bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Reducing Sugar Retard Kindling?
Authors: Rho Jong M.
Published: April 2008

2-Deoxy-d-Glucose Reduces Epilepsy Progression by NRSF-CtBP-Dependent Metabolic Regulation of Chromatin Structure. Garriga-Canut M, Schoenike B, Qazi R, Bergendahl K, Daley TJ, Pfender RM, Morrison JF, Ockuly J, Stafstrom C, Sutula T, Roopra A. Nat Neurosci 2006;9(11):1382–1387. Temporal lobe epilepsy is a common form of drug-resistant epilepsy that sometimes responds to dietary manipulation such as the ‘ketogenic diet’. Here we have investigated the effects of the glycolytic inhibitor 2-deoxy-d-glucose (2DG) in the rat kindling model of temporal lobe epilepsy. We show that 2DG potently reduces the progression of kindling and blocks seizure-induced increases in the expression of brain-derived neurotrophic factor and its receptor, TrkB. This reduced expression is mediated by the transcription factor NRSF, which recruits the NADH-binding co-repressor CtBP to generate a repressive chromatin environment around the BDNF promoter. Our results show that 2DG has anticonvulsant and antiepileptic properties, suggesting that anti-glycolytic compounds may represent a new class of drugs for treating epilepsy. The metabolic regulation of neuronal genes by CtBP will open avenues of therapy for neurological disorders and cancer.
Quantitative Risk Assessment from Farm to Fork and Beyond: A Global Bayesian Approach Concerning Food‐Borne Diseases
Authors: Albert Isabelle , Grenier Emmanuel , Denis Jean‐Baptiste , Rousseau Judith
Published: April 2008

A novel approach to the quantitative assessment of food‐borne risks is proposed. The basic idea is to use Bayesian techniques in two distinct steps: first by constructing a stochastic core model via a Bayesian network based on expert knowledge, and second, using the data available to improve this knowledge. Unlike the Monte Carlo simulation approach as commonly used in quantitative assessment of food‐borne risks where data sets are used independently in each module, our consistent procedure incorporates information conveyed by data throughout the chain. It allows “back‐calculation” in the food chain model, together with the use of data obtained “downstream” in the food chain. Moreover, the expert knowledge is introduced more simply and consistently than with classical statistical methods. Other advantages of this approach include the clear framework of an iterative learning process, considerable flexibility enabling the use of heterogeneous data, and a justified method to explore the effects of variability and uncertainty. As an illustration, we present an estimation of the probability of contracting a campylobacteriosis as a result of broiler contamination, from the standpoint of quantitative risk assessment. Although the model thus constructed is oversimplified, it clarifies the principles and properties of the method proposed, which demonstrates its ability to deal with quite complex situations and provides a useful basis for further discussions with different experts in the food chain.
Estimating Consumer Exposure to PFOS and PFOA
Authors: Trudel David , Horowitz Lea , Wormuth Matthias , Scheringer Martin , Cousins Ian T. , Hungerbühler Konrad
Published: April 2008

Perfluorinated compounds have been used for more than 50 years as process aids, surfactants, and for surface protection. This study is a comprehensive assessment of consumer exposure to perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) from a variety of environmental and product‐related sources. To identify relevant pathways leading to consumer exposure to PFOS and PFOA a scenario‐based approach has been applied. Scenarios represent realistic situations where age‐ and gender‐specific exposure occurs in the everyday life of consumers. We find that North American and European consumers are likely to experience ubiquitous and long‐term uptake doses of PFOS and PFOA in the range of 3 to 220 ng per kg body weight per day (ng/kgbw/day) and 1 to 130 ng/kgbw/day, respectively. The greatest portion of the chronic exposure to PFOS and PFOA is likely to result from the intake of contaminated foods, including drinking water. Consumer products cause a minor portion of the consumer exposure to PFOS and PFOA. Of these, it is mainly impregnation sprays, treated carpets in homes, and coated food contact materials that may lead to consumer exposure to PFOS and PFOA. Children tend to experience higher total uptake doses (on a body weight basis) than teenagers and adults because of higher relative uptake via food consumption and hand‐to‐mouth transfer of chemical from treated carpets and ingestion of dust. The uptake estimates based on scenarios are within the range of values derived from blood serum data by applying a one‐compartment pharmacokinetic model.
Modeling Exposure to Air Pollution from the WTC Disaster Based on Reports of Perceived Air Pollution
Authors: Lederman Sally Ann , Becker Mark , Sheets Stephen , Stein Janet , Tang Deliang , Weiss Lisa , Perera Frederica P.
Published: April 2008

We examined the utility of a newly developed perceived air pollution (PAP) scale and of a modeled air pollution (MAP) scale derived from it for predicting previously observed birth outcomes of pregnant women enrolled following September 11, 2001. Women reported their home and work locations in the four weeks after September 11, 2001 and the PAP at each site on a four‐point scale designed for this purpose. Locations were geocoded and their distance from the World Trade Center (WTC) site determined. PAP values were used to develop a model of air pollution for a 20‐mile radius from the WTC site. MAP values were assigned to each geocoded location. We examined the relationship of PAP and MAP values to maternal characteristics and to distance of home and work sites from the WTC site. Both PAP and MAP values were highly correlated with distance from the WTC. Maternal characteristics that were associated with PAP values reported for home or work sites (race, demoralization, material hardship, first trimester on September 11) were not associated with modeled MAP values. Relationships of several birth outcomes to proximity to the WTC, which we previously reported using this data set, were also seen when MAP values were used as the measure of exposure, instead of proximity. MAP developed from reports of PAP may be useful to identify high‐risk areas and predict health outcomes when there are multiple sources of pollution and a “distance from source” analysis is impossible.
Rate of Foot‐and‐Mouth Disease Virus Transmission by Carriers Quantified from Experimental Data
Authors: Tenzin  , Dekker Aldo , Vernooij Hans , Bouma Annemarie , Stegeman Arjan
Published: April 2008

Upon infection with foot‐and‐mouth disease virus (FMDV) a considerable number of animals become carriers of the virus. These carriers are considered to be a risk for new outbreaks, but the rate at which these animals can transmit the infection has not been quantified. An analysis was carried out using data from previously published experiments in order to quantify the transmission rate parameter β of FMDV infection from carriers to susceptible animals. The parameter β was estimated at 0.0256 (likelihood‐based confidence interval: 0.008–0.059) infections per carrier per month. Moreover, analysis of published experimental data indicates that the proportion of FMDV carriers decreases at a rate of 0.115 per month. Both parameters obtained from this study are useful for quantitative risk analyses of the trade of animals from FMDV‐infected areas or the lifting of vaccination programs.
European Public Perceptions of Food Risk: Cross‐National and Methodological Comparisons
Authors: Hohl Katrin , Gaskell George
Published: April 2008

This article presents a comparative study of public perceptions of food risk across 25 European member states. A secondary data analysis is conducted on a Eurobarometer survey fielded to nationally representative samples in 2005. The survey included closed questions as well as free associations to map risk perceptions. Taking a quantitative approach, we find that people in a majority of European countries express similar levels of concern about food risks. However, outside this majority a North‐South divide is evident, with the Northern countries worrying less than the Southern countries. Multilevel modeling shows that cross‐national differences in individual respondents' level of worry are in part attributable to shared country effects and to generalized risk sensitivity about a range of personal risks. On the underlying structure of food risk concerns, factor analysis points to three dimensions described by groupings of risks related to adulteration and contamination, health effects, and production and hygiene. A qualitative analysis of respondents' free associations about problems and risks with food identifies three major themes that are consistent with the quantitative results. However, the free associations also point toward greater cross‐national diversity and to striking variations in the range and importance of food risks. Overall, the picture is of a public that frames food risks in a wider context of beliefs about the links between diet and health. We conclude with some implications for research on food risk perceptions in particular and risk perception studies in general.
Communicating the Risks of a New, Emerging Pathogen: The Case of Cryptococcus gattii
Authors: Nicol Anne‐Marie , Hurrell Christie , McDowall Will , Bartlett Karen , Elmieh Negar
Published: April 2008

The news media are an important channel for communicating public health messages, providing important information about geographic extent, symptoms, and precautionary measures. This function may be particularly important in the case of new and emerging infectious diseases, which are unfamiliar to both the public and health professionals. We conducted a content analysis of the coverage in six Canadian newspapers of two ¨emerging infectious pathogens in British Columbia (BC), West Nile virus and Cryptococcus gattii (C. gattii), between 2001 and 2006. C. gattii was first identified in the Canadian Pacific Northwest in 1999, having previously been restricted to tropical and subtropical areas. By summer 2006, C. gattii had killed at least eight people and was responsible for over 150 hospitalizations in the province of BC, as well as significant morbidity and mortality among companion animals. West Nile virus reached Canada in 2001 and has since caused significant morbidity and mortality. It has not, to date, reached BC. Despite the much higher incidence of disease and death caused by C. gattii in BC, West Nile virus received five times more news coverage in the British Columbian and national newspapers examined. Surprisingly, the local newspaper closest to the center of the British Columbia C. gattii outbreak had a much lower proportion of coverage of the disease than other papers in the province. The article discusses possible explanations for these findings, and the implications for public health communication.
Hazard Perception, Risk Perception, and the Need for Decontamination by Residents Exposed to Soil Pollution: The Role of Sustainability and the Limits of Expert Knowledge
Authors: Vandermoere Frédéric
Published: April 2008

This case study examines the hazard and risk perception and the need for decontamination according to people exposed to soil pollution. Using an ecological‐symbolic approach (ESA), a multidisciplinary model is developed that draws upon psychological and sociological perspectives on risk perception and includes ecological variables by using data from experts' risk assessments. The results show that hazard perception is best predicted by objective knowledge, subjective knowledge, estimated knowledge of experts, and the assessed risks. However, experts' risk assessments induce an increase in hazard perception only when residents know the urgency of decontamination. Risk perception is best predicted by trust in the risk management. Additionally, need for decontamination relates to hazard perception, risk perception, estimated knowledge of experts, and thoughts about sustainability. In contrast to the knowledge deficit model, objective and subjective knowledge did not significantly relate to risk perception and need for decontamination. The results suggest that residents can make a distinction between hazards in terms of the seriousness of contamination on the one hand, and human health risks on the other hand. Moreover, next to the importance of social determinants of environmental risk perception, this study shows that the output of experts' risk assessments—or the objective risks—can create a hazard awareness rather than an alarming risk consciousness, despite residents' distrust of scientific knowledge.
Significant Factors of Aviation Insurance and Risk Management Strategy: An Empirical Study of Taiwanese Airline Carriers
Authors: Lin Yi Hsin , Chang Yu Hern
Published: April 2008

Aviation insurance premiums have become a heavy burden for the airline industry since September 11, 2001. Although the industry must constantly balance its operations between profitability and safety, the reality is that airlines are in the business of making money. Therefore, their ability to reduce cost and manage risk is a key factor for success. Unlike past research, which used subjective judgment methods, this study applied quantitative historical data (1999–2000) and gray relation analysis to identify the primary factors influencing ratemaking for aviation insurance premiums. An empirical study of six airlines in Taiwan was conducted to determine these factors and to analyze the management strategies used to deal with them. Results showed that the loss experience and performance of individual airlines were the key elements associated with aviation insurance premiums paid by each airline. By identifying and understanding the primary factors influencing ratemaking for aviation insurance, airlines will better understand their relative operational strengths and weaknesses, and further help top management identify areas for further improvement. Knowledge of these factors combined with effective risk management strategies, may result in lower premiums and operating costs for airline companies.
Human Salmonellosis: Estimation of Dose‐Illness from Outbreak Data
Authors: Bollaerts Kaatje , Aerts Marc , Faes Christel , Grijspeerdt Koen , Dewulf Jeroen , Mintiens Koen
Published: April 2008

The quantification of the relationship between the amount of microbial organisms ingested and a specific outcome such as infection, illness, or mortality is a key aspect of quantitative risk assessment. A main problem in determining such dose‐response models is the availability of appropriate data. Human feeding trials have been criticized because only young healthy volunteers are selected to participate and low doses, as often occurring in real life, are typically not considered. Epidemiological outbreak data are considered to be more valuable, but are more subject to data uncertainty. In this article, we model the dose‐illness relationship based on data of 20 Salmonella outbreaks, as discussed by the World Health Organization. In particular, we model the dose‐illness relationship using generalized linear mixed models and fractional polynomials of dose. The fractional polynomial models are modified to satisfy the properties of different types of dose‐illness models as proposed by Teunis et al. Within these models, differences in host susceptibility (susceptible versus normal population) are modeled as fixed effects whereas differences in serovar type and food matrix are modeled as random effects. In addition, two bootstrap procedures are presented. A first procedure accounts for stochastic variability whereas a second procedure accounts for both stochastic variability and data uncertainty. The analyses indicate that the susceptible population has a higher probability of illness at low dose levels when the combination pathogen‐food matrix is extremely virulent and at high dose levels when the combination is less virulent. Furthermore, the analyses suggest that immunity exists in the normal population but not in the susceptible population.
Avian Influenza in Vietnam: Chicken‐Hearted Consumers?
Authors: Figuié M. , Fournier T.
Published: April 2008

This study, based on quantitative and qualitative surveys conducted from July 2004 to September 2005, examines the perceptions of Hanoi consumers and their reactions to the Avian Influenza epizootic (H5N1). Hanoi consumers clearly link the risk of human contamination by the virus to the preparation and ingestion of poultry. During the first crisis, consumers reacted quickly and intensely (74% of them had already stopped eating poultry in January 2004). Nevertheless, once the crisis abated, they quickly resumed their consumption of poultry. This behavior corresponds to the pattern described by empirical studies of other crises, such as BSE. What is more surprising is the speed with which the different steps of this common pattern succeeded one another. It may be explained by a rapid decrease in risk anxiety. A logit model shows that, soon after the beginning of the crisis, AI risk anxiety was tempered by confidence in the information and recommendations issued by the government concerning AI and, in the long term, by a high perceived self‐efficiency to deal with AI. Indeed, not only has poultry consumption been affected in terms of the quantity consumed, but alternative ways of selecting and preparing poultry have also been adopted as anti‐risk practices. Risk communication strategies should take this into account, and rely on a previous assessment of consumer practices adopted to deal with the risk.
The Influence of Top Management Team Heterogeneity on the Capital Raised through an Initial Public Offering
Authors: Zimmerman Monica A.
Published: April 2008

A significant body of research exists on the top management teams (TMTs) of established firms and specifically on the heterogeneity of TMTs of established firms. Little research exists, however, on the heterogeneity of TMTs of firms in the early stages of their existence. In this study, I examine the relationship among TMT heterogeneity and the capital raised by the firm through its initial public offering (IPO). I argue that TMT heterogeneity provides a signal to potential investors about the quality of the IPO and hence is associated with greater capital accumulations. My findings suggest that heterogeneity in the TMT's functional background and educational background is associated with greater capital raised through an IPO.
The Effect of Small Business Managers’ Growth Motivation on Firm Growth: A Longitudinal Study
Authors: Delmar Frédéric , Wiklund Johan
Published: April 2008

This study addresses the role of small business managers’ growth motivation for business growth, taking into account the important effects of previous motives and feedback from earlier performance. We hypothesize that small business managers’ growth motivation has a unique influence on firm outcome measured as growth in sales and in number of employees. Data were gathered from two different Swedish samples of small firms using telephone interviews. Using cross–lagged regression analysis, we find support for our hypotheses when examining employment growth, but only partial support when examining sales.
Entrepreneurial Orientation and Growth of SMEs: A Causal Model
Authors: Moreno Ana M. , Casillas José C.
Published: April 2008

The literature existing on entrepreneurship implicitly assumes that entrepreneurial orientation (EO) and growth orientation are positively related with each other. However, few studies, whether theoretical or empirical, analyze such relation in an explicit manner. Instead, most previous works have focused on the EO–performance relation, even though growth and profitability do not always correlate positively. This work has been carried out on a sample of 434 SMEs, and contributes two novelties with regard to previous research: (1) the analysis focuses on the EO–growth relation; and (2) it uses a flexible method (Partial Least Squares) which allows the study of several simultaneous relationships. The results reveal the complexity of the relationships between EO, strategy, environment, resources and growth.
How International is Entrepreneurship?
Authors: Gamboa Ernesto C. , Brouthers Lance Eliot
Published: April 2008

Nine major entrepreneurship, international business (IB), and management journals used by the Financial Times to rank business schools were examined to see if the amount of international entrepreneurship (IE) research published in major entrepreneurship, IB, and management journals is increasing over time. Findings from two time periods spaced a decade apart indicate that although IE content more than doubled in the entrepreneurship journals, only a modest increase occurred in the international business journals and no increase occurred in the management journals. We proposed and found that: (1) entrepreneurship journals tend to favor replication studies while IB and management journals prefer nonreplications; and (2) because replication is straightforward while nonreplication is more difficult to conceptualize and execute, there are many more replication than nonreplication IE studies. As a result, IE studies appear more frequently in entrepreneurship journals. Managerial and scholarly implications are discussed.
Amorphous Calcific Tumor of the Mitral Annulus Echocardiographically Mimicking a Vegetation
Authors: Inamdar Vatsal , Wanat Francis E. , Nanda Navin C. , Pothineni Koteswara R. , Burri Manjula V. , Kimmler Stephen
Published: April 2008

We describe echocardiographic findings in an elderly patient with histologically proven amorphous tumor involving the posterior mitral annulus, mimicking a vegetation.
Evaluation of Right Atrial Size in Patients with Atrial Arrhythmias: Comparison of 2D versus Real Time 3D Echocardiography
Authors: Müller Hajo , Burri Haran , Lerch René
Published: April 2008

Aim: This study compares different parameters of right atrial size evaluated by two‐dimensional (2D) echocardiography with right atrial volume measured using three‐dimensional echocardiography (3DE). Methods and Results: One hundred sixty‐three consecutive patients with a history of atrial arrhythmias were studied by standard two‐dimensional and by real time 3DE. Of these 142 (87%) recordings were of sufficient quality for interpretation of the right atrium by both imaging techniques. The following parameters of right atrial size were measured: apical four‐chamber short‐axis diameter (4CH short axis), apical four‐chamber long axis diameter (4CH long axis), and apical four‐chamber planimetry area. The 2D‐derived right atrial volume was calculated by using the single plane area‐length method (4CH area‐length). The 2D parameters were then correlated with right atrial volume measured by real time 3DE. Linear regression analysis showed moderate correlation for four‐chamber planimetry area (r = 0.72, P < 0.001) and 2D‐derived volume calculation (r of 4CH single plane area‐length RA volume = 0.70, P < 0.001). Diameters correlated clearly less well with 3DE volume (r of 4CH short axis = 0.61, 4CH long axis = 0.59, P < 0.001 respectively). Conclusion: Real time 3DE is highly feasible for right atrial volume determination. The results demonstrate that measurements of dimensions using 2D echocardiography may not accurately assess right atrial size. If 3DE is not available, apical 4CH planimetry area is a simple alternative that may be used for evaluating right atrial size in clinical practice. The 2D‐derived right atrial volume by single plane area‐length method was not better correlated with 3DE volume than four‐chamber planimetry area.
Relationship between Left Ventricular Geometry and Left Ventricular Systolic and Diastolic Functions in Patients with Chronic Severe Aortic Regurgitation
Authors: Çayli Murat , Kanadaşi Mehmet , Akpinar Onur , Usal Ayhan , Poyrazoğlu Hakan
Published: April 2008

Background: Chronic aortic regurgitation (AR) is a form of volume overload inducing left ventricle (LV) dilatation. Myocardial fibrosis, apoptosis, progressive LV dilatation, and eventually LV dysfunction are seen with the progression of disease. The aim of the study was to assess the relation between LV geometry and LV systolic and diastolic functions in patients with chronic severe AR. Methods: The study population consisted of 88 patients with chronic severe AR and 42 healthy controls. The LV ejection fraction (LVEF) was calculated. Subjects were divided as Group I (controls, n = 42), Group II (LVEF > 50%, n = 47), and Group III (LVEF < 50%, n = 41). Transmitral early and late diastolic velocities and deceleration time were measured. The annular systolic (Sa) and diastolic (Ea and Aa) velocities were recorded. Diastolic function was classified as normal, impaired relaxation (IR), pseudonormalization (PN), and restrictive pattern (RP). Results: The LVEF was similar in Group I and II, while significantly lower in Group III. Sa velocity was progressively decreasing, but LV long‐ and short‐axis diameters were increasing from Group I to Group III. Forty‐six, 31 and 11 patients had IR, PN, and RP, respectively. LV long‐axis systolic and diastolic diameters were significantly increasing, while LVEF and Sa velocity were significantly decreasing from patients with IR to patients with RP. The LV long‐axis diastolic diameter is independently associated with LV systolic and diastolic functions. Conclusions: The LV long‐axis diastolic diameter is closely related with LV systolic and diastolic functions in patients with chronic severe AR.
Flying Saucer Located at the Basal Septum
Authors: Akcay Murat , Senkaya Emine Bilen , Bilge Mehmet , Bozkurt Mehmet , Arslantas Ugur , Karakas Fatih
Published: April 2008

Left ventricular thrombus formation is a frequent complication in patients with ischemic heart disease and is associated with a high risk of systemic embolization. Generally, thrombi localize at the apical segment. However, thrombus localized at the basal septum has not been reported yet. In this case, we discuss a flying saucer shaped mass located at the basal septum, which was later diagnosed as thrombus after anticoagulant therapy.
Diazepam versus Fentanyl for Premedication during Percutaneous Coronary Intervention: Results from the Myocardial Protection by Fentanyl during Coronary Intervention (PROFIT) Trial
Authors: ABDEL‐WAHAB MOHAMED , KHATTAB AHMED A. , LISKA BRANISLAV , KASSNER GUIDO , GEIST VOLKER , TOELG RALPH , RICHARDT GERT
Published: April 2008

Background: Sedation is a cornerstone in the premedication for percutaneous coronary intervention (PCI). Benzodiazepines and opioids are frequently used. Previous results suggest that opioids mimic the adaptation to ischemia during repeated balloon inflations and may provide direct myocardial protection in addition to their sedative effect. However, no comparative data exist.

Methods: We conducted a prospective, randomized, controlled, single‐blind trial comparing diazepam and fentanyl in 276 patients undergoing elective PCI. Patients were randomized to either diazepam 5 mg sublingually or fentanyl 0.05 mg or 0.1 mg intravenously at least 5 minutes prior to the first balloon inflation. The primary end‐point was the postprocedural elevation of myocardial markers of necrosis defined as an elevation of cardiac troponin T ≥ 0.01 ng/ml.

Results: The three groups had similar baseline clinical, angiographic, and procedural characteristics, with no significant differences in lesion morphology, procedural complexity, or adjunctive medical treatment. No significant variation in the hemodynamic response to the study drugs was observed in the three groups. The rate of postprocedural troponin T elevation was 28% in the diazepam group, 20% in the fentanyl 0.05 mg group, and 30% in the fentanyl 0.1 mg group (P = 0.26). Rates of postprocedural myocardial infarction were 3%, 2%, and 2%, respectively (P = 0.84), with one case of in‐hospital death in the diazepam group and no urgent TVR in the whole study population.

Conclusion: Although providing a well‐tolerated alternative to diazepam for sedation during PCI, fentanyl did not provide additional cardioprotection assessed through the postinterventional elevation of cardiac troponin T during elective coronary intervention.
Innovation and Implementation in the Public Sector: An Examination of Public Entrepreneurship
Authors: Mack W.R. , Green Deanna , Vedlitz Arnold
Published: April 2008

This article develops an empirical measure of public entrepreneurship and uses it to discover the correlates that distinguish between those participants in a policy domain who are seen as more or less important in the entrepreneurial process. Looking at two rural regions dealing with telemedicine technologies, the authors examine the role of personal attributes and situational attributes in predicting who will emerge as the most mentioned public entrepreneurs on these issues in their community. Status in the local community, membership in the health professions, and strong local focus and ties are the most instrumental variables in distinguishing between those in a policy domain who are more likely to be identified as entrepreneurial. The authors provide an empirical test that can, for the first time, identify in a comparative context the traits that distinguish more entrepreneurial individuals from less entrepreneurial ones (or nonentrepreneurial ones) participating in the same policy domain.
Informed Consent for Research: Current Practices in Academic Emergency Medicine
Authors: Monico Edward , Larkin Gregory Luke , Degutis Linda
Published: April 2008

Background:  The emergency department (ED) environment presents unique barriers to the process of obtaining informed consent for research.

Objectives:  The objective was to identify commonalities and differences in informed consent practices for research employed in academic EDs.

Methods:  Between July 1, 2006, and June 30, 2007, an online survey was sent to the research directors of 142 academic emergency medicine (EM) residency training programs identified through the Accreditation Council for Graduate Medical Education (ACGME).

Results:  Seventy‐one (50%) responded. The average number of simultaneous clinical ED‐based research projects reported was 7.3 (95% confidence interval [CI] = 5.53 to 9.07). Almost half (49.3%) of respondents reported that EM residents are responsible for obtaining consent. Twenty‐nine (41.4%) participating institutions do not require documentation of an individual resident’s knowledge of the specific research protocol and consent procedure before he or she is allowed to obtain consent from research subjects.

Conclusions:  It is common practice in academic EDs for clinical investigators to rely on on‐duty health care personnel to obtain research informed consent from potential research subjects. This practice raises questions regarding the sufficiency of the information received by research subjects, and further study is needed to determine the compliance of this consent process with federal guidelines.
Use of a Standardized Order Set for Achieving Target Temperature in the Implementation of Therapeutic Hypothermia after Cardiac Arrest: A Feasibility Study
Authors: Hope Kilgannon J. , Roberts Brian W. , Stauss Mary , Jo Cimino Mary , Ferchau Lynn , Chansky Michael E. , Phillip Dellinger R. , Parrillo Joseph E. , Trzeciak Stephen
Published: April 2008

Objectives:  Induced hypothermia (HT) after cardiac arrest improved outcomes in randomized trials. Current post–cardiac arrest treatment guidelines advocate HT; however, utilization in practice remains low. One reported barrier to adoption is clinician concern over potential technical difficulty of HT. We hypothesized that using a standardized order set, clinicians could achieve HT target temperature in routine practice with equal or better efficiency than that observed in randomized trials.

Methods:  After a multidisciplinary HT education program, we implemented a standardized order set for HT induction and maintenance including sedation and paralysis, intravenous cold saline infusion, and an external cooling apparatus, with a target temperature range of 33–34°C. We performed a retrospective analysis of a prospectively compiled and maintained registry of cardiac arrest patients with HT attempted (intent‐to‐treat) over the first year of implementation. The primary outcome measures were defined a priori by extrapolating treatment arm data from the largest and most efficacious randomized trial: 1) successful achievement of target temperature for ≥85% of patients in the cohort and 2) median time from return of spontaneous circulation (ROSC) to achieving target temperature <8 hours.

Results:  Clinicians attempted HT on 23 post–cardiac arrest patients (arrest location: 78% out‐of‐hospital, 22% in‐hospital; initial rhythm: 26% ventricular fibrillation/tachycardia, 70% pulseless electrical activity or asystole) and achieved the target temperature in 22/23 (96%) cases. Median time from ROSC to target temperature was 4.4 (interquartile range 2.8–7.2) hours. Complication rates were low.

Conclusions:  Using a standardized order set, clinicians can achieve HT target temperature in routine practice.
Toward Vocabulary Control for Chief Complaint
Authors: Haas Stephanie W. , Travers Debbie , Tintinalli Judith E. , Pollock Daniel , Waller Anna , Barthell Edward , Burt Catharine , Chapman Wendy , Coonan Kevin , Kamens Donald , McClay James
Published: April 2008

The chief complaint (CC) is the data element that documents the patient’s reason for visiting the emergency department (ED). The need for a CC vocabulary has been acknowledged at national meetings and in multiple publications, but to our knowledge no groups have specifically focused on the requirements and development plans for a CC vocabulary.

The national consensus meeting “Towards Vocabulary Control for Chief Complaint” was convened to identify the potential uses for ED CC and to develop the framework for CC vocabulary control. The 10‐point consensus recommendations for action were 1) begin to develop a controlled vocabulary for CC, 2) obtain funding, 3) establish an infrastructure, 4) work with standards organizations, 5) address CC vocabulary characteristics for all user communities, 6) create a collection of CC for research, 7) identify the best candidate vocabulary for ED CCs, 8) conduct vocabulary validation studies, 9) establish beta test sites, and 10) plan publicity and marketing for the vocabulary.
Java project on periodontal diseases: serotype distribution of Aggregatibacter actinomycetemcomitans and serotype dynamics over an 8‐year period
Authors: Van Der Reijden Wil A. , Bosch‐Tijhof Carolien J. , Van Der Velden Ubele , Van Winkelhoff Arie Jan
Published: April 2008

Objective: To investigate the serotype distribution and stability of Aggregatibacter actinomycetemcomitans over an 8‐year period in untreated Indonesian subjects.

Material and Methods: Clinical periodontal status and the presence of A. actinomycetemcomitans were established in 1994 and 2002 in 107 subjects from an Indonesian tea estate deprived from dental care. On an average, 3.6 isolates per patient were subcultured and serotyped using specific PCR reactions.

Results: In 1994, the predominant serotype was b (53.7%), whereas a and c occurred in 17.1% and 14.6% of the subjects, respectively. In 2002, a reduction in serotypes a (7.5%) and b (30.2%) occurred. Serotypes c and e increased in prevalence from 14.6% to 35.8% and 2.4% to 9.4%, respectively. Multiple serotypes were found in 12.2% in 1994 and 17% in 2002. From 24 subjects who were positive at both time points, 14 (58.3%) had the same serotype, whereas in 10 subjects (41.7%), a different serotype was found. Mean clinical attachment loss had increased from 0.74 mm in 1994 to 1.96 mm in 2002 but could not be related to subgingival presence of A. actinomycetemcomitans.

Conclusions: A. actinomycetemcomitans serotypes distribution in Indonesian young adults shifts from predominantly serotype b to a more equal prevalence of serotypes b and c. This shift suggests an opportunistic character of A. actinomycetemcomitans.
Malignant cutaneous glomus tumor presenting as a rapidly growing leg mass in a pregnant woman
Authors: Cibull Thomas L. , Gleason Briana C. , O’Malley Dennis P. , Billings Steven D. , Wiersema Pieter , Hiatt Kim M.
Published: April 2008

A 21‐year‐old pregnant woman presented with a rapidly growing >2 cm nodule on her right leg, involving dermis and subcutaneous tissue. Histologically, the tumor was composed of sheets and nests of neoplastic cells with variable cytomorphology, including typical round to ovoid glomus cells with clear cytoplasm and well‐defined cell borders, small cells and spindle cells. Numerous medium to large vessels were present throughout the tumor. Moderate‐ to high cellularity, nuclear atypia and frequent mitotic figures (42 MF/50 High power field (HPF)) were noted. Immunohistochemistry showed cytoplasmic and membranous expression of actin (HHF‐35) and membranous expression of type IV collagen. The histologic features and immunoprofile were consistent with the diagnosis of malignant glomus tumor, a rare soft tissue neoplasm that typically arises on the extremities. Histologic features that infer malignancy in glomus tumors include the combination of large size (>2 cm) and deep location, or atypical mitotic figures, or moderate to severe cytologic atypia with high mitotic activity (>5 mitoses /50 HPF). Although our case was superficially located, the nuclear atypia and mitotic rate, as well as the large size, fulfilled the criteria for a malignant glomus tumor.
Genital herpes masquerading as a cutaneous T‐cell lymphoma: a report of two cases
Authors: Wain E. Mary , Antony Fiona , Appleton Mark A.C. , Whittaker Sean J. , Robson Alistair
Published: April 2008

Genital herpes simplex virus (HSV) infection is usually a straightforward clinical diagnosis, rarely requiring histological confirmation. We report two cases of immunosuppressed patients in which the clinical and pathological features were initially suspicious for cutaneous lymphoma with a T‐cell clone detected in one case. A diagnosis of HSV infection was eventually made on the basis of histological features and confirmed with immunohistochemistry.
Application of internal wool lipids to hair
Authors: Méndez Sandra , Barba Clara , Lanzilotta Alisa Roddick , Kelly Rob , Parra Jose Luís , Coderch Luísa
Published: April 2008

Purpose: Hair lipids can contribute to physicochemical phenomena such as diffusion, cell cohesion and mechanical strength, although lipids occur at much lower levels (1–6% dry weight) than proteins (>90%).Hair lipids can be diminished by hair washing and submission to chemical treatments. Studies have shown that internal wool lipids (IWL) resemble those membranes of other keratinic tissues such as human hair or stratum corneum.

Results: In this work, the IWL, in the form of liposomes or from an emulsion system, were applied to untreated hair fibres and also treated hair fibres. The results showed that application of IWL to pretreated hair samples lead to an improvement in mechanical strength properties of the fibres when the IWL were applied structured as liposomes. Differential scanning calorimetry studies demonstrated that the application of IWL to pretreated hair sample led to a slight increase in the crystalline material of the fibres. Moreover, scanning electron microscopy studies showed that application of IWL liposomes to damaged hair fibres lead to an improvement of the cuticle scale, demonstrating the importance of the use of a delivery vehicle with a bilayer structure similar to the one present in the hair fibre to restore the natural properties of the fibre.
Development of a novel method to measure the elastic properties of skin including subcutaneous tissue: New age‐related parameters and scope of application
Authors: Fujimura Tsutomu , Osanai Osamu , Moriwaki Shigeru , Akazaki Syuichi , Takema Yoshinori
Published: April 2008

Background/purpose: We have developed a new apparatus to measure the elastic properties of skin without contact using an air blown technique.

Methods: Real‐time measurements of skin movement induced by air blown on the surface were measured at various times. We investigated age‐related changes in the displacement of the skin surface caused by air using various parameters. Ninety‐eight female Japanese volunteers, aged from 10 to 70 years, were used in this study.

Results: The maximum distance (the denting state) that cheek skin moved reached 2–5 mm within 10–15 ms. After that, the skin generally recovered to its original state within 40–50 ms. The average maximum speed of movement was 0.49±0.08 (average±SD) m/s and the average recovery speed was 0.25±0.06 m/s. Significant changes with age were not observed in the denting state, but significant correlations with age were observed in the recovery state. The maximum recovery speed decreased significantly with age and the time required for recovery increased significantly with age. Although similar results were obtained at the corner of the mouth or the inner upper arm, different results were obtained at the below eyes and the forehead.

Conclusions: This apparatus differs from other conventional instruments in that it measures the elastic properties of skin including subcutaneous tissue without contact.
ORIGINAL ARTICLE: Placental Fas/Fas Ligand Expression in Early Pregnancy Losses
Authors: Guvendag Guven Emine Seda , Okur Hamza , Beksac Mehmet Sinan
Published: April 2008

Problem  The aim of this study was to compare the expression levels of Fas and Fas ligand (FasL) in first‐trimester placentas obtained from spontaneous abortions in patients with antiphospholipid antibody syndrome (APS) or factor V (FV) Leiden mutation, compared with values in placentas from induced abortions in patients negative for these conditions.

Method of study  We studied explants from 6‐ to 10‐week‐old placentas  that had been prepared by collagenase digestion from 10 spontaneous abortions from APS‐positive patients, nine spontaneous abortions in patients positive for FV Leiden mutation, and 10 induced abortions. All tissues were analyzed by flow cytometry for expression of Fas and FasL.

Results  Flow cytometric analysis showed that placental FasL expression was significantly lower in abnormal pregnancies than in normal ones. However, no such difference was observed for Fas expression.

Conclusion  FasL on placental cells may be involved in the maintenance of immune privilege, thereby ensuring the safety and growth of placental tissues. Dysregulation of apoptotic mechanisms may play a critical role in spontaneous abortions.
Mutants of Saccharomyces cerevisiae deficient in acyl‐CoA synthetases secrete fatty acids due to interrupted fatty acid recycling
Authors: Scharnewski Michael , Pongdontri Paweena , Mora Gabriel , Hoppert Michael , Fulda Martin
Published: April 2008

In the present study, acyl‐CoA synthetase mutants of Saccharomyces cerevisiae were employed to investigate the impact of this activity on certain pools of fatty acids. We identified a genotype responsible for the secretion of free fatty acids into the culture medium. The combined deletion of Faa1p and Faa4p encoding two out of five acyl‐CoA synthetases was necessary and sufficient to establish mutant cells that secreted fatty acids in a growth‐phase dependent manner. The mutants accomplished fatty acid export during exponential growth‐phase followed by fatty acid re‐import into the cells during the stationary phase. The data presented suggest that the secretion is driven by an active component. The fatty acid re‐import resulted in a severely altered ultrastructure of the mutant cells. Additional strains deficient of any cellular acyl‐CoA synthetase activity revealed an almost identical phenotype, thereby proving transfer of fatty acids across the plasma membrane independent of their activation with CoA. Further experiments identified membrane lipids as the origin of the observed free fatty acids. Therefore, we propose the recycling of endogenous fatty acids generated in the course of lipid remodelling as a major task of both acyl‐CoA synthetases Faa1p and Faa4p.
Calculation of Sample Size for Stroke Trials Assessing Functional Outcome: Comparison of Binary and Ordinal Approaches
Authors: Bath Philip
Published: April 2008

Background

Many acute stroke trials have given neutral results. Sub-optimal statistical analyses may be failing to detect efficacy. Methods which take account of the ordinal nature of functional outcome data are more efficient. We compare sample size calculations for dichotomous and ordinal outcomes for use in stroke trials.

Methods

Data from stroke trials studying the effects of interventions known to positively or negatively alter functional outcome – Rankin Scale and Barthel Index – were assessed. Sample size was calculated using comparisons of proportions, means, medians (according to Payne), and ordinal data (according to Whitehead). The sample sizes gained from each method were compared using Friedman 2 way ANOVA.

Results

Fifty-five comparisons (54 173 patients) of active vs. control treatment were assessed. Estimated sample sizes differed significantly depending on the method of calculation ( P<00001). The ordering of the methods showed that the ordinal method of Whitehead and comparison of means produced significantly lower sample sizes than the other methods. The ordinal data method on average reduced sample size by 28% (inter-quartile range 14–53%) compared with the comparison of proportions; however, a 22% increase in sample size was seen with the ordinal method for trials assessing thrombolysis. The comparison of medians method of Payne gave the largest sample sizes.

Conclusions

Choosing an ordinal rather than binary method of analysis allows most trials to be, on average, smaller by approximately 28% for a given statistical power. Smaller trial sample sizes may help by reducing time to completion, complexity, and financial expense. However, ordinal methods may not be optimal for interventions which both improve functional outcome and cause hazard in a subset of patients, e.g. thrombolysis.
Risk Factors for Ischaemic Stroke
Authors: Allen Claire L. , Bayraktutan Ulvi
Published: April 2008

Stroke is a leading cause of morbidity and mortality in western populations, with up to 40% of survivors not expected to recover independence from severe disabilities. This equates to an immense financial burden on health systems worldwide. Hence further education is required to inform individuals of the risks to promote secondary prevention strategies in future generations. Stroke is a heterogeneous, multifactorial disease regulated by modifiable and nonmodifiable risk factors. Modifiable factors include a history of high blood pressure, diabetes mellitus and coronary heart disease. Nonmodifiable factors include age, sex and race. Other less-well documented risk factors include geographic location, socioeconomic status and alcoholism. Approximately 80% of stroke events could be reduced by making simple lifestyle modifications. Further studies are required to clarify the role and interplay of the risk factors outlined to give a more comprehensive understanding of stroke and to aid and drive the development of more effective stroke prevention programs, in high risk groups.
The Philosophy of Harmony in Classical Confucianism
Authors: Li Chenyang
Published: April 2008

This essay introduces the philosophy of harmony in Classical Confucianism. In the first part of the essay the author summarizes the concept of harmony as it was developed in various Confucian classics. In the second part, the author offers an account of the Confucian program of harmony, ranging from internal harmony in the person, to harmony in the family, the state, the international world, and finally to harmony in the entire universe.
Russell and the Unity of the Proposition
Authors: Stevens Graham
Published: April 2008

In this article I present a summary of Bertrand Russell's protracted attempts to solve the problem of the unity of the proposition, and explain the significance of the problem for Russell's philosophy. Unlike many other accounts which take the problem to be confined to Russell's early theories of propositional content, I argue that the problem (or variants of it) is a recurring theme throughout the whole of Russell's career.