Impact of Splenectomy on Thrombocytopenia, Chemotherapy, and Survival in Patients with Unresectable Pancreatic Cancer

Patients with unresectable pancreatic cancer (PDAC) or endocrine tumors (PET) often develop splenic vein thrombosis, hypersplenism, and thrombocytopenia which limits the administration of chemotherapy. From 2001 to 2009, 15 patients with recurrent or unresectable PDAC or PET underwent splenectomy for hypersplenism and thrombocytopenia. The clinical variables of this group of patients were analyzed. The overall survival of patients with PDAC was compared to historical controls. Of the 15 total patients, 13 (87%) had PDAC and 2 (13%) had PET. All tumors were either locally advanced (n = 6, 40%) or metastatic (n = 9, 60%). The platelet counts significantly increased after splenectomy (p < 0.01). All patients were able to resume chemotherapy within a median of 11.5 days (range 6–27). The patients with PDAC had a median survival of 20 months (range 4–67) from the time of diagnosis and 10.6 months (range 0.6–39.8) from the time of splenectomy. Splenectomy for patients with unresectable PDAC or PET who developed hypersplenism and thrombocytopenia that limited the administration of chemotherapy, significantly increased platelet counts, and led to resumption of treatment in all patients. Patients with PDAC had better disease-specific survival as compared to historical controls

The possible benefits of reduced errors in the motor skills acquisition of children

An implicit approach to motor learning suggests that relatively complex movement skills may be better acquired in environments that constrain errors during the initial stages of practice. This current concept paper proposes that reducing the number of errors committed during motor learning leads to stable performance when attention demands are increased by concurrent cognitive tasks. While it appears that this approach to practice may be beneficial for motor learning, further studies are needed to both confirm this advantage and better understand the underlying mechanisms. An approach involving error minimization during early learning may have important applications in paediatric rehabilitation

Thermal comfort in urban spaces: a cross-cultural study in the hot arid climate

This cross-cultural research is an inaugural attempt to investigate the outdoor thermal comfort and the effect of cultural and social differences in hot arid climates. Case studies were carefully selected in two different parts of the world (Marrakech in North Africa and Phoenix, Arizona, in North America) to represent two different cultures in similar climatic context. Field surveys, carried out during winter and summer, included structured interviews with a standard questionnaire, observations and microclimatic monitoring. The results demonstrate a wide thermal comfort zone and prevalence of air-conditioning influencing thermal comfort requirements. The work also provides evidence of substantial cross-cultural differences in thermal comfort requirements between residents in Marrakech and Phoenix. It shows that adaptive measures, such as level of clothing, changing place, cold drinks consumption and thermal experience, varies between cultures and this influences the thermal evaluation of visitors in outdoor spaces in the hot arid climate. Evidence between the time spent in outdoor spaces and thermal expectations has been found. Moreover, environmental variables such as air temperature and solar radiation have a great impact on the use of the outdoor spaces in the hot arid climate and may determine the number of people in urban spaces. The study also identified significant differences in thermal comfort requirements between different socio-economic groups, highlighting the need for comfortable open spaces

Different Patterns of Inappropriate Antimicrobial Use in Surgical and Medical Units at a Tertiary Care Hospital in Switzerland: A Prevalence Survey

Audits of individual patient care provide important data to identify local problems in antimicrobial prescription practice. In our study, antimicrobial prescriptions without indication, and divergence from institutional guidelines were frequent errors. Based on these results, we will tailor education, amend institutional guidelines and further develop the infectious diseases consultation service

Improving implementation of evidence-based practice in mental health service delivery: protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions

BACKGROUND: There is growing acceptance that optimal service provision for individuals with severe and recurrent mental illness requires a complementary focus on medical recovery (i.e., symptom management and general functioning) and personal recovery (i.e., having a ‘life worth living’). Despite significant research attention and policy-level support, the translation of this vision of healthcare into changed workplace practice continues to elude. Over the past decade, evidence-based training interventions that seek to enhance the knowledge, attitudes, and skills of staff working in the mental health field have been implemented as a primary redress strategy. However, a large body of multi-disciplinary research indicates disappointing rates of training transfer. There is an absence of empirical research that investigates the importance of worker-motivation in the uptake of desired workplace change initiatives. ‘Autonomy’ is acknowledged as important to human effectiveness and as a correlate of workplace variables like productivity, and wellbeing. To our knowledge, there have been no studies that investigate purposeful and structured use of values-based interventions to facilitate increased autonomy as a means of promoting enhanced implementation of workplace change. METHODS: This study involves 200 mental health workers across 22 worksites within five community-managed organisations in three Australian states. It involves cluster-randomisation of participants within organisation, by work site, to the experimental (values) condition, or the control (implementation). Both conditions receive two days of training focusing on an evidence-based framework of mental health service delivery. The experimental group receives a third day of values-focused intervention and 12 months of values-focused coaching. Well-validated self-report measures are used to explore variables related to values concordance, autonomy, and self-reported implementation success. Audits of work files and staff work samples are reviewed for each condition to determine the impact of implementation. Self-determination theory and theories of organisational change are used to interpret the data. DISCUSSION: The research adds to the current knowledge base related to worker motivation and uptake of workplace practice. It describes a structured protocol that aims to enhance worker autonomy for imposed workplace practices. The research will inform how best to measure and conceptualise transfer. These findings will apply particularly to contexts where individuals are not ‘volunteers’ in requisite change processes. TRIAL REGISTRATION: ACTRN: ACTRN12613000353796

Two sides of the same coin? An investigation on the effects of frames on tax compliance and charitable giving

Despite tax compliance being mandatory and charitable giving being voluntary, both can be seen as two sides of the same coin. Paying taxes and making monetary donations are two complementary ways to financially provide for the common good. Using goal-framing theory, an experimental study with a mixed-factorial design (N = 435) was conducted to test the effects of different frames on the intention to pay taxes and make charitable donations. Our results showed that for real taxpayers (i.e., for employees, self-employed, and entrepreneurs, but not for students) using a gain goal frame as a support to the normative goal frame was only effective in increasing intended tax compliance, whereas a supporting hedonic goal frame was only effective in increasing donation intention. In addition, it was found that gain and hedonic goal frames worked differently according to the prevailing motivation behind tax compliance and charitable giving. When the intrinsic motivation was already high, frames were ineffective (in the tax context) or even counter-productive (in the charitable giving context). In the presence of extrinsic motivations, instead, frames are especially effective.Social decision makin

Auditory beat stimulation modulates memory-related single-neuron activity in the human medial temporal lobe

AbstractAuditory beats are composed of two sine waves using nearby frequencies, which can either be applied as a superposed signal to both ears or to each ear separately. In the first case, the beat sensation results from hearing an amplitude-modulated signal (monaural beat). In the second case, it is generated by phase-sensitive neurons in the brain stem (binaural beat). We investigated the effects of monaural and binaural 5 Hz beat stimulation on neural activity and memory performance in neurosurgical patients performing an associative recognition task. Previously, we had reported that these beat stimulation conditions modulated memory performance in opposite directions. Here, we analyzed data from a patient subgroup, in which microwires were implanted in the amygdala, hippocampus, entorhinal cortex and parahippocampal cortex. We identified neurons responding with firing rate changes to binaural versus monaural 5 Hz beat stimulation. In these neurons, we correlated the differences in firing rates for binaural versus monaural beats to the memory-related differences for remembered versus forgotten items and associations. In the left hemisphere for these neurons, we detected statistically significant negative correlations between firing rate differences for binaural versus monaural beats and remembered versus forgotten items/associations. Importantly, such negative correlations were also observed between beat stimulation-related firing rate differences in the baseline window and memory-related firing rate differences in the poststimulus windows. In line with concepts of homeostatic plasticity, we interpret our findings as indicating that beat stimulation is linked to memory performance via shifting baseline firing levels.</jats:p