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Search Results: 1 - 10 of 323206 matches for " Neal J Thomas "
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Surfactant protein genetics in community-acquired pneumonia: balancing the host inflammatory state
Joanna Floros, Neal J Thomas
Critical Care , 2011, DOI: 10.1186/cc10115
Abstract: Community-acquired pneumonia (CAP) is a common cause of intensive care unit admission and can lead to acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS), major causes of mortality after CAP. At present, treatment is supportive, and determining which patients will have a higher likelihood of disease severity is not possible. In the previous issue of Critical Care, García-Laorden and colleagues [1] attempted to begin to unravel the complex gene-environment interactions in a syndrome whose progression is felt to be multifactorial. The authors should be commended for this work. Determining who is more likely or less likely to develop CAP, develop ARDS and MODS after CAP, or die from this infection is an important endeavor. Innate immunity clearly plays an important role. Abnormalities in the first step of host defense may severely compromise subsequent steps of successfully combating infections. The hope is that novel therapies can target these most susceptible patients, even before the downstream clinical events fully develop. However, before this next step may be taken, certain limitations of the present study require further work. Of paramount importance is whether the results of this study are generalizable to populations other than a relatively homogeneous Spanish Caucasoid group. Before studies such as the present one can be universally accepted, they require validation in a distinct group of individuals.The authors reported genetic associations between single-nucleotide polymorphisms of the surfactant proteins, as well as haplotypes encompassing these genes, with susceptibility, severity, and outcome of CAP. Several associations remain significant even after stringent multiple comparison corrections. These findings are not surprising, given the important role of innate immunity in host defense. There are a significant number of studies in which associations of genetic variants of surfactant protein A (SFTPA) 1, SFTPA2, and S
Pro/con clinical debate: do colloids have advantages over crystalloids in paediatric sepsis?
Puran Khandelwal, Desmond Bohn, Joseph A Carcillo, Neal J Thomas
Critical Care , 2002, DOI: 10.1186/cc1510
Abstract: A 5-year-old girl is admitted to the paediatric intensive care unit with meningococcal sepsis. She is hypotensive and requires fluid resuscitation. You are trying to decide which type of fluid to choose (crystalloids or natural colloids [albumin]).Puran Khandelwal and Desmond BohnMeningococcal sepsis is a fulminant form of Gram-negative sepsis associated with profound shock. The release of endotoxins (lipopolysaccharides) from the bacterial cell wall initiates a cascade of events resulting in the release of cytokines (IL-1, IL-6, tumour necrosis factor alpha), which in turn causes endothelial cell injury with capillary leak and loss of vasomotor tone [1].Plasma proteins, including albumin, and water from the intravascular compartment leak into the interstitium, resulting in hypovolaemia and hypotension [2]. Fleck and colleagues [3] showed that there is an increase of 300% in the albumin escape rate from the vascular to the interstitial space, associated with hypoalbuminaemia, in septic patients. Hypoalbuminaemia is also associated with increased mortality in critically ill patients [4].Holland and colleagues [5]found albumin fragments of approximately 45 kDa, 25 kDa, and <20 kDa in the urine of children with meningococcal sepsis and associated purpura. They suggested that exogenous or endogenous proteases, or both, may be released in severe meningococcal sepsis and, in association with an inadequate antiprotease response, result in albumin degradation. This may be a contributory factor to the rapid shock, hypocalcaemia, and rash seen in meningococcal sepsis.Early fluid resuscitation in paediatric septic shock improves outcome [6], but there is ongoing controversy over the type of fluid to be used [7,8,9,10]. Two published meta-analyses, by the Cochrane group, of randomised trials that compared crystalloids with colloids or crystalloids with albumin attracted considerable attention [8,10]. They concluded that the use of both colloids was associated with increased mor
An unexpected diagnosis of methicillin-resistant Staphylococcus aureus septic arthritis.
Tanujan Thangarajah,Timothy J. Neal,Thomas D. Kennedy
Orthopedic Reviews , 2009, DOI: 10.4081/or.2009.e13
Abstract: Hand infections can result in serious tissue damage and gross functional impairment. This is particularly true in the case of septic arthritis, the most destructive of all joint disease. We report the first case of methicillin-resistant Staphylococcus aureus septic arthritis of the distal interphalangeal joint to have occurred in a patient devoid of all risk factors traditionally associated with a hospital-associated infection (HA-MRSA). The afflicted patient’s only exposure to the pathogen was during her role as a community carer for an asymptomatic carrier. Delayed treatment allowed the infection to rapidly destroy surrounding soft tissue and necessitate in the need for arthrodesis. It is, therefore imperative that clinicians maintain a low index of suspicion for methicillin-resistant Staphylococcus aureus as the causative pathogen in similar cases. Consequently, consideration of empirical antibiotic therapy for this patient subgroup is discussed.
Magnetized Accretion and Dead Zones in Protostellar Disks
Natalia Dzyurkevich,Neal J. Turner,Thomas Henning,Wilhelm Kley
Physics , 2013, DOI: 10.1088/0004-637X/765/2/114
Abstract: The edges of magnetically-dead zones in protostellar disks have been proposed as locations where density bumps may arise, trapping planetesimals and helping form planets. Magneto-rotational turbulence in magnetically-active zones provides both accretion of gas on the star and transport of mass to the dead zone. We investigate the location of the magnetically-active regions in a protostellar disk around a solar-type star, varying the disk temperature, surface density profile, and dust-to-gas ratio. We also consider stellar masses between 0.4 and 2 $M_\odot$, with corresponding adjustments in the disk mass and temperature. The dead zone's size and shape are found using the Elsasser number criterion with conductivities including the contributions from ions, electrons, and charged fractal dust aggregates. The charged species' abundances are found using the approach proposed by S. Okuzumi. The dead zone is in most cases defined by the ambipolar diffusion. In our maps, the dead zone takes a variety of shapes, including a fish-tail pointing away from the star and islands located on and off the midplane. The corresponding accretion rates vary with radius, indicating locations where the surface density will increase over time, and others where it will decrease. We show that density bumps do not readily grow near the dead zone's outer edge, independently of the disk parameters and the dust properties. Instead, the accretion rate peaks at the radius where the gas-phase metals freeze out. This could lead to clearing a valley in the surface density, and to a trap for pebbles located just outside the metal freeze-out line.
Discovering Servant Leader Relations with New Followers in Nonprofit Organizations: Does a Servant Leader Always Serve First?  [PDF]
David Neal Ammons, Thomas Chalmers McLaughlin
Open Journal of Leadership (OJL) , 2017, DOI: 10.4236/ojl.2017.62003
Abstract: This study focused on discovering servant leadership in the nonprofit organization (NPO) of the church with a concentration on new follower relations. The investigation was conducted as an Interpretative Phenomenological Analysis (IPA) so as to be able to capture the life experiences and identifications of the servant leaders in the church clergy. Servant leadership theory is a management model and practice for the business community including large organizations, such as Southwest Airlines, to small businesses and to NPOs, including the church. The problem is the lack of clarity on how clear servant leaders in NPOs cultivate relationships with new followers and empower them to develop a caring community while meeting the NPO’s needs. The researchers investigated the experiences of servant leaders to receive and develop new follower relations in the NPO of the Christian Protestant church. The research revealed a potential lack of clarity and the need for specific research on new followers focused on the initial concept of servant leadership; the definition of a servant leader is a leader who serves first. The participants in this study were servant leader pastors from Christian churches in the Northern United States. Two research questions were developed to inquire, first, about how the participant’s actions were received when they were new followers and secondly, to inquire about the participants’ servant leader undertakings toward their new followers. The data were analyzed and superordinate themes were developed based on data provided by the interviews and the derived interlocking information produced. The resulting superordinate theme for research question one was “Commitment to the Growth of People.” The superordinate themes for research question two were “Empowering and Developing People” and “Providing Direction.” The results from the interviews and double hermeneutic analysis demonstrated that the servant leader participants taught new followers first and then, once the new follower attained a sufficient basic level of knowledge, were served by these servant leaders. Scholars highly regard the historical individual known as Jesus of Nazereth as one of the original servant leaders and his teachings to his disciples as prime examples of servant leadership guidelines. The generalizability of the research relates to any new follower who receives little to no screening in any organization, like the selected group of the NPO of the church, a secular NPO like the United Way, or a standard business which increases its workforce with little screening.
A prospective assessment of the effect of aminophylline therapy on urine output and inflammation in critically ill children
Robert F. Tamburro,Neal J. Thomas,Gary D. Ceneviva,Michael D. Dettorre,Steven E. Lucking
Frontiers in Pediatrics , 2014, DOI: 10.3389/fped.2014.00059
Abstract: Background: Aminophylline, an established bronchodilator, is also purported to be an effective diuretic and anti-inflammatory agent. However, the data to support these contentions are scant. We conducted a prospective, open-label, single arm, single center study to assess the hypothesis that aminophylline increases urine output and decreases inflammation in critically ill children.
Trapping Solids at the Inner Edge of the Dead Zone: 3-D Global MHD Simulations
Natalia Dzyurkevich,Mario Flock,Neal J. Turner,Hubert Klahr,Thomas Henning
Physics , 2010, DOI: 10.1051/0004-6361/200912834
Abstract: The poorly-ionized interior of the protoplanetary disk is the location where dust coagulation processes may be most efficient. However even here, planetesimal formation may be limited by the loss of solid material through radial drift, and by collisional fragmentation of the particles. Our aim is to investigate the possibility that solid particles are trapped at local pressure maxima in the dynamically evolving disk. We perform the first 3-D global non-ideal MHD calculations of the disk treating the turbulence driven by the magneto-rotational instability. The domain contains an inner MRI-active region near the young star and an outer midplane dead zone, with the transition between the two modeled by a sharp increase in the magnetic diffusivity. The azimuthal magnetic fields generated in the active zone oscillate over time, changing sign about every 150 years. We thus observe the radial structure of the `butterfly pattern' seen previously in local shearing-box simulations. The mean magnetic field diffuses from the active zone into the dead zone, where the Reynolds stress nevertheless dominates. The greater total accretion stress in the active zone leads to a net reduction in the surface density, so that after 800 years an approximate steady state is reached in which a local radial maximum in the midplane pressure lies near the transition radius. We also observe the formation of density ridges within the active zone. The dead zone in our models possesses a mean magnetic field, significant Reynolds stresses and a steady local pressure maximum at the inner edge, where the outward migration of planetary embryos and the efficient trapping of solid material are possible.
Bowen Ratio Energy Balance Measurement of Carbon Dioxide (CO2) Fluxes of No-Till and Conventional Tillage Agriculture in Lesotho  [PDF]
Deb O’Dell, Thomas J. Sauer, Bruce B. Hicks, Dayton M. Lambert, David R. Smith, Wendy Bruns, August Basson, Makoala V. Marake, Forbes Walker, Michael D. Wilcox Jr., Neal Samuel Eash
Open Journal of Soil Science (OJSS) , 2014, DOI: 10.4236/ojss.2014.43012
Abstract:

Global food demand requires that soils be used intensively for agriculture, but how these soils are managed greatly impacts soil fluxes of carbon dioxide (CO2). Soil management practices can cause carbon to be either sequestered or emitted, with corresponding uncertain influence on atmospheric CO2 concentrations. The situation is further complicated by the lack of CO2 flux measurements for African subsistence farms. For widespread application in remote areas, a simple experimental methodology is desired. As a first step, the present study investigated the use of Bowen Ratio Energy Balance (BREB) instrumentation to measure the energy balance and CO2 fluxes of two contrasting crop management systems, till and no-till, in the lowlands within the mountains of Lesotho. Two BREB micrometeorological systems were established on 100-m by 100-m sites, both planted with maize (Zea mays) but under either conventional (plow, disk-disk) or no-till soil mangement systems. The results demonstrate that with careful maintenance of the instruments by appropriately trained local personnel, the BREB approach offers substantial benefits in measuring real time changes in agroecosystem CO2 flux. The periods where the two treatments could be compared indicated greater CO2 sequestration over the no-till treatments during both the growing and non-growing seasons.

Optical Sensor for Diverse Organic Vapors at ppm Concentration Ranges
J. Christopher Thomas,John E. Trend,Neal A. Rakow,Michael S. Wendland,Richard J. Poirier,Dora M. Paolucci
Sensors , 2011, DOI: 10.3390/s110303267
Abstract: A broadly responsive optical organic vapor sensor is described that responds to low concentrations of organic vapors without significant interference from water vapor. Responses to several classes of organic vapors are highlighted, and trends within classes are presented. The relationship between molecular properties (vapor pressure, boiling point, polarizability, and refractive index) and sensor response are discussed.
Reducing selection bias in case-control studies from rare disease registries
J Alexander Cole, John S Taylor, Thomas N Hangartner, Neal J Weinreb, Pramod K Mistry, Aneal Khan
Orphanet Journal of Rare Diseases , 2011, DOI: 10.1186/1750-1172-6-61
Abstract: The objective of the study was to demonstrate the utility of case-control matching and the risk-set method in order to control bias in data from a rare disease registry. Data from the International Collaborative Gaucher Group (ICGG) Gaucher Registry were used as an example.A case-control matching analysis using the risk-set method was conducted to identify two groups of patients with type 1 Gaucher disease in the ICGG Gaucher Registry: patients with avascular osteonecrosis (AVN) and those without AVN. The frequency distributions of gender, decade of birth, treatment status, and splenectomy status were presented for cases and controls before and after matching. Odds ratios (and 95% confidence intervals) were calculated for each variable before and after matching.The application of case-control matching methodology results in cohorts of cases (i.e., patients with AVN) and controls (i.e., patients without AVN) who have comparable distributions for four common parameters used in subject selection: gender, year of birth (age), treatment status, and splenectomy status. Matching resulted in odds ratios of approximately 1.00, indicating no bias.We demonstrated bias in case-control selection in subjects from a prototype rare disease registry and used case-control matching to minimize this bias. Therefore, this approach appears useful to study cohorts of heterogeneous patients in rare disease registries.Rare diseases, exemplified by Gaucher disease, are defined as having a prevalence of fewer than 200,000 patients [1]. A major impediment to the study of these diseases is the scarcity of patients in any one city or country. Nevertheless, the global burden of patients affected by rare diseases is substantial: at least 30 million patients are estimated to suffer from one of the 7,000 rare diseases currently identified [2]. On average, each rare disease is estimated to afflict 4,200 patients [2]. Our search of the word 'registry' on clinicaltrials.gov as of 4 May 2011 identified
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