bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective Analysis of the Influence of Older Age on Physician and Patient Decision-Making When Considering Enrollment in Breast Cancer Clinical Trials (SWOG S0316)
Authors: Javid Sara H. , Unger Joseph M. , Gralow Julie R. , Moinpour Carol M. , Wozniak Antoinette J. , Goodwin J. Wendall , Lara Primo N. , Williams Pamela A. , Hutchins Laura F. , Gotay Carolyn C. , Albain Kathy S.
Published: June 2012

Learning Objectives

After completing this course, the reader will be able to: Cite reasons given by patients older than 65 years for their decisions to participate or not to participate in clinical trials.Cite reasons given by physicians for their decisions not to enroll patients older than 65 years in clinical trials or discuss enrollment with these patients.

CME This article is available for continuing medical education credit at CME.TheOncologist.com

Purpose.

Patients older than 65 years are underrepresented in clinical trials. We conducted a prospective study (SWOG S0316) to determine physician- and patient-perceived barriers to breast cancer clinical trial enrollment for older patients.

Methods.

Eight geographically diverse SWOG institutions participated. The study assessed patients' and physicians' decisions to enroll in or decline clinical treatment trials, including demographics, trial availability, and eligibility. Patient and physician questionnaires elicited concerns related to treatment, medical status, age, family, and financial or transportation concerns.

Results.

A total of 1,079 patients were registered and eligible and 909 (84%) returned for follow-up. The major reason for nonaccrual was either trial unavailability or ineligibility (60%). Older patients were less likely to be eligible for trials (65% for age ≥65 years vs. 78% for age <65 years). If eligible, trial participation rates did not differ significantly by age (34% for age ≥65 years vs. 40% for age <65 years). Patients ≥65 years more often were concerned about side effects, had friends opposed to participation, or believed that participation would not benefit other generations. When trials were available and patients were eligible, physicians discussed trial participation with 76% of patients <65 years versus 58% of patients ≥65 years of age. For patients ≥65 years, 11% of physicians indicated age as a reason they did not enroll a patient in a clinical trial.

Conclusion.

Trial unavailability or patient ineligibility were the major reasons for lack of enrollment in breast cancer clinical trials for patients of all ages in this prospective study. Older patients were less likely to be eligible for trials, but if eligible they participated at similar rates to younger patients.
Review and Uses of Stereotactic Body Radiation Therapy for Oligometastases
Authors: Alongi Filippo , Arcangeli Stefano , Filippi Andrea Riccardo , Ricardi Umberto , Scorsetti Marta
Published: June 2012

Learning Objectives

After completing this course, the reader will be able to: Assess stereotactic body radiation therapy (SBRT) as an emerging modality in the treatment of oligometastatic patients.Discuss data on safety and efficacy of SBRT in the oligometastatic setting.Evaluate SBRT as a competitive option in patients with a low burden of disease in the metastatic setting.

CME This article is available for continuing medical education credit at CME.TheOncologist.com

In patients with proven distant metastases from solid tumors, it has been a notion that the condition is incurable, warranting palliative care only. The term “oligometastases” was coined to refer to isolated sites of metastasis, whereby the entire burden of disease can be recognized as a finite number of discrete lesions that can be potentially cured with local therapies. Stereotactic body radiation therapy (SBRT) is a novel treatment modality in radiation oncology that delivers a very high dose of radiation to the tumor target with high precision using single or a small number of fractions. SBRT is the result of technological advances in patient and tumor immobilization, image guidance, and treatment planning and delivery. A number of studies, both retrospective and prospective, showed promising results in terms of local tumor control and, in a limited subset of patients, of survival. This article reviews the radiobiologic, technical, and clinical aspects of SBRT for various anatomical sites.
Resource unpredictability promotes species diversity and coexistence in an avian scavenger guild: a field experiment
Authors: Cortés-Avizanda A. , Jovani R. , Carrete M. , Donázar J. A.
Published: June 2012

Chance per se plays a key role in ecology and evolution, e.g., genetic mutation, resource spatiotemporal unpredictability. In community ecology, chance is recognized as a key factor in community assemblage, but less is known about its role in intraguild processes leading to species coexistence. Here we study the relevance of resource unpredictability per se as a promoter of intraguild positive interspecific interactions and as a biodiversity enhancer in an Old World avian scavenger guild, which has evolved to feed upon spatially and temporally unpredictable resources, i.e., carcasses. We performed a large‐scale field experiment in which 58 carcasses were disposed of and observed until complete consumption, either in continuously active supplementary feeding stations (predictable carcasses) or disposed of at random in the field (unpredictable carcasses). Richness of scavenger species was similar at unpredictable and predictable carcasses, but their relative abundances were highly uneven at predictable carcasses leading to higher scavenger diversity (Shannon index) at unpredictable carcasses. Facilitatory interspecific processes only occurred at unpredictable resources but were disrupted in predictable conditions because the dominant specialist species (in our case, the Griffon VultureGyps fulvus) arrived earlier and in larger numbers, monopolizing the resource. Small, endangered scavengers congregated at supplementary feeding stations but profited less compared to unpredictable carcasses, suggesting that they could constitute an ecological trap. Our findings offer new insights into the relevance of unpredictability of trophic resources in promoting both positive facilitatory interspecific interactions and species diversity and thus maintaining the function of guilds. Finally, the preservation of randomness in resource availability and the processes associated with its exploitation should be a major goal of conservation strategies aimed to preserve scavenger guilds evolved under naturally unpredictable trophic resources.
Assessing the Relationship Between Work–Family Conflict and Smoking
Authors: Nelson Candace C. , Li Yi , Sorensen Glorian , Berkman Lisa F.
Published: June 2012

Objectives. We examined the relationship between smoking and work–family conflict among a sample of New England long-term-care facility workers.

Methods. To collect data, we conducted in-person, structured interviews with workers in 4 extended-care facilities.

Results. There was a strong association between smoking likelihood and work–family conflict. Workers who experienced both stress at home from work issues (i.e., work-to-home conflict) and stress at work from personal issues (i.e., home-to-work conflict) had 3.1 times higher odds of smoking than those who did not experience these types of conflict. Workers who experienced home-to-work conflict had an odds of 2.3 compared with those who did not experience this type of conflict, and workers who experienced work-to-home conflict had an odds of 1.6 compared with workers who did not experience this type of conflict.

Conclusions. The results of this study indicate that there is a robust relationship between work–family conflict and smoking, but that this relationship is dependent upon the total amount of conflict experienced and the direction of the conflict.
Student Attitudes Toward Concealed Handguns on Campus at 2 Universities
Authors: Cavanaugh Michael R. , Bouffard Jeffrey A. , Wells William , Nobles Matt R.
Published: June 2012

We examined student support for a policy that would allow carrying of concealed handguns on university campuses. Large percentages of students at 2 universities expressed very low levels of comfort with the idea of permitting concealed handgun carrying on campus, suggesting that students may not welcome less restrictive policies. Students held slightly different opinions about concealed handguns on and off campus, suggesting that they view the campus environment as unique with respect to concealed handgun carrying.
Paid Sick Leave and Nonfatal Occupational Injuries
Authors: Asfaw Abay , Pana-Cryan Regina , Rosa Roger
Published: June 2012

Objectives. We examined the association between US workers’ access to paid sick leave and the incidence of nonfatal occupational injuries from the employer’s perspective. We also examined this association in different industries and occupations.

Methods. We developed a theoretical framework to examine the business value of offering paid sick leave. Data from the National Health Interview Survey were used to test the hypothesis that offering paid sick leave is associated with a reduced incidence of occupational injuries. We used data on approximately 38 000 working adults to estimate a multivariate model.

Results. With all other variables held constant, workers with access to paid sick leave were 28% (95% confidence interval = 0.52, 0.99) less likely than workers without access to paid sick leave to be injured. The association between the availability of paid sick leave and the incidence of occupational injuries varied across sectors and occupations, with the greatest differences occurring in high-risk sectors and occupations.

Conclusions. Our findings suggest that, similar to other investments in worker safety and health, introducing or expanding paid sick leave programs might help businesses reduce the incidence of nonfatal occupational injuries, particularly in high-risk sectors and occupations.
Prediction of ferric iron precipitation in bioleaching process using partial least squares and artificial neural network
Authors: Golmohammadi Hassan , Rashidi Abbas , Safdari Seyed
Published: June 2012

A quantitative structure-property relationship (QSPR) study based on partial
least squares (PLS) and artificial neural network (ANN) was developed for the
prediction of ferric iron precipitation in bioleaching process. The leaching
temperature, initial pH, oxidation/reduction potential (ORP), ferrous
concentration and particle size of ore were used as inputs to the network.
The output of the model was ferric iron precipitation. The optimal condition
of the neural network was obtained by adjusting various parameters by
trial-and-error. After optimization and training of the network according to
back-propagation algorithm, a 5-5-1 neural network was generated for
prediction of ferric iron precipitation. The root mean square error for the
neural network calculated ferric iron precipitation for training, prediction
and validation set are 32.860, 40.739 and 35.890, respectively, which are
smaller than those obtained by PLS model (180.972, 165.047 and 149.950,
respectively). Results obtained reveal the reliability and good predictivity
of neural network model for the prediction of ferric iron precipitation in
bioleaching process.
Kinetic behaviour of DPPH radical scavenging activity of tomato waste extracts
Authors: Savatovic Sladjana , Cetkovic Gordana , Canadanovic-Brunet Jasna , Djilas Sonja
Published: June 2012

The kinetic behaviour of tomato waste extracts (obtained from six genotypes)
and standard antioxidant compounds (ascorbic and caffeic acid) were
investigated using 2,2-diphenyl-1-picrylhydrazyl radical test. Based on the
time needed for the reaction to reach steady state, the investigated extracts
show very slow (steady state ? 180 min) antiradical behaviour, ascorbic acid
act as rapid antioxidant (steady state < 5min) while caffeic acid is
rapidintermediate antioxidant (5 min < steady state < 20 min). The efficient
concentrations at different kinetic times EC50,t were determined for all
extracts, ascorbic and caffeic acid. EC50,t was used as a parameter to screen
and compare antiradical activities of food extracts with slow kinetic action.
Irrespective of the time considered, the comparison of the EC50,t for
extracts showed that the DPPH radicals scavenging activity of extracts
decreased in the order of O2 > Knjaz > Backa > Saint Pierre > Rutgers >
Novosadski niski. Tomato waste extracts showed very slow kinetic action,
which is probably result of the different kinetic bevaviour of phenolic
compounds, present in tomato waste, as well as other antioxidants (vitamins,
carotenoids etc).
Verifying the modes of cyclic conjugation in tetrabenzo[bc,ef,op,rs]circumanthracene
Authors: Gutman Ivan , Djurdjevic Jelena , Matovic Zoran , Markovic Marija
Published: June 2012

Cyclic conjugation in the "empty" central ring of tetrabenzo-
[bc,ef,op,rs]circumanthracene (TBCA) is stronger than in its neighboring
"nonempty" rings, contradicting the predictions of Kekul?-structure-based
theoretical models. Earlier examples of such anomalous cyclic conjugation
were observed in highly strained, non-planar benzenoid systems. Because the
molecule of TBCA is perfectly planar and strain-free, its cyclic conjugation
pattern could be tested and verified by means of high-level, B3LYP/6-
311+G(d,p), ab initio DFT calculations.
Baby Events: Assembling Descriptions of Infants in Family Day Care
Authors: Bradley Ben , Sumsion Jennifer , Stratigos Tina , Elwick Sheena
Published: June 2012

The idea that research on infants should ‘voice’ their ‘perspectives’, their experiences, what they are ‘really saying,’ is a central feature of current moves toward participatory research. While embracing the ethos of participation, this article steps away from the binary logic of identity that implicitly underpins such approaches — self—other, adult—infant, subject—object. Instead, it demonstrates the generativity of concepts of ‘assemblage,’ ‘event,’ ‘line of flight,’ in rethinking what should form the focus for the theorising, pedagogy and practices surrounding infants and toddlers. To that end, it assembles a description of mealtime, a common segment of the lives of four young children in an Australian Family Day Care home. The assemblage connects a variety of heterogeneous elements, human and non-human, animate and inanimate, including highchairs, bottles, researchers, technologies, ideas, regulations, food, gravity and our own attempts to enunciate and engage with mealtime. It is concluded that, through the relations afforded by and made between these diverse elements, the descriptions of mealtime show how highchairs and their allies may afford a new infant-world symbiosis that entails not just a time and place to eat, but access to unanticipated relations of power, opportunities for connection, and ways of becoming. Such is the ‘what’ that should inform theorising, practice and pedagogy involving very young children.
Acting with the Clock: Clocking Practices in Early Childhood
Authors: Pacini-Ketchabaw Veronica
Published: June 2012

In this article, the author addresses intra-actions that take place among humans and non-human others — the physical world, the materials — in early childhood education's everyday practices. Her object of study is the clock. Specifically, she provides an example of what it might mean to account for the intra-activity of the material-discursive relations that encompass early childhood education clocking practices. Drawing on the work of Karen Barad and other posthumanist theories, she proposes a particular approach to early childhood clocking practices, an onto-epistemology, as she argues that we learn to act with clocks in early childhood classrooms.
Early Childhood Education as a Site of Ecocentric Counter-Colonial Endeavour in Aotearoa New Zealand
Authors: Ritchie Jenny
Published: June 2012

This article draws upon a range of theoretical domains, first to outline the historical rationale for the urgent changes needed to challenge and transform the dominator culture which has justified exploitation of Indigenous peoples and the resources of the earth. It invites educators to reconsider the narratives that are either consciously or inadvertently promoted in our work, suggesting that we can learn from Indigenous epistemologies in which humans are situated alongside earth others, as respectful, related guardians and caretakers. It finally draws on some examples from a recent qualitative study conducted with ten early childhood centres from across Aotearoa, to illuminate possibilities for enactment of counter-colonial renarrativisation within early childhood settings in service of an ethical project of enhancing relationalities, reconnecting children and their families with the more-than-human world.
Response to: The Ongoing Debate about the Impact of the 150-Hour Education Requirement on the Supply of Certified Public Accountants
Authors: Allen Arthur C. , Woodland Angela M.
Published: June 2012

In an earlier paper in this journal, Allen and Woodland (2006; hereafter AW) provided evidence that the 150-hour education requirement for licensure significantly reduced the number of candidates taking and passing the CPA exam, but had little effect on pass rates. Gramling and Rosman (2009; hereafter GR) extended AW by examining the number of candidates based on whether the 150-hour requirement applies to the exam or for licensure, concluding that the 150-hour requirement does not reduce the number of candidates taking and passing the exam. In this paper, we reopen the discussion of whether the 150-hour education requirement affects entrants into the accounting profession by comparing the AW and GR research designs and conclusions. We conclude that the GR research design yields results about whether differences in 150-hour implementation methods affect the number of candidates taking and passing the exam, but does not directly provide evidence about whether the 150-hour education requirement itself affects the number of candidates.
A PRISMA assessment of the reporting quality of systematic reviews in orthodontics
Authors: Fleming Padhraig S. , Seehra Jadbinder , Polychronopoulou Argy , Fedorowicz Zbys , Pandis Nikolaos
Published: June 2012

Objectives:

To assess the reporting quality of Cochrane and non-Cochrane systematic reviews (SR) in orthodontics and to compare the reporting quality (PRISMA score) with methodological quality (AMSTAR criteria).

Materials and Methods:

Systematic reviews (n  =  109) published between January 2000 and July 2011 in five leading orthodontic journals were identified and included. The quality of reporting of the included reviews was assessed by two authors in accordance with the PRISMA guidelines. Each article was assigned a cumulative grade based on fulfillment of the applicable criteria, and an overall percentage score was assigned. Descriptive statistics and simple and multiple linear regression analyses were undertaken.

Results:

The mean overall PRISMA score was 64.1% (95% confidence interval [CI], 62%–65%). The quality of reporting was considerably better in reviews published in the Cochrane Database of Systematic Reviews (P < .001) than in non-Cochrane reviews. Both multivariable and univariable analysis indicated that journal of publication and number of authors was significantly associated with the PRISMA score. The association between AMSTAR score and modified PRISMA score was also found to be highly statistically significant.

Conclusion:

Compliance of orthodontic SRs published in orthodontic journals with PRISMA guidelines was deficient in several areas. The quality of reporting assessed using PRISMA guidelines was significantly better in orthodontic SRs published in the Cochrane Database of Systematic Reviews.
Effects of canine parvovirus strain variations on diagnostic test results and clinical management of enteritis in dogs
Authors: Markovich Jessica E. , Stucker Karla M. , Carr Alaina H. , Harbison Carole E. , Scarlett Janet M. , Parrish Colin R.
Published: June 2012

Objective—To estimate the prevalence of canine parvovirus (CPV) strains among dogs with enteritis admitted to a referral hospital in the southwestern United States during an 11-month period and to compare diagnostic test results, disease severity, and patient outcome among CPV strains.

Design—Prospective observational study.

Animals—72 dogs with histories and clinical signs of parvoviral enteritis.

Procedures—For each dog, a fecal sample or rectal swab specimen was evaluated for CPV antigen via an ELISA. Subsequently, fecal samples (n = 42 dogs) and pharyngeal swab specimens (16) were obtained and tested for CPV antigen via an ELISA and CPV DNA via a PCR assay. For specimens with CPV-positive results via PCR assay, genetic sequencing was performed to identify the CPV strain.

Results—56 dogs tested positive for CPV via ELISA or PCR assay. For 42 fecal samples tested via both ELISA and PCR assay, 27 had positive results via both assays, whereas 6 had positive PCR assay results only. Ten pharyngeal swab specimens yielded positive PCR assay results. Genetic sequencing was performed on 34 fecal or pharyngeal swab specimens that had CPV-positive PCR assay results; 25 (73.5%) were identified as containing CPV type-2c, and 9 (26.5%) were identified as containing CPV type-2b. No association was found between CPV strain and disease severity or clinical outcome.

Conclusions and Clinical Relevance—CPV type-2b and CPV type-2c posed similar health risks for dogs; therefore, genetic sequencing of CPV does not appear necessary for clinical management of infected patients. The diagnostic tests used could detect CPV type-2c.
Comparison of time to loss of consciousness and maintenance of anesthesia following intraosseous and intravenous administration of propofol in rabbits
Authors: Mazaheri-Khameneh Ramin , Sarrafzadeh-Rezaei Farshid , Asri-Rezaei Siamak , Dalir-Naghadeh Bahram
Published: June 2012

Objective—To compare time to loss of consciousness (LOC) and effective maintenance of anesthesia following intraosseous (IO) and IV administration of propofol in rabbits.

Design—Evaluation study.

Animals—24 New Zealand White rabbits.

Procedures—Rabbits were selected to receive IO (n = 6) or IV (6) bolus administration of 1% propofol (12.5 mg/kg [5.67 mg/lb]) only or an identical bolus of propofol IO (6) or IV (6) followed by a constant rate infusion (CRI; 1 mg/kg/min [0.45 mg/lb/min]) by the same route for 30 minutes. Physiologic variables were monitored at predetermined time points; time to LOC and durations of anesthesia and recovery were recorded.

Results—Following IO and IV bolus administration, mean time to LOC was 11.50 and 7.83 seconds, respectively; changes in heart rate, respiratory rate, oxygen saturation (as measured by pulse oximetry), and mean arterial blood pressure values were evident, but findings did not differ between groups. For the IO- and IV-CRI groups, propofol-associated changes in heart rate, oxygen saturation, and mean arterial blood pressure values were similar, and although mean arterial blood pressure decreased significantly from baseline, values remained > 60 mm Hg; respiratory rate decreased significantly during CRI in both groups, but remained higher in the IO-CRI group. Anesthesia and recovery time did not differ between the IO- and IV-CRI groups.

Conclusions and Clinical Relevance—In all evaluated aspects of anesthesia, IO administration of propofol was as effective as IV administration in rabbits. Results suggested that total IO anesthesia can be performed in rabbits with limited vascular access.
Gender differences in veterinarian-client-patient communication in companion animal practice
Authors: Shaw Jane R. , Bonnett Brenda N. , Roter Debra L. , Adams Cindy L. , Larson Susan
Published: June 2012

Objective—To describe the relationship between veterinarian and client genders and veterinarian-client-patient communication.

Design—Cross-sectional descriptive study.

Sample—Random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets.

Procedures—For each practitioner, 6 clinical appointments were videotaped, and the resulting 300 videotapes were analyzed with the Roter interaction analysis system (RIAS). Linear regression was conducted to study the relationship between demographic factors, measures of veterinarian-client-patient communication, and gender of the veterinarian and client.

Results—Female veterinarians conducted more relationship-centered appointments, provided more positive and rapport-building statements, talked more to the patient, and were perceived as less hurried or rushed, compared with male veterinarians. Clients were more likely to provide lifestyle-social information to female veterinarians. Same-gender veterinarian-client interactions were relationship centered and included client provision of more lifestyle-social information.

Conclusions and Clinical Relevance—Gender influenced veterinarian-client-patient communication, and previously described physician gender differences in medical communication were largely replicated in the veterinary context.
Generalised elliptic functions
Authors: England Matthew , Athorne Chris
Published: June 2012

We consider multiply periodic functions, sometimes called Abelian functions, defined with respect to the period matrices associated with classes of algebraic curves. We realise them as generalisations of the Weierstraß ℘-function using two different approaches. These functions arise naturally as solutions to some of the important equations of mathematical physics and their differential equations, addition formulae, and applications have all been recent topics of study.

The first approach discussed sees the functions defined as logarithmic derivatives of the σ-function, a modified Riemann θ-function. We can make use of known properties of the σ-function to derive power series expansions and in turn the properties mentioned above. This approach has been extended to a wide range of non hyperelliptic and higher genus curves and an overview of recent results is given.

The second approach defines the functions algebraically, after first modifying the curve into its equivariant form. This approach allows the use of representation theory to derive a range of results at lower computational cost. We discuss the development of this theory for hyperelliptic curves and how it may be extended in the future. We consider how the two approaches may be combined, giving the explicit mappings for the genus 3 hyperelliptic theory. We consider the problem of generating bases of the functions and how these decompose when viewed in the equivariant form.
Refractive index of light and the quark-gluon plasma
Authors: Liu Juan , Luo Min-Jie , Xu Hao-Jie
Published: June 2012

The refractive index (RI) of light propagating in a medium of quark-gluon plasma (QGP) is studied. The weakly coupled QGP is studied in the framework of hard-thermal-loop (HTL) perturbation theory, and the strongly coupled one is treated based on the holographic approach. In more realistic setups, the feasibility of observing the optical phenomenon related to the RI of QGP is also discussed.
Scaffolds for tissue engineering produced by inkjet printing
Authors: Zhang Yi , Tse Christopher , Rouholamin Davood , Smith Patrick
Published: June 2012

This review discusses the use of scaffolds in tissue engineering and summarises the means by which they might be fabricated. The review identifies the main features a scaffold should have, and discusses the progress that has been made towards obtaining these targets. In particular, the review focuses on inkjet printing as a viable production route and discusses why this additive manufacturing technique holds considerable appeal and promise. The article concludes with an overview of the current challenges in this field and reviews the different types of material that can be used for scaffolds.
Soot in Cretaceous-Paleogene boundary clays worldwide: is it really derived from fossil fuel beds close to Chicxulub?
Authors: Premović Pavle
Published: June 2012

High soot contents have been reported in Cretaceous-Paleogene boundary (KPB) clays worldwide. One of the interpretations suggests this material comes from combustion of fossil fuels such as crude oil, coal or oil shales near the Chicxulub impact site. Combustion was triggered by the KPB impactor. In this Note, I show that the estimated mass of crude oil (or fossil hydrocarbons in general) burned (ca. 1017–1019 g), based on the average amount of soot (0.0022–0.012 g cm−2) or elemental carbon (0.011 g cm−2) found at the marine KPB sites, contradicts the fossil hydrocarbons hypothesis.
Modeling and measurements of angular truncation for an aerosol albedometer
Authors: Qian F. , Ma L. , Thompson J. E.
Published: June 2012

In this work, we examine the angular truncation behavior and present correction factors for the aerosol albedometer previously developed in our laboratory. This new instrument makes simultaneous measurement of extinction and scattering coefficients (bext and bscat) on dispersed aerosol samples. The aerosol extinction coefficient is measured with cavity ring-down spectroscopy (CRDS), and the scattering coefficient is determined through the integrating sphere nephelometer. However, all nephelometers are not able to collect light scattered from an aerosol sample very near the forward (0°) and reverse (180°) directions, due to the geometrical constraints. This can result in systematic underestimation of scattering coefficient known as truncation error. In order to account for this problem and describe scattering by aerosols more precisely, correction factors (C) for this angular non-ideality have been theoretically developed. Truncation angles (θ) were calculated upon consideration of the geometry of the sphere nephelometer. As truncation error largely depends on particle size and refractive index, C values were computed for a series of spherical, homogeneous aerosol particles with different known particle sizes and refractive indices by Lorenz-Mie theory. Measurements on size-selected, laboratory generated aerosols of known size and composition allowed empirical measurement of truncation correction factors to compare with the Mie model results. Results indicate the model we built overestimates the fraction of light not collected by the sphere. Empirically observed correction factors of ≤ 1.12 for particles with size parameters (α) < 6 were determined. In addition, the effect of number of particles within the probe beam on the suitability of correction factors was also examined. Observations support the hypothesis that particles are rapidly transported / mixed through the probe beam, and measurement integration times as short as 52 s yield data that is indistinguishable from the probe region being homogeneously filled with aerosol, even at very low particle concentrations.
Qualifying for The Quality Health Care for Children
Authors: Sharma P R
Published: June 2012

No abstract available.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6332 Kathmandu Univ Med J 2011;9(4):227-8
Sex Preferences Among Mothers Delivering at Patan Hospital
Authors: Chhetri U D , Ansari I , Bhandary S , Adhikari N
Published: June 2012

Background High sex ratios at birth (SRB) are seen in China, Taiwan, South Korea, parts of India and Vietnam. The imbalance is the result of son preference, accentuated by declining fertility. Prenatal sex determination and female feticides are common in many countries. It is reflected in sex ratio Objective To determine reasons for the preferences for different sex; to find out whether there is altered sex ratio at birth and to find out whether female feticide are common among women who had abortion. Method It is a prospective study. Women who had previous history of abortion and had delivered at Patan Hospital in the year 2066 were interviewed as per questionnaires. Results Among 560 women with total live births of 965, (462 male and 503 female) during their life time the overall sex ratio was 92 male per 100 female birth; total abortions were 663. Preferences for male were 10%, female 15.4% and either was for 74%. The reason for male preference was to continue family lineage, to bring honor, old age security, and performing funeral rites while the reasons for daughter preferences were that they understand mother’s pain, help in household work. The sex ratio of the babies born during the study period was 113 male per 100 female births. The Sex ratio at birth from 1st to 6th deliveries was 61, 79, 101, 210, 286 and 1100 male per 100 female birth respectively. Prenatal sex selection was 8% (by USG) but none had sex selected abortion. ConclusionSex ratio of those delivered during the study period was skewed (136 boys per 100 girls) towards male. There was shift in SRB in 4th and subsequent pregnancies in favor of boys. As the male sex ratio increased the number of induced abortion decreased in subsequent pregnancies.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6334 Kathmandu Univ Med J 2011;9(4):229-232
Prevalence and Factors Associated with Current Smoking Among Medical Students in Coastal South India
Authors: Ganesh Kumar S , Subba S H , Unnikrishnan B , Jain A , Badiger S
Published: June 2012

Background Smoking among health care personnel such as medical students is an important public health issue. More effective measures to reduce tobacco smoking among medical students are needed worldwide. Very few studies had been conducted in past in India and other developing countries to understand the magnitude of problem. Objectives To determine the prevalence and associated factors of current smoking among medical students. Methods Cross sectional study was conducted during January and February 2009 among 333 study subjects selected randomly from four batches of a teaching institution. Subjects were administered a self administered pre tested questionnaire and smoking status was assessed as per the criteria laid down by WHO. Proportion, chi square test and multiple logistic regression analysis were used for statistical analysis. Results The prevalence of current smoking was found to be 22.4% (67). There were widespread deficiencies in knowledge of smoking among students of different classes, as an important causal factor in many diseases like gastro intestinal malignancy, heart problems, asthma, and emphysema. It was found that only half of them were willing to quit smoking (33). Fourth year students (OR=2.54) and presence of peer pressure (OR=21.91) had independent significant association with current smoking. Conclusion Prevalence of smoking among medical students is high that warrants adoption of comprehensive smoking control interventions among them.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6335 Kathmandu Univ Med J 2011;9(4):233-7
Use of Gabapentin, Esmolol or Their Combination to Attenuate Haemodynamic Response to Laryngoscopy and Intubation
Authors: Shrestha G S , Marhatta M N , Amatya R
Published: June 2012

Background Laryngoscopy and intubation increases blood pressure and heart rate. Objective The study aims to investigate the effect and safety of gabapentin, esmolol or their combination on the haemodynamic response to laryngoscopy and intubation. Methods A total of 72 patients undergoing elective surgery were randomly allocated to one of the four groups. First study drug was administered orally as gabapentin 1200mg or placebo. Second study drug was administered intravenously as esmolol 1.5mg/kg or normal saline. Heart rate, rate pressure product, systolic blood pressure and mean arterial pressure were recorded at baseline and at zero, one, three and five minutes after tracheal intubation. Results Baseline values were compared with the values at various time intervals within the same group. In group PE (placebo, esmolol), there was significant decrease in heart rate and rate pressure product at five minutes. In group GN (gabapentin, normal saline), there was significant decrease in systolic blood pressure and mean arterial pressure at five minutes. In group GE (gabapentin, esmolol), there was significant decrease in heart rate at zero, three and five minutes. Systolic blood pressure, mean arterial pressure and rate pressure product was significantly lower at three and five minutes. In group PN (placebo, normal saline), there was significant increase in heart rate at zero, one, three and five minutes; systolic blood pressure at zero and one minutes; mean arterial pressure at zero and one minutes & rate pressure product at zero, one and three minutes. In group GN (gabapentin, normal saline), there was significant increase in heart rate at zero, one and three minutes & rate pressure product at zero, one and three minutes. In group PE (placebo, esmolol), there was significant increase in systolic blood pressure at zero and one minutes & mean arterial pressure at zero and one minutes. However, in group GE (gabapentin, esmolol) none of the variables showed statistically significant increase at any time. Inter-group comparison was made for each time point. At zero minute, there was significant difference in heart rate between groups PN and GE, GN and PE & GN and GE Significant difference was also noted in rate pressure product between PN and GE at zero minute. At one minute there was difference in heart rate between PN and PE, PN and GE, GN and PE & between GN and GE. Significant difference was observed in rate pressure product between PN and PE & between PN and GE at one minute. No significant side effects of the study drugs were observed. ConclusionsCombination of gabapentin and esmolol in this study design is safe and better attenuates both the pressor and tachycardic response to laryngoscopy and intubation, than either agent alone.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6336 Kathmandu Univ Med J 2011;9(4):238-43
A Study of Risk Factors of Stroke in Patients Admitted in Manipal Teaching Hospital, Pokhara.
Authors: Maskey A , Parajuli M , Kohli S C
Published: June 2012

Background Stroke is usually end result of predisposing conditions that originated years before the ictus. Identification of its modifiable risk factors can help in planning preventive strategies. Objective To study the risk factors of stroke in adult patients. Methods A hospital based prospective cross sectional study was carried out in 160 stroke patients admitted in Manipal Teaching Hospital, Pokhara from November 2007- October 2010. Diagnosis of stroke was confirmed by CT scan of brain. Patients were then investigated for presence of conventional risk factors. The data was statistically analysed using Epi-Info. Results The mean age of stroke patients was 65.98 years ± 10.69 with 126 (78.8%) of patients belonging to age group ? 60 years. It afflicted higher percentage of males 104 (65%) than females 56 (35%). Analysis of stroke subtypes showed preponderance of haemorrhagic stroke in 85 (53.1%) as against infarction in 75 (46.9%) of cases. Other conventional modifiable risk factors were seen as follows: hypertension 98 (61.2 %), cigarette smoking 95 (59.4%), alcohol use 43 (26.9%), left ventricular hypertrophy 44 (27.5%), atrial fibrillation 37(23%), elevated triglyceride 37(23%), diabetes mellitus 15 (9.3%) and elevated total cholesterol 12 (7.5%). Multiple risk factors (? 2) were seen in 122 (76.5 %) cases. ConclusionsThe maximum occurrence of stroke was seen in patients > 60 years. Overall male preponderance and higher occurrence of haemorrhagic stroke was seen in our study. Significant risk factors in order of descending order were hypertension, cigarette smoking, left ventricular hypertrophy, alcohol use, atrial fibrillation and elevated triglycerides.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6337 Kathmandu Univ Med J 2011;9(4):244-7
C–reactive Protein and Early Mortality in Acute Ischemic Stroke
Authors: Dewan K R , Rana P V S
Published: June 2012

Background There is growing evidence that inflammation plays an important role in atherogenesis. Several studies have shown that C-reactive protein (CRP), an inflammatory marker, is associated with stroke severity and outcome. But limited studies are there which show the relationship of CRP with early mortality i.e within seven days. Objective To study the association of CRP within 24 hours after acute ischemic stroke onset with severity during admission, types of ischemic stroke and outcome. Methods This cross sectional study was done including 100 consecutive cases of acute ischemic stroke admitted to Neurology center of College of Medical Sciences, Bharatpur (Chitwan), Nepal. The cases were classified as per TOAST classification and severity at admission assessed using National Institutes of Health Stroke Scale. C-reative protein (CRP) level was estimated by latex particle agglutination test. Result Thirteen percent patients expired by 7th day. In the expired group, CRP was positive in 15.3 percent, 15.3 percent and 61.5 percent in patients with lacunar, cardioembolic and large artery atherosclerotic infarction respectively (p 0.19). CRP was positive in all 7 patients (53.8%) who had expired with severe NIHS scale (p 0.004). ConclusionHigh CRP level is associated with stroke severity at admission and is an independent predictor of early seven day mortality after ischemic strokeDOI: http://dx.doi.org/10.3126/kumj.v9i4.6339 Kathmandu Univ Med J 2011;9(4):252-5
Use of Non Invasive Ventilation in Patients with Respiratory Failure in Nepal
Authors: Pandey R , Chokhani R , K C N B
Published: June 2012

Background Non-invasive ventilation (NIV) has become an integral tool in the management of acute and chronic respiratory failure. Studies have shown that use of NIV decreases the length of hospital stay, improves symptoms and also reduces the need for invasive mechanical ventilation in patients with respiratory failure. However, NIV is not used sufficiently in our country. Objective To find out the outcome of Non Invasive Ventilation in Respiratory failure in Nepal. Methods Retrospective analysis of data of 28 patients in between June 2010- November 2010 was done. All the patients selected had respiratory failure. Records were analysed for documentation of clinical diagnosis. Arterial blood gases were assessed prior to, after starting and after discontinuation of NIV. The outcome of NIV and the need for domiciliary oxygen was evaluated at discharge. Results Thirty four patients received NIV out of which 6 were excluded from the study due to insufficient documentation. Out of these 28 patients, 27 received bi-level and one patient received Continuous Positive Airway Pressure. Mean age of patients was 66.5 years and ranged from 42-87 years. Majority (19, 79%) were from age group 60-80 years. Most common cause for the use of bi-level ventilation was chronic obstructive pulmonary disease with type 2 respiratory failure in 19 patients (67.8%). Others included obesity hypoventilation syndrome two, acute interstitial pneumonia two, cardiogenic pulmonary oedema two, Interstitial lung disease one, bronchogenic carcinoma one, and bronchiectasis one. Arterial blood gas analysis was done on admission and 12 hours or earlier after the onset of bi-level ventilation. At the time of admission, 89.3% of the patients had type 2 respiratory failure, of which 60.6% had respiratory acidosis and 67.9% of patients had pCO2 above 60 mm Hg. Arterial blood pH prior to admission ranged from 7.19 to 7.50. Twelve hours after bi-level ventilation, only 21.3% had pH <7.35 and 42.8% had pCO2 above 60 mm Hg. Non invasive ventilation was successful in 27 patients (96.4%). All patients were advised domiciliary oxygen and all patients had respiratory follow up arranged. Conclusions COPD patients with type 2 respiratory failure were seen to benefit most with NIV. It is a very cost effective and safe method of treatment and should be used first in patients with COPD with type 2 respiratory failure.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6340 Kathmandu Univ Med J 2011;9(4):256-59
Increasing Access to Safe Abortion Services Through Auxiliary Nurse Midwives Trained as Skilled Birth Attendants
Authors: K C N P , Basnett I , Sharma S K , Bhusal C L , Parajuli R R , Anderson K L
Published: June 2012

Background The use of medical abortion methods was approved by Department of Health Services in 2009 and introduced in hospitals and a few primary health centres (PHCs). Access would increase if services were available at health post level and provided by auxiliary nurse midwives trained as skilled birth attendants. Evidence from South Africa, Bangladesh, Nepal and Vietnam show that mid-level health workers can provide medical abortion safely. Objectives To determine the best way to implement the new strategies of medical abortion into the existing health system of Nepal; and to facilitateits full-scale implementation, monitoring and evaluation. Methods An implementation research involving a baseline study, implementation phase and end line study was done in ten districts covering five development regions from July 2010 to June 2011. Both qualitative and quantitative methods were used. Results Of 1,799 medical abortion clients who received service, 46% were disadvantaged Janjati, 14% were Dalit, 42% were upper caste groups and rest were advantaged Janjati (7%), Muslim (1%) and others. 14% were referred by female community health volunteers and 56% were referred by others. Complication rate of 0.3% was well below acceptable levels. Condom use increased from 8% to 28% by the end of study. Use of Pills, Depo, intra uterine devices and Implants also increased, but use of long acting family planning methods was negligible. Conclusions This model should be replicated nationwide at health posts and sub-health posts where auxiliary nurse milwifes are available 24 hours/day. Focus should be given first to those areas where access is difficult, time consuming and costly.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6341 Kathmandu Univ Med J 2011;9(4):260-66
Study on Curvatures of Clavicle With Its Clinical Importance
Authors: Haque M K , Mansur D I , Sharma K
Published: June 2012

Background The clavicle is the most frequently fractured bone of the human skeleton. 70–80% of fractures occur at the middle third of the shaft of the bone. Anatomical variations in the clavicle of relevance to form intramedullary fixation. Objectives The purpose of this study was attempted to know about comparative differences between curvatures of the right and left clavicles, from certain metrical parameters. Methods The materials for the present study consisted of 257 (135 right and 122 left) adult clavicles, which were collected from the Department of Anatomy and from the students of the first year M.B.B.S during the period 2010 - 2011, Department of Anatomy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. The deepest points of the curvatures of the clavicle, where the convexities were the maximum. These angles were measured with the help of a protractor. The sum of the two angles constituted the total curvature of the bone. Results The average medial angle, lateral angle and sum of the two angles of right side were 150.97º ±6.16 SD, 139.76º ±7.55 SD and 290.73º ±11.14 respectively and that of the left side were 151.50º ±5.67SD, 141.73º ±8.44 SD and 293.23º ±11.69SD respectively. The present study revealed that the medial and lateral angles of the left clavicle were greater than that of the right clavicle and medial curvature was more than the lateral curvature of the same clavicle. Conclusions It is important to recognize anatomical variations in the curvatures of clavicle when considering intramedullary nailing techniques. It also helps Anthropologists in their study of evolution.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6344 Kathmandu Univ Med J 2011;9(4):279-82