Advance care planning norms may contribute to hospital variation in end-of-life ICU use: a simulation study.

Background: There is wide variation in end-of-life (EOL) intensive care unit (ICU) use among academic medical centers (AMCs). Our objective was to develop hypotheses regarding medical decision-making factors underlying this variation.

Methods: This was a high-fidelity simulation experiment involving a critically and terminally ill elder, followed by a survey and debriefing cognitive interview and evaluated using triangulated quantitative-qualitative comparative analysis.

Comparative performance of the probable case definitions of dengue by WHO (2009) and the WHO-SEAR expert group (2011).

Background: The primary objective of this study was to find the performance of the 2009 probable case definition of dengue and compare it with the definition given by the WHO-SEAR expert group in 2011.

Methods: A cross-sectional study was conducted in Thiruvananthapuram district of Kerala, which is hyperendemic for dengue. A consecutive series of 851 participants defined by the selection criteria were recruited from the primary, secondary, and tertiary health care settings.

Discovery of a relict lineage and monotypic family of passerine birds.

Analysis of one of the most comprehensive datasets to date of the largest passerine bird clade, Passerida, identified 10 primary well-supported lineages corresponding to Sylvioidea, Muscicapoidea, Certhioidea, Passeroidea, the 'bombycillids' (here proposed to be recognized as Bombycilloidea), Paridae/Remizidae (proposed to be recognized as Paroidea), Stenostiridae, Hyliotidae, Regulidae (proposed to be recognized as Reguloidea) and spotted wren-babbler Spelaeornis formosus. The latter was found on a single branch in a strongly supported clade with Muscicapoidea, Certhioidea and Bombycilloidea, although the relationships among these were unresolved. We conclude that the spotted wren-babbler represents a relict basal lineage within Passerida with no close extant relatives, and we support the already used name Elachura formosa and propose the new family name Elachuridae for this single species.

A modern minimally invasive transcallosal approach to the third ventricle. A personal experience of 30 patients.

Introduction: Expansive processes around the third ventricle have always been a major neurosurgical challenge. Despite all the technological and scientific progress recorded over the last few years, third ventricle tumors are still a very difficult pathology to approach due to their formidable complexity.Treating such a tumor demands a good knowledge of local anatomy, pathophysiology, pathology and a good capacity to integrate all the data gathered from the patient prior to and during surgery.

Phenotypic characteristics associated with reduced short physical performance battery score in COPD.

Background: The Short Physical Performance Battery (SPPB) is commonly used in gerontology, but its determinants have not been previously evaluated in COPD. In particular, it is unknown whether pulmonary aspects of COPD would limit the value of SPPB as an assessment tool of lower limb function.

Methods: In 109 patients with COPD, we measured SPPB score, spirometry, 6-min walk distance, quadriceps strength, rectus femoris cross-sectional area, fat-free mass, physical activity, health status, and Medical Research Council dyspnea score.

Testosterone conversion blockade increases breathing stability in healthy men during NREM sleep.

Study Objectives: Gender differences in the prevalence of sleep apnea/hypopnea syndrome may be mediated via male sex hormones. Our objective was to determine the exact pathway for a testosterone-mediated increased propensity for central sleep apnea via blockade of the 5α-reductase pathway of testosterone conversion by finasteride.

Design: Randomization to oral finasteride vs.

Biochar as a sorbent for contaminant management in soil and water: a review.

Biochar is a stable carbon-rich by-product synthesized through pyrolysis/carbonization of plant- and animal-based biomass. An increasing interest in the beneficial application of biochar has opened up multidisciplinary areas for science and engineering. The potential biochar applications include carbon sequestration, soil fertility improvement, pollution remediation, and agricultural by-product/waste recycling.

Gaucher disease and its treatment options.

Objective: To review the epidemiology, pathophysiology, and treatments of Gaucher disease (GD), focusing on the role of enzyme replacement therapy (ERT), andsubstrate reduction therapy (SRT).

Data Sources: A literature search through PubMed (1984-May 2013) of English language articles was performed with terms: Gaucher's disease, lysosomal storage disease. Secondary and tertiary references were obtained by reviewing related articles.

Renal failure in Hay-Wells syndrome.

Ectodermal dysplasia (ED) is a group of disorders involving developmental defects of the ectodermal structures, with abnormalities in the skin, hair, nails and sweat glands. Ankyloblepharon - ectodermal defects-cleft lip/palate (AEC) syndrome, also known as Hay-Wells syndrome, is characterized by eyelid fusion, ED and cleft lip/palate. We report a 15-year-old Omani boy with AEC syndrome who presented with end-stage renal disease (ESRD) requiring renal replacement therapy.

Validating a vignette-based instrument to study physician decision making in trauma triage.

Background: The evidence supporting the use of vignettes to study physician decision making comes primarily from the study of low-risk decisions and the demonstration of good agreement at the group level between vignettes and actual practice. The validity of using vignettes to predict decision making in more complex, high-risk contexts and at the individual level remains unknown.

Methods: We had previously developed a vignette-based instrument to study physician decision making in trauma triage.

Study of optical phase conjugation in amorphous Zn(x)-S(y)-Se(100-x-y) chalcogenide thin films using degenerate four-wave mixing.

Degenerate four-wave mixing (DFWM) experiment is performed to obtain light wavefront inversion (phase conjugation) in semiconducting chalcogenide thin films. Third order nonlinearity of amorphous Zn(x)-S(y)-Se(100-x-y) chalcogenide thin films using DFWM technique is studied at second harmonic of Nd:YAG laser. Influence of total input irradiance on phase conjugate signal is deliberated using log-log plot that has a slope of three and hence implies third order nonlinearity.

Biocompatibility studies of polyacrylonitrile membranes modified with carboxylated polyetherimide.

Poly (ether-imide) (PEI) was carboxylated and used as the hydrophilic modification agent for the preparation of polyacrylonitrile (PAN) membranes. Membranes were prepared with different blend compositions of PAN and CPEI by diffusion induced precipitation. The modified membranes were characterized by thermo gravimetric analysis (TGA), mechanical analysis, scanning electron microscopy (SEM) and contact angle measurement to understand the influence of CPEI on the properties of the membranes.

Sodium hydroxide catalyzed N-alkylation of (hetero) aromatic primary amines and N1,C5-dialkylation of 4-phenyl-2-aminothiazoles with benzyl alcohols.

In the presence of a catalytic amount of NaOH, the selective N-alkylation of various heteroaromatic primary amines is reported. With 1 equiv of NaOH, N1,C5-dialkylation of 4-phenyl-2-aminothiazoles has been investigated. Reaction of in situ generated aldehyde with amine yields the N-alkylated and N1,C5-dialkylated products through hydride ion transformation from alcohol.

Trauma triage in the emergency departments of nontrauma centers: an analysis of individual physician caseload on triage patterns.

Background: Treatment at Level I/II trauma centers improves outcomes for patients with severe injuries. Little is known about the role of physicians' clinical judgment in triage at outlying hospitals. We assessed the association between physician caseload, case mix, and the triage of trauma patients presenting to nontrauma centers.

Modeling adsorption kinetics of trichloroethylene onto biochars derived from soybean stover and peanut shell wastes.

Trichloroethylene (TCE) is one of the most hazardous organic pollutants in groundwater. Biochar produced from agricultural waste materials could serve as a novel carbonaceous adsorbent for removing organic contaminants from aqueous media. Biochars derived from pyrolysis of soybean stover at 300 °C and 700 °C (S-300 and S-700, respectively), and peanut shells at 300 °C and 700 °C (P-300 and P-700, respectively) were utilized as carbonaceous adsorbents to study batch aqueous TCE remediation kinetics.

Clinical analysis of 73 cases of intraspinal nerve sheath tumor.

Seventy-three patients with spinal nerve sheath tumor who were surgically treated in our hospital during the years 2004-2010 were retrospectively reviewed with respect to recovery of neurological function, recurrence of the tumor and occurrence of kyphotic deformities. Preoperative clinical manifestations, imaging data, surgical records and follow-up results were comprehensively analyzed. The follow-up duration was 12-60 months with an average of 32.

Arsenate adsorption on three types of granular schwertmannite.

Schwertmannite was synthesized on a 2 m(3)-scale and fabricated to irregular, cylindrical and spherical shape granules using drum granulation, extrusion and spray coating, respectively. The granules were systematically evaluated for As(V) removal from drinking water in terms of both performance and safety. The irregular and cylindrical shape granules (IS and CS) had larger schwertmannite loadings, higher porosity, more abundant pore structure and larger micropore volumes than those with a spherical shape (SS).

Physicians' decision-making roles for an acutely unstable critically and terminally ill patient.

Objectives: There is substantial variation in use of life sustaining technologies in patients near the end of life but little is known about variation in physicians' initial ICU admission and intubation decision making processes. Our objective is to describe variation in hospital-based physicians' communication behaviors and decision-making roles for ICU admission and intubation decisions for an acutely unstable critically and terminally ill patient.

Design: We conducted a secondary analysis of transcribed simulation encounters from a multi-center observational study of physician decision making.

Sofia Ionescu, the first woman neurosurgeon in the world.

The authors present the activity of Mrs. Sofia Ionescu, the one female surgeon who was nominated as the first woman neurosurgeon in the world. Sofia Ionescu worked in the field of neurosurgery for 47 years, performing all the known neurosurgical procedures of the time.

L-proline: an efficient catalyst for transamidation of carboxamides with amines.

In the presence of a catalytic amount of L-proline (10 mol %), transamidations of carboxamides with amines were achieved under solvent-free conditions. The transamidation process is compatible with a wide range of amines.

Subgaleo-peritoneal shunt: An effective and safer alternative to lumboperitoneal shunt in the management of persistent or recurrent iatrogenic cranial pseudomeningoceles.

Subgaleo-peritoneal (SP) shunting for pseudomeningoceles (PMCs) is an effective and safer alternative as compared to the lumboperitoneal (LP) shunt. SP shunting was done in six patients (14-60 years) with persistent or recurrent PMCs using the cranial (ventricular part) and the distal parts of a Chhabra shunt connected by a rigid connector without any intervening chamber or valve. Two patients had undergone a prior LP shunt that had failed.

Surgical management of thalamic gliomas: case selection, technical considerations, and review of literature.

This study aimed to identify (1) the thalamic gliomas suitable for surgical resection and (2) the appropriate surgical approach based on their location and the displacement of the posterior limb of the internal capsule (PLIC). A retrospective study over a 5-year period (from 2006 to 2010) was performed in 41 patients with thalamic gliomas. The mean age of these patients was 20.