This book combines practical guidance and theoretical background for analysts using empirical techniques in competition and antitrust investigations. Peter Davis and Eliana Garcs show how to ...integrate empirical methods, economic theory, and broad evidence about industry in order to provide high-quality, robust empirical work that is tailored to the nature and quality of data available and that can withstand expert and judicial scrutiny. Davis and Garcs describe the toolbox of empirical techniques currently available, explain how to establish the weight of pieces of empirical work, and make some new theoretical contributions. The book consistently evaluates empirical techniques in light of the challenge faced by competition analysts and academics--to provide evidence that can stand up to the review of experts and judges. The book's integrated approach will help analysts clarify the assumptions underlying pieces of empirical work, evaluate those assumptions in light of industry knowledge, and guide future work aimed at understanding whether the assumptions are valid. Throughout, Davis and Garcs work to expand the common ground between practitioners and academics.
Retail markets are extremely important, but economists have few practical tools for analyzing the way dispersed buyers and sellers affect the properties of markets. I develop an econometric model of ...retail demand in which products are location specific and consumers have preferences over both geographic proximity and other store and product characteristics. The model uses data on the observed geographic distribution of consumers within a market to (1) help explain observed variation in market shares and (2) affect predicted substitution patterns between stores. Using data from the U.S. cinema industry, I use the estimated model to evaluate the form of consumer transport costs, the effect of a theater's price and quality choices on rivals, the effects of geographic differentiation, and the nature and extent of market power.
Nasal continuous positive airway pressure (NCPAP) is a strategy for maintaining positive airway pressure throughout the respiratory cycle through the application of bias flow of respiratory gas to an ...apparatus attached to the nose. Treatment with NCPAP is associated with decreased risk of mechanical ventilation and might be effective in reducing chronic lung disease. Nasal intermittent positive pressure ventilation (NIPPV) is a form of noninvasive ventilation during which patients are exposed intermittently to higher levels of airway pressure, along with NCPAP through the same nasal device.
To examine the risks and benefits of early NIPPV versus early NCPAP alone for preterm infants at risk of or in respiratory distress within the first hours after birth.Primary endpoints are respiratory failure and the need for intubated ventilatory support during the first week of life. Secondary endpoints include chronic lung disease (CLD) (oxygen therapy at 36 weeks' postmenstrual age), air leaks, duration of respiratory support, duration of oxygen therapy, intraventricular hemorrhage, and incidence of mortality.
We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 9), MEDLINE via PubMed (1966 to September 28, 2015), Embase (1980 to September 28, 2015), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to September 28, 2015). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. A member of the Cochrane Neonatal Review Group handsearched abstracts from the European Society of Pediatric Research (ESPR). We contacted the authors of ongoing clinical trials to ask for information.
We considered all randomized and quasi-randomized controlled trials. Studies selected compared NIPPV versus NCPAP treatment, starting at birth or shortly thereafter in preterm infants (< 37 weeks' gestational age).
We performed data collection and analysis using the recommendations of the Cochrane Neonatal Review Group.
Ten trials, enrolling a total of 1061 infants, met criteria for inclusion in this review. Meta-analyses of these studies showed significantly reduced risk of meeting respiratory failure criteria (typical risk ratio (RR) 0.65, 95% confidence interval (CI) 0.51 to 0.82; typical risk difference (RD) -0.09, 95% CI -0.13 to -0.04) and needing intubation (typical RR 0.78, 95% CI 0.64 to 0.94; typical RD -0.07, 95% CI -0.12 to -0.02) among infants treated with early NIPPV compared with early NCPAP. The meta-analysis did not demonstrate a reduction in the risk of CLD among infants randomized to NIPPV (typical RR 0.78, 95% CI 0.58 to 1.06). Investigators observed no evidence of harm. Review authors graded the quality of the evidence as moderate (unblinded studies).
Early NIPPV does appear to be superior to NCPAP alone for decreasing respiratory failure and the need for intubation and endotracheal tube ventilation among preterm infants with respiratory distress syndrome. Additional studies are needed to confirm these results and to assess the safety of NIPPV compared with NCPAP alone in a larger patient population.
Cohort studies have suggested that nasal continuous positive airways pressure (CPAP) starting in the immediate postnatal period before the onset of respiratory disease (prophylactic CPAP) may be ...beneficial in reducing the need for intubation and intermittent positive pressure ventilation (IPPV) and in preventing bronchopulmonary dysplasia (BPD) in preterm or low birth weight infants.
To determine if prophylactic nasal CPAP started soon after birth regardless of respiratory status in the very preterm or very low birth weight infant reduces the use of IPPV and the incidence of bronchopulmonary dysplasia (BPD) without adverse effects.
We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 1), MEDLINE via PubMed (1966 to 31 January 2016), EMBASE (1980 to 31 January 2016), and CINAHL (1982 to 31 January 2016). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.
All trials using random or quasi-random patient allocation of very preterm infants (under 32 weeks' gestation) or less than 1500 grams at birth were eligible. We included trials if they compared prophylactic nasal CPAP started soon after birth regardless of the respiratory status of the infant with 'standard' methods of treatment such as IPPV, oxygen therapy or supportive treatment. We excluded studies where prophylactic CPAP was compared with CPAP along with other interventions.
We used the standard methods of Cochrane and its Neonatal Review Group, including independent study selection, assessment of trial quality and extraction of data by two authors. Data were analysed using risk ratio (RR) and the meta-analysis was performed using a fixed-effect model.
Seven trials recruiting 3123 babies were included in the meta-analysis. Four trials recruiting 765 babies compared CPAP with supportive care and three trials (2364 infants) compared CPAP with mechanical ventilation. Apart from a lack of blinding of the intervention all studies were of low risk of bias.In the comparison of CPAP with supportive care there was a reduction in failed treatment (typical risk ratio (RR) 0.66, 95% confidence interval (CI) 0.45 to 0.98; typical risk difference (RD) -0.16, 95% CI -0.34 to 0.02; 4 studies, 765 infants, very low quality evidence). There was no reduction in bronchopulmonary dysplasia (BPD) or mortality.In trials comparing CPAP with assisted ventilation with or without surfactant, CPAP resulted in a small but clinically significant reduction in the incidence of BPD at 36 weeks, (typical RR 0.89, 95% CI 0.79 to 0.99; typical RD -0.04, 95% CI -0.08 to 0.00; 3 studies, 772 infants, moderate-quality evidence); and death or BPD (typical RR 0.89, 95% CI 0.81 to 0.97; typical RD -0.05, 95% CI -0.09 to 0.01; 3 studies, 1042 infants, moderate-quality evidence). There was also a clinically important reduction in the need for mechanical ventilation (typical RR 0.50, 95% CI 0.42 to 0.59; typical RD -0.49, 95% CI -0.59 to -0.39; 2 studies, 760 infants, moderate-quality evidence); and the use of surfactant in the CPAP group (typical RR 0.54, 95% CI 0.40 to 0.73; typical RD -0.41, 95% CI -0.54 to -0.28; 3 studies, 1744 infants, moderate-quality evidence).
There is insufficient evidence to evaluate prophylactic CPAP compared to oxygen therapy and other supportive care. However when compared to mechanical ventilation prophylactic nasal CPAP in very preterm infants reduces the need for mechanical ventilation and surfactant and also reduces the incidence of BPD and death or BPD.
Respiratory distress, particularly respiratory distress syndrome (RDS), is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive respiratory ...insufficiency, intermittent positive pressure ventilation (IPPV) with surfactant has been the usual treatment, but it is invasive, potentially resulting in airway and lung injury. Continuous positive airway pressure (CPAP) has been used for the prevention and treatment of respiratory distress, as well as for the prevention of apnoea, and in weaning from IPPV. Its use in the treatment of RDS might reduce the need for IPPV and its sequelae.
To determine the effect of continuous distending pressure in the form of CPAP on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress.
We used the standard strategy of Cochrane Neonatal to search CENTRAL (2020, Issue 6); Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions; and CINAHL on 30 June 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.
All randomised or quasi-randomised trials of preterm infants with respiratory distress were eligible. Interventions were CPAP by mask, nasal prong, nasopharyngeal tube or endotracheal tube, compared with spontaneous breathing with supplemental oxygen as necessary.
We used standard methods of Cochrane and its Neonatal Review Group, including independent assessment of risk of bias and extraction of data by two review authors. We used the GRADE approach to assess the certainty of evidence. Subgroup analyses were planned on the basis of birth weight (greater than or less than 1000 g or 1500 g), gestational age (groups divided at about 28 weeks and 32 weeks), timing of application (early versus late in the course of respiratory distress), pressure applied (high versus low) and trial setting (tertiary compared with non-tertiary hospitals; high income compared with low income) MAIN RESULTS: We included five studies involving 322 infants; two studies used face mask CPAP, two studies used nasal CPAP and one study used endotracheal CPAP and continuing negative pressure for a small number of less ill babies. For this update, we included one new trial. CPAP was associated with lower risk of treatment failure (death or use of assisted ventilation) (typical risk ratio (RR) 0.64, 95% confidence interval (CI) 0.50 to 0.82; typical risk difference (RD) -0.19, 95% CI -0.28 to -0.09; number needed to treat for an additional beneficial outcome (NNTB) 6, 95% CI 4 to 11; I
= 50%; 5 studies, 322 infants; very low-certainty evidence), lower use of ventilatory assistance (typical RR 0.72, 95% CI 0.54 to 0.96; typical RD -0.13, 95% CI -0.25 to -0.02; NNTB 8, 95% CI 4 to 50; I
= 55%; very low-certainty evidence) and lower overall mortality (typical RR 0.53, 95% CI 0.34 to 0.83; typical RD -0.11, 95% CI -0.18 to -0.04; NNTB 9, 95% CI 2 to 13; I
= 0%; 5 studies, 322 infants; moderate-certainty evidence). CPAP was associated with increased risk of pneumothorax (typical RR 2.48, 95% CI 1.16 to 5.30; typical RD 0.09, 95% CI 0.02 to 0.16; number needed to treat for an additional harmful outcome (NNTH) 11, 95% CI 7 to 50; I
= 0%; 4 studies, 274 infants; low-certainty evidence). There was no evidence of a difference in bronchopulmonary dysplasia, defined as oxygen dependency at 28 days (RR 1.04, 95% CI 0.35 to 3.13; I
= 0%; 2 studies, 209 infants; very low-certainty evidence). The trials did not report use of surfactant, intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis and neurodevelopment outcomes in childhood.
In preterm infants with respiratory distress, the application of CPAP is associated with reduced respiratory failure, use of mechanical ventilation and mortality and an increased rate of pneumothorax compared to spontaneous breathing with supplemental oxygen as necessary. Three out of five of these trials were conducted in the 1970s. Therefore, the applicability of these results to current practice is unclear. Further studies in resource-poor settings should be considered and research to determine the most appropriate pressure level needs to be considered.
This collection provides an in-depth and up-to-date examination of the concept of Intangible Cultural Heritage and the issues surrounding its value to society. Critically engaging with the UNESCO ...2003 Convention for the Safeguarding of the Intangible Cultural Heritage , the book also discusses local-level conceptualizations of living cultural traditions, practices and expressions, and reflects on the efforts that seek to safeguard them. Exploring a global range of case studies, the book considers the diverse perspectives currently involved with intangible cultural heritage and presents a rich picture of the geographic, socioeconomic and political contexts impacting research in this area. With contributions from established and emerging scholars, public servants, professionals, students and community members, this volume is also deeply enhanced by an interdisciplinary approach which draws on the theories and practices of heritage and museum studies, anthropology, folklore studies, ethnomusicology, and the study of cultural policy and related law. The Routledge Companion to Intangible Cultural Heritage undoubtedly broadens the international heritage discourse and is an invaluable learning tool for instructors, students and practitioners in the field.
Introduction Michelle Stefano and Peter Davis
A Decade Later: Critical Reflections on the UNESCO-ICH Paradigm
1. Development of UNESCO’s 2003 Convention: Creating a New Heritage Protection Paradigm? Janet Blake 2. The Examination of Nomination Files under the UNESCO Convention for the Safeguarding of the Intangible Cultural Heritage Rieks Smeets and Harriet Deacon 3. A Conversation with Richard Kurin 4. Placing Intangible Cultural Heritage, Owing a Tradition, Affirming Sovereignty: the Role of Spatiality in the Practice of the 2003 Convention Chiara Bortolloto 5. Is Intangible Cultural Heritage an Anthropological Topic? Towards Interdisciplinarity in France Christian Hottin and Sylvie Grenet 6. The Impact of UNESCO’s 2003 Convention on National Policy-making: Developing a New Heritage Protection Paradigm? Janet Blake
Reality Check: The Challenges Facing ICH Safeguarding
7. From the Bottom Up: the Identification and Safeguarding of Intangible Cultural Heritage in Guyana Aron Mazel, Gerard Corsane, Raquel Thomas and Samantha James 8. Making the Past Pay? Intangible (Cultural) Heritage in South Africa and Mauritius Rosabelle Boswell 9. A Conversation with Yelsy Hernández Zamora on Intangible Cultural Heritage in Cuba 10. The Management of Intangible Cultural Heritage in China Tracey L-D Lu 11. Ageing Musically: Tangible Sites of Intangible Cultural Heritage Bradley Hanson 12. Intangible Cultural Heritage in the Czech Republic: Between National and Local Heritage Petr Janeček 13. Damming Ava Mezin: Challenges to Safeguarding Minority Intangible Cultural Heritage in Turkey Sarah Elliott 14. Documenting and Safeguarding Intangible Cultural Heritage: the Experience in Scotland Alison McCleery and Jared Bowers
Intangible Cultural Heritage Up Close
15. Officially Ridin’ Swangas: Slab as Tangible and Intangible Cultural Heritage in Houston, Texas Langston Collin Wilkins 16. Locating Intangible Cultural Heritage in Norway Joel Taylor 17. Intangible Cultural Heritage in India: Reflections on Selected Forms of Dance Parasmoni Dutta 18. Second-hand as Living Heritage: Intangible Dimensions of Things with History Staffan Appelgren and Anna Bohlin 19. A Conversation with Linina Phuttitarn on Safeguarding a Spiritual Festival in Thailand 20. Public Experiences and the Social Capacity of Intangible Cultural Heritage in Japan: Bingata, a Textile-Dyeing Practice from Okinawa Sumiko Sarashima 21. Stretching the Dough: Economic Resiliency and the Kinaesthetics of Food Heritage across the US-Mexico Border Maribel Alvarez
Intangible Cultural Heritage and Place
22. Refuting Timelessness: Emerging Relationships to Intangible Cultural Heritage for Younger Indigenous Australians Amanda Kearney and Gabrielle Kowalewski 23. Common Ground: Insurgence, Imagination and Intangible Cultural Heritage Jos Smith 24. Indigenous Geography and Place-Based Intangible Cultural Heritage RDK Herman 25. ‘If there’s no place to dance to it, it’s going to die’: A Conversation on the Living Tradition of Baltimore Club Music and the Importance of Place Michelle L. Stefano with Christopher Clayton and Baronhawk Poitier 26. Landscape and Intangible Cultural Heritage: Interactions, Memories and Meanings Maggie Roe
Intangible Cultural Heritage, Museums and Archives
27. Making History Tangible: POLIN Museum of the History of Polish Jews, Warsaw Barbara Kirshenblatt-Gimblett 28. A Conversation with Clifford Murphy on Archives and Intangible Cultural Heritage 29. Bin Jelmood House: Narrating an Intangible History in Qatar Scott Cooper and Karen Exell 30. Standing in the Gap: Lumbee Cultural Preservation at the Baltimore American Indian Center Ashley Minner 31. A Conversation with Tara Gujadhur on the Traditional Arts and Ethnology Center in Laos 32. Museums and Intangible Cultural Heritage in Lusophone Countries Ana Mercedes Stoffel and Isabel Victor
Alternative Approaches to Safeguarding and Promoting Intangible Cultural Heritage
33. Safeguarding Maritime Intangible Cultural Heritage: Ecomuseum Batana, Croatia Dragana Lucija Ratković Aydemir 34. Reflections of a Heritage Professional: Intangible Cultural Heritage at the Ecomuseum of Terraces and Vineyards, Italy Donatella Murtas 35. Conveying Peruvian Intangible Heritage through Digital Environments Natalie Underberg-Goode 36. Growing Ecomuseums on the Canadian Prairies: Prospects for Intangible Cultural Heritage Glenn Sutter 37. The Intangible Made Tangible in Wales Einir M. Young, Gwenan H. Griffith, Marc Evans, S. Arwel Jones 38. A Conversation with Paula dos Santos and Marcelle Pereira on Intangible Cultural Heritage and Social and Ecological Justice
"It is a most welcome addition to literature, and a must-have for all who want to deepen their understanding of the scholarly research into and safeguarding practice of Intangible Cultural Heritage. (...) With the publication of this Routledge Companion, Intangible Cultural Heritage has certainly reached a new level of scholarly recognition. And that is a very good thing."
- Steven Engelsman, Director, Weltmuseum Wien, Austria "The Routledge Companion to Intangible Cultural Heritgae provides asnapshop- or rather, a whole picture album- of the evolution of a profoundly important cultural policiy and paradigm... The editors have assembled here a massive and varied set of essays- 38 individual chapters written by 54 authors, including anthropologists, folklorists, legals scholars, museum professionals, ethomusicologists, and community members." - Michael Dylan Foster, University of California, USA
Michelle L. Stefano is a Folklife Specialist (Research and Programs) at the American Folklife Center of the Library of Congress, Washington, DC. From 2011-2016, Stefano worked for Maryland Traditions, the folklife program of the state of Maryland, of which she was its Co-Director from 2015-2016. From 2012-2016, she led the partnership between Maryland Traditions and the University of Maryland, Baltimore County, where she was Visiting Assistant Professor in American Studies. She co-edited Safeguarding Intangible Cultural Heritage (2012) with Peter Davis and Gerard Corsane.
Peter Davis is Emeritus Professor of Museology in the International Centre for Cultural and Heritage Studies at Newcastle University, UK. He is honorary editor of Archives of Natural History , the journal of the Society for the History of Natural History, and a series editor for Heritage Matters . His research interests include the interactions between nature, culture and concepts of place and space. He has published widely on ecomuseums and intangible cultural heritage.
Open access – no commercial reuse
Floating ice shelves are the Achilles' heel of the Antarctic Ice Sheet. They limit Antarctica's contribution to global sea level rise, yet they can be rapidly melted from beneath by a warming ocean. ...At Filchner-Ronne Ice Shelf, a decline in sea ice formation may increase basal melt rates and accelerate marine ice sheet mass loss within this century. However, the understanding of this tipping-point behavior largely relies on numerical models. Our new multi-annual observations from five hot-water drilled boreholes through Filchner-Ronne Ice Shelf show that since 2015 there has been an intensification of the density-driven ice shelf cavity-wide circulation in response to reinforced wind-driven sea ice formation in the Ronne polynya. Enhanced southerly winds over Ronne Ice Shelf coincide with westward displacements of the Amundsen Sea Low position, connecting the cavity circulation with changes in large-scale atmospheric circulation patterns as a new aspect of the atmosphere-ocean-ice shelf system.
Previous randomised trials and meta-analyses have shown that nasal continuous positive airway pressure (NCPAP) is a useful method for providing respiratory support after extubation. However, this ...treatment sometimes 'fails' in infants, and they may require endotracheal re-intubation with its attendant risks and expense. Nasal intermittent positive pressure ventilation (NIPPV) can augment NCPAP by delivering ventilator breaths via nasal prongs. Older children and adults with chronic respiratory failure benefit from NIPPV, and the technique has been applied to neonates. However, serious side effects including gastric perforation have been reported with older methods of providing NIPPV.
Primary objective To compare effects of management with NIPPV versus NCPAP on the need for additional ventilatory support in preterm infants whose endotracheal tube was removed after a period of intermittent positive pressure ventilation. Secondary objectives To compare rates of gastric distension, gastrointestinal perforation, necrotising enterocolitis and chronic lung disease; duration of hospitalisation; and rates of apnoea, air leak and mortality for NIPPV and NCPAP.
We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 9), MEDLINE via PubMed (1966 to 28 September 2015), Embase (1980 to 28 September 2015) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 28 September 2015). We also searched clinical trials databases, conference proceedings and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.
We included randomised and quasi-randomised trials comparing use of NIPPV versus NCPAP in extubated preterm infants. NIPPV included non-invasive support delivered by a mechanical ventilator or a bilevel device in a synchronised or non-synchronised way. Participants included ventilated preterm infants who were ready to be extubated to non-invasive respiratory support. Interventions compared were NIPPV, delivered by short nasal prongs or nasopharyngeal tube, and NCPAP, delivered by the same methods.Types of outcomes measures included failure of therapy (respiratory failure, rates of endotracheal re-intubation); gastrointestinal complications (i.e. abdominal distension requiring cessation of feeds, gastrointestinal perforation or necrotising enterocolitis); pulmonary air leak; chronic lung disease (oxygen requirement at 36 weeks' postmenstrual age) and mortality.
Three review authors independently extracted data regarding clinical outcomes including extubation failure; endotracheal re-intubation; rates of apnoea, gastrointestinal perforation, feeding intolerance, necrotising enterocolitis, chronic lung disease and air leak; and duration of hospital stay. We analysed trials using risk ratio (RR), risk difference (RD) and the number needed to treat for an additional beneficial outcome (NNTB) or an additional harmful outcome (NNTH) for dichotomous outcomes, and mean difference (MD) for continuous outcomes. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence.
Through the search, we identified 10 trials enrolling a total of 1431 infants and comparing extubation of infants to NIPPV or NCPAP. Three trials had methodological limitations and possible selection bias.Five trials used the synchronised form of NIPPV, four used the non-synchronised form and one used both methods. Eight studies used NIPPV delivered by a ventilator, one used a bilevel device and one used both methods. When all studies were included, meta-analysis demonstrated a statistically and clinically significant reduction in the risk of meeting extubation failure criteria (typical RR 0.70, 95% CI 0.60 to 0.80; typical RD -0.13, 95% CI -0.17 to -0.08; NNTB 8, 95% CI 6 to 13; 10 trials, 1431 infants) and needing re-intubation (typical RR 0.76, 95% CI 0.65 to 0.88; typical RD -0.10, 95% CI -0.15 to -0.05; NNTB 10, 95% CI 7 to 20; 10 trials, 1431 infants). We graded evidence for these outcomes as moderate, as all trial interventions were unblinded. Although methods of synchronisation varied (Graseby capsule or pneumotachograph/flow-trigger), the five trials that synchronised NIPPV showed a statistically significant benefit for infants extubated to NIPPV in terms of prevention of extubation failure up to one week after extubation.Unsynchronised NIPPV also reduced extubation failure. NIPPV provided via a ventilator is more beneficial than that provided by bilevel devices in reducing extubation failure during the first week. When comparing interventions, investigators found no significant reduction in rates of chronic lung disease (typical RR 0.94, 95% CI 0.80 to 1.10; typical RD -0.02, 95% CI -0.08 to 0.03) or death, and no difference in the incidence of necrotising enterocolitis. Air leaks were reduced in infants randomised to NIPPV (typical RR 0.48, 95% CI 0.28 to 0.82; typical RD -0.03, 95% CI -0.05 to -0.01; NNTB 33, 95% CI 20 to 100). We graded evidence quality as moderate (unblinded studies) or low (imprecision) for secondary outcomes.
Implications for practice NIPPV reduces the incidence of extubation failure and the need for re-intubation within 48 hours to one week more effectively than NCPAP; however, it has no effect on chronic lung disease nor on mortality. Synchronisation may be important in delivering effective NIPPV. The device used to deliver NIPPV may be important; however, data are insufficient to support strong conclusions. NIPPV does not appear to be associated with increased gastrointestinal side effects. Implications for research Large trials should establish the impact of synchronisation of NIPPV on safety and efficacy of the technique and should compare the efficacy of bilevel devices versus a ventilator for providing NIPPV.
To review the literature on moral distress experienced by nursing and medical professionals within neonatal intensive care units (NICUs) and paediatric intensive care units (PICUs).
Pubmed, EBSCO ...(Academic Search Complete, CINAHL and Medline) and Scopus were searched using the terms neonat*, infant*, pediatric*, prematur* or preterm AND (moral distress OR moral responsibility OR moral dilemma OR conscience OR ethical confrontation) AND intensive care.
13 studies on moral distress published between January 1985 and March 2015 met our inclusion criteria. Fewer than half of those studies (6) were multidisciplinary, with a predominance of nursing staff responses across all studies. The most common themes identified were overly 'burdensome' and disproportionate use of technology perceived not to be in a patient's best interest, and powerlessness to act. Concepts of moral distress are expressed differently within nursing and medical literature. In nursing literature, nurses are often portrayed as victims, with physicians seen as the perpetrators instigating 'aggressive care'. Within medical literature moral distress is described in terms of dilemmas or ethical confrontations.
Moral distress affects the care of patients in the NICU and PICU. Empirical data on multidisciplinary populations remain sparse, with inconsistent definitions and predominantly small sample sizes limiting generalisability of studies. Longitudinal data reflecting the views of all stakeholders, including parents, are required.
Persistent patent ductus arteriosus (PDA) is associated with mortality and morbidity in preterm infants. Prostaglandin synthetase inhibitors such as indomethacin promote PDA closure but also have ...potential side effects. The effect of the prophylactic use of indomethacin, where infants who may not have gone on to develop a symptomatic PDA would be exposed to indomethacin, warrants particular scrutiny.
To determine the effect of prophylactic indomethacin on mortality and morbidity in preterm infants.
The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 5, 2010), MEDLINE, EMBASE and CINAHL (until April 2010), conference proceedings, and previous reviews.
Randomised or quasi-randomised controlled trials that compared prophylactic indomethacin versus placebo or no drug in preterm infants.
The standard methods of the Cochrane Neonatal Review Group were used, with separate evaluation of trial quality and data extraction by two review authors.
Nineteen eligible trials in which 2872 infants participated were identified. Most participants were very low birth weight, but the largest single trial restricted participation to extremely low birth weight infants (N = 1202). The trials were generally of good quality.The incidence of symptomatic PDA typical relative risk (RR) 0.44, 95% confidence interval (CI) 0.38 to 0.50 and PDA surgical ligation (typical RR 0.51, 95% CI 0.37,0.71) was significantly lower in treated infants. Prophylactic indomethacin also significantly reduced the incidence of severe intraventricular haemorrhage (typical RR 0.66, 95% CI 0.53 to 0.82). Meta-analyses found no evidence of an effect on mortality (typical RR 0.96, 95% CI 0.81 to 1.12) or on a composite of death or severe neurodevelopmental disability assessed at 18 to 36 months old (typical RR 1.02, 95% CI 0.90, 1.15).
Prophylactic indomethacin has short-term benefits for preterm infants including a reduction in the incidence of symptomatic PDA, PDA surgical ligation, and severe intraventricular haemorrhage. However, there is no evidence of effect on mortality or neurodevelopment.
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