Management of severe intraoperative hemorrhage during intraventricular neuroendoscopic procedures: the dry field technique

Objective Neuroendoscopic procedures inside the ventricular system always bear the risk for an unexpected intraoperative hemorrhage with potentially devastating consequences. The authors present here their experience, and a stage-to-stage guide for the endoscopic management of intraoperative hemorrhages. Methods A step-by-step guide for the management to gain control of and stop the bleeding is described including a grading system. More advanced techniques are presented in cases examples. Conclusion Most of intraoperative hemorrhages can be controlled by constant irrigation and coagulation. More advanced techniques can be applied quickly and easily to ensure control of the hemorrhages and avoid the need for a microsurgical conversion

Organizational culture, leadership style and effectiveness: A case study of middle eastern construction clients

During the last few decades, organizational effectiveness has received a great deal of attention in many industrial sectors. As a result, a variety of models have been formulated which measure organizational performance. In the construction industry, two factors have subsequently captured the imagination and interest of researchers and practitioners alike: the culture of the organization and the leadership style of project managers. This focus places a requirement upon construction organizations to recognize and understand their organizational culture, and equally, to clearly communicate it to their employees as part of their capitalist drive of constantly improving performance, productivity and profit. Traditional ways of conducting construction business require a sound understanding of the technical and managerial demands of executing projects, which in turn, places an increased emphasis upon the management and leadership competencies of individual project managers. The purpose of the research is to explore the relationship between organizational culture, authentic leadership style and effectiveness within the context of a case study investigation centred on Middle Eastern construction clients and their project managers. The outcomes of the investigation, which include the presentation of an explanatory model, indicate that organizational culture is directly and positively related to performance and effectiveness, while project managers' leadership style has an indirect relationship to effectiveness. A strong organizational culture is therefore deemed critical to organizational performance

MR-IMPACT II: Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary artery disease Trial: perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: a comparative multicentre, multivendor trial

Aims Perfusion-cardiac magnetic resonance (CMR) has emerged as a potential alternative to single-photon emission computed tomography (SPECT) to assess myocardial ischaemia non-invasively. The goal was to compare the diagnostic performance of perfusion-CMR and SPECT for the detection of coronary artery disease (CAD) using conventional X-ray coronary angiography (CXA) as the reference standard. Methods and results In this multivendor trial, 533 patients, eligible for CXA or SPECT, were enrolled in 33 centres (USA and Europe) with 515 patients receiving MR contrast medium. Single-photon emission computed tomography and CXA were performed within 4 weeks before or after CMR in all patients. The prevalence of CAD in the sample was 49%. Drop-out rates for CMR and SPECT were 5.6 and 3.7%, respectively (P = 0.21). The primary endpoint was non-inferiority of CMR vs. SPECT for both sensitivity and specificity for the detection of CAD. Readers were blinded vs. clinical data, CXA, and imaging results. As a secondary endpoint, the safety profile of the CMR examination was evaluated. For CMR and SPECT, the sensitivity scores were 0.67 and 0.59, respectively, with the lower confidence level for the difference of +0.02, indicating superiority of CMR over SPECT. The specificity scores for CMR and SPECT were 0.61 and 0.72, respectively (lower confidence level for the difference: −0.17), indicating inferiority of CMR vs. SPECT. No severe adverse events occurred in the 515 patients. Conclusion In this large multicentre, multivendor study, the sensitivity of perfusion-CMR to detect CAD was superior to SPECT, while its specificity was inferior to SPECT. Cardiac magnetic resonance is a safe alternative to SPECT to detect perfusion deficits in CA

Kinetics of H2–O2–H2O redox equilibria and formation of metastable H2O2 under low temperature hydrothermal conditions

Author Posting. © The Author(s), 2010. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Geochimica et Cosmochimica Acta 75 (2011): 1594-1607, doi:10.1016/j.gca.2010.12.020.Hydrothermal experiments were conducted to evaluate the kinetics of H2(aq) oxidation in the homogeneous H2-O2-H2O system at conditions reflecting subsurface/near-seafloor hydrothermal environments (55-250 oC and 242-497 bar). The kinetics of the water-forming reaction that controls the fundamental equilibrium between dissolved H2(aq) and O2(aq), are expected to impose significant constraints on the redox gradients that develop when mixing occurs between oxygenated seawater and high- temperature anoxic vent fluid at near-seafloor conditions. Experimental data indicate that, indeed, the kinetics of H2(aq)-O2(aq) equilibrium become slower with decreasing temperature, allowing excess H2(aq) to remain in solution. Sluggish reaction rates of H2(aq) oxidation suggest that active microbial populations in near-seafloor and subsurface environments could potentially utilize both H2(aq) and O2(aq), even at temperatures lower than 40 oC due to H2(aq) persistence in the seawater/vent fluid mixtures. For these H2-O2 disequilibrium conditions, redox gradients along the seawater/hydrothermal fluid mixing interface are not sharp and microbially-mediated H2(aq) oxidation coupled with a lack of other electron acceptors (e.g. nitrate) could provide an important energy source available at low-temperature diffuse flow vent sites. More importantly, when H2(aq)-O2(aq) disequilibrium conditions apply, formation of metastable hydrogen peroxide is observed. The yield of H2O2(aq) synthesis appears to be enhanced under conditions of elevated H2(aq)/O2(aq) molar ratios that correspond to abundant H2(aq) concentrations. Formation of metastable H2O2 is expected to affect the distribution of dissolved organic carbon (DOC) owing to the existence of an additional strong oxidizing agent. Oxidation of magnetite and/or Fe++ by hydrogen peroxide could also induce formation of metastable hydroxyl radicals (•OH) through Fenton-type reactions, further broadening the implications of hydrogen peroxide in hydrothermal environments.This research was conducted with partial support from the NSF OCE-0752221 and the Geophysical Laboratory Postdoctoral Fellowship. We would also like to acknowledge contributions by the W.M. Keck Foundation and Shell towards supporting the hydrothermal lab at the Geophysical Lab. SMS acknowledges support from NSF OCE-0452333 and the Alfried-Krupp Wissenschaftskolleg Greifswald (Germany), while WES acknowledges support from NSF grants OCE-0549457 and OCE- 0813861