bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative Approach Applied to User Interface of Latin American Web OPACs
Authors: Barber Elsa , Pisano Silvia , Romagnoli Sandra , Parsiale Verónica , de Pedro Gabriela , Gregui Carolina , Blanco Nancy
Published: August 2012

This chapter studies user interfaces of Web Online Public Access Catalogs (OPACs) and presents their principal difficulties in facing the man-machine interaction and the contributions of Web 2.0 to overcome these limitations. Methodologies used to study OPACs interfaces are examined. A quantitative approach is used to analyze Web OPACs in academic, special, national, and public libraries through the conclusive use of several tests: chi-square or test of independence, logistic regression, odds ratio, analysis of variance, and discriminant analysis. The situation of Latin American Web OPACs is verified in relation to the use of Integrated Library Systems (ILS) and Database Management Systems (DBMS). This methodology is proposed to study the 2.0 functionalities in these catalogs.
Introduction
Authors: Al-Hamadani Badya , Lu Joan
Published: August 2012

The eXtensible Markup Language (XML) is a World Wide Web Consortium (W3C) recommendation which has widely been used in both commerce and research. As the importance of XML documents increase, the need to deal with these documents increases as well. This chapter illustrates the methodology that has been used throughout the research, discussing all its parts and how these parts were adopted in the research.
Conclusion
Authors: Pein Raoul Pascal , Lu Joan , Renz Wolfgang
Published: August 2012

In this final chapter of the section, the conclusion of this book section is given. It is summarized how the initial hypothesis has been investigated and which answer has been found. A brief summary of the achievements as well as the intended future work in this area are presented.
Modeling Process Exception Handling
Authors: Xue Gang , Zhang Kun , Hu Yurong , Yao Shaowen
Published: August 2012

In this chapter, process exception handling at work item level, exception handling at case level, and recovery action are discussed and represented in bigraphs for CCS. Based on the discussion, models for process exception patterns are proposed. The work intends to provide abstract models for analyzing the behavior of exception handling, and the result shows that some advanced features of bigraphs are introduced in representations.
Opportunistic Spectrum Sensing and Transmissions
Authors: Alam S. S. , Marcenaro L. , Regazzoni C. S.
Published: August 2012

Nowadays, cognitive radio is one of the most promising paradigms in the arena of wireless communications, as it aims at the proficient use of radio resources. Proper utilization of the radio spectrum requires dynamic spectrum accessing. To this end, spectrum sensing is undoubtedly necessary. In this chapter, various approaches for dynamic spectrum access scheme are presented, together with a survey of spectrum sensing methodologies for cognitive radio. Moreover, the challenges are analyzed that are associated with spectrum sensing and dynamic spectrum access techniques. Sensing beacon transmitted from different cognitive terminals creates significant interference to the primary users if proper precautions have not been taken into consideration. Consequently, cognitive radio transmitter power control are finally addressed to analyze energy efficiency aspects.
Spectrum Sensing in Cognitive Radio
Authors: Chung Wei-Ho
Published: August 2012

The cognitive radio has been widely investigated to support modern wireless applications. To exploit the spectrum vacancies in cognitive radios, the chapter considers the collaborative spectrum sensing by multiple sensor nodes in the likelihood ratio test (LRT) frameworks. In this chapter, the functions of sensors can be served through the cooperative regular nodes in the cognitive radio, or the specifically deployed sensor nodes for spectrum sensing. In the LRT, the sensors make individual decisions. These individual decisions are then transmitted to the fusion center to make the final decision, which provides better detection accuracy than the individual sensor decisions. The author provides the lowered-bounded probability of detection (LBPD) criterion as an alternative criterion to the conventional Neyman-Pearson (NP) criterion. In the LBPD criterion, the detector pursues the minimization of the probability of false alarm while maintaining the probability of detection above the pre-defined value. In cognitive radios, the LBPD criterion limits the probabilities of channel conflicts to the primary users. Under the NP and LBPD criteria, the chapter provides explicit algorithms to solve the LRT fusion rules, the probability of false alarm, and the probability of detection for the fusion center. The fusion rules generated by the algorithms are optimal under the specified criteria. In the spectrum sensing, the fading channels influence the detection accuracies. The chapter investigates the single-sensor detection and collaborative detections of multiple sensors under various fading channels and derives testing statistics of the LRT with known fading statistics.
Adoption of a New Online Travel Management System for FED-AK
Authors: Kell Aundrea , Pierre Shari , Hoanca Bogdan
Published: August 2012

This case describes the implementation of an online travel management system at FED-AK, the Alaska office of a U.S. government agency. The previous system was intended to accomplish the same functionality, but due to employee resistance, it was used only as a forms generator in conjunction with a paper- and mail-based process. The new system is integrated, which compels employees to use all the functionality provided. It also incorporates many lessons learned from the old system—in particular, extensive training and online help functions. The system is expected to significantly reduce the cost of travel by minimizing errors, enforcing policies, and reducing transaction costs. The system will also lead to faster reimbursement of employee travel expenses.
Investigating the Online Interactions of a Team of Test Developers Working in a Wiki Environment
Authors: Filipi Anna , Lissonnet Sophie
Published: August 2012

This chapter reports an investigation of online interactions occurring in the context of the development of a suite of foreign language tests known as the Assessment of Language Competence (ALC) (http://www.acer.edu.au/alc/). The interactions took place in a wiki environment from 2007 to 2009. The aim of the investigation was twofold. The first was to identify the features of the organization of online postings in an asynchronous online environment and to compare them with the organization of face-to-face interaction. The second was to examine how expertise is invoked in interactions centered on the vetting of test items. The chapter uses selected findings from Conversation Analysis and applies them to the postings on the wiki. Findings from the analysis include the rarity of self-repair, similarities in the organization of sequence structure and the same orientations to affiliative behavior found in conversation.
Drug Reaction, Skin Care, Skin Loss
Authors: Cooper Karen L.
Published: August 2012

Stevens-Johnson syndrome is a rare, potentially fatal drug reaction that causes necrosis of epidermal cells. Early recognition of the syndrome is essential to prevent complications. This article discusses identification, complications, and treatment of Stevens-Johnson syndrome.
Spontaneous Coronary Artery Dissection: A Rare Threat to Young Women
Authors: Martinez Linda Griego
Published: August 2012

Spontaneous coronary artery dissection not associated with underlying coronary artery disease is rare. When the dissection does occur, it most often is manifested as an acute ST-elevation myocardial infarction in young women. Although the condition can occur in men, most often it involves women who are in their third trimester of pregnancy or the early postpartum period or are engaging in vigorous exercise. Because little is known about spontaneous coronary artery dissection in this population of women, recommendations for treatment are the same as for treatment of acute myocardial infarction associated with atherosclerotic coronary disease.
Use of a 1-Piece Chlorhexidine Gluconate Transparent Dressing on Critically Ill Patients
Authors: Pfaff Barbara , Heithaus Teresa , Emanuelsen Madeline
Published: August 2012

Background

New transparent dressings with chlorhexidine gluconate in the dressing are available.

Objectives

To compare the effectiveness of a new 1-piece occlusive dressing that incorporates chlorhexidine gluconate with that of a dressing plus a chlorhexidine gluconate patch in maintaining the low rate of catheter-related bloodstream infections in the intensive care unit and to evaluate nurses’ satisfaction with and cost of the new dressing.

Methods

A quality improvement observational study was done in an adult medical-surgical intensive care unit. All patients with a central venous catheter had initial and/or subsequent dressing changes done with the new dressing. The central catheter bundle elements of the Institute for Healthcare Improvement were followed. Patients were monitored for catheter-related bloodstream infections, and the rate of infection was calculated.

Results

During the study period of 1881 device days, the infection rate was 0.051 per 1000 device days, compared with a rate of 0.052 in 2008. Nurses preferred the new dressing. Cost savings were $3807.

Conclusion

A low rate of catheter-related bloodstream infections can be maintained, nurses’ satisfaction achieved, and cost savings realized with the new dressing.
Using Evidence-Based Practice to Prevent Ventilator-Associated Pneumonia
Authors: Sedwick Mary Beth , Lance-Smith Mary , Reeder Sara J. , Nardi Jessica
Published: August 2012

Background

Strategies are needed to help prevent ventilator-associated pneumonia.

Objective

To develop a ventilator bundle and care practices for nurses in critical care units to reduce the rate of ventilator-associated pneumonia.

Method

The ventilator bundle developed by the Institute for Healthcare Improvement was expanded to include protocols for mouth care and hand washing, head-of-bed alarms, subglottic suctioning, and use of an electronic compliance feedback tool. Compliance audits were used to provide immediate electronic feedback.

Results

Adherence to practices included in the bundle increased. Compliance rates were greater than 98% for prophylaxis for peptic ulcer disease and deep-vein thrombosis, interruption of sedation, and elevation of the head of the bed. The compliance rate for the oral care protocol increased from 76% to 96.8%. Readiness for extubation reached at least 92.4%. Rates of ventilator-associated pneumonia decreased from 9.47 to 1.9 cases per 1000 ventilator days. The decrease in rates produced an estimated savings of approximately $1.5 million.

Conclusion

Strict adherence to bundled practices for preventing ventilator-associated pneumonia, enhanced accountability for initiating protocols, use of a feedback system, and interdisciplinary collaboration improved patients’ outcomes and produced marked savings in costs.
Biodiversity conservation in Sri Lanka's novel ecosystems
Authors: Pethiyagoda Rohan
Published: August 2012

With Sri Lanka's old-growth forests having been reduced to less than 20% of their pre-colonial extent, increasing areas of land, formerly heavily influenced by humans, are being allowed to return to secondary forests. These range from land recovering from swidden cultivation in the dry zone, through abandoned tea plantations in the lower-montane zone, to partly-logged forests throughout the country. Although the secondary vegetation of these ‘emerging ecosystems’ is often dominated by alien plant species and includes only a depauperate native flora, many threatened animals, ranging from amphibians to elephants, are able to utilize them for part or all of their life cycles. These novel ecosystems offer valuable conservation opportunities in two ways: (1) by increasing the area of occupancy of threatened species they contribute directly to a reduction in the level of threat; and (2) they provide a filter for triage, whereby threatened species that are intolerant of modified habitats could be awarded higher priority in the design of recovery plans. Available data suggest that among the Sri Lankan terrestrial vertebrates presently assessed as Endangered or Critically Endangered in the IUCN Red List, 12 of 14 mammal species, three of four reptile species and 40 of 48 amphibian species occur also in emerging ecosystems. Despite their impoverished plant diversity, therefore, such ecosystems should be viewed as a conservation opportunity rather than a threat; they should be incorporated into the national protected areas network and their biodiversity monitored, especially in relation to threatened species. Those that establish stable populations over multiple generations could be down-listed so that greater conservation attention could be allocated to threatened species obligatorily dependent on old-growth forests. DOI: http://dx.doi.org/10.4038/cjsbs.v41i1.4532 Ceylon Journal of Science (Bio. Sci.) 41 (1): 1-10, 2012
Mineral bioavailability in three locally consumed pulses processed using popular methods: interpreted using molar ratios with phytic acid
Authors: Seneviratne Mihiri , Gunasinghe WKR Niroshini , Gama-Arachchige NS , Dissanayake N Bhagya U , Karunaratne Anjani M
Published: August 2012

Pulses, an essential component of the Sri Lankan diet, have high levels of phytic acid (PA) which chelate essential mineral nutrients limiting their bioavailability. Three locally grown pulses; mung beans, black gram and soya bean were investigated to determine the effects of popular processing methods on their Zn, Fe and Ca bioavailability as affected mainly by phytic acid (PA). Processed mung beans (Vigna radiata var. MI 6) and black gram (Vigna mungo var. MI 1) had very high levels of PA. In mung beans, with increasing germination time, a significant decrease (P=0.05) in PA from 2517 to 1998 mg per 100g (dry weight basis) was observed but PA:Zn molar ratio did not improve. Natural fermentation of black gram, did not affect PA level effectively, but levels decreased when inoculated with a lactic acid bacterium or with Pantoea agglomerans. In soya bean (Glycine max var. Pb), significant (P=0.05) reduction in PA was observed in tempeh (487 mg/100 g dry weight). Overall, in soya products, the Zn bioavailability has increased from low to moderate levels in both tofu and tempeh. The molar ratio of PA:Fe was lower in all soya products. Although, PA:Zn molar ratio has decreased in germinated mung beans, the Ca x PA:Zn ratio exceeded 0.5 indicating that Ca influences Zn bioavailability DOI: http://dx.doi.org/10.4038/cjsbs.v41i1.4534 Ceylon Journal of Science (Bio. Sci.) 41 (1): 19-26, 2012
Disease control strategies for extending storage life of papaya (Carica papaya), cultivars 'Red Lady' and 'Rathna'
Authors: Abeywickrama K , Wijerathna C , Rajapaksha N , Sarananda K , Kannangara Sushil
Published: August 2012

Anthracnose (Colletotrichum gloeosporioides), stem-end rot (Lasiodiplodia theobromae) and Phomopsis rot (Phomopsis caricae-papayae) are major post-harvest diseases in papaya resulting in relatively high postharvest losses, up to 45%, in Sri Lanka. The current consumer preference is for tropical fruits free of synthetic pesticides. The objectives of the present investigation were to identify major post-harvest pathogens in papaya fruits, test in vitro fungitoxic effect of basil oil (Ocimum basillicum) and alum (sodium aluminium sulphate) on major fungal pathogens of papaya fruit and develop a relatively safe, disease control strategy. Alum (1% w/v) and basil oil (0.12– 0.16% v/v) in a liquid bioassay, indicated fungistatic and fungicidal efficacy on C. gloeosporioides, L. theobromae and P. caricae-papayae isolated from ‘Red Lady’ and ‘Rathna’ cultivars of papaya. In vivo investigation of fruits of both papaya cultivars harvested from fruit plantations in Sri Lanka (‘Red Lady’–Yatawarawatta plantation, Kurunegala, ‘Rathna’ – CIC plantation, Kekirawa and the Agricultural farm, Polonnaruwa) at 25% maturity level indicated that papaya washed in 1% (w/v) alum and subsequently sprayed with an emulsion solution of 0.16% (v/v) basil oil and enclosed in styrofoam sleeves could be stored for 14 days at 12–14 °C. The visual quality rating (VQR) was high (11–13), shriveling and ‘green islands’ were low on fruits with zero disease severity where results were statistically similar to 500 mg/L Bavistin treatment. Physicochemical properties assessed were unaffected by the treatments and were comparable to the controls washed only in water. The organoleptic properties were slightly low in fruits subjected to cold temperature compared to fruits subjected to ambient temperature. No residues of basil oil could be detected on fruit peel by gas chromatography at the end of the experimental period of 14 days. The treatment strategy developed could be adopted for sea shipment or temperature-regulated supermarket storage of papaya fruits where storage life could be lengthened up to 14 days. DOI: http://dx.doi.org/10.4038/cjsbs.v41i1.4535 Ceylon Journal of Science (Bio. Sci.) 41 (1): 27-34, 2012
Extravasation of Antineoplastic Agents: Prevention And Treatments
Authors: Boschi Rita , Rostagno Elena
Published: August 2012

The extravasation of antineoplastic agents is an unwanted and distressing situation that can easily occur. It may cause severe and irreversible local injuries. Left untreated, vesicant chemotherapy extravasation can potentially cause tissue necrosis, functional impairment and permanent disfigurement. This article provides a review of current literature regarding recommendations on the prevention and treatment of extravasation of antineoplastic agents.
Hotel Clinic-Based Diarrheal and Respiratory Disease Surveillance in U.S. Service Members Participating in Operation Bright Star in Egypt, 2009
Authors: Sebeny Peter J. , Nakhla Isabelle , Moustafa Manal , Bruton Jody A. , Cline Joanne , Hawk Douglas , El-Mohammady Hanan , Nada Rania A. , Ahmed Salwa F. , Pimentel Guillermo , Young Sylvia Y. N.
Published: August 2012

We conducted clinic-based, influenza-like illness and diarrheal disease surveillance among U.S. service members participating in Operation Bright Star 2009. Epidemiologic data and samples were collected. Nasopharyngeal swab specimens were tested for viruses, and feces was tested for microbiologic, immunologic, and molecular diagnostics. A survey was used to collect self-reported data. From 1,529 surveys, 41% reported diarrheal disease and 25% reported respiratory illness (incidence rate = 62 of 100 versus 37 of 100 person-months; incidence rate ratio = 1.7, 95% confidence interval = 1.5–1.9). Enterotoxigenic Escherichia coli was identified in 74% (69 of 93) of fecal samples. In the influenza-like illness case series, 17% (9 of 52) were positive for influenza A; all were positive for pandemic (pH1N1) 2009 virus. Rates of decreased work performance reported by patients with diarrhea and influenza-like illness were similar (46% versus 48%; P = 0.8). Diarrheal diseases and respiratory illness remain common among deployed military personnel, with important operational impact. Despite an ongoing influenza pandemic, diarrheal disease incidence was higher than that of respiratory illness.
Human African Trypanosomiasis in a Traveler: Diagnostic Pitfalls
Authors: Meltzer Eyal , Leshem Eyal , Steinlauf Shmuel , Michaeli Shulamit , Sidi Yechezkel , Schwartz Eli
Published: August 2012

An Israeli traveler returning from Tanzania presented with a relapsing febrile illness. A diagnosis of Trypanosoma brucei rhodesiense infection was established by blood smear after nearly a month. Blood polymerase chain reaction failed to provide an early diagnosis of human African trypanososmiasis. Recognition of suggestive signs should prompt physicians to perform repeated tests before ruling out human African trypanososmiasis.
Identification of Diverse Bartonella Genotypes among Small Mammals from Democratic Republic of Congo and Tanzania
Authors: Gundi Vijay A. K. B. , Kosoy Michael Y. , Makundi Rhodes H. , Laudisoit Anne
Published: August 2012

Small mammals from the Democratic Republic (DR) of the Congo and Tanzania were tested to determine the prevalence and genetic diversity of Bartonella species. The presence of Bartonella DNA was assessed in spleen samples of the animals by rpoB- and gltA-polymerase chain reactions (PCRs). By rpoB-PCR, Bartonella was detected in 8 of 59 animals of DR Congo and in 16 of 39 Tanzanian animals. By gltA-PCR, Bartonella was detected in 5 and 15 animals of DR Congo and Tanzania, respectively. The gene sequences from Arvicanthis neumanni were closely related to Bartonella elizabethae. The genotypes from Lophuromys spp. and from Praomys delectorum were close to Bartonella tribocorum. Five genogroups were not genetically related to any known Bartonella species. These results suggest the need to conduct further studies to establish the zoonotic risks linked with those Bartonella species and, in particular, to verify whether these agents might be responsible for human cases of febrile illness of unknown etiology in Africa.
Emerging Nucleic Acid–Based Tests for Point-of-Care Detection of Malaria
Authors: Cordray Michael S. , Richards-Kortum Rebecca R.
Published: August 2012

Malaria remains a serious disease in the developing world. There is a growing consensus that new diagnostics are needed in low-resource settings. The ideal malaria diagnostic should be able to speciate; measure parasitemia; low-cost, quick, and simple to use; and capable of detecting low-level infections. A promising development are nucleic acid tests (NATs) for the diagnosis of malaria, which are well suited for point-of-care use because of their ability to detect low-level infections and speciate, and because they have high sensitivity and specificity. The greatest barrier to NAT use in the past has been its relatively high cost, and the amount of infrastructure required in the form of equipment, stable power, and reagent storage. This review describes recent developments to decrease the cost and run time, and increase the ease of use of NAT while maintaining their high sensitivity and specificity and low limit of detection at the point-of-care.
Evidence for Stopping Mass Drug Administration for Lymphatic Filariasis in Some, But Not All Local Government Areas of Plateau and Nasarawa States, Nigeria
Authors: King Jonathan D. , Eigege Abel , Umaru John , Jip Nimzing , Miri Emmanuel , Jiya Jonathan , Alphonsus Kal M. , Sambo Yohanna , Graves Patricia , Richards Frank
Published: August 2012

An average of six annual rounds of ivermectin and albendazole were distributed in Plateau and Nasarawa States, Nigeria, to eliminate lymphatic filariasis. From 2007 to 2008, population-based surveys were implemented in all 30 local government areas (LGAs) of the two states to determine the prevalence of Wuchereria bancrofti antigenemia to assess which LGA mass drug administration (MDA) could be halted. In total, 36,681 persons from 7,819 households were examined for filarial antigen as determined by immunochromatographic card tests. Overall antigen prevalence was 3.05% (exact upper 95% confidence interval [CI] = 3.41%) with an upper 95% CI range by LGA of 0.50–19.3%. Among 3,233 children 6–7 years of age, overall antigen prevalence was 1.71% (exact upper 95% CI = 2.19%), too high to recommend generally halting MDA in the two-state area. However, based on criteria of < 2% antigenemia among persons > 2 years of age, stopping MDA was recommended for 10 LGAs.
A Fatal Urban Case of Rocky Mountain Spotted Fever Presenting an Eschar in San José, Costa Rica
Authors: Argüello Ana Patricia , Hun Laya , Rivera Patricia , Taylor Lizeth
Published: August 2012

This study reports the first urban human case of Rocky Mountain spotted fever caused by Rickettsia rickettsii, in Costa Rica. An 8-year-old female who died at the National Children's Hospital 4 days after her admission, and an important and significant observation was the presence of an “eschar” (tache noire), which is typical in some rickettsial infections but not frequent in Rocky Mountain spotted fever cases.
Buprenorphine therapy for opioid addiction in rural Washington: The experience of the early adopters
Authors: Quest, BS Tyler L. , Merrill, MD Joseph O. , Roll, PhD John , Saxon, MD Andrew J. , Rosenblatt, MD, MPH Roger A.
Published: August 2012

Background: The introduction of buprenorphine as office-based treatment for opioid dependence was designed to expand treatment capacity, but virtually there are no data about use of this medication in rural areas.Methods: The survey of the first cohort of physicians in rural Washington State who obtained buprenorphine waivers (2002-2010) to determine the volume of treated patients, physician appraisal of the efficacy of this treatment, and perceived barriers to treatment was conducted. Twenty-four (73 percent) of the 33 rural buprenorphine-certified physicians practicing in the state were interviewed in 2010.Results: Twenty physicians (83 percent) were actively prescribing buprenorphine/naloxone for treatment of addiction. Those currently prescribing averaged 23 active patients and had treated 125 patients since certification. All respondents reported that buprenorphine was efficacious in the treatment of addiction and 95 percent recommended that other rural colleagues adopt buprenorphine treatment. The following four major barriers were cited: 1) lack of adequate financial support from Medicaid, the largest source of third-party coverage for these patients; 2) unavailability of local mental health and behavioral addiction treatment services; 3) difficulty in finding consultants to assist in managing complex patients; and 4) shortages of other rural physicians providing this service.Conclusions: Buprenorphine is viewed as a highly effective treatment of opioid addiction by early adopters in rural Washington State, but relatively few rural physicians currently provide this service. Inadequate insurance coverage, a shortage of effective links with consultants and colleagues, and the lack of mental health services are persistent barriers to the use of this modality in rural Washington State.
PCA-derived factors that may be predictive of postoperative pain in pediatric patients: A possible role for the PCA ratio
Authors: Mc Donnell, MD, MB Conor , Pehora, MN Carolyne , Crawford, MBBS Mark W.
Published: August 2012

Objective: No method exists to reliably predict which patients will develop severe postoperative pain. The authors hypothesized that data derived from patient-controlled analgesia (PCA) pumps (specifically the ratio of patient demands to pump deliveries) may predict which patients would develop severe pain after scoliosis repair.Setting: Quaternary, university-affiliated, pediatric hospital.Patients and participants: Forty American Society of Anesthesiologists I-II pediatric patients who had undergone elective scoliosis repair and had consented to recruitment to a randomized clinical trial investigating the effects of early morphine administration on remifentanil-induced hyperalgesia.Interventions: To test the hypothesis of the current study, the authors calculated the PCA ratio of demand to delivery at every 4 hours throughout the first 24 hours after surgery for all the patients recruited to the original study.Main outcome measures: The authors compared calculated PCA ratios, numeric rating scale pain scores, and cumulative morphine consumption for those patients who developed severe postoperative pain and met the criteria for opioid rotation versus those patients who did not.Results: Seven patients required opioid rotation from PCA morphine to PCA hydromorphone. Eight hours after surgery, the median PCA ratio for those seven patients (2.5 [range, 1.8-4.3]) was significantly greater than that for all other recruited patients (1.3 [range, 0-2.7]; p < 0.001).Conclusions: Patients who developed severe postoperative pain and met the criteria for opioid rotation demonstrated significantly increased PCA ratios of demand to delivery as early as 8 hours after surgery.
Physician survey examining the impact of an educational tool for responsible opioid prescribing
Authors: Young, PhD Aaron , Alfred, MS Kelly C. , Davignon, MA Philip P. , Hughes, MBA LaSharn M. , Robin, MLA Lisa A. , Chaudhry, DO Humayun J.
Published: August 2012

Introduction: In response to the need for physician education on proper opioid prescribing, the Federation of State Medical Boards (FSMB) and the FSMB Foundation, the philanthropic arm of the FSMB, commissioned and distributed Responsible Opioid Use: A Physician’s Guide to more than 165,000 licensed physicians in the United States. The book, written by pain management specialist Scott Fishman, MD, seeks to further physicians’ continuing medical education by providing information on how to properly prescribe opioids to treat patients in pain. Although the book has been widely distributed, there have been no systematic studies of its impact. To address this knowledge gap, the authors surveyed licensed physicians in Georgia who received a copy of the book to determine whether it added to their knowledge about prescribing opioids, and if they planned to make changes in their practice based on reading the book.Methods: Six weeks after licensed physicians in Georgia received the book, a survey was sent to 12,666 of them via e-mail.Results: A total of 508 physicians completed the online survey. Of these, 82.1 percent rated the book either “very good” or “good” on providing pragmatic steps for improved care for patients in pain, and more than 80 percent agreed that the book is a useful educational tool. Almost one-third (32.2 percent) claimed that they intend to make changes to their practice after reading the book. The analysis also showed physicians in a solo practice were more likely to make changes (41.8 percent) than their counterparts in office-based group practice (33.3 percent) and hospital-based (25.0 percent) settings. Primary care providers (41.6 percent) were also much more likely to make changes than physicians working in other specialty areas of medicine (22.8 percent). Well over half (57.7 percent) of the respondents indicated the book was better than other publications they had read on opioid prescribing and pain management.Conclusions: The results from this state-wide survey of licensed physicians demonstrate the value of educating physicians about how to appropriately prescribe, document, and treat patients who need opioid medications for pain management. The findings should be of value to organizations seeking to better educate physicians about appropriate opioid prescribing by providing insight into which physician population would be the most receptive to the type of information presented in Dr. Fishman’s book. When faced with limited resources, an organizational strategy that first targets solo and primary care practitioners may improve physician educational efforts about prescribing opioids better than a strategy targeting medical and surgical specialists or those physicians participating in group practice settings.
Continuous hydromorphone for pain and sedation in mechanically ventilated infants and children
Authors: Reiter, PharmD Pamela D. , Ng, PharmD Jennifer , Dobyns, MD Emily L.
Published: August 2012

Objective: To describe dosing regimens and efficacy of continuous infusion hydromorphone in mechanically ventilated children.Design: Retrospective review.Setting: Tertiary care, pediatric hospital.Patients: Ninety-two critically ill children (<18 years old).Main outcome measure(s): Hydromorphone dosing requirements, concomitant pain and sedation therapy, patient-specific pain scores (using Face Legs Activity Cry Consolability [FLACC] pain scale), and possible adverse drug events related to therapy.Results: Starting dose was 0.024 ± 0.04 mg/kg/h. Maximum dose was 0.05 ± 0.1 mg/kg/h. Duration of therapy was 182 ± 169 hours. Most patients received additional pain and sedation therapy. Most mean daily FLACC scores (66 percent) were below 1. Less than 10 percent of scores were above 3; only 1 score was above 6. Mean FLACC score, when averaged per patient course, was 1.004 ± 0.71. Extracorporeal membrane oxygenation (ECMO) patients had a significantly higher initial and maximum dosing requirement than non-ECMO patients (p = 0.001).Conclusions: Continuous infusion hydromorphone appears to be an effective adjunctive analgesic in mechanically ventilated children.
Older adults’ postoperative pain medication usage after total knee arthroplasty: A qualitative descriptive study
Authors: Bremner, MSc Samantha , Webster, PhD Fiona , Katz, PhD Joel , Watt-Watson, PhD Judy , McCartney, MBChB Colin
Published: August 2012

Objective: Most total knee arthroplasty (TKA) recipients experience pain following the procedure. Patients are provided with medications to manage pain but there is little information regarding their usage of analgesics after hospital discharge. This study investigated analgesic usage in recent TKA recipients.Design and participants: A qualitative descriptive approach was taken to produce a summary of the experiences of 14 participants. Purposive sampling methods were used during recruitment. One semistructured interview was conducted with each participant. Interviewing continued until theoretical saturation was reached.Results: Most participants used less medication than was prescribed and stopped taking prescription analgesics before requiring a renewal. Participants adjusted their usage in response to pain, adverse effects, advice from their family and healthcare providers, fears of becoming “hooked,” and a general dislike of taking medications.Conclusions: Patient modifications to medication regimens are often labeled as patient nonadherence; however, participants in this study considered their actions to be adaptive. This conceptual distinction has practical implications for healthcare providers. These findings emphasize the importance of having TKA patients develop their pain management regimen in conjunction with healthcare providers so that regimens can be tailored to individual needs.
Detailed flow, hydrometeor and lightning characteristics of an isolated thunderstorm during COPS
Authors: Schmidt K. , Hagen M. , Höller H. , Richard E. , Volkert H.
Published: August 2012

Abstract. The three-hour life-cycle of the isolated thunderstorm on 15 July 2007 during the Convective and Orographically-induced Precipitation Study (COPS) is documented in detail, with a special emphasis on the rapid development and mature phases. Remote sensing techniques as 5-min rapid scans from geostationary satellites, combined velocity retrievals from up to four Doppler-radars, the polarimetric determination of hydrometeors and spatio-temporal occurrences of lightning strokes are employed to arrive at a quantification of the physical parameters of this, during the COPS period, singular event. Inner cloud flow fields are available from radar multiple Doppler analyses at four consecutive times separated by 15 min-intervals. They contain horizontal winds of around 15 m s−1 and updrafts exceeding 5 m s−1, the latter collocated with lightning strokes. Reflectivity and polarimetric data indicate the existence of hail at the 2 km level around 14:40. Furthermore, polarimetric and Doppler radar variables indicate intense hydrometeor variability and turbulence corresponding to an enhanced variance of the retrieved 3-D wind fields. Profiles of flow and hydrometeor statistics over the entire cloud volume provide reference data for high-resolution numerical weather prediction runs in research mode. The study embarks from two movie-loops of geostationary satellite imagery (as Supplement), which provide an intuitive distinction of six phases making up the entire life-cycle of the thunderstorm. It concludes with a triple-image loop, juxtaposing a close-up of the cloud motion as seen by Meteosat, simulated brightness temperature (as a proxy for clouds seen by the infrared satellite channel), and a perspective view on the model generated system of cloud cells. The simulation suggests that several updrafts fed from a low level convergence line eventually removed the convective inhibition and set deep convection in motion. A shear line in the radial velocity relative to the Feldberg radar site shows good agreement beween observation and simulation, whereas the onset location of deep convection exhibits a horizontal discrepancy of 15 km. A quantitative schematic of the isolated thunderstorm synthesizes all retrieved characteristics.
The formaldehyde budget as seen by a global-scale multi-constraint and multi-species inversion system
Authors: Fortems-Cheiney A. , Chevallier F. , Pison I. , Bousquet P. , Saunois M. , Szopa S. , Cressot C. , Kurosu T. P. , Chance K. , Fried A.
Published: August 2012

Abstract. For the first time, carbon monoxide (CO) and formaldehyde (HCHO) satellite retrievals are used together with methane (CH4) and methyl choloroform (CH3CCl3 or MCF) surface measurements in an advanced inversion system. The CO and HCHO are respectively from the MOPITT and OMI instruments. The multi-species and multi-satellite dataset inversion is done for the 2005–2010 period. The robustness of our results is evaluated by comparing our posterior-modeled concentrations with several sets of independent measurements of atmospheric mixing ratios. The inversion leads to significant changes from the prior to the posterior, in terms of magnitude and seasonality of the CO and CH4 surface fluxes and of the HCHO production by non-methane volatile organic compounds (NMVOC). The latter is significantly decreased, indicating an overestimation of the biogenic NMVOC emissions, such as isoprene, in the GEIA inventory. CO and CH4 surface emissions are increased by the inversion, from 1037 to 1394 TgCO and from 489 to 529 TgCH4 on average for the 2005–2010 period. CH4 emissions present significant interannual variability and a joint CO-CH4 fluxes analysis reveals that tropical biomass burning probably played a role in the recent increase of atmospheric methane.
The scavenging processes controlling the seasonal cycle in Arctic sulphate and black carbon aerosol
Authors: Browse J. , Carslaw K. S. , Arnold S. R. , Pringle K. , Boucher O.
Published: August 2012

Abstract. The seasonal cycle in Arctic aerosol is typified by high concentrations of large aged anthropogenic particles transported from lower latitudes in the late Arctic winter and early spring followed by a sharp transition to low concentrations of locally sourced smaller particles in the summer. However, multi-model assessments show that many models fail to simulate a realistic cycle. Here, we use a global aerosol microphysics model (GLOMAP) and surface-level aerosol observations to understand how wet scavenging processes control the seasonal variation in Arctic black carbon (BC) and sulphate aerosol. We show that the transition from high wintertime concentrations to low concentrations in the summer is controlled by the transition from ice-phase cloud scavenging to the much more efficient warm cloud scavenging in the late spring troposphere. This seasonal cycle is amplified further by the appearance of warm drizzling cloud in the late spring and summer boundary layer. Implementing these processes in GLOMAP greatly improves the agreement between the model and observations at the three Arctic ground-stations Alert, Barrow and Zeppelin Mountain on Svalbard. The SO4 model-observation correlation coefficient (R) increases from: −0.33 to 0.71 at Alert (82.5° N), from −0.16 to 0.70 at Point Barrow (71.0° N) and from −0.42 to 0.40 at Zeppelin Mountain (78° N). The BC model-observation correlation coefficient increases from −0.68 to 0.72 at Alert and from −0.42 to 0.44 at Barrow. Observations at three marginal Arctic sites (Janiskoski, Oulanka and Karasjok) indicate a far weaker aerosol seasonal cycle, which we show is consistent with the much smaller seasonal change in the frequency of ice clouds compared to higher latitude sites. Our results suggest that the seasonal cycle in Arctic aerosol is driven by temperature-dependent scavenging processes that may be susceptible to modification in a future climate.
An analysis of fast photochemistry over high northern latitudes during spring and summer using in-situ observations from ARCTAS and TOPSE
Authors: Olson J. R. , Crawford J. H. , Brune W. , Mao J. , Ren X. , Fried A. , Anderson B. , Apel E. , Beaver M. , Blake D. , Chen G. , Crounse J. , Dibb J. , Diskin G. , Hall S. R. , Huey L. G. , Knapp D. , Richter D. , Riemer D. , Clair J. St. , Ullmann K. , Walega J. , Weibring P. , Weinheimer A. , Wennberg P. , Wisthaler A.
Published: August 2012

Abstract. Observations of chemical constituents and meteorological quantities obtained during the two Arctic phases of the airborne campaign ARCTAS (Arctic Research of the Composition of the Troposphere from Aircraft and Satellites) are analyzed using an observationally constrained steady state box model. Measurements of OH and HO2 from the Penn State ATHOS instrument are compared to model predictions. Forty percent of OH measurements below 2 km are at the limit of detection during the spring phase (ARCTAS-A). While the median observed-to-calculated ratio is near one, both the scatter of observations and the model uncertainty for OH are at the magnitude of ambient values. During the summer phase (ARCTAS-B), model predictions of OH are biased low relative to observations and demonstrate a high sensitivity to the level of uncertainty in NO observations. Predictions of HO2 using observed CH2O and H2O2 as model constraints are up to a factor of two larger than observed. A temperature-dependent terminal loss rate of HO2 to aerosol recently proposed in the literature is shown to be insufficient to reconcile these differences. A comparison of ARCTAS-A to the high latitude springtime portion of the 2000 TOPSE campaign (Tropospheric Ozone Production about the Spring Equinox) shows similar meteorological and chemical environments with the exception of peroxides; observations of H2O2 during ARCTAS-A were 2.5 to 3 times larger than those during TOPSE. The cause of this difference in peroxides remains unresolved and has important implications for the Arctic HOx budget. Unconstrained model predictions for both phases indicate photochemistry alone is unable to simultaneously sustain observed levels of CH2O and H2O2; however when the model is constrained with observed CH2O, H2O2 predictions from a range of rainout parameterizations bracket its observations. A mechanism suitable to explain observed concentrations of CH2O is uncertain. Free tropospheric observations of acetaldehyde (CH3CHO) are 2–3 times larger than its predictions, though constraint of the model to those observations is sufficient to account for less than half of the deficit in predicted CH2O. The box model calculates gross O3 formation during spring to maximize from 1–4 km at 0.8 ppbv d−1, in agreement with estimates from TOPSE, and a gross production of 2–4 ppbv d−1 in the boundary layer and upper troposphere during summer. Use of the lower observed levels of HO2 in place of model predictions decreases the gross production by 25–50%. Net O3 production is near zero throughout the ARCTAS-A troposphere, and is 1–2 ppbv in the boundary layer and upper altitudes during ARCTAS-B.
Simulation of mineral dust aerosol with Piecewise Log-normal Approximation (PLA) in CanAM4-PAM
Authors: Peng Y. , von Salzen K. , Li J.
Published: August 2012

Abstract. A new size-resolved dust scheme based on the numerical method of piecewise log-normal approximation (PLA) was developed and implemented in the fourth generation of the Canadian Atmospheric Global Climate Model with the PLA Aerosol Model (CanAM4-PAM). The total simulated annual global dust emission is 2500 Tg yr−1, and the dust mass load is 19.3 Tg for year 2000. Both are consistent with estimates from other models. Results from simulations are compared with multiple surface measurements near and away from dust source regions, validating the generation, transport and deposition of dust in the model. Most discrepancies between model results and surface measurements are due to unresolved aerosol processes. Biases in long-range transport are also contributing. Radiative properties of dust aerosol are derived from approximated parameters in two size modes using Mie theory. The simulated aerosol optical depth (AOD) is compared with satellite and surface remote sensing measurements and shows general agreement in terms of the dust distribution around sources. The model yields a dust AOD of 0.042 and dust aerosol direct radiative forcing (ADRF) of −1.24 W m−2 respectively, which show good consistency with model estimates from other studies.
Effects of business-as-usual anthropogenic emissions on air quality
Authors: Pozzer A. , Zimmermann P. , Doering U.M. , van Aardenne J. , Tost H. , Dentener F. , Janssens-Maenhout G. , Lelieveld J.
Published: August 2012

Abstract. The atmospheric chemistry general circulation model EMAC has been used to estimate the impact of anthropogenic emission changes on global and regional air quality in recent and future years (2005, 2010, 2025 and 2050). The emission scenario assumes that population and economic growth largely determine energy and food consumption and consequent pollution sources with the current technologies ("business as usual"). This scenario is chosen to show the effects of not implementing legislation to prevent additional climate change and growing air pollution, other than what is in place for the base year 2005, representing a pessimistic (but plausible) future. By comparing with recent observations, it is shown that the model reproduces the main features of regional air pollution distributions though with some imprecisions inherent to the coarse horizontal resolution (~100 km) and simplified bottom-up emission input. To identify possible future hot spots of poor air quality, a multi pollutant index (MPI), suited for global model output, has been applied. It appears that East and South Asia and the Middle East represent such hotspots due to very high pollutant concentrations, while a general increase of MPIs is observed in all populated regions in the Northern Hemisphere. In East Asia a range of pollutant gases and fine particulate matter (PM2.5) is projected to reach very high levels from 2005 onward, while in South Asia air pollution, including ozone, will grow rapidly towards the middle of the century. Around the Persian Gulf, where natural PM2.5 concentrations are already high (desert dust), ozone levels are expected to increase strongly. The population weighted MPI (PW-MPI), which combines demographic and pollutant concentration projections, shows that a rapidly increasing number of people worldwide will experience reduced air quality during the first half of the 21st century. Following this business as usual scenario, it is projected that air quality for the global average citizen in 2050 would be almost comparable to that for the average citizen in East Asia in the year 2005, which underscores the need to pursue emission reductions.