Contrast-enhanced computed tomography in acute pancreatitis: does contrast medium worsen its course due to impaired microcirculation?

Background: An early and accurate diagnosis of severe acute (necrotizing) pancreatitis is important to allow timely institution of therapy to limit the extra-pancreatic sequelae of this necrotizing process and to minimize the incidence of super-infection of the necrosis (i.e., progression to infected necrosis). Contrast-enhanced computed tomography (CECT) has become the cornerstone of diagnosis by confirming the clinical diagnosis of severe acute pancreatitis based on the various clinical scoring criteria. Moreover, CECT serves as an anatomic roadmap for guiding radiological and surgical interventions. However, still-controversial experimental studies in animals in the mid-1990s suggested that the use of intravenous radiographic contrast media early in the course of the disease might exacerbate the necrotizing process by further impairing the already compromised pancreatic microcirculation. A series of experimental and clinical studies followed that have both refuted and supported this claim; unfortunately, none is conclusive, and the topic remains, as yet, unresolved. Aims: Our objective was to review objectively the available literature found by a Medline search on this subject. Methods: Meta-analysis and review. Results and conclusion: Our conclusion, after analysis of these studies, is that there are no well-substantiated data that could resolve the controversy. However, several caveats will be offere

The Role of Cognitive Control in Understanding Speech in Noise

Purpose: During speech perception, lexical candidates compete for word recognition. Incorrect candidates are briefly activated and then become suppressed. An aspect of word recognition is the ability to suppress these incorrect candidates especially in noisy environments. Previous work examining lexical inhibition and domain-general cognitive control found no correlation, suggesting cognitive control was not involved in spoken word recognition. Few studies have examined individual characteristics that impact a listener’s ability to process speech in noise. This study aims to understand the role cognitive control when speech is presented in noise. Methods: We utilized the visual world paradigm (VWP) to measure lexical competition over the time course of word recognition. In the VWP, listeners heard words and clicked on the referent from a screen containing targets, cohorts, rhymes, and unrelated items, while eye-movements are monitored as a measure of lexical competition. Two classic cognitive controls tasks, the Flanker and Simon, were used to measure inhibition, a domain general cognitive mechanism. An experimental task, Temporal Flanker, was used because it simulates how speech unfolding over time. Results: In the noise condition, listeners waited around 400 ms after the onset of the word to launch eye-movements. They showed slower and reduced activation of the target and increased competition. A significant interaction between Temporal Flanker score and timing of target fixations suggests that individuals who were better at the Temporal Flanker task were quicker to activate the target. Discussion: The study showed a link between spoken word recognition and cognitive control. It has been well documented that the development of cognitive control is slow in childhood. This could have potential implications for children with Developmental Language Disorder or who use a cochlear implant. The development of cognitive control may be a potential avenue for intervention for language and hearing disorders

Vincent de Paul and Saul Alinsky: Community Organizers

In this annual Saint Vincent de Paul lecture at DePaul University, Charles Plock explores the similarities between Vincent and Saul Alinsky as community organizers. Alinksy founded the Industrial Areas Foundation and organized different types of laborers in different parts of the United States so that they gained better working conditions. According to Plock, Vincent and Alinsky were practical people who were able to meet short-term needs while addressing the larger injustices that caused those needs. Plock writes, “Organizing people and empowering men and women is a truly Vincentian way of evangelizing” especially if it is done in partnership with the poor. He goes on to discuss coalition building, how it can be done, and what it can accomplish, citing specific successes and failures of community organizing

‘A relational approach to supervision’: Some reflections on supervision from an existential-phenomenological perspective

This paper draws attention to the dearth of information on clinical supervision in the existential-phenomenological literature. It suggests that this should be of concern to existential trainers and practitioners since it seems indicative of a lack of the reflectiveness and clarity which are at the core of existential-phenomenological practice. The author proposes an experiential approach to this situation which utilizes some aspects of existential therapy to facilitate exploration of the concept of ‘supervision’ per se from an existential perspective. The author reminds us of the centrality of relationship in existential-phenomenological therapy, particularly in the form of healing encounter espoused by Buber and the equality of client and therapist engaged in an investigation of the difficulties in living which is proposed by Heidegger. In doing so, the author raises the possibility that an ‘attitude’ to, rather than a model for, existential-phenomenological supervision may emerge which takes relationship as its primary focus: he describes this as a ‘relational approach to supervision’

Microdialysis to optimize cord perfusion and drug delivery in spinal cord injury.

OBJECTIVE: There is lack of monitoring from the injury site to guide management of patients with acute traumatic spinal cord injury. Here we describe a bedside microdialysis monitoring technique for optimizing spinal cord perfusion and drug delivery at the injury site. METHODS: 14 patients were recruited within 72 hours of severe spinal cord injury. We inserted intradurally at the injury site a pressure probe, to monitor continuously spinal cord perfusion pressure, and a microdialysis catheter, to monitor hourly glycerol, glutamate, glucose, lactate and pyruvate. The pressure probe and microdialysis catheter were placed on the surface of the injured cord. RESULTS: Microdialysis monitoring did not cause serious complications. Spinal cord perfusion pressure 90 - 100 mmHg and tissue glucose >4.5 mM minimized metabolic derangement at the injury site. Increasing spinal cord perfusion pressure by ∼10 mmHg, increased the entry of intravenously administered dexamethasone at the injury site three-fold. INTERPRETATION: This study determined the optimum spinal cord perfusion pressure and optimum tissue glucose concentration at the injury site. We also identified spinal cord perfusion pressure as a key determinant of drug entry into the injured spinal cord. Our findings challenge current guidelines, which recommend maintaining mean arterial pressure at 85 - 90 mmHg for a week after spinal cord injury. We propose that future drug trials for spinal cord injury include pressure and microdialysis monitoring to optimize spinal cord perfusion and maximize drug delivery at the injury site. This article is protected by copyright. All rights reserved

"Sartorial Connections: Fashion, Clothes, and Character in Elizabeth Bowen's To the North"

Post print version deposited in accordance with SHERPA RoMEO guidelines. Copyright © 2012 Johns Hopkins University Press. This article first appeared in Modernism/Modernity Vol.19(2), p287-302. Reprinted with permission by The Johns Hopkins University Press

A relational approach to supervision’: Some reflections on supervision from an existential-phenomenological perspective

This paper draws attention to the dearth of information on clinical supervision in the existential-phenomenological literature. It suggests that this should be of concern to existential trainers and practitioners since it seems indicative of a lack of the reflectiveness and clarity which are at the core of existential-phenomenological practice. The author proposes an experiential approach to this situation which utilizes some aspects of existential therapy to facilitate exploration of the concept of ‘supervision’ per se from an existential perspective. The author reminds us of the centrality of relationship in existential-phenomenological therapy, particularly in the form of healing encounter espoused by Buber and the equality of client and therapist engaged in an investigation of the difficulties in living which is proposed by Heidegger. In doing so, the author raises the possibility that an ‘attitude’ to, rather than a model for, existential-phenomenological supervision may emerge which takes relationship as its primary focus: he describes this as a ‘relational approach to supervisionEste texto chama a atenção para a falta de informação sobre a supervisão clínica na bibliografia fenomenológica existencial. Sugere que esta deve ser motivo de preocupação para os formadores e profissionais visto que parece indicativo de falta de reflexão e clareza que estão no centro da prática fenomenológica existencial. O autor propõe uma abordagem baseada na experiência a esta situação, que utiliza alguns aspectos da terapia existencial para facilitar a exploração do conceito de supervisão per se numa perspectiva existencial. O autor relembra-nos da centralidade da relação na terapia fenomenológica existencial, particularmente na forma de sarar confrontos defendidos por Buber e a igualdade do cliente e terapeuta envolvidos numa investigação das dificuldades em viver que é proposta por Heidegger. Ao proceder assim, o autor suscita a possibilidade que uma ‘atitude em relação à supervisão fenomenológica existencial mais do que um modelo pode emergir que toma a relação como o seu principal enfoque: descreve isto como uma abordagem relacionada com a supervisão”.info:eu-repo/semantics/publishedVersio