bluuebunny/crossref_metadata_2025 huggingface dataset:
The association between time to disposition plan in the emergency department and in‐hospital mortality of general medical patients
Authors: Mitra B. , Cameron P. A. , Archer P. , Bailey M. , Pielage P. , Mele G. , Smit D. V. , Newnham H.
Published: April 2011

Background:  A perceived risk of time‐limited emergency department (ED) assessment of patients is inadequate workup leading to inappropriate disposition. The aim of this study was to examine the association of time to disposition plan (TDP) on ED length of stay (LOS) and correlate this to mortality.

Methods:  A retrospective review of data collected from ED information systems at three hospitals was conducted between June 2008 and October 2009. Included patients were admitted to a general medical unit. Patients were excluded if admitted to intensive care, coronary care, a cardiac monitored bed or required surgery in first 24 h or had an expected LOS of <48 h. Multivariate regression analysis was used to identify independent associations with mortality.

Results:  A total of 10 107 patient episodes was analysed, of which 6768 patients (67.0%) had an ED LOS of ≥8 h. There was significant effect modification by ED LOS in the association of TDP and mortality. In the setting of longer ED LOS, a TDP of <4 h was associated with significantly higher mortality (OR 1.57, 95% CI: 1.28–1.92, P < 0.001), corrected for age, gender and triage category. This association was not significant when ED LOS was <8 h (OR 0.88, 95% CI: 0.60–1.27, P= 0.49).

Conclusions:  In the setting of prolonged ED LOS, completing ED assessment and management within 4 h of presentation was associated with significantly higher mortality. Further prospective studies are required to understand the relationship between rapid decision making in the ED and patient safety.
On How Firms Located in an Industrial District Profit from Knowledge Spillovers: Adoption of an Organic Structure and Innovation Capabilities
Authors: Camisón César , Villar‐López Ana
Published: April 2011

The canonical approach argues that firms located in industrial districts enjoy advantages for both innovation and performance as a consequence of the exceptionally strong knowledge spillovers that flow freely and spontaneously within them. However, diffusion of shared competences is not as easy and free as postulated in the literature. Using the resource‐based view, we study whether clustered firms perform better than non‐clustered firms, by providing empirical evidence that location of firms in an industrial district does not directly create innovation capabilities or economic rents. This research question is important because it enables us to better understand how firms benefit from this external knowledge flow, both to create advantages in technological innovation and to obtain superior organizational performance. To stand out in capabilities that are often localized at the centre of the same industrial district, a firm needs to develop a learning internal micro‐environment capable of better absorbing localized knowledge spillovers. In particular, the organic form is revealed as a configuration well suited to combining structural flexibility with the productive flexibility offered by the district and to strengthening technological innovation capabilities, thus improving organizational performance.
Business statistics at the top 50 US business programmes
Authors: Haskin Heather N. , Krehbiel Timothy C.
Published: April 2011

We surveyed fifty leading undergraduate business schools concerning their statistics requirements. We report on many aspects including credit‐hours required, topics covered, computer integration, faculty background, teaching pedagogy, textbooks, and recent and proposed changes.
Decoding codewords: statistical analysis of a newspaper puzzle
Authors: Meacock Susan , Meacock Geoff
Published: April 2011

This article presents various statistical analyses of a type of word puzzle common in English newspapers.
Putting Cognitive Science Behind a Statistics Teacher's Intuition
Authors: Jones Karrie A. , Jones Jennifer L. , Vermette Paul J.
Published: April 2011

Recent advances in cognitive science have led to an enriched understanding of how people learn. Using a framework presented by Willingham, this article examines instructional best practice from the perspective of conceptual understanding and its implications on statistics education.
Strategies for improving the quality of care in psoriasis with the use of treatment goals – a report on an implementation meeting
Authors: Mrowietz U , Kragballe K , Nast A , Reich K
Published: April 2011

Targeted treatment, early intervention and the use of treatment goals is a new approach in medicine that has been implemented across several disciplines (e.g. diabetes, pulmonary arterial hypertension and rheumatoid arthritis) over the last 5–10 years. As in other chronic diseases, well‐defined treatment goals may be helpful in guiding physicians in their care of patients with psoriasis, thereby obviating poor outcomes. Individual treatment goals were recently developed for the first time in psoriasis by a European Consensus group of experts from 19 European countries to supplement guidelines and promote the consistent use of available therapies to improve patient care. Goal‐oriented therapy involves treating according to a treatment algorithm, regularly monitoring therapeutic response and prompt modification of therapy if goals are not met. In the absence of hard outcomes in psoriasis (e.g. biomarkers or biomedical predictors of clinical response), the European Consensus group based their treatment goals on changes in Psoriasis Area Severity Index and Dermatology Life Quality Index scores. Further evidence generation is important to determine whether surrogate markers for disease progression (e.g. co‐morbidities) or predictors of clinical response can be identified for psoriasis. Furthermore, psoriasis may have a potential cumulative effect on the life course of patients, the understanding of which is likely to provide the rationale for earlier treatment strategies in psoriasis. For the work of the European Consensus group to have an impact on clinical care, transmission of treatment goals into guidelines, along with implementation of treatment goals at both the regional and national level is needed. Thus, dermatology experts from Europe, the Middle East, Australia and Canada gathered in Frankfurt, 2010, for a 1.5 day educational meeting run by the Progressive Psoriasis Initiative to discuss how treatment goals in psoriasis might best be implemented in clinical practice. The meeting conclusions are presented here.
Stock Market Driven Acquisitions versus the Q Theory of Takeovers: The UK Evidence
Authors: Bi Xiao Gang , Gregory Alan
Published: April 2011

Abstract: Using a sample of UK mergers and acquisitions from 1985–2004, we show that equity over‐valuation appears to play an important role in the determination of financing method. Our results are broadly consistent with those theories based upon market over‐valuation driving mergers and their financing, rather than a Q‐theory explanation. In some contrast to the US results ofDong et al. (2006)we find that proxies for over‐valuation appear to be the more persuasive explanation for acquisition financing behaviour in the UK. Given the evidence in favour of valuation effects, we argue that a treatment effects model is necessary in investigating the long‐run performance of acquirers. Taken together with results from a univariate analysis, such a model reveals some modest support for theShleifer and Vishny (2003)hypothesis.
Improving Communication in Crisis Management by Evaluating the Relevance of Messages
Authors: Netten Niels , van Someren Maarten
Published: April 2011

Efficient communication is a major challenge for emergency responders during crisis management. Reports show that missing information and information overload are important factors that determine the success of crisis management. We propose a method as basis for a software system that improves text or voice‐based communication. Communication is split into segments and the system determines from the content of the communication, the tasks of actors and their locations for which responders in the crisis the information is relevant. The system is tested on data recorded at a fire fighting disaster management exercise and found to be accurate enough to be useful.
Influence of Federal Disaster Assistance on Family Business Survival and Success
Authors: Haynes George W. , Danes Sharon M. , Stafford Kathryn
Published: April 2011

This study examines the impact of federal disaster assistance on the survival and success of small family‐owned businesses with fewer than 500 employees from 1996 to 1999. Small family‐owned business owners were defined as those who had been in business at least a year, had spent a least 6 hours a week or a minimum of 312 hours annually working in the business, had lived with at least one family member and had fewer than 500 employees. This study suggests firms located in counties receiving more disaster assistance are not more likely to survive, however these firms are more likely to realize positive changes in revenue than firms located in counties receiving less disaster assistance. Businesses located in an economically vulnerable rural county, those engaged in family to business resource intermingling and those transferring more business income to the household were more likely to survive. Larger businesses, those headed by women and those transferring more income from the business to the family were most likely to succeed.
Presence‐only versus presence–absence data in species composition determinant analyses
Authors: Kent Rafi , Carmel Yohay
Published: April 2011

Aim  Studying relationships between species and their physical environment requires species distribution data, ideally based on presence–absence (P–A) data derived from surveys. Such data are limited in their spatial extent. Presence‐only (P‐O) data are considered inappropriate for such analyses. Our aim was to evaluate whether such data may be used when considering a multitude of species over a large spatial extent, in order to analyse the relationships between environmental factors and species composition.

Location  The study was conducted in virtual space. However, geographic origin of the data used is the contiguous USA.

Methods  We created distribution maps for 50 virtual species based on actual environmental conditions in the study. Sampling locations were based on true observations from the Global Biodiversity Information Facility. We produced P–A data by selecting ∼1000 random locations and recorded the presence/absence of all species. We produced two P‐O data sets. Full P‐O set was produced by sampling the species in locations of true occurrences of species. Partial P‐O was a subset of full P‐O data set matching the size of the P–A data set. For each data set, we recorded the environmental variables at the same locations. We used CCA to evaluate the amount of variance in species composition explained by each variable. We evaluated the bias in the data set by calculating the deviation of average values of the environmental variables in sampled locations compared to the entire area.

Results  P–A and P‐O data sets were similar in terms of the amount of variance explained by the different environmental variables. We found sizable environmental and spatial bias in the P‐O data set, compared to the entire study area.

Main conclusions  Our results suggest that although P‐O data from collections contain bias, the multitude of species, and thus the relatively large amount of information in the data, allow the use of P‐O data for analysing environmental determinants of species composition.
Adaptive gait changes in older people due to lens magnification
Authors: Chapman Graham J , Scally Andy J , Elliott David B
Published: April 2011

Citation information: Chapman GJ, Scally AJ & Elliott DB. Adaptive gait changes in older people due to lens magnification. Ophthalmic Physiol Opt 2011, 31, 311–317 doi: 10.1111/j.1475‐1313.2010.00807.x

Purpose:  Intervention trials that reduce visual impairment in older adults have not produced the expected improvements in reducing falls rate. We hypothesised that this may be caused by adaptation problems in older adults due to changes in magnification provided by new spectacles and cataract surgery. This study assessed the effects of ocular magnification on adaptive gait in young and older adults.

Methods:  Adaptive gait was measured in 10 young (mean age 22.3 ± 4.6 years) and 10 older adults (mean age 74.2 ± 4.3 years) with the participants’ habitual refractive correction (0%) and with size lenses producing ocular magnification of ±1%, ±2%, ±3%, and ±5%. Adaptive gait parameters were measured when participants approached and stepped up onto a raised surface.

Results:  Adaptive gait changes in the young and older age groups were similar. Increasing amounts of magnification (+1% to +5%) led to an increased distance of the feet from the raised surface, increased vertical toe clearance and reduced distance of the lead heel position on the raised surface (p < 0.0001). Increasing amounts of minification (−1% to −5%) led to the opposite of these changes (p < 0.0001). Adaptation to ocular magnification did not occur in the short term in young or older adults.

Conclusion:  The observed adaptive gait changes were driven by the magnification changes provided by the size lenses. The raised surface appeared closer and larger with magnification and further away and smaller with minification and gait was adjusted accordingly. Magnification may explain the mobility problems some older adults have with updated spectacles and after cataract surgery.
An exploratory study of visual search performance in glaucoma
Authors: Smith Nicholas D , Crabb David P , Garway‐Heath David F
Published: April 2011

Citation information: Smith ND, Crabb DP & Garway‐Heath DF. An exploratory study of visual search performance in glaucoma. Ophthalmic Physiol Opt 2011, 31, 225–232. doi: 10.1111/j.1475‐1313.2011.00836.x

Purpose:  Visual search plays an integral role in many daily activities. This study aimed to determine whether patients with glaucoma are slower than visually healthy age‐matched individuals when searching for items in computer displayed images.

Methods:  Forty participants were recruited for the study: 20 patients with a clinical diagnosis of glaucoma and 20 age‐similar visually healthy control subjects. All participants had visual acuity of 6/12 or better. Participants were presented with 20 images with Landolt C symbols and 15 photographic images of everyday scenes on a computer. The time taken by each participant to locate a specified item in each image was recorded. Average search times were calculated across participants and compared between groups.

Results:  All the patients had visual field defects in both eyes. On average, the patients also differed from control subjects by binocular contrast sensitivity measurements (p = 0.01) and visual acuity (p = 0.003). The patients (mean age = 67 years, S.D.: 10 years) and controls (mean age: 67 years, S.D.: 11 years) were age similar (p = 0.40). The median search time for patients finding target items in photographs of everyday scenes was 15.2 s (interquartile range 9.4–20.6 s) and this was significantly slower than the median time (10.0 s; interquartile range 7.2–10.3 s) taken by the controls (p = 0.007). There was no statistical evidence for a difference in median search times between groups in the Landolt C search task (p = 0.24).

Conclusion:  Some individuals with glaucomatous visual field defects in both eyes find it especially difficult to locate objects in photographs of everyday scenes when compared to visually healthy individuals of a similar age.
Circulating apoptotic and necrotic cell death markers in patients with acute liver injury
Authors: Craig Darren G. N. , Lee Patricia , Pryde Elizabeth A. , Masterton Gail S. , Hayes Peter C. , Simpson Kenneth J.
Published: April 2011

Background: The host response to cell death underpins the immune activation that follows acute liver injury, and measurement of circulating cell death markers could therefore aid prognostication following paracetamol overdose. Nucleosomes, formed during apoptosis, can complex with high‐mobility group box 1 (HMGB1) protein and may play a pathogenic role in liver injury.

Aims: To explore the levels and prognostic significance of nucleosomes, HMGB1, and other cell death markers following acute liver injury.

Methods: Levels of plasma nucleosomes, HMGB1, caspase‐cleaved cytokeratin‐18 (M30) and total cytokeratin‐18 (M65) were measured by immunoassay, in a cohort of 33 patients with paracetamol‐ and non‐paracetamol‐induced acute liver injury.

Results: Admission nucleosome levels in paracetamol overdose patients were significantly higher than in chronic liver disease and healthy control subjects, but were similar in paracetamol and non‐paracetamol patients (P=0.11). Nucleosome levels were not associated with death or requirement for liver transplantation, fulfillment of poor prognostic criteria or organ failure in paracetamol patients. Nucleosome levels correlated with levels of HMGB1 (r=0.500, P=0.009), alanine aminotransferase (r=0.410, P=0.038) and M65 (r=0.709, P<0.001), but not with M30 (r=0.309, P=0.124). None of the cell death markers analysed improved prognostication in paracetamol patients beyond the King's College criteria.

Conclusions: Plasma nucleosomes are significantly elevated following acute liver injury. Neither apoptotic nor necrotic cell death markers accurately predict survival following paracetamol‐induced hepatotoxicity, suggesting that the extent and type of cell death play a limited role in determining outcome.
Four new species of Scythrididae (Lepidoptera: Gelechioidea) from Irano–Turanian area, with notes on taxonomy and distribution
Authors: PASSERIN D'ENTRÈVES Pietro , ROGGERO Angela
Published: April 2011

Four new scythridid species are described: Scythris kabulella sp. nov. and S. claudiae sp. nov. from Afghanistan, S. alborzensis sp. nov. from Iran and S. bifasciella sp. nov. from Iran and Turkey. Scythris kabulella is closely related to S. bagdadiella Amsel, 1949 and is assigned to the S. bagdadiella species group because of its genital features. Scythris claudiae is also assigned to Scythris pascuella species group due to its genital features. At present, S. alborzensis and S. bifasciella could not be assigned to any known species group.
Hepatitis B and residual risk of infection in English and Welsh blood donors, 1996 through 2008
Authors: Brant Lisa J. , Reynolds Claire , Byrne Lisa , Davison Katy L.
Published: April 2011

BACKGROUND: Globally, of all infections that donations are tested for, hepatitis B has the highest residual risk of transfusion transmission, despite donor selection criteria and advances in testing. Every blood donation in England and Wales is tested for hepatitis B surface antigen. Knowledge of infections being detected can inform donor selection and testing strategies.

STUDY DESIGN AND METHODS: Data on donation testing and infections detected are collated by the NHS Blood and Transplant and Health Protection Agency Epidemiology Unit. Infected donors are classified as having acute or chronic hepatitis B virus (HBV) by a clinician; their demographic characteristics were described. The prevalence (by acute or chronic HBV status, ethnicity, and geography) and incidence of infection were calculated between 1996 and 2008. The residual risk was calculated for four periods using a modification of the incidence and window period model; the effects of modifying variables were investigated.

RESULTS: Most infections (1047/1155) detected were chronic and seen in new donors. People with acute infections were more likely to be white and/or born in Western Europe. Prevalence was highest in donors from minority ethnic communities and in London. Incidence in repeat donors has halved in recent years. The estimated frequency of an infectious donation being missed was 1.37 per million donations (2006‐2008), the lowest since surveillance began or three per year.

CONCLUSION: Many HBV infections in England and Wales were detected among new donors, who had chronic infection and were born overseas. The residual risk of infection declined over the 13 study years, but is still higher for HBV than other viral infections for which testing is undertaken.
The appropriateness of red blood cell use and the extent of overtransfusion: right decision? Right amount?
Authors: Barr Paul J. , Donnelly Michael , Cardwell Chris R. , Parker Michael , Morris Kieran , Bailie Karen E.M.
Published: April 2011

BACKGROUND: Shrinkage of the donor pool coupled with an increasing demand for blood presents a major challenge to maintaining an adequate blood supply. Consequently it has become even more important to reduce inappropriate blood use, including decisions about when and how much blood to prescribe. This study aimed to ascertain the levels of inappropriate practice and factors associated with it.

STUDY DESIGN AND METHODS: The medical records of a randomly selected sample of hospital patients in Northern Ireland who received a red blood cell transfusion during 2005 (n = 1474) were reviewed, and inappropriate transfusion and overtransfusion criteria were applied. Logistic regression models were used to identify factors associated with inappropriate practice and overtransfusion.

RESULTS: In this study 23% of transfusions were considered inappropriate, occurring most commonly where the lowest hemoglobin (Hb) threshold for transfusion applied. Younger patients, those undergoing surgery, and those with lower comorbidity and higher Hb values were most likely to have an inappropriate transfusion. Among patients appropriately transfused, 19% were overtransfused. Females and those of lower weight (<65 kg) were most likely to be overtransfused.

CONCLUSION: While the choice of criteria used to judge decisions will influence the absolute level of inappropriate or overtransfusion reported, our findings suggest that a significant minority of clinicians are either unaware of or are reluctant to accept lower transfusion thresholds. To improve further improve transfusion practice we suggest that barriers to the implementation of recommended transfusion thresholds should be examined and guidance on an appropriate posttransfusion Hb level developed.
Mean‐Deviation Analysis in the Theory of Choice
Authors: Grechuk Bogdan , Molyboha Anton , Zabarankin Michael
Published: April 2011

Mean‐deviation analysis, along with the existing theories of coherent risk measures and dual utility, is examined in the context of the theory of choice under uncertainty, which studies rational preference relations for random outcomes based on different sets of axioms such as transitivity, monotonicity, continuity, etc. An axiomatic foundation of the theory of coherent risk measures is obtained as a relaxation of the axioms of the dual utility theory, and a further relaxation of the axioms are shown to lead to the mean‐deviation analysis. Paradoxes arising from the sets of axioms corresponding to these theories and their possible resolutions are discussed, and application of the mean‐deviation analysis to optimal risk sharing and portfolio selection in the context of rational choice is considered.
Intrathoracic Impedance and Ultrasound Lung Comets in Heart Failure Deterioration Monitoring
Authors: MAINES MASSIMILIANO , CATANZARITI DOMENICO , ANGHEBEN CARLO , VALSECCHI SERGIO , COMISSO JENNIFER , VERGARA GIUSEPPE
Published: April 2011

Purpose: Echographic examination of the lung surface may reveal multiple ultrasound lung comets (ULCs) originating from water‐thickened interlobular septa. These images were demonstrated to be useful for noninvasive assessment of interstitial pulmonary edema. Similarly, the correlation between implantable defibrillator‐measured intrathoracic impedance and pulmonary capillary wedge pressure (PCWP) was demonstrated in heart failure (HF) patients. The aims of this analysis were to assess the agreement between defibrillator‐detected impedance decrease and the presence of ULCs, as well as to compare the performance of the impedance‐detection algorithm and the ULCs assessment in predicting HF worsening.

Methods and Results: We studied 23 HF patients implanted with a defibrillator capable of intrathoracic impedance measurement and alerting for fluid accumulation diagnosis. At regular follow‐up and at visits for HF decompensation or device alert, clinical status was assessed, chest ultrasound was performed, and PCWP was noninvasively estimated with Doppler echocardiography. During 23 ± 11 months of follow‐up, 45 paired assessments of defibrillator‐measured intrathoracic impedance and ULCs were performed. The number of ULCs resulted significantly correlated to the paired PCWP estimations (r = 0.917, P < 0.001) and to the impedance fluid index (r = 0.669, P < 0.001). During follow‐up, 12 episodes of HF decompensation were reported in 12 patients. The impedance alert detected clinical HF deterioration with 92% sensitivity and 69% positive predictive value. The presence of ≥5 ULCs showed 83% sensitivity and 91% positive predictive value.

Conclusions: These data demonstrate the correlation between intrathoracic impedance and the number of ULCs at chest ultrasound, and a good agreement between the defibrillator warning for fluid index and the detection of multiple ULCs. (PACE 2011; 34:968–974)
Influence of Pb(In1/2Nb1/2)O3 on the Phase Transitions, Electrical, and Thermal Properties of a PbZrO3 Ceramic
Authors: Sukkha Usa , Muanghlua Rangson , Niemcharoen Surasak , Boonchom Banjong , Vittayakorn Naratip
Published: April 2011

The solid solution of a (1−x)PbZrO3–xPb(In1/2Nb1/2)O3 (PZ–PIN) system, with x=0.00–0.50, was synthesized using the wolframite precursor method. The effects of the PIN content on the crystal structure, and the electrical and thermal properties of a PbZrO3 ceramic were investigated using X‐ray diffraction, dielectric spectroscopy, hysteresis measurement, and differential scanning calorimetry techniques. Furthermore, the morphology and grain size were determined using scanning electron microscopy. The results indicated that the pure perovskite phase was obtained for all compositions, and the solid solution, PZ–PIN, changed from orthorhombic to rhombohedral symmetry when the amount of PIN increased. A ferroelectric intermediate phase began to appear between the paraelectric and the antiferroelectric phases of pure PZ, with increasing PIN content. The temperature range width of the ferroelectric phase also increased continuously with increasing PIN. At room temperature, the polymorphic phase transition (PPT) was identified from the orthorhombic to the rhombohedral phase in (1−x)PZ–xPIN at the composition, x=0.40. The ceramics (x=0.40) with PPT close to room temperature exhibited excellent electrical properties (ɛrmax=33240 and Pr=26.94 μC/cm2).
GaPO4–EuPO4 System in NanoSize Dimensions: An Investigation Based on Luminescence and 31P Magic Angle Spinning Nuclear Magnetic Resonance Techniques
Authors: Naidu Boddu S. , Vishwanadh Bathula , Sudarsan Vasanthakumaran , Vatsa Rajesh K.
Published: April 2011

GaPO4 nanoparticles having hexagonal structure with different amounts of Eu3+ ions were prepared at 130°C based on precipitation method in glycerol medium. The interaction between GaPO4 nanoparticles and Eu3+ ions has been investigated using Eu3+ luminescence and 31P magic angle spinning nuclear magnetic resonance (MAS NMR) techniques. Based on these studies, it is established that Eu3+ ions up to 2.5 at.% replace the protons of the hydroxyl groups attached on Ga3+ ions present on the surface of the nanoparticles and above 2.5 at.%, a separate EuPO4 phase is formed. The anisotropy parameters derived from the side band intensities of the 31P MAS NMR patterns from these samples confirmed the surface ion exchange at low Eu3+ concentration (2.5 at.%) and EuPO4 phase formation at high Eu3+ concentration (5 at.% and more). The increase in anisotropy at high Eu3+ contents has been attributed to the presence of paramagnetic EuPO4 phase.
Hydrothermal Synthesis and White Luminescence of Dy3+‐Doped NaYF4 Microcrystals
Authors: Cao Chunyan , Yang Hyun Kyoung , Chung Jong Won , Moon Byung Kee , Choi Byung Chun , Jeong Jung Hyun , Kim Kwang Ho
Published: April 2011

2 mol% Dy3+‐doped NaYF4 microcrystals with different morphologies and crystalline phases have been synthesized through a hydrothermal method without assistance of any surfactant, catalyst, or template by controlling reaction temperatures, reaction time, and molar ratios of reactants. For comparison, the samples were also synthesized by a direct coprecipitation method. The final products were characterized by X‐ray diffraction, field emission scanning electron microscopy, photoluminescence excitation and emission spectra, and luminescent dynamic decay curves. Dy3+ exhibits bright white light under near ultraviolet 350 or 351 nm excitation and the white light was evaluated by chromaticity coordinates. The experimental results suggest that the obtained Dy3+‐doped NaYF4 microcrystals have potential applications in white light materials.
Alterations in Surgical Plan Based on Intraoperative Portable Head Computed Tomography Imaging
Authors: Carlson Andrew P. , Phelps Jeremy , Yonas Howard
Published: April 2011

BACKGROUND

Intraoperative imaging offers potential for utility in many clinical scenarios. Portable computed tomography (CT) offers a versatile potential alternative when immediate imaging may alter the surgical plan and magnetic resonance imaging is not practical.

METHODS

The medical records from the University or New Mexico were reviewed for portable head CT scans done in the operating room since the scanner has been available. Operative reports and imaging studies were reviewed to determine changes in surgical decision after the CT scan.

FINDINGS

The portable head CT scanner was used in 50 cases from May 2007 through March 2010. Average operative time overall was 121 minutes and for reservoir placement was 54 minutes. Procedures included reservoir placement (28%), tumor resection (24%), cerebrospinal fluid shunting (24%), vascular lesion resection (8%), trauma craniotomy (6%), abscess drainage (4%), stereotactic biopsy (4%), and open reduction internal fixation of facial fractures (2%). Findings on the CT scan lead to alterations in the surgical plan 16 times (32%).

CONCLUSION

In select cases, intraoperative portable head CT leads to changes in the surgical plan in 32% of cases. This potentially prevents a return to the operating room and offers a cost‐effective alternative to fixed intraoperative imaging facilities.
Decreased need for emergency services after changing management for suspected miscarriage
Authors: ADOLFSSON ANNSOFIE , TULLANDER‐TJÖRNSTRAND KARIN , LARSSON PER‐GÖRAN
Published: April 2011

We investigated the effect of a changed routine to identify women with a nonviable pregnancy, in order to utilize health care resources more efficiently during office hours rather than relying on emergency care services. From hospital register data about where and when women with miscarriages were treated, there was a significant trend during a nine‐year period for miscarriages to be more rarely diagnosed (p‐value<0.001) in the emergency ward after office hours. The proportion of miscarriages that were diagnosed and handled at the emergency ward decreased from 31% in 2001 to 17% in 2009. Furthermore, the number of women showing up with bleeding at the emergency ward, but who also had a normal viable pregnancy, declined during the same period (p‐value<0.01). Women with suspected miscarriage benefit from structured information and standardized management and can effectively be scheduled for day‐time assessment including ultrasound with a concomitant reduced need for emergency services.
Marathon of eponyms: 18 Robin sequence
Authors: Scully C , Langdon J , Evans J
Published: April 2011

Oral Diseases (2011) 17, 443–444

The use of eponyms has long been contentious, but many remain in common use, as discussed elsewhere (Editorial: Oral Diseases. 2009: 15; 185). The use of eponyms in diseases of the head and neck is found mainly in specialties dealing with medically compromised individuals (paediatric dentistry, special care dentistry, oral and maxillofacial medicine, oral and maxillofacial pathology, oral and maxillofacial radiology and oral and maxillofacial surgery) and particularly by hospital‐centred practitioners. This series has selected some of the more recognized relevant eponymous conditions and presents them alphabetically. The information is based largely on data available from MEDLINE and a number of internet websites as noted below: the authors would welcome any corrections. This document summarizes data about Robin sequence.
The antimicrobial efficacy of a silver alginate dressing against a broad spectrum of clinically relevant wound isolates
Authors: Percival Steven L , Slone Will , Linton Sara , Okel Tyler , Corum Linda , Thomas John G
Published: April 2011

Wound dressings impregnated with silver have a role to play in aiding to reduce both the dressing and wound microbial bioburden. It is therefore imperative that antimicrobial wound dressings have efficacy on a broad range of clinical significant microorganisms. Accordingly, this study aimed to determine the antimicrobial efficacy of a silver alginate dressing against 115 wound isolates that had been isolated routinely from patients at West Virginia University Hospital. Standardised corrected zones of inhibition (CZOIs) were performed on all clinical isolates. It was found that the silver alginate dressing was able to inhibit the growth of all microorganisms tested. In particular, the silver alginate dressing inhibited the growth of Candida albicans and yeasts with CZOI of 3–11·5 mm. All meticillin‐resistant Staphylococcus aureus (MRSA) strains were found to be sensitive to the silver alginate dressing with a CZOI range calculated at 3–7·8 mm. Sensitivity to the silver alginate dressing was also evident for S. aureus and vancomycin‐resistant Enterococci. CZOIs of 4·25 mm were calculated for Enterococcus faecium and 9·8 mm for viridans streptococcus. The bacteria which demonstrated the highest tolerance to ionic silver included Enterobacter cloacae and Acinetobacter baumannii. Contrary to this the most responsive microorganisms to ionic silver included strains of staphylococci, viridans streptococcus and Candida albicans. No antibiotic‐resistant isolates, as identified by Kirby Bauer Clinical Laboratory Standards Institute classification system, were found to be resistant to ionic silver. When a selected number of microorganisms were grown in the biofilm phenotypic state enhanced tolerance to silver was observed, compared to their non biofilm counterparts. Overall, this study has demonstrated the broad antimicrobial activity of a silver alginate dressing on wound isolates grown in the non biofilm and biofilm state. This finding is clinically relevant as both the non biofilm and biofilm phenotypic states of microorganisms are evident in wounds and therefore significant to delayed healing. Consequently, it is imperative that antimicrobial wound dressings demonstrate antimicrobial activity against microorganisms in both phenotypic states.
Review article: Resources for the management of ocular emergencies in Australia
Authors: O'Connor Patricia M , Crock Carmel T , Dhillon Rana S , Keeffe Jill E
Published: April 2011

The aim of the present paper is to assess the practical utility of the most common print resources used by practitioners in the management of ocular emergencies. Ten print resources were identified for review (three specialty eye texts, six general emergency medicine texts and one general practice text). The main outcome measures used were the extent a text matched crucial skills criteria in clinical assessment and treatment, and usability. No single print resource addressed all criteria. Red flag systems for clinical assessment and ease of navigation were the best match areas. Only one text inadequately stressed red flag conditions and one text was not ranked as easy to navigate. All texts made assumptions regarding the knowledge/skill level of practitioners, particularly in relation to eye examination procedures and treatment. Photographs ranged in number from 8 to 1500; 3/10 texts provided no photographs. Five texts included detailed instructions on the indications and urgency of referral and follow up for all conditions covered. The remainder lacked details. Only one text used the Australasian Triage Scale. Three texts included photographs/diagrams and instructions for the slit lamp and ophthalmoscope. None covered all procedures specified in the criteria. Only two reflected drug current practice in Australia and provided adequate details on usage. A single comprehensive reference (print and/or web‐based) for dealing with ocular emergencies in Australia is clearly needed. Additionally, training and confidence levels of eye care providers must be addressed so that the risk of misdiagnosis and mismanagement of eye emergencies is reduced.
Evaluating a Continuous Medical Education Program to Improve General Practitioners Awareness and Practice on Erectile Dysfunction as a Cardiovascular Risk Factor
Authors: Mas Manuel , García-Giralda Luís , Rey Juan Ramón , Martínez-Salamanca Juan Ignacio , Guirao Lorenzo , Turbí Carmen
Published: April 2011

Introduction

The clear link between erectile dysfunction (ED) and cardiovascular disease (CVD) together with the increased potential for effectively treating ED with oral pharmacological agents make the primary care setting the ideal place to detect and treat ED and its potential comorbidities. Given the observed shortcomings in knowledge related to ED among primary care physicians, continuous medical education (CME) on this topic stands out as a potentially effective way to improve patient care.

Aim

To assess general practitioners' (GPs) knowledge, attitudes, and self-confidence about ED management and the relationship between ED and CVD and to test whether these can be improved by means of a brief training program.

Methods

Eighty GPs completed two similar questionnaires on ED issues, one prior to a CME intervention and one following it. The CME program consisted of reading an annotated set of four review articles and six research articles followed by a live half-day seminar conducted by a GP, a urologist, and a cardiologist.

Main Outcome Measures

Changes in the answers to the two questionnaires were evaluated by tests for matched pairs using both statistical significance and effect size estimates, and assessment of different predictors were evaluated by multivariate analysis.

Results

A marked improvement was observed in physician knowledge, attitudes, and self-confidence with regard to diagnosing and treating ED following the CME training intervention.

Conclusions

The present study shows that a relatively simple educational procedure can substantially improve the awareness of primary care physicians about the cardiovascular implications of ED and their self confidence in the management of these patients.
Different Treatment Modalities for Refractory Vaginismus in Western Saudi Arabia
Authors: Fageeh Wafa M.K.
Published: April 2011

Introduction

Although vaginismus is a common sexual dysfunction in Saudi Arabia, there are limited data concerning the treatment modalities associated with patients with symptoms of vaginismus.

Aim

This study is aimed to evaluate the presentation and different modalities of management in patients with severe refractory vaginismus in western Saudi Arabia.

Main Outcome Measures

Successful penetrative sexual intercourse suggesting that common elements of the therapies used were successful.

Methods

A retrospective study of patients presenting with severe refractory vaginismus treated in Jeddah, Saudi Arabia. The subjects were 15 women with third to fourth degree vaginismus who presented to King Abdulazziz University Hospital between January 1, 2008 and January 1, 2009.

Results

The mean age of the participants was 23 years. The mean duration of marriage before seeking medical advice was 12 months. Six patients had undergone conventional therapy successfully. The other six cases, four of which had a previous history of treatment failure, and two who were unresponsive to 4 months of conventional therapy were offered botulinum toxin type A. Five patients who received the Botox therapy had satisfactory intercourse on the same day of the treatment. One patient required a repeat injection after 2 months for recurrent vaginismus. Three of the 15 patients refused the treatment as they were already divorced and had only come in to exclude organic causes for their condition.

Conclusions

Vaginismus is an overlooked topic in conservative societies such as Saudi Arabia. For most patients, not knowing who to confide in or where to turn to plays a major role in the under diagnosis of vaginismus. Conventional therapy proved effective in mild and moderate cases, while botulinum toxin has a more rapid effect and was thus more effective in severe cases.
Memory in place
Authors: Hill Stephen
Published: April 2011

Geographers and psychologists both seek to understand people's behaviour and their cognitive and emotional lives so it is somewhat surprising that there has not been more theoretical cross‐fertilisation of the two disciplines. ‘On time, place and happiness’ is a rare but welcome exception, showing how research in social‐cognitive psychology might usefully clarify thinking about temporality, place and well‐being. This commentary examines several additional human memory phenomena that geographers might like to consider in their theorising about these matters.
The measurement of modern sedimentation in estuarine environments in New Zealand
Authors: Woods Josephine L. D. , Kennedy David M.
Published: April 2011

Concern about coastal sedimentation in New Zealand is widespread. As a result, many regional councils now undertake monitoring programmes to understand the rate of change that is occurring within estuarine environments. A variety of techniques are used to understand estuarine infill from short‐term (fixed rods, marker layers, laser surveying) to long‐term studies (coring). Short‐term studies provide detailed but temporally restricted data sets, while coring studies provide long‐term generalised data. This paper reviews the common methods used within New Zealand and suggests that a combination of both methods is the ideal for understanding sediment infill.
Interaction of gonadal steroids and the glucocorticoid corticosterone in the regulation of the L‐type Ca2+ current in rat left ventricular cardiomyocytes
Authors: Wagner M. , Moritz A. , Volk T.
Published: April 2011

Aim:  Gonadal steroids as well as glucocorticoids have been shown to regulate the cardiac L‐type Ca2+ current (ICaL). Herein, we compare the effects of the gonadal steroids testosterone and 17β‐estradiol with the glucocorticoid corticosterone on ICaL, and investigate the interaction between the gonadal steroids and corticosterone.

Methods:  Myocytes were isolated from the left ventricular free wall of female and male Wistar rats and investigated using the ruptured‐patch whole‐cell patch‐clamp technique.

Results:  In myocytes isolated from female rats, 24 h incubation with 100 nm testosterone led to a 33% increase in ICaL compared with control (−8.8 ± 0.5 pA pF−1, n = 25 vs. −6.6 ± 0.4 pA pF−1, n = 26, P < 0.01, VPip = 0 mV). Incubation with 1 μm corticosterone resulted in a 79% increase in ICaL (−11.8 ± 0.7 pA pF−1, n = 29, P < 0.001). However, the combination of testosterone and corticosterone did not have any additional effect compared with corticosterone alone (−11.7 ± 0.6 pA pF−1, n = 25, ns). In cardiomyocytes from male rats, ICaL was not affected by testosterone, whereas the effect of corticosterone was preserved (P < 0.05). 24 h incubation with 17β‐estradiol increased ICaL by 32% from −7.6 ± 0.5 pA pF−1 (n = 15) to 10.0 ± 0.9 pA pF−1 (n = 15, P < 0.05). 17β‐estradiol did not exert an additional effect upon co‐incubation with corticosterone and did not have an effect on ICaL in cardiomyocytes from female rats. Higher concentrations of the gonadal steroids did not result in increased effects.

Conclusion:  When compared with corticosterone, the in vitro effects of the gonadal steroids are small. However, under conditions in which ICaL is not fully activated by glucocorticoids, gonadal steroids may significantly contribute to ICaL regulation.
Mechanisms of K+ induced renal vasodilation in normo‐ and hypertensive rats in vivo
Authors: Magnusson L. , Sorensen C. M. , Braunstein T. H. , Holstein‐Rathlou N.‐H. , Salomonsson M.
Published: April 2011

Aim:  We investigated the mechanisms behind K+‐induced renal vasodilation in vivo in normotensive Sprague–Dawley (SD) rats and spontaneously hypertensive rats (SHR).

Methods:  Renal blood flow (RBF) was measured utilizing an ultrasonic Doppler flow probe. Renal vascular resistance (RVR) was calculated as the ratio of mean arterial pressure (MAP) and RBF (RVR = MAP/RBF). Test drugs were introduced directly into the renal artery. Inward rectifier K+ (Kir) channels and Na+,K+‐ATPase were blocked by Ba2+ and ouabain (estimated plasma concentrations ∼20 and ∼7 μm) respectively.

Results:  Confocal immunofluorescence microscopy demonstrated Kir 2.1 channels in pre‐glomerular vessels of SD and SHR. Ba2+ caused a transient (6–13%) increase in baseline RVR in both SD and SHR. Ouabain had a similar effect. Elevated renal plasma [K+] (∼12 mm) caused a small and sustained decrease (5–13%) in RVR in both strains. This decrease was significantly larger in SHR than in SD. The K+‐induced vasodilation was attenuated by Ba2+ in control SD and SHR and by ouabain in SD. Nitric oxide (NO) blockade using l‐NAME treatment increased MAP and decreased RBF in both rat strains, but did not affect the K+‐induced renal vasodilation.

Conclusion:  K+‐induced renal vasodilation is larger in SHR, mediated by Kir channels in SD and SHR, and in addition, by Na+,K+‐ATPase in SD. In addition, NO is not essential for K+‐induced renal vasodilation.
Detection of Viable Salmonella in Lettuce by Propidium Monoazide Real‐Time PCR
Authors: Liang Ningjian , Dong Jin , Luo Laixin , Li Yong
Published: April 2011

Abstract:  Contamination of lettuce by Salmonella has caused serious public health problems. Polymerase chain reaction (PCR) allows rapid detection of pathogenic bacteria in food, but it is inaccurate as it might amplify DNA from dead target cells as well. This study aimed to investigate the stability of DNA of dead Salmonella cells in lettuce and to develop an approach to detecting viable Salmonella in lettuce. Salmonella‐free lettuce was inoculated with heat‐killed Salmonella Typhimurium cells and stored at 4 °C. Bacterial DNA extracted from the sample was amplified by real‐time PCR targeting the invA gene. Our results indicate that DNA from the dead cells remained stable in lettuce for at least 8 d. To overcome this limitation, propidium monoazide (PMA), a dye that can selectively penetrate dead bacterial cells and cross‐link their DNA upon light exposure, was combined with real‐time PCR. Lettuce samples inoculated with different levels of dead or viable S. Typhimurium cells were treated or untreated with PMA before DNA extraction. Real‐time PCR suggests that PMA treatment effectively prevented PCR amplification from as high as 108 CFU/g dead S. Typhimurium cells in lettuce. The PMA real‐time PCR assay could detect viable Salmonella at as low as 102 CFU/mL in pure culture and 103 CFU/g in lettuce. With 12‐h enrichment, S. Typhimurium of 101 CFU/g in lettuce was detectable. In conclusion, the PMA real‐time PCR assay provides an alternative to real‐time PCR assay for accurate detection of Salmonella in food.