Scope Of Indicators Research Articles

SIMULATED AEROMEDICAL EVACUATION EXACERBATES ACUTE LUNG INJURY VIA HYPOXIA-INDUCIBLE FACTOR 1Α-MEDIATED BNIP3/NIX-DEPENDENT MITOPHAGY.

Background: With the advancement of medicine and the development of technology, the limiting factors of aeromedical evacuation are gradually decreasing, and the scope of indications is expanding. However, the hypobaric and hypoxic environments experienced by critically ill patients in flight can cause lung injury, leading to inflammation and hypoxemia, which remains one of the few limiting factors for air medical evacuation. This study aimed to examine the mechanism of secondary lung injury in rat models of acute lung injury that simulate aeromedical evacuation. Methods: An acute lung injury model was induced in SD rats by the administration of lipopolysaccharide (LPS) followed by exposure to a simulated aeromedical evacuation environment (equivalent to 8,000 feet above sea level) or a normobaric normoxic environment for 4 h. The expression of hypoxia-inducible factor 1α (HIF-1α) was stabilized by pretreatment with dimethyloxalylglycine. The reactive oxygen species levels and the protein expression levels of HIF-1α, Bcl-2-interacting protein 3 (BNIP3), and NIX in lung tissue were measured. Results: Simulated aeromedical evacuation exacerbated pathological damage to lung tissue and increased the release of inflammatory cytokines in serum as well as the reactive oxygen species levels and the protein levels of HIF-1α, BNIP3, and NIX in lung tissue. Pretreatment with dimethyloxalylglycine resulted in increases in the protein expression of HIF-1α, BNIP3, and NIX. Conclusion: Simulated aeromedical evacuation leads to secondary lung injury through mitophagy.

Clinical practice status of the adjuvant therapy in hepatocellular carcinoma (HCC): A survey of Chinese hepatobiliary surgeons.

e16127 Background: There are different views on the scope of indications for surgical treatment of HCC worldwide. Unlike the Barcelona Clinic Liver Cancer, the European Association for Study of the Liver, and the American Association for the Study of Liver Diseases which recommend surgical resection as the first choice only for early HCC, it is also recommended as the first treatment for selected patients with intermediate or advanced HCC in China. However, in any case, postoperative recurrence is an important issue affecting the long-term survival of HCC patients, and to date, there is no globally recognized treatment algorithm for adjuvant therapy. We performed a survey to understand the patient characteristics and clinical status of hepatobiliary surgeons’ decision aids for adjuvant treatment. Methods: This survey was conducted among senior hepatobiliary surgeons who work at high-volume hospitals in China. Surgeons were asked to fill out an online questionnaire by scanning the QR code. Results: From September to November 2021, 511 surgeons from 55 cities responded. Among them, 70.3% worked in general hospitals, 26.8% in cancer hospitals, and 2.9% in integrative medicine hospitals. The majority of the institutions were tertiary hospitals (91.2 %). When determining whether a patient was suitable or not for adjuvant therapy, surgeons mainly considered tumor factors (chosen by 92.8% and 81.6%) and patient factors (chosen by 80.8% and 75.3%). The analysis showed that the patients whom surgeons considered for adjuvant therapy had one or more of the following characteristics: Tumor factors including China liver cancer (CNLC) stage Ia-IIIb (preoperative), R1 resection, Child-Pugh A or B liver function, well recovery from surgery, presence of ≥1 high-risk recurrence factors (i.e. microvascular invasion, macrovascular tumor thrombus, and hilar lymph node metastasis); Patient factors which were hepatocarcinoma-related medical history (e.g., HBV/HCV) and affordability. Most surgeons used targeted therapy (83.8%, mainly anti-angiogenic multi-kinase inhibitors), TACE (72.8%), or combination therapy (60.3%, mainly targeted drugs combined with immunotherapy or TACE) as adjuvant therapy. When asked to choose the two most related factors impacting treatment compliance, 52.1% chose patients' financial status, and 51.7% considered adverse reactions. Less adverse reactions (71.0% of surgeons), better efficacy (66.7%), and a higher reimbursement ratio (53.3%) were the top 3 unmet need for future adjuvant therapy. Conclusions: This survey presented a patient portrait that Chinese hepatobiliary surgeons considered for adjuvant therapy and the practice patterns in adjuvant therapy for HCC. However, the patient group that can benefit from adjuvant therapy remains to be explored and validated in prospective clinical studies.

Postoperative assessment of malignant melanoma aggressiveness for further treatment personalization

The aim of the study was to develop, implement and evaluate a method for predicting the aggressiveness of primary melanoma after surgical removal.It was established that the method for predicting tumor aggressiveness allows to determine the degree of aggressiveness, life expectancy, and to identify patients with poor prognosis in order to individualize treatment. The survival rate of patients was found to depend on the degree of aggressiveness of the tumor. A group of patients with stages 0-IIa (16,4 %) and tumor aggressiveness Grade II was identified as having a potentially high risk of progression, which can help individualize treatment for this category of patients. Using the method for predicting disease progression may potentially expand the scope of indications for further personalized treatment.

Early Warning Indicators in Education: Innovations, Uses, and Optimal Conditions for Effectiveness

Background/Context The passage of the No Child Left Behind Act in 2002 and the Every Student Succeeds Act in 2015 spurred changes in the way educators use data. On the one hand, the policies inspired educators’ awareness of large gaps in achievement between subgroups based on gender, race, and socioeconomic status. On the other hand, the policies inspired the use of data-based indicators in day-to-day routines in schools. In some cases, practitioners started working with researchers to analyze data using advanced measurement techniques to develop “early warning indicators.” These indicators identify when students are at risk of not achieving key milestones, such as graduating from high school, in hopes of providing practitioners with time to intervene early enough to change the students’ trajectories. Educational leaders have created “early warning systems” that produce reports summarizing these indicators, provide a process for the leaders to organize interventions based on the indicator reports, and a further process to examine whether students are back on track toward milestones such as high school graduation as a result of the intervention. Given the pace at which the science and use of these indicators is advancing, the topic is in need of a new resource explaining the most up-to-date elements involved with early warning indicators. Purpose/Focus of the Study This article will describe the evolution of the research, use, and conditions that influence the use of early warning indicators. The review of the literature includes a description of each of the yearbook articles and how they summarize some of the most recent advancements in early warning indicators in education. Research Design This is a review of literature. Findings As indicators in education have improved, these indicators show practitioners when students are not on track to reach certain milestones and provide practitioners with time to intervene early enough to change the child's trajectory. Allensworth and other authors (e.g., Balfanz et al.; Faria et al.; and Soland) provide evidence that these early warning indicators are impactful when used by practitioners in certain ways. Earlier efforts around early warning indicators focused on identifying measures that were predictive of key outcomes, such as high school graduation. As efforts to use indicators in practice became more mature, the focus expanded from providing information through indicators and information systems to ensuring that practitioners had the capacity and opportunity to engage in indicator use to guide their daily practice, and that the conditions in schools, school districts, and states supported indicator use. More recently, methodological advances around data analytics and a growing interest in social–emotional learning have expanded the approach and scope of indicators and their use. That said, the research on the nature and use of these indicators needs further documentation to keep up with the rapid pace at which the indicators are advancing and becoming more precise. The field still lacks a robust research base on how to use the indicators to improve practices and policies, and what conditions support the development and use of the indicators in education. Conclusions/Recommendations We will explain how the studies in this yearbook provide more up-to-date information on measurement related to the indicators, on the influence of certain approaches to using the indicators, as well as research on how conditions interact with the development and use of the indicators. The article demonstrates an important slice of what the field knows, as well as challenges and opportunities for further work to improve the development and use of early warning indicators.

Determination of critical quality attributes of mesenchymal stem cell by defining critical process parameters and efficacy of the product

Background & Aim Today, despite thousands of MSC clinical trials conducted, we have not reached any conclusion on what are the Critical Quality Attribute's (CQA's) for MSC. MSC is generated from various mesodermal tissues and can differentiate to mesoderm lineage cells or secret immuno-modulatory cytokines after transplant, which makes the definition of CQA vague. To resolve this, we propose to specify the origin of the cell, the mechanism and scope of indication, and then consider to name the tissue specific-stem cell instead of ‘MSC’. Methods, Results & Conclusion We select immuno-suppression as an indication of tissue specific-stem cells to define the CQA easily. In this case, it will be defined mainly by two major events: having proliferative potential as a process parameter and expecting anti-inflammatory effect as an efficacy. Tissue stem cells cease to proliferate after certain number of mitosis, which relates to the “aging” process. “Aged” cells can be described by increased production of ROS, hyperpolarization of mitochondrial membrane, decreased Rho activity related to spindle shape of cell and low mobility, decrease serine uptake and increase kynurenine secretion that could relate to the loss of intracellular anti-oxidization mechanism. The above parameters can explain the status of exponential cell growth, non-senescence stage in a real time manner via in process monitoring, and can be used as critical process parameters (CPPs) to verify the CQA of the product. As process parameters may vary depending on the culture condition, it is essential to define an optimized culture condition first to address CPPs and CQA. CPPs are used as monitoring points during manufacturing (quality by design) and are well matched to automated mass culturing systems with sensors, not manual manufacturing that verifies the quality of final product only at the release stage (quality by testing) due to lack of information on material and process variability. Efficacy of the final product also constitutes a CQA of the product. We propose to set up a simple immuno-modulation assay such as measuring INF-g or IL-4 secreted from PBMC in Th1 or Th2 induction conditions in the presence of tissue stem cells to address immunosuppressant effect of the product, such an assay needs further refinement in a future study. We hope our approach to define CQA can contribute to find the answer of a decades-long question “what is MSC” and will pave the way to commercial manufacturing of cell products.

Advanced botulinum toxin injection techniques for lower facial correction

Botulinum toxin type A (BoNT-A) received approval from the Food and Drug Administration for the treatment of glabellar lines in 2002. Since then, the scope of indications for facial aesthetics has expanded greatly. According to the most recent statistics from the International Society of Aesthetic Plastic Surgery, nearly 5 million BoNT-A treatments were carried out worldwide in 2014. Following the long history of success using BoNT-A in the upper face, it is now becoming more widely used to treat the mid and lower face safely and effectively. In this article, the author describes BoNT-A injection techniques for the aesthetic improvement of the lower third of the face, and discusses the prevention and reduction of visible signs of ageing, such as jowls and bunny lines.

Anna Freud and the Holocaust: Mourning and survival guilt

This article explores the period of Anna Freud's life after she was informed of the deaths of her aunts in Nazi concentration camps during World War . Understanding of this period may be enhanced by consideration of the role of the Holocaust in her complicated mourning process. A series of her dreams is re‐examined from the point of view of survivor guilt and the complicated mourning of her father in the context of the Holocaust. It is argued that unconscious reproaches against her father led to an identification with him that included his ‘decision’ to leave his sisters in Vienna. Survivor guilt in relation to her aunts’ murders is seen as one of the complicating factors in the mourning process. In addition the article discusses the possible role of this period, particularly her work with child concentration camp survivors, in her post‐war writing. The noted duality in her work between innovation and conservatism is explored in terms of an outcome of the mourning process of this period. It is argued that her views on mourning, trauma, attachment, and the widening scope of indications for psychoanalysis were influenced by the outcome of her mourning process. Finally, an irony is noted in the fact that her attitude about altruism never changed despite the role of the altruism of others in her rescue from the Nazis.

Integrating Two Measures of Quality Practice into Clinical and Practical Legal Education Assessment: Good client interviewing and effective community legal education

<p>This paper will examine, through two case studies (an undergraduate clinical program and a Practical Legal Education (PLE) advice clinic) the scope for indicators developed by Curran to assess the outcomes, effectiveness and quality of legal assistance service in Australia to be used in clinical assessment. This article will explore how two particular indicators evaluated as fundamental in that research might be utilised to assess students so as to enhance the quality of their clinical participation.</p><p>Clinical Legal Education is seen by its adherents as ‘a premier method of learning and teaching. Its intensive, one-on-one or small group nature can allow students to apply legal theory and develop their lawyering skills to solve client legal problems. Its teaching pedagogy is distinguished by a system of self-critique and supervisory feedback enabling law students to learn how to learn from their experiences’. In many senses it is a form of experiential learning through engagement with the practice of law.It aims to contextualise the study of law and draw on student learning in other courses to guide and support them in identifying, developing and applying ethical legal practice skills. But its scope is much wider than simply ‘skills’, it also aims to develop students’ critical understanding of approaches to legal practice, to their understanding of the roles of lawyers in relation to individual clients and social justice issues and to encourage and as a means to validate student aspirations to promote access to justice and equality through the law.</p><p>We suggest ways to assess the quality of such engagement by clinical students, focusing on Curran’s core quality measures of ‘a good client interview’ and ‘quality community legal education’. The value of utilising these two indicators to assess the quality of student engagement is that they themselves are core to the activities in which students are involved in clinic.</p>

The Widening Scope of Indications for Perversion

Much has changed in clinical practice and theory that bears on the diagnosis and treatment of perversion since Freud’s Three Essays on the Theory of Sexuality (1905). Definitions of perversion have been freed from assumptions of a heterosexual normality and from moralistic interpretations. The authors endorse the current emphasis on aggression and early narcissistic problems and include the notion of splitting and sexualized scenarios in their definition of perversion. They present several vignettes of male and female patients to demonstrate the debts owed to Freud’s theories and the way in which their thinking differs. They emphasize the understanding of the transference-countertransference picture and the patient’s management and control of excitement.

Effects of Chinese herbs in children with Henoch-Schonlein purpura nephritis: a randomized controlled trial

ObjectiveTo research the curative effect of Chinese herbs for clearing away heat, promoting diuresis, nourishing the kidney, and consolidating essence in children with Henoch-Schonlein purpura nephritis (HSPN) with internal accumulation of damp-toxin using randomized controlled observations on large samples. To seek the mechanism of the therapy and its scope of indications. MethodsOverall, 186 children with HSPN were randomly divided into two groups: treatment group (n=126) treated with Chinese herbs for clearing heat and promoting diuresis and a control group (n=60) treated with Western Medicine. The treatment was carried out for three courses of 4 weeks each. We recorded changes in patient urine routines, 24 h urinary protein, blood-coagulating series, immunoglobulin and T-cell subgroups, and improvements in main symptoms. We evaluated the alleviation of clinical symptoms and the improvement of proteinuria, hematuria, and other laboratory test results. Finally, we analyzed the patient population suitable for this therapy according to the relationship between the grouping of patient body weight and curative effect. ResultsDamp-heat syndrome improved in the treatment group, with a significant difference in total effective rate after a 4-week treatment (χ2= 13.5220, P=0.0002) and in curative rate after a 12-week treatment (χ2=6.3410, P=0.0118), compared to those in the control group. The curative effect in the treatment group was greater than that in the control group but there was no statistical difference between the two groups. The curative effect after a 4-week treatment of patients in the treatment group weighing 30 kg or less based on Traditional Chinese Medicine (TCM) signs and urinary protein was significantly greater than that in the control group. However, there was no statistical difference in the curative effect on urinary red cells and various indexes after a 12-week treatment between the two groups. ConclusionTherapy for clearing away heat, promoting diuresis, nourishing the kidney, and consolidating essence using TCM is effective in children with HSPN from internal accumulation of damp-toxin. The therapy is especially suitable for patients weighing 30 kg or less. The curative effect may be related to the improvement of immune function and blood-coagulation.

Forensische Risikokalkulationen: Grundlegende methodische Aspekte zur Beurteilung der Anwendbarkeit und Validität verschiedener Verfahren

Risk assessment instruments have been the subject of a number of validation studies which have mainly examined the psychometric properties known primarily from psychological test development (objectivity, reliability and validity). Hardly any attention was paid to the fact that validation of forensic risk assessment instruments is confronted with a whole row of methodical challenges. Risk assessments include a quantitative and a qualitative component in that they state the probability (quantitative) of a particular offense (qualitative) to occur. To disregard the probabilistic nature of risk calculations leads to methodically faulty assumptions on the predictive validity of an instrument and what represents a suitable statistical method to test it. For example, ROC analyses are considered to be state of the art in the validation of risk assessment instruments. This method does however not take into account the probabilistic nature of prognoses and its results can be interpreted only to a limited degree. ROC analyses for example disregard certain aspects of an instrument's calibration which might lead in an instrument's validation to high ROC values while demonstrating only low validity. Further shortcomings of validation studies are that they ignore changes of risk dispositions or that they don't differentiate between offense specific risks (e. g. any recidivism vs. violent or sexual recidivism). The paper discusses and reviews different quality criteria of risk assessment instruments in view of methodological as well as practical issues. Many of these criteria have been ignored so far in the scientific discourse even though they are essential to the evaluation of the validity and the scope of indication of an instrument.

Vocal Cord Paralysis after Laryngeal Mask Airway Ventilation

The laryngeal mask airway (LMA) is being used with increasing frequency since its introduction into the United States in 1991. Currently, the LMA is being used in the United States in approximately one third of all operations or greater than 100 million surgeries. In Britain, where it was first introduced for use in 1988, the LMA is estimated to be used in up to 50% of cases. Not only has its use in elective cases increased, but the scope of indications for the LMA has also grown. Its use in emergent and difficult airway management has increased, and new LMA products have been introduced to address the limitations of the classic model. As the LMA has increased in popularity, however, so has the incidence of LMA-related complications. Cases of mucosal trauma, hematoma, tongue cyanosis, arytenoid dislocation, and lingual, hypoglossal, and recurrent laryngeal nerve paralyses have been documented in various anesthesia journals. Reports of these injuries are sparse in the otolaryngology literature. As otolaryngologists who will manage the sequelae of LMA-related injuries, we must remain cognizant of potential problems and their underlying mechanisms. We report a case of unilateral vocal cord paralysis, which required operative repair after the use of an LMA. We review the existing case reports, propose mechanisms of injury, and discuss practical applications of our findings.

Biological debridement: maggots

Biological debridement: maggots M Jones (UK) When the orthopaedic surgeon William S. Baer presented his method and results of maggot therapy in 19311 his focus of interest was bone and soft tissue infection. Later, it was mainly the work of Ronald Sherman which enlarged the scope of indications to chronic wounds, like stasis ulcers and bed sores2 Presently, clinical emphasis is put to the problem of impaired wound healing as found in diabetic patients3 Maggots secrete digestive juices into the wound which contain growth factors, antiseptic substances and proteases. The high proteolytic activity liquefies necrotic tissue, which is the main food source of maggots4. Clinically, there is an effective, atraumatic debridement of the wound and contaminating bacteria are removed as well as dead tissue. Maggots may either be applied directly to the wound surface or enclosed in a porous pouch, so that there is only a fluid but not a physical contact to the wound. With regard to patients' comfort, ease of maggot application, hygiene and aesthetics the maggot pouch dressing revolutionizes maggot therapy5 In superficial defect wounds like stasis and diabetic ulcers or some bed sores mechanical macro-debridement (scalpel etc.) should be performed as a first measure, mainly to accelerate healing and reduce costs of treatment. Maggots are then used for microdebridement and as an antiseptic agent. In deep soft tissue and bone infections the septic focus is either completely removed by surgery or extensively exposed by tissue incisions or excisions to give maggots and their secretions enough space to do their work. To prevent suffocation of maggots when put into deep wounds either textile spacers or polyvinyl-alcohol sponges are introduced to keep the wound edges apart. Profuse wound secretions need to be drawn off with drainage systems. To enhance the survival rate of maggots in particularly deep wounds special drains for ventilation purposes may be necessary. Having achieved a clean, healing wound by maggot therapy vacuum dressings may be applied for acceleration of wound healing and external skin expansion for rapid closure of remaining wound defects (Concept of Biosurgical-Mechanical Wound treatment, BMW). Maggots are an excellent low-risk tool for the therapy of necrotic, infected and chronic wounds, given that it is embedded in an effective concept of interdisciplinary wound management.

NONSURGICAL MANAGEMENT OF PELVIC FLOOR DYSFUNCTION

In the 50 years since pelvic muscle exercises were introduced for the nonsurgical management of pelvic floor dysfunction related to parturition, a variety of approaches have been introduced and the scope of indications has grown. This article describes the evaluation of patients with pelvic floor complaints, discusses additional techniques for performing pelvic muscle exercises including biofeedback and electrical stimulation, details a comprehensive educational program, and examines the literature on the use of pelvic muscle exercises for the treatment of stress and urge urinary incontinence.

The molecular genetics of multiple endocrine neoplasia type 2A and related syndromes.

Identification of RET gene mutations in patients at-risk for the development of the hereditary forms of medullary thyroid carcinoma has simplified management and expanded the scope of indications for surgical intervention. Patients who carry this mutation can be offered thyroidectomy at a very young age, hopefully at a point when the cancer has not yet developed or spread. Those who are found not to have inherited the mutation are spared further genetic and biochemical screening. This achievement marks a new paradigm in surgery--the recommendation that an operation be performed based on the result of a genetic test. Experience with management of patients with multiple endocrine neoplasia types 2A and 2B and with familial, non-multiple endocrine neoplasia medullary thyroid carcinoma will provide information that will aid in the future management of patients with other hereditary cancers.

The “Widening Scope” Reconsidered

This paper reviews the current status of the relationship between psychoanalysis and psychoanalytic psychotherapy and notes that, since the 1950s, the scope of indications for psychoanalysis has widened so that it has absorbed some of the clinical territory previously assigned to psychoanalytic psychotherapy. Simultaneously, these developments have brought changes in therapeutic technique and more blurring of the boundaries between these two approaches. By examining the manifestations of transference and their management both in psychoanalysis and in psychoanalytic psychotherapy, the author offers the view that these modalities of treatment, though linked in multiple ways, are basically different and that each has its preferential indications.

The lithium toxic patient in the medical hospital: diagnostic and management dilemmas.

Patients with lithium toxicity can pose difficulties in diagnosis and management in the general hospital setting. The authors examined patients who were referred to the Psychiatric Consultation-Liaison Service with suspicion of lithium overdose to delineate and characterize medical and psychiatric risk factors for toxicity and to follow the course and resolution of their toxicity. The authors reviewed the charts of patients with lithium levels > 1.5 mEq/L who were admitted consecutively to a general hospital over an 18-month period. Of twelve patients, eight were found to have developed lithium toxicity due to incidental and iatrogenic factors. These patients presented with a variety of confusing signs and symptoms. Hypothyroidism and coexisting organic illness contributed to the lack of clarity in their clinical picture. The widening scope of indication for lithium therapy leads to increased risk of toxic reactions which challenge the diagnostic skills of the consulting psychiatrist in a general hospital setting.

Simultaneous Replantation of Both Lower Legs in a Child

The progress of contemporary medicine and operative techniques makes it possible to successfully perform the simultaneous replantation of major segments of two extremities, especially in young patients, taking into consideration their high biologic potential. An adequate antishock management, hemotransfusion therapy in particular, at all stages of treatment is an indispensable condition of a favorable outcome of such operations. The method of lengthening the extremities using a distraction apparatus is rather promising for the improvement of functional results of replantations of major segments of the lower extremities. The use of this method makes it possible to broaden the scope of indications for such operations.