scholarly journals COMPLICATED PLEURAL SPACE INFECTIONS ARE ASSOCIATED WITH PROLONGED RECOVERY AND REDUCED WORK EFFECTIVENESS

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A2045-A2046
Author(s):  
Austin Meggyesy ◽  
Candice Wilshire ◽  
ShihTing Chiu ◽  
Christopher Gilbert ◽  
Najib Rahman ◽  
...  
Keyword(s):  
Pleural Space ◽  
Work Effectiveness ◽  
Prolonged Recovery

Relative Importance of Leader Influences for Subordinates’ Proactive Behaviors, Prosocial Behaviors, and Task Performance

2014 ◽  
Vol 13 (2) ◽  
pp. 70-86 ◽  
Author(s):  
Dan S. Chiaburu ◽  
Troy A. Smith ◽  
Jiexin Wang ◽  
Ryan D. Zimmerman
Keyword(s):  
Task Performance ◽  
Transformational Change ◽  
Future Research ◽  
Contingent Reward ◽  
Work Effectiveness ◽  
Leader Influence ◽  
Member Exchange ◽  
Proactive Behaviors ◽  
Reported Data ◽  
Transactional Leader

We meta-analytically examine the relationships between three forms of leader influence, contingent reward (transactional), leader-member exchange (LMX; relational), and transformational (change-oriented) on subordinates’ proactive behaviors. Using non-self-reported data from a combined sample of more than 9,000 employees, we confirm positive relationships between leader influences and employee proactive outcomes. We examine the extent to which one leadership influence is stronger than the others in promoting subordinate proactivity. By combining our new meta-analytic data with existing meta-analytic correlations, we further investigate the extent to which various leadership predictors are differentially related to proactive and prosocial contextual performance, and to task performance. For all outcomes, there are only minimal differences between the contingent reward, LMX, and transformational leadership predictors. Using our results, we propose future research directions for the relationship between leader influences and subordinate work effectiveness.

The Influence of Leadership on the Transfer of Knowledge and Work Effectivity at Secretariat Office in Boven Digoel Regency

2020 ◽  
Vol 2 (4) ◽  
pp. 44-52
Author(s):  
Yoseph Awunim ◽  
Abdul Rahman Kadir ◽  
Mahlia Muis
Keyword(s):  
Data Analysis ◽  
Knowledge Transfer ◽  
Path Analysis ◽  
Positive Impact ◽  
Direct Impact ◽  
Transfer Of Knowledge ◽  
Analysis Model ◽  
Work Effectiveness ◽  
Statistical Results ◽  
Path Analysis Model

The research objective is to analyze the direct impact of leadership toward transfer knowledge and work effectiveness in Boven Digoel. Data analysis in this research is quantitative using a path analysis model (path analysis) with the help of Smart PLS Software version 3.2 .8. The research distributed questionnaires to 89 respondents of officers assigned at the secretariat office in Boven Digoel Regency. On the basis of statistical results, it was found that leadership can be said to have impacted positively and significant knowledge transfer and work effectiveness. The knowledge transfer also has a positive impact on work effectiveness.

Comparison of Heffner Criteria and Light Criteria in Differentiating Exudative and Transudative Pleural Effusion

2020 ◽  
Vol 22 (3) ◽  
pp. 141-145
Author(s):  
Krishna Chandra Devkota ◽  
S Hamal ◽  
PP Panta
Keyword(s):  
Pleural Effusion ◽  
Cross Sectional Study ◽  
Pleural Space ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Medical College ◽  
The Common ◽  
The Mean ◽  
Exudative Pleural Effusion

Pleural effusion is present when there is >15ml of fluid is accumulated in the pleural space. It can be divided into two types; exudative and transudative pleural effusion. Tuberculosis and parapneumonic effusion are the common cause of exudative pleural effusion whereas heart failure accounts for most of the cases of transudative pleural effusion. This study was a hospital based cross sectional study performed at Nepal Medical College during the period of January 2016-December 2016. A total of 50 patients who fulfilled the inclusion criteria were enrolled. Pleural effusion was confirmed by clinical examination and radiology. After confirmation of pleural effusion, pleural fluid was aspirated and was analysed for protein, LDH, cholesterol. The Heffner criteria was compared with Light criteria to classify exudative or transudative pleural effusion. Among 50 patients, 30 were male and 20 were female. The mean age of patient was 45.4±21.85 years. The sensitivity and specificity of using Light criteria to detect the two type of pleural effusion was 100% and 90.9%, whereas using Heffner criteria was 94.87%, 100% respectively(P<0.01). There are variety of causes for development of pleural effusion and no one criteria is definite to differentiate between exudative or transudative effusion. In this study Light criteria was more sensitive whereas Heffner criteria was more specific to classify exudative pleural effusion. Hence a combination of criteria might be useful in case where there is difficulty to identify the cause of pleural effusion.

scholarly journals Optimal Initial Positioning of Chest Tubes to Prevent Retained Hemothorax Using a Novel Steerable Chest Tube With Extendable Infusion Cannula

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 324-330
Author(s):  
John B Fortune ◽  
Serena Murphy ◽  
Kimberley Tiller
Keyword(s):  
Chest Tube ◽  
Animal Studies ◽  
Training Session ◽  
Penetrating Trauma ◽  
Pleural Space ◽  
Tube Placement ◽  
Clot Lysis ◽  
Retained Hemothorax ◽  
Tip Position

ABSTRACT Introduction With blunt and penetrating trauma to the chest, warfighters and civilians frequently suffer from punctured lung (pneumothorax) and/or bleeding into the pleural space (hemothorax). Optimal management of this condition requires the rapid placement of a chest tube to evacuate as much of the blood and air as possible. Incomplete drainage of blood leading to retained hemothorax may be the result of the final tube tip position not being in contact with the blood collections. To address this problem, we sought to develop a “steerable” chest tube that could be accurately placed or repositioned into a specific desired position in the pleural space to assure optimal drainage. An integrated infusion cannula was added for the instillation of anticoagulants to maintain tube patency, thrombolytics for clot lysis, and analgesics for pain control if required. Materials and Methods A triple-lumen tube was designed to provide a channel for a pull-wire which was wound around an axle integrated into a small proximal handle and controlled by a ratcheted thumbwheel. Tension on the wire creates an arc on the tube that allows for positioning. In vitro testing focused on the relationship between the tension on the pull-wire and the resultant arc. Two adult cadavers and two anesthetized pigs were used to study the feasibility of accurate tube placement. After a brief training session, providers were asked to place tubes inferiorly along the diaphragm where blood was anticipated to accumulate or at the apex of the lung for pneumothorax. Success was determined with fluoroscopic images and was judged as a tube tip lying in the targeted position. Results The design was prototyped with an extruded polyvinyl chloride multilumen tube and a 3D printed tensioning handle. In vitro studies showed that one turn of the thumbwheel created 70° to 90° of arc of the tube. Cadaver and animal studies showed consistent success in the desired placement of the tube at or near the lateral diaphragm or in the apex. Attempts were also successful by surgical residents with minimal training. Conclusions Initial preliminary studies on a novel steerable chest tube have demonstrated the ability to appropriately position the tube in a desired location. The addition of an extendable cannula will allow for safe clot lysis or maintained tube patency. Additional studies are planned to confirm the benefit of this device in preventing retained hemothorax.

Removal of a compressive mass causes a transient disruption of blood-brain barrier but a long-term recovery of spiny stellate neurons in the rat somatosensory cortex

2021 ◽  
pp. 1-17
Author(s):  
Tzu-Yin Yeh ◽  
Pei-Hsin Liu
Keyword(s):  
Somatosensory Cortex ◽  
Blood Brain Barrier ◽  
Dendritic Spines ◽  
Late Onset ◽  
Brain Barrier ◽  
Blood Brain ◽  
Afferent Fibers ◽  
Prolonged Recovery ◽  
Rat Somatosensory Cortex

Background: In the cranial cavity, a space-occupying mass such as epidural hematoma usually leads to compression of brain. Removal of a large compressive mass under the cranial vault is critical to the patients. Objective: The purpose of this study was to examine whether and to what extent epidural decompression of the rat primary somatosensory cortex affects the underlying microvessels, spiny stellate neurons and their afferent fibers. Methods: Rats received epidural decompression with preceding 1-week compression by implantation of a bead. The thickness of cortex was measured using brain coronal sections. The permeability of blood-brain barrier (BBB) was assessed by Evans Blue and immunoglobulin G extravasation. The dendrites and dendritic spines of the spiny stellate neurons were revealed by Golgi— Cox staining and analyzed. In addition, the thalamocortical afferent (TCA) fibers in the cortex were illustrated using anterograde tracing and examined. Results: The cortex gradually regained its thickness over time and became comparable to the sham group at 3 days after decompression. Although the diameter of cortical microvessels were unaltered, a transient disruption of the BBB was observed at 6 hours and 1 day after decompression. Nevertheless, no brain edema was detected. In contrast, the dendrites and dendritic spines of the spiny stellate neurons and the TCA fibers were markedly restored from 2 weeks to 3 months after decompression. Conclusions: Epidural decompression caused a breakdown of the BBB, which was early-occurring and short-lasting. In contrast, epidural decompression facilitated a late-onset and prolonged recovery of the spiny stellate neurons and their afferent fibers.

scholarly journals A safe and simple procedure for laparoscopic hepatectomy with combined diaphragmatic resection

2021 ◽  
Author(s):  
Keisuke Oyama ◽  
Shin Nakahira ◽  
Sakae Maeda ◽  
Akihiro Kitagawa ◽  
Yuki Ushimaru ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Laparoscopic Liver Resection ◽  
Liver Tumors ◽  
Simple Procedure ◽  
Laparoscopic Hepatectomy ◽  
Pleural Space ◽  
Absorbable Suture ◽  
Surgical Field

AbstractDiaphragmatic resection may be required beneath the diaphragm in some patients with liver tumors. Laparoscopic diaphragmatic resection is technically difficult to secure in the surgical field and in suturing. We report a case of successful laparoscopic hepatectomy with diaphragmatic resection. A 48-year-old man who underwent laparoscopic partial hepatectomy for liver metastasis of rectal cancer 20 months ago underwent surgery because of a new hepatic lesion that invaded the diaphragm. The patient was placed in the left hemilateral decubitus position. The liver and diaphragm attachment areas were encircled using hanging tape. Liver resection preceded diaphragmatic resection with the hanging tape in place. Two snake retractors were used to secure the surgical field for the inflow of CO2 into the pleural space after diaphragmatic resection. The defective part of the diaphragm was repaired using continuous or interrupted sutures. Both ends of the suture were tied with an absorbable suture clip without ligation. In laparoscopic liver resection with diaphragmatic resection, the range of diaphragmatic resection can be minimized by performing liver resection using the hanging method before diaphragmatic resection. The surgical field can be secured using snake retractors. Suturing with an absorbable suture clip is conveniently feasible.

scholarly journals 53. Incidence of Bloodstream Infections and Outcomes in Patients with Severe COVID-19 Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S156-S157
Author(s):  
Aikaterini Papamanoli ◽  
Jeanwoo Yoo ◽  
Azad Mojahedi ◽  
Robin Jacob ◽  
Prabhjot Grewal ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Medical Records ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
Blood Cultures ◽  
High Flow ◽  
University Hospital ◽  
Skin Microbiota ◽  
Prolonged Recovery ◽  
The Impact

Abstract Background Coronavirus disease 19 (COVID-19) leading to acute respiratory distress syndrome is associated with need for intensive care (IC), mechanical ventilation (MV), and prolonged recovery. These patients are thus predisposed to blood stream infections which can worsen outcomes. This risk may be aggravated by adjunctive therapies. Methods We reviewed the medical records of all adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (requiring high-flow O2). Patients who received MV or died within 24h were excluded. Patients were followed until death or hospital discharge. We reviewed positive blood cultures (PBC) for pathogenic microorganisms, and calculated the incidence of bacteremia, rates of infective endocarditis (IE), and impact on mortality. Microbes isolated only once and belonging to groups defined as commensal skin microbiota were labelled as contaminants. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on bacteremia. Results A total of 469 patients with severe COVID-19 pneumonia were included (Table 1). Of these, 199 (42.4%) required IC and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 94 (20.0%) had PBC. Of these, 43 were considered true pathogens (bacteremia), with predominance of E. faecalis and S. epidermidis, and 51 were considered contaminants (Table 2). The incidence of bacteremia (43/469, 9.2%) was 5.1 per 1000 patient-days (95%CI 3.8–6.4). An echocardiogram was performed in 21 patients, 1 had an aortic valve vegetation (IE) by methicillin sensitive S. aureus. Bacteremia rates were nonsignificantly higher with steroids (5.9 vs 3.7 per 1000 patient-days; P=0.057). Use of tocilizumab was not associated with bacteremia (5.8 vs 4.8 per 1000 patient-days; P=0.28). Mortality was nonsignificantly higher in patients with (15/43, 34.9%) vs. without (108/426, 25.4%) bacteremia (P=0.20). Length of stay was the strongest predictor of bacteremia, with risk increasing by 7% (95%CI 6%-9%, P&lt; 0.001) per additional day. Cohort Characteristics of Patients with Severe COVID-19 Pneumonia on High-Flow O2 (N= 469) All Microorganisms Isolated from Blood Cultures Conclusion The incidence of bacteremia was relatively low and IE was uncommon in this study of severe COVID-19 patients. Risk of bacteremia increased with longer hospital stay and with steroids use, but not with tocilizumab. Disclosures All Authors: No reported disclosures

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