Search

Respiratory compromise is a serious panoperative complication that requires urgent and accurate diagnosis and treatment. This chapter will review differential diagnosis of respiratory distress. Appropriate diagnosis and early management will be emphasized.

PurposeThe purpose of this paper is to discover which social networking sites international students prefer for information dissemination activities. As more libraries experiment with social networking to inform and connect with students, there is a need to determine the effectiveness of this strategy for reaching international students. The paper seeks to address three questions: what social networking sites do international students prefer and why? Which sites do they use to socialise and which do they use to gather and distribute information? How can libraries leverage this information to enhance the international student experience?Design/methodology/approachInformation on social networking preferences and usage was gathered from 13 per cent of students at Bond University via an online survey.FindingsThe findings confirm that for some international student populations, social networking preferences differentiated between the domestic students' preferences. In addition to social activities, international and domestic students are using particular social networking sites for a wide range of educational purposes, including group work and sharing and gathering information. Although Facebook is still the predominant choice for the majority of students, the findings suggest particular sites such as Twitter and YouTube should be considered by libraries as a means to engage both international and domestic students. Institutions with large Chinese student populations should consider the use of Renren.Originality/valueAs of yet there have been no studies that have investigated and compared international students' social networking preferences to domestic students. The study connects the findings to practical implications for academic library use of social networking sites.

Social media is reshaping healthcare and the way healthcare professionals and patients interact. In Scotland, few allied health professionals (AHPs) use these media to connect with policy makers, service users, the public, or colleagues. We aimed to establish whether social media, could be used to raise the profile of AHPs—three members of the AHP Directors Scotland Group (ADSG) and one AHP national lead. Training in the use of social media tools was supplemented by support by a subject matter expert throughout the 12-week project. Each AHP used social media in support of their own area of expertise. Over 1348 tweets and 8 blogs were posted, 753 followers attracted. Various audiences were reached; including UK and international AHPs; other healthcare professionals, professional bodies, the public, third sector and patient representative organisations. Working within an ethical framework, AHPs can use social media to promote greater awareness of their role and impact. It can also be used to forge new relationships and connect with individuals and organisations not routinely experienced.

Simple Summary An evidence-based analysis of whip rule breaches in horse racing is needed to address community expectations that racehorses are treated humanely. The study provides the first peer-reviewed characterisation of whip rule breaches and their regulatory outcomes in horseracing, and considers the relationship between rules affecting racing integrity and the welfare of racehorses in a major Australian racing jurisdiction. Abstract Whip use in horseracing is increasingly being questioned on ethical, animal welfare, social sustainability, and legal grounds. Despite this, there is weak evidence for whip use and its regulation by Stewards in Australia. To help address this, we characterised whip rule breaches recorded by Stewards using Stewards Reports and Race Diaries from 2013 and 2016 in New South Wales (NSW) and the Australian Capital Territory (ACT). There were more recorded breaches at Metropolitan (M) than Country (C) or Provincial (P) locations, and by riders of horses that finished first, second, or third than by riders of horses that finished in other positions. The most commonly recorded breaches were forehand whip use on more than five occasions before the 100-metre (m) mark (44%), and whip use that raises the jockey’s arm above shoulder height (24%). It is recommended that racing compliance data be analysed annually to inform the evidence-base for policy, education, and regulatory change, and ensure the welfare of racehorses and racing integrity.

The prognosis for patients with metastatic breast cancer remains poor. Metastatic breast cancer confined to the bones may have a better prognosis, especially hormone receptor-positive disease. We performed a prospective, randomized clinical trial to compare immediate consolidation with high-dose chemotherapy and hematopoietic support versus observation with high-dose consolidation at the time of disease progression in women with metastatic breast cancer and only bone metastases. The patients received chemotherapy with doxorubicin, 5-fluorouracil and methotrexate before randomization. In all, 85 patients were enrolled and 69 were randomized. The median follow-up is 8.1 years from randomization. The median event-free survival (EFS) for the immediate transplant arm is 12 months and for the observation arm is 4.3 months (P

We conducted this study to determine event-free and overall survival among women with hormone-insensitive or hormone-resistant metastatic breast cancer receiving consolidation with high-dose chemotherapy (HDC) and hematopoietic support versus no further chemotherapy after intensive induction chemotherapy. Eligible patients received induction doxorubicin, 5-fluorouracil, and methotrexate (AFM) for 2 to 4 cycles. Women in complete remission were randomized to immediate HDC with cyclophosphamide, cisplatin, and carmustine followed by autologous hematopoietic support or to no further therapy. Patients on the observation arm of therapy were offered salvage HDC at the time of relapse. Partial responders to AFM were offered immediate HDC. A total of 425 patients were enrolled onto the study. The median event-free survival for women randomized to induction therapy alone was 3.8 months, compared with 9.7 months for women who completed HDC (P < .006). Of the patients randomized to observation, 5 (10%) of 51 remain event free, compared with 13 (26%) of 49 patients who underwent immediate HDC (P = .03). Of women converted to a complete response by salvage HDC after a partial response to AFM, overall survival was similar to that in women randomized to immediate HDC. Follow-up is now in excess of 5 years. The 5-year event-free survival is 15% (95% confidence interval, 12%-18%), and the 5-year overall survival is 20% (95% confidence interval, 17%-25%). Immediate HDC after a complete response to AFM produced some durable long-term responses in hormone-insensitive/-resistant metastatic breast cancer. Salvage HDC converted 30% of partial responders to complete responders with similar survivals. The addition of novel targeted therapies to intensive-dose chemotherapy regimens may further improve survival in metastatic breast cancer.

The Western Australian Group of University Librarians (WAGUL) has a long history of successful collaborative ventures. A well‐established cooperative interlending agreement is one notable venture that has operated successfully for over 20 years. To further enhance this service, WAGUL decided to participate in the national local interlending and document delivery administration system (LIDDAS) project with the objective of implementing an automated system, using the VDX software, to manage document delivery activity. Since 2002, VDX has been used for the transmission of requests and documents between the WAGUL member libraries. The success of this project has largely been the result of the four libraries working together to share expertise and problem‐solving. This article discusses the process of working collaboratively across institutions ‐ and its benefits and difficulties – in the context of implementing an automated document delivery system.

PURPOSE: To evaluate the efficacy of inhaled fluticasone propionate (Flovent) as prophylaxis against delayed pulmonary toxicity syndrome (DPTS) and decline in pulmonary function in breast cancer patients undergoing high-dose chemotherapy with the conditioning regimen of cyclophosphamide, cisplatin, and carmustine (CPB) followed by autologous stem cell transplantation (ASCT). PATIENTS AND METHODS: Sixty-three consecutive patients with multinode-positive or metastatic breast cancer undergoing high-dose chemotherapy with CPB and ASCT who were treated at the Duke University Adult Bone Marrow Transplant Program. All patients were started on inhaled fluticasone propionate, 880 microg every 12 hours, for 12 weeks from the start date of their CPB conditioning regimen. Pulmonary function tests (PFTs) with a single-breath diffusing capacity of carbon monoxide (DLCO) were performed pre-ASCT as well as approximately 6 and 12 weeks post-ASCT. DPTS was defined as follows: (1) development of a nonproductive cough and dyspnea with or without fever, plus a fall in DLCO to less than 60% predicted; or (2) decline in DLCO to less than 50% predicted with or without symptoms. RESULTS: Pulmonary function tests were done on all patients pre-ASCT, on 56 of the 63 patients at a median of 44 days (range, 25 to 73 days) post-ASCT, and on 51 of the 63 patients at a median of 96 days (range, 50 to 190 days) post-ASCT. The PFTs showed an average of an 8% (+/-26%) and 21% (+/-22%) decline in DLCO. These declines compare favorably with our historical control group of 45 consecutive breast cancer patients undergoing ASCT with CPB as a conditioning regimen, who experienced average declines in DLCO of 29% (+/-18%) (P < .001) and 33% (+/-18%) (P < .001) at comparable time periods post-ASCT. Delayed pulmonary toxicity syndrome occurred in 35% of treated patients compared to 73% of the historical controls (P = .0003). No patients died of DPTS or pulmonary problems, and there were no fungal pneumonias. CONCLUSION: Inhaled fluticasone propionate may decrease the incidence of DPTS in patients treated with CPB as a conditioning regimen for ASCT, as well as help to preserve pulmonary function as measured by DLCO. These results are worthy of further study in a randomized clinical trial.Biol Blood Marrow Transplant 2001;7(5):274-8.

We closely followed the pulmonary function of 150 consecutive high-risk breast cancer patients who underwent standard induction CAF (cyclophosphamide, doxorubicin, 5-fluorouracil) chemotherapy, followed by randomization to either standard-dose CPB (cyclophosphamide, cisplatin, bischloroethylnitrosourea [BCNU]) chemotherapy (SDC) or to high-dose CPB chemotherapy (HDC) with autologous bone marrow transplantation (ABMT) and peripheral blood progenitor cell support (PBPCS). Previously, we have described a delayed pulmonary toxicity syndrome (DPTS) which characterizes the pulmonary dysfunction after HDC and ABMT in this patient population. However, little is known concerning the role induction chemotherapy plays in its development. We found that after three cycles of induction CAF, the mean diffusing capacity of the lungs for carbon monoxide (DL(CO)) significantly decreased by 12.6%. Additionally, in patients receiving HDC, the mean DL(CO) further decreased to a nadir of 55.2 +/- 14.1% which was significantly lower than those receiving SDC (nadir: 80.7 +/- 12.3%). DPTS occurred in 72% of patients receiving HDC as compared with only 4% of patients receiving SDC. All individuals diagnosed with DPTS were treated with prednisone and the 2-yr follow-up of pulmonary function revealed a gradual improvement in mean DL(CO) such that there were no differences between HDC and SDC groups at the end of the study. No mortality was attributable to pulmonary toxicity in either group. After induction chemotherapy, but before HDC, bronchoalveolar lavage (BAL) demonstrated significant elevations in interleukin-6 (IL-6), IL-8, neutrophils, and lymphocytes. We conclude that induction CAF produces asymptomatic pulmonary dysfunction and inflammation which may prime the lungs for further injury by HDC and predispose to the development of DPTS. Fortunately, in this specific ABMT patient population, the early and judicious use of prednisone appears to improve pulmonary function in patients who develop DPTS.

BACKGROUND/AIMS—Hyaluronan (sodium hyaluronate) has been shown to confer objective and subjective improvement in patients with dry eye syndrome. This study compared the efficacy and safety of a 0.1% solution of hyaluronan with 0.9% saline, when administered topically to the eye, in the treatment of symptoms of severe dry eye syndrome. METHODS—A randomised, double blind, crossover clinical trial in which subjects were randomised to receive either hyaluronan or saline, applied as one or two drops to the eye, three or four times a day or as required. After 28 days' treatment, subjects crossed over to the other study medication for a further 28 days' treatment. RESULTS—70 subjects were included in the analyses of efficacy and significant improvements in Schirmer's score (p=0.0006) and rose bengal staining score (p=0.0001) were observed during treatment with hyaluronan. In a subjective assessment of the effectiveness of two treatments, a majority of subjects felt that hyaluronan was more effective than saline in alleviating the symptoms of burning and grittiness (p

BACKGROUND. Delayed hematopoietic recovery is a major drawback of umbilical cord blood (UCB) transplantation. Transplantation of ex vivo–expanded UCB shortens time to hematopoietic recovery, but long-term, robust engraftment by the expanded unit has yet to be demonstrated. We tested the hypothesis that a UCB-derived cell product consisting of stem cells expanded for 21 days in the presence of nicotinamide and a noncultured T cell fraction (NiCord) can accelerate hematopoietic recovery and provide long-term engraftment. METHODS. In a phase I trial, 11 adults with hematologic malignancies received myeloablative bone marrow conditioning followed by transplantation with NiCord and a second unmanipulated UCB unit. Safety, hematopoietic recovery, and donor engraftment were assessed and compared with historical controls. RESULTS. No adverse events were attributable to the infusion of NiCord. Complete or partial neutrophil and T cell engraftment derived from NiCord was observed in 8 patients, and NiCord engraftment remained stable in all patients, with a median follow-up of 21 months. Two patients achieved long-term engraftment with the unmanipulated unit. Patients transplanted with NiCord achieved earlier median neutrophil recovery (13 vs. 25 days, P < 0.001) compared with that seen in historical controls. The 1-year overall and progression-free survival rates were 82% and 73%, respectively. CONCLUSION. UCB-derived hematopoietic stem and progenitor cells expanded in the presence of nicotinamide and transplanted with a T cell–containing fraction contain both short-term and long-term repopulating cells. The results justify further study of NiCord transplantation as a single UCB graft. If long-term safety is confirmed, NiCord has the potential to broaden accessibility and reduce the toxicity of UCB transplantation. TRIAL REGISTRATION. Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01221857","term_id":"NCT01221857"}}NCT01221857. FUNDING. Gamida Cell Ltd.

Plerixafor, given on day 4 of G-CSF treatment is more effective than G-CSF alone in mobilizing hematopoietic progenitor cells. We tested a strategy of preemptive plerixafor use following assessment of the peak mobilization response to 5 days of G-CSF. Patients were eligible for plerixafor if, on day 5 of G-CSF, there were less than 7 circulating CD34+ cells/μl or if

Quantitative measurement of grip strength is an important variable when plotting the progress of a hand-injured patient. When utilizing traditional commercially available apparatuses, obtaining meaningful grip strength measurement in these subjects is frequently difficult due to severe deformity, high tissue sensitivity, and low levels of force generated. The purpose of this study was to measure hand grip strength using two instruments having different physical characteristics and units of measurement to determine the reliability of repeated measures with each instrument. Additionally, validity of the sphygmomanometer for strength measurement was established through comparison with the values obtained from measurements using the research-validated Jamar dynamometer. Twenty-nine right hand dominant female college-age subjects volunteered to perform hand grip strength testing. Measurements were taken with a sphygmomanometer and a Jamar dynamometer while utilizing standardized measurement procedures. A Spearman Rho correlation coefficient test utilized in measuring within-instrument reliability showed a high correlation for each instrument at .85 for the sphygmomanometer and .82 for the Jamar dynamometer. Construct validity testing performed to determine validity of the measurements by the sphygmomanometer compared with the Jamar dynamometer produced a .75 correlation. A formula for conversion of the sphygmomanometer scores into Jamar units was developed to enhance reporting of sphygmomanometer scores utilizing the Jamar standard. The study showed that the sphygmomanometer and Jamar dynamometer exhibit good within-instrument reliability. Validity of the sphygmomanometer as a grip measurement device is acceptable and reportable using the conversion formula developed. Therefore, it can be utilized with confidence as essentially equal to the Jamar unit for grip strength measurement. J Orthop Sports Phys Ther 1992;16(5):215-219.

In het verleden zijn verschillende instrumenten en methoden voor het meten van grijpkracht van de hand ontwikkeld. In de jaren vijftig werden de dynamometers van Sklar, Narrangansett, Geckler en Collins gebruikt. In 1954 introduceerde Bechtol de Jamar dynamometer. Het bestond uit een hydraulisch systeem

Coagulation factor VIII and IX concentrates produced in Scotland inhibited human lymphocyte transformation induced by lectins or the recall antigen, purified protein derivative of tuberculin (PPD). Although concanavalin A could bind factor VIII directly and PHA could bind factor IX directly, most of the inhibition was not due to direct clotting factor – lectin interaction nor to simple toxicity. Most of the inhibitory activity from both clotting factors could be removed by dialysis. A similar degree of inhibition was observed when the buffers used to prepare the concentrates were substituted for the concentrates themselves, and a comparable concentration of sodium citrate was also found to be inhibitory. Coagulation factor VIII partially purified by gel filtration was not found to have an appreciable effect on lymphocyte transformation in vitro.