3,696 research outputs found
Timing of initiation and discontinuation of renal replacement therapy in AKI: Unanswered key questions
No full textPatients with acute kidney injury (AKI) often require initiation of renal replacement therapy (RRT). Currently, there is wide variation worldwide on the indications for and timing of initiation and discontinuation of RRT for AKI. Various parameters for metabolic, solute, and fluid control are generally used to guide the initiation and discontinuation of therapy; however, there are currently no standards in this field. Members of the recently established Acute Kidney Injury Network, representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI, participated in a 3-d conference in Vancouver in September 2006 to evaluate the available literature on this topic and draft consensus recommendations for research studies in this area. Key questions included the following: what are the indications for RRT, when should acute RRT support be initiated, and when should RRT be stopped? This report summarizes the available evidence and describes in detail the key questions, and some of the methods of answering them that will need to be addressed with the goal of standardizing the care of patients with AKI and improving outcomes
Emotional availability (EA) teleintervention for adoptive families
No full text2012 Fall.Includes bibliographical references.This study evaluated the new online Emotional Availability (EA) Intervention for use with adoptive families in enhancing parent-child EA, parental perceptions of EA, child attachment behaviors, parent-child emotional attachment, and reducing parent-reported child behavioral problems and parenting-related stress. Participants in this study were adoptive parents and their adopted children ages 1.5 - 5 years old (N = 15 dyads). Participants were placed in an immediate intervention group (IG) or a delayed intervention group (DG) that would receive the 6-week EA Intervention after the IG. Results revealed significant differences in the IG in child behavioral problems, parent-child EA, parental perceptions of EA, and parent-child emotional attachment, improvements not seen in the DG. Analysis of effects of the DG after receiving the EA Intervention revealed significant differences over time also in child behavioral problems, parent-child EA, parental perceptions of EA, and parent-child emotional attachment. Implications, limitations, and future directions are discussed
Environmental (waste) compliance control systems for UK SMEs
No full textWhile the ‘environment’ is often perceived as a heavily regulated area of business, in reality, directly-regulated businesses represent a small proportion of the business community. This study aimed to evaluate and outline potential improvements to compliance controls for small and medium-sized enterprises (SMEs), particularly those involved in the waste sector. Forty-four SMEs from England were interviewed/audited between April-September 2008. Using a UK-based system as a case-in-point, the Environment Agency’s (EA) Operational Risk Appraisal (‘Opra’)/Compliance Assessment Report (CAR) system was analysed. Environmental compliance performance indicators and an initial assessment methodology for SMEs were developed. The study showed:• Compliance with permitting legislation was poor in many areas.• Regulatory authorities are either unable/failing to implement their enforcement policies or unable/failing to identify non-compliances due to the infrequency or limited nature of their inspections.• Improvements are needed to the EA Opra/CAR system – control measures are not fully taken into account when calculating risk.Recommendations to improve SME compliance controls include using internationally applicable general and specific compliance and non-compliance performance indicators, re-designing the Opra system and using an initial assessment methodology based on understanding the hazardousness of SME categories, compliance levels and operator competency.<br/
The effects of terlipressin on regional hemodynamics and kidney function in experimental hyperdynamic sepsis.
No full textBACKGROUND AND AIMS: Although terlipressin (TP) may improve renal function in cirrhotic patients, its use in sepsis remains controversial due to concerns about regional ischemia. We investigated the effects of TP on regional hemodynamics and kidney function in experimental hyperdynamic sepsis. METHODS: We studied thirteen merino ewes in a university physiology laboratory using a randomized controlled cross over design. We implanted flow probes around the pulmonary, circumflex coronary, superior mesenteric, renal and iliac arteries. We injected live Escherichia coli and induced hyperdynamic sepsis. We treated animals with either bolus vehicle or a single dose of TP (sTP = 1 mg). In a second group, after 1 mg of TP, two additional bolus injections (mTP) of 0.5 mg were given at 2 hourly intervals. MAIN RESULTS: sTP (1 mg) significantly increased mean arterial pressure (MAP) (74 to 89 mmHg; P<0.0001) creatinine clearance (31 to 85 mL/min; P<0.0001) and urine output (24 to 307 mL/hr) (P<0.0001). However, it decreased CO (5.7 to 3.9 L/min; p<0.0001), coronary blood flow (CBF) (43 to 32 mL/min; p<0.0001) and mesenteric blood flow (MBF) (944 to 625 mL/min; p = 0.004) and increased blood lactate (2.1 to 4.0 mmol/L; p<0.0001). Extra doses of TP caused little additional effect. CONCLUSIONS: In hyperdynamic sepsis, bolus TP transiently improves MAP and renal function, but reduces CO, CBF and MBF, and increases blood lactate. Caution should be applied when prescribing bolus TP in septic patients at risk of coronary or mesenteric ischemia
Comparative genomic and transcriptomic analysis revealed genetic characteristics related to solvent formation and xylose utilization in <it>Clostridium acetobutylicum </it>EA 2018
No full textAbstract Background Clostridium acetobutylicum, a gram-positive and spore-forming anaerobe, is a major strain for the fermentative production of acetone, butanol and ethanol. But a previously isolated hyper-butanol producing strain C. acetobutylicum EA 2018 does not produce spores and has greater capability of solvent production, especially for butanol, than the type strain C. acetobutylicum ATCC 824. Results Complete genome of C. acetobutylicum EA 2018 was sequenced using Roche 454 pyrosequencing. Genomic comparison with ATCC 824 identified many variations which may contribute to the hyper-butanol producing characteristics in the EA 2018 strain, including a total of 46 deletion sites and 26 insertion sites. In addition, transcriptomic profiling of gene expression in EA 2018 relative to that of ATCC824 revealed expression-level changes of several key genes related to solvent formation. For example, spo0A and adhEII have higher expression level, and most of the acid formation related genes have lower expression level in EA 2018. Interestingly, the results also showed that the variation in CEA_G2622 (CAC2613 in ATCC 824), a putative transcriptional regulator involved in xylose utilization, might accelerate utilization of substrate xylose. Conclusions Comparative analysis of C. acetobutylicum hyper-butanol producing strain EA 2018 and type strain ATCC 824 at both genomic and transcriptomic levels, for the first time, provides molecular-level understanding of non-sporulation, higher solvent production and enhanced xylose utilization in the mutant EA 2018. The information could be valuable for further genetic modification of C. acetobutylicum for more effective butanol production.</p
Navigating Enterprise Architecture (EA) Institutionalization: The Interplay of EA and Agile
No full textIn the rapidly evolving context of digital transformation, the effective adoption, management, and institutionalization of Enterprise Architecture (EA) have emerged as significant efforts for organizations looking for ways to navigate the complex requirements of modern business environments. This Ph.D. thesis embarks on a comprehensive exploration of different aspects of EA, ranging from its adoption challenges to its interaction with agile transformations. This study's main objective is to shed light on different aspects of EA adoption, management, challenges, and integration within large-scale organizations.
The research questions that form the foundation of this thesis are designed to explore the complex nuances of an EA's journey within an organization. The thesis investigates the role of stakeholders in influencing the perception and institutionalization of EA in order to respond to the first research question. It highlights the complex interactions between different stakeholders and their different interests, showing how these interactions can have a big impact on how successful EA initiatives are. The study goes deeper into the organizational factors that contributed to the failure of EA management initiatives, explaining the significance of legitimacy and showing challenges to achieving normative and cultural-cognitive legitimacy.
The third research question focuses on the topic of delegitimization of established EA practices. The thesis shows the ways through which EA practices can lose momentum and relevance within organizations by examining the complex interplay of regulatory, pragmatic, normative, and cultural-cognitive legitimacy. Building on this foundation, the thesis navigates the cycles of EA's institutionalization, de-institutionalization, and re-institutionalization within the organizational context. This dynamic approach highlights the importance of regaining legitimacy and adapting to modern organizational approaches in order to achieve successful re-institutionalization.
In light of the growing popularity of agile approaches, the thesis investigates the challenges posed by such paradigm shifts to established EA practices. The study outlines the modifications that must be made to EA practices by identifying the main functions that EA must do to support organizational agility. The outcome of this study is a collection of five papers, each of which shows a different part of EA's journey. Together, these contributions enhance the understanding of EA's adoption, management, and integration with agile paradigms, significantly advancing the body of knowledge in this domain.
This Ph.D. thesis gives a comprehensive overview of EA's strategic, operational, and innovative capacity. It shows how stakeholders, organizational dynamics, and an evolving digital environment all work together. This thesis helps organizations looking to use the advantages of EA in their goals of sustainable growth and agility by addressing the research questions and highlighting different aspects of the EA's role.Fulltext not availabl
Acute kidney injury due to tropical infectious diseases and animal venoms – a tale of two continents
No full textSouth and Southeast Asia and Latin American together comprise 46 countries and are home to about 40% of the world population. The sociopolitical and economic heterogeneity, tropical climate and malady transitions characteristic of the region strongly influence disease behavior and healthcare delivery. AKI epidemiology mirrors these inequalities. In addition to hospital-acquired AKI in tertiary care centers, these countries face a large preventable burden of community-acquired AKI secondary to tropical infectious diseases or animal venoms, affecting previously healthy young individuals. This manuscript reviews the epidemiology, clinical picture, prevention, risk factors and pathophysiology of AKI associated with tropical diseases (malaria, dengue, leptospirosis, scrub typhus, and yellow fever) and animal venom (snakes, bees, caterpillars, spiders and scorpions) in tropical regions of Asia and Latin America, and discusses the potential future challenges due to emerging issues
Emotional availability of adult interpersonal relationships questionnaire (EA-AIRQ): validation and implications for research and practice
No full text2017 Summer.Includes bibliographical references.Emotional Availability (EA) is commonly known as a parent-child construct used to describe the level of healthy emotional connection in the dyadic relationships (Biringen et al., 2014). Stemming from John Bowlby's (Bowlby, 1969) work on attachment, EA provides a gauge to the level of parent's receptiveness to a child's emotional feedback, both positive and negative (Biringen et al., 2014). In addition to relationships between the parent and child, EA conceptually should be applicable to a wide array of relationships. This paper will define the construct of EA and its foundations in attachment theory. It will then focus on the development and validation of a brief EA Adult Interpersonal Relationships Questionnaire (EA-AIRQ). A total of 215 Amazon Mechanical Turk workers were administered this measure (with request for participants to complete the measure for 'friends' and then for 'romantic partners'). Participants also completed the measures of attachment and mental well being. The EA-AIRQ was composited in two ways: 1-unit-weighted, with each item equally weighted (by adding all items), and 2-regression-weighted, that is, from a factor analysis for friends and romantic partners separately with the aim of obtaining a one-factor solution. Correlations between these composites and the other administered measures revealed meaningful patterns. Implications for research and clinical practice are discussed
Why Organizations Fail in Implementing Enterprise Architecture Initiatives?
No full textEnterprise architecture (EA) initiatives consist of functions, processes, tools, instruments, and principles to guide the design of IT and its alignment with business. EA is often presented as a silver bullet to ensure that IT contributes to business. Yet, many EA initiatives do not work out or even fail, but in the literature this area is undertheorized. This study aims to understand the factors influencing the failure of EA initiatives. We identified 15 factors and invited 8 EA experts to evaluate the factors and their influence based on an approach combining grey systems theory, Decision-Making and Trial Evaluation Laboratory (DEMATEL), and Interpretative Structural Modeling (ISM). The findings indicate that the factors are correlated and interwoven in complex causal chains. This study reveals the root factor and suggests enhancing high-level managers’ EA knowledge and ensuring communication and leadership skills of enterprise architects as the starting point to avoid EA failure. Only later, organizing the EA function becomes important.Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Information and Communication Technolog
Forest plot for the incidence of EA.
No full text<p>The plot displays the study, sample size, weighted risk ratio (RR), confidence interval (CI), and P value. Meta-analysis indicates dexmedetomidine significantly decreased the incidence of EA compared with placebo. The square shown for each study (first author and year of publication) is the RR for individual trials, and the corresponding horizontal line is the 95% CI. The diamond is the pooled RR with the CI. The different sizes of squares indicate the weight the individual trials had in the analysis, taking into account sample size.</p
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