on anxiety and agitation in mechanically ventilated patients in the intensive care unit (ICU). Using search engines, data bases, key words, and criteria, twenty studies are discussed and critically appraised. Findings consistently show that music listening may be a cost effective and alternative therapy to decrease anxiety and agitation in this population. Based on appraisal of study validity, reliability, and applicability, recommendations for practice and future research are advanced

Corona, Jet, and Relativistic Line Models for Suzaku/RXTE/Chandra-HETG Observations of the Cygnus X-1 Hard State

Using Suzaku and the Rossi X-ray Timing Explorer, we have conducted a series of four simultaneous observations of the galactic black hole candidate Cyg X-1 in what were historically faint and spectrally hard low states. Additionally, all of these observations occurred near superior conjunction with our line of sight to the X-ray source passing through the dense phases of the focused wind from the mass donating secondary. One of our observations was also simultaneous with observations by the Chandra-High Energy Transmission Grating. These latter spectra are crucial for revealing the ionized absorption due to the secondary's focused wind. Such absorption is present and must be accounted for in all four spectra. These simultaneous data give an unprecedented view of the 0.8-300 keV spectrum of Cyg X-1, and hence bear upon both corona and X-ray emitting jet models of black hole hard states. Three models fit the spectra well: coronae with thermal or mixed thermal/non-thermal electron populations, and jets. All three models require a soft component that we fit with a low temperature disk spectrum with an inner radius of only a few tens of GM/c^2. All three models also agree that the known spectral break at 10\,keV is not solely due to the presence of reflection, but each gives a different underlying explanation for the augmentation of this break. Thus whereas all three models require that there is a relativistically broadened Fe line, the strength and inner radius of such a line is dependent upon the specific model, {thus making premature line-based estimates of the black hole spin in the Cyg X-1 system. We look at the relativistic line in detail, accounting for the narrow Fe emission and ionized absorption detected by HETG. Although the specific relativistic parameters of the line are continuum-dependent, none of the broad line fits allow for an inner disk radius that is >40 GM/c^2.Comment: 22 pages, 16 figures. Uses emulateapj style. Final three tables inserted as a figure to avoid issues with astro-ph's version of latex mangling the use of lscape. To be published in the Astrophysical Journal, January, 201

The Deep Space Network: A Radio Communications Instrument for Deep Space Exploration

The primary purpose of the Deep Space Network (DSN) is to serve as a communications instrument for deep space exploration, providing communications between the spacecraft and the ground facilities. The uplink communications channel provides instructions or commands to the spacecraft. The downlink communications channel provides command verification and spacecraft engineering and science instrument payload data

A randomized cross-over study of the quality of cardiopulmonary resuscitation among females performing 30:2 and hands-only cardiopulmonary resuscitation

Abstract Background Hands-Only cardiopulmonary resuscitation (CPR) is recommended for use on adult victims of witnessed out-of-hospital (OOH) sudden cardiac arrest or in instances where rescuers cannot perform ventilations while maintaining minimally interrupted quality compressions. Promotion of Hands-Only CPR should improve the incidence of bystander CPR and, subsequently, survival from OOH cardiac arrest; but, little is known about a rescuer's ability to deliver continuous chest compressions of adequate rate and depth for periods typical of emergency services response time. This study evaluated chest compression rate and depth as subjects performed Hands-Only CPR for 10 minutes. For comparison purposes, each also performed chest compressions with ventilations (30:2) CPR. It also evaluated fatigue and changes in body biomechanics associated with each type of CPR. Methods Twenty healthy female volunteers certified in basic life support performed Hands-Only CPR and 30:2 CPR on a manikin. A mixed model repeated measures cross-over design evaluated chest compression rate and depth, changes in fatigue (chest compression force, perceived exertion, and blood lactate level), and changes in electromyography and joint kinetics and kinematics. Results All subjects completed 10 minutes of 30:2 CPR; but, only 17 completed 10 minutes of Hands-Only CPR. Rate, average depth, percentage at least 38 millimeters deep, and force of compressions were significantly lower in Hands-Only CPR than in 30:2 CPR. Rates were maintained; but, compression depth and force declined significantly from beginning to end CPR with most decrement occurring in the first two minutes. Perceived effort and joint torque changes were significantly greater in Hands-Only CPR. Performance was not influenced by age. Conclusion Hands-Only CPR required greater effort and was harder to sustain than 30:2 CPR. It is not known whether the observed greater decrement in chest compression depth associated with Hands-Only CPR would offset the potential physiological benefit of having fewer interruptions in compressions during an actual resuscitation. The dramatic decrease in compression depth in the first two minutes reinforces current recommendations that rescuers take turns performing compressions, switching every two minutes or less. Further study is recommended to determine the impact of real-time feedback and dispatcher coaching on rescuer performance.http://deepblue.lib.umich.edu/bitstream/2027.42/112830/1/12912_2008_Article_58.pd

At Sea Test 2 recovery cruise : Cruise 206 on board R/V Knorr April 10 - 15, 2012 Woods Hole - Woods Hole, MA

The R/V Knorr, on Cruise 206, carried out the recovery of three moorings for the Coastal and Global Scale Nodes (CGSN) Implementing Organization of the NSF Ocean Observatories Initiative. These three moorings are prototypes of the moorings to be used by CGSN at the Pioneer, Endurance, and Global Arrays. Knorr departed from Woods Hole, Massachusetts on April 10, 2012 and steamed south to the location of the mooring deployments on the shelf break. Over five days, April 10-15, Knorr surveyed the bottom at the planned mooring sites, recovered the moorings, and carried out preliminary investigations of mechanical and electrical functionality on the recovered moorings and mooring hardware, including observations of biofouling and corrosion. Knorr returned to Woods Hole on April 15, 2012.Funding was provided by the National Science Foundation contract #SA9-10 through the Consortium for Ocean Leadershi

Aerobic capacity, activity levels and daily energy expenditure in male and female adolescents of the kenyan nandi sub-group

The relative importance of genetic and socio-cultural influences contributing to the success of east Africans in endurance athletics remains unknown in part because the pre-training phenotype of this population remains incompletely assessed. Here cardiopulmonary fitness, physical activity levels, distance travelled to school and daily energy expenditure in 15 habitually active male (13.9±1.6 years) and 15 habitually active female (13.9±1.2) adolescents from a rural Nandi primary school are assessed. Aerobic capacity ([Formula: see text]) was evaluated during two maximal discontinuous incremental exercise tests; physical activity using accelerometry combined with a global positioning system; and energy expenditure using the doubly labelled water method. The [Formula: see text] of the male and female adolescents were 73.9±5.7 ml(.) kg(-1.) min(-1) and 61.5±6.3 ml(.) kg(-1.) min(-1), respectively. Total time spent in sedentary, light, moderate and vigorous physical activities per day was 406±63 min (50% of total monitored time), 244±56 min (30%), 75±18 min (9%) and 82±30 min (10%). Average total daily distance travelled to and from school was 7.5±3.0 km (0.8-13.4 km). Mean daily energy expenditure, activity-induced energy expenditure and physical activity level was 12.2±3.4 MJ(.) day(-1), 5.4±3.0 MJ(.) day(-1) and 2.2±0.6. 70.6% of the variation in [Formula: see text] was explained by sex (partial R(2) = 54.7%) and body mass index (partial R(2) = 15.9%). Energy expenditure and physical activity variables did not predict variation in [Formula: see text] once sex had been accounted for. The highly active and energy-demanding lifestyle of rural Kenyan adolescents may account for their exceptional aerobic fitness and collectively prime them for later training and athletic success

General insurance marketing: a review and future research agenda

The financial services sector is a huge and diverse industry comprising many different forms of organisations and product offerings. Yet, a review of past papers in the Journal of Financial Services Marketing (JFSM) reveals a heavy bias towards articles on banking, to the neglect of other equally important financial services categories. The purpose of this paper is to address this imbalance and to call for more research to be conducted in a wider range of financial services categories. In particular, general insurance is singled out as a category worthy of further research. Looking to the past, this paper reviews research published to-date on general insurance in the JFSM to establish a benchmark and explore theoretical contributions. Attention is then turned to the future to identify a research agenda for the general insurance sector going forward. 5 important themes are identified: trust, transparency and simplification, technology, HNW and Takaful

Assessment of a continuous blood gas monitoring system in animals during circulatory stress

<p>Abstract</p> <p>Background</p> <p>The study was aimed to determine the measurement accuracy of The CDI™ blood parameter monitoring system 500 (Terumo Cardiovascular Systems Corporation, Ann Arbor MI) in the real-time continuous measurement of arterial blood gases under different cardiocirculatory stress conditions</p> <p>Methods</p> <p>Inotropic stimulation (Dobutamine 2.5 and 5 μg/kg/min), vasoconstriction (Arginine-vasopressin 4, 8 and 16 IU/h), hemorrhage (-10%, -20%, -35%, and -50% of the theoretical volemia), and volume resuscitation were induced in ten swine (57.4 ± 10.7 Kg).Intermittent blood gas assessments were carried out using a routine gas analyzer at any experimental phase and compared with values obtained at the same time settings during continuous monitoring with CDI™ 500 system. The Bland-Altman analysis was employed.</p> <p>Results</p> <p>Bias and precision for pO₂were - 0.06 kPa and 0.22 kPa, respectively (r²= 0.96); pCO₂- 0.02 kPa and 0.15 kPa, respectively; pH -0.001 and 0.01 units, respectively ( r²= 0.96). The analysis showed very good agreement for SO₂(bias 0.04,precision 0.33, r²= 0.95), Base excess (bias 0.04,precision 0.28, r²= 0.98), HCO₃(bias 0.05,precision 0.62, r²= 0.92),hemoglobin (bias 0.02,precision 0.23, r²= 0.96) and K⁺(bias 0.02, precision 0.27, r²= 0.93). The sensor was reliable throughout the experiment during hemodynamic variations.</p> <p>Conclusions</p> <p>Continuous blood gas analysis with the CDI™ 500 system was reliable and it might represent a new useful tool to accurately and timely monitor gas exchange in critically ill patients. Nonetheless, our findings need to be confirmed by larger studies to prove its reliability in the clinical setting.</p

Genomics of Signaling Crosstalk of Estrogen Receptor α in Breast Cancer Cells

BACKGROUND: The estrogen receptor alpha (ERalpha) is a ligand-regulated transcription factor. However, a wide variety of other extracellular signals can activate ERalpha in the absence of estrogen. The impact of these alternate modes of activation on gene expression profiles has not been characterized. METHODOLOGY/PRINCIPAL FINDINGS: We show that estrogen, growth factors and cAMP elicit surprisingly distinct ERalpha-dependent transcriptional responses in human MCF7 breast cancer cells. In response to growth factors and cAMP, ERalpha primarily activates and represses genes, respectively. The combined treatments with the anti-estrogen tamoxifen and cAMP or growth factors regulate yet other sets of genes. In many cases, tamoxifen is perverted to an agonist, potentially mimicking what is happening in certain tamoxifen-resistant breast tumors and emphasizing the importance of the cellular signaling environment. Using a computational analysis, we predicted that a Hox protein might be involved in mediating such combinatorial effects, and then confirmed it experimentally. Although both tamoxifen and cAMP block the proliferation of MCF7 cells, their combined application stimulates it, and this can be blocked with a dominant-negative Hox mutant. CONCLUSIONS/SIGNIFICANCE: The activating signal dictates both target gene selection and regulation by ERalpha, and this has consequences on global gene expression patterns that may be relevant to understanding the progression of ERalpha-dependent carcinomas

Codes of Fair Competition: The National Recovery Act, 1933-1935, and the Women’s Dress Manufacturing Industry

Controversial issues prevalent in today’s ready-to-wear apparel industry include the right of workers to join unions, the proliferation of sweatshops and sweatshop conditions, and design piracy. The idea of forming codes of conduct to establish criteria of ethical business practices is not new to the apparel industry. Indeed, the women’s dress manufacturing industry discussed and debated codes of fair competition under the New Deal Policies of the National Recovery Act (NRA) of 1933 to 1935. Primary sources for this study included governmental hearings in the establishment of the NRA Dress Code, The New York Times, Women’s Wear Daily, and the Journal of the Patent Office Society. The history of the NRA codes implemented in the U.S. women’s ready-to-wear apparel industry provides an important case study highlighting the difficulties and complexities of creating and achieving industry-wide standard practices through self-regulation. The failure of the NRA demonstrates that even with the joint cooperation of industry, labor, and consumer groups and the backing of the force of law, codes of fair competition proved impossible to enforce