bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of fresh‐frozen plasma at Royal Darwin Hospital: a retrospective audit
Authors: Moylan S. , Szabo F. , Scott H. , Kwok G.
Published: June 2008

Background:  The aim of the study was to assess the appropriateness of use of fresh‐frozen plasma (FFP) at Royal Darwin Hospital against the National Health and Medical Research Council and Australian and New Zealand Society for Blood Transfusion guidelines.

Methods:  A retrospective review of blood product request forms, online pathology storage system data, pathology records and clinical notes between 1 January 2006 and 31 December 2006 was carried out. The appropriateness of requests was assessed against existing guidelines. The percentage of appropriate and inappropriate FFP transfusions was obtained.

Results:  Six hundred and forty‐eight of 950 units (68%) of FFP were used with an appropriate indication as per National Health and Medical Research Council/Australian and New Zealand Society for Blood Transfusion guidelines. Of the remaining units, 14% (137 units) was given without a clear indication and a decision of appropriateness could not be established for 17% (165 units) because of inadequate clinical or pathology information (e.g. coagulation results). Multiple issues around prescribing practice were identified.

Conclusion:  There is significant use of FFP at Royal Darwin Hospital without clear clinical indication. The employment of a transfusion nurse to monitor use of FFP (and other blood products) and provide education is aimed at improving transfusion efficiency and patient safety.
Clinical applications of RANK‐ligand inhibition
Authors: Romas E.
Published: June 2008

An enhanced rate of bone remodelling fuelled by osteoclastogenesis mediates diseases such as osteoporosis, arthritic bone destruction, Paget’s disease and malignancy‐induced bone loss. Thus, the control of osteoclastogenesis is of major clinical importance. The receptor activator of nuclear factor κ B (RANK); its ligand, RANKL and decoy receptor, osteoprotegerin, are critical determinants of osteoclastogenesis, and increased RANK signalling is involved in several bone diseases, providing the rationale for RANKL inhibition. The effects of RANKL inhibition are being witnessed in clinical trials of neutralizing fully human monoclonal antibodies that target RANKL (e.g. denosumab) and which induce profound and sustained inhibition of bone resorption. The relative efficacy, cost‐effectiveness and side‐effects of targeted RANKL inhibition compared with conventional antiresorptive drugs (i.e. bisphosphonates) should be resolved by clinical trials in coming years.
Prioritizing quality indicator development across the healthcare system: identifying what to measure
Authors: Evans S. M. , Lowinger J. S. , Sprivulis P. C. , Copnell B. , Cameron P. A.
Published: June 2008

Measuring healthcare quality has become an increasingly important task for regulating bodies and healthcare institutions. Strategically chosen quality indicators provide a means of understanding the quality and safety of the healthcare system. Current frameworks developed to determine aspects of care to be measured do not provide the level of precision required to ensure that indicators are best selected to enable focused action to improve health. We propose a clearly structured process for selecting indicators at a national and local level based on six steps: (i) identify the problem for which measurement is needed, (ii) identify the perspective from which to measure, (iii) focus measurement on transition points through the health system, (iv) identify the type of probe required, (v) apply evaluation criteria to prioritize indicator selection and action and (vi) test the indicator in the clinical setting to which it will be applied. These steps should form the basis of a framework to drive quality indicator development.
Outcomes and predicting response in anaemic chemotherapy patients treated with epoetin alfa. A multicentre, 4‐month, open‐label study in Australia and New Zealand
Authors: Bell D. , Grimes D. , Gurney H. , Dalley D. , Blackwell T. , Fox R. , Jeffery M.
Published: June 2008

Background:  The aim of the study was to evaluate the effectiveness, safety, and clinical outcomes of erythropoietin therapy in the treatment of anaemic cancer subjects receiving chemotherapy and to examine hypochromic red blood cell measurement as an indicator of functional iron sufficiency and as a predictor of responsiveness or non‐responsiveness to erythropoietin therapy.

Methods:  Patients who had a non‐myeloid malignancy, had Hb ≤ 11.0 g/dL, had a life expectancy of more than 6 months, were 18 years or older, were receiving chemotherapy and would continue to be treated for at least 2 months were given s.c. epoetin alfa three times a week.

Results:  Haemoglobin levels increased significantly at all time periods compared with baseline and the number of transfusions received decreased significantly at all time periods compared with baseline. Quality of life as measured by Functional Assessment of Cancer Therapy‐Anaemia showed significant increases at months 2 and 4 and there were significant improvements in the fatigue subscale at both time points (P < 0.05). Significant improvements at end‐point were observed for the physical, emotional and functional well‐being, and additional concern subscales (all P < 0.05). Haematocrit and reticulocytes increased significantly at end‐point compared with at baseline (haematocrit 33.4 vs 28.3%, P < 0.001; reticulocytes 105.8 vs 78.6 × 109/dL, P = 0.005). The percentage of hypochromic red blood cells did not show predictive value for response to treatment status.

Conclusion:  Epoetin alfa improved haemoglobin levels and quality of life in anaemic cancer patients receiving chemotherapy.
Safety and efficacy results from an international Expanded Access Programme to bortezomib for patients with relapsed and/or refractory multiple myeloma: a subset analysis of the Australian and New Zealand data of 111 patients
Authors: Quach H. , Horvath N. , Cannell P. , Mikhael J. R. , Butcher B. E. , Prince H. M.
Published: June 2008

Background: Bortezomib has been shown to be a safe and efficacious for the treatment of relapsed and refractory multiple myeloma (MM). Here we report a subset analysis of Australian and New Zealand data from the International Extended Access Programme for bortezomib.

Methods: Patients with more than or equal to two prior lines of therapy were given bortezomib 1.3 mg/m2 (i.v. bolus days 1, 4, 8, 11) for up to eight 21‐day cycles (C). Dexamethasone, 20 mg/day p. o. on the day of, and day after, bortezomib was added after C2 for progressive disease or after C4 for stable disease. Efficacy was assessed using modified Southwest Oncology Group criteria in the intent‐to‐treat group. Results were compared between the Australian and New Zealand and international cohort.

Results: One hundred and eleven patients from 16 centres (55% men, median age 61.9 years) had a median of 5.2 ± 2.8 treatment cycles of bortezomib. Among them, 82% had ≥3 prior therapies. Grade 3–4 treatment‐related adverse events were reported in 57 patients (52%); the most common were thrombocytopenia (25.7%), anaemia (8.3%), peripheral neuropathy (7.3%) and diarrhoea (7.3%). Responses were evaluable in 106 patients: 22% achieved a best response of complete response/response and 20% partial response (overall response rate of 42%). Median times to first and best responses were 42 days and 69 days, respectively. Compared with the international cohort, the cohorts from Australian and New Zealand showed inferior overall response rates (54 vs 42%, P = 0.001), possibly due to heavier pretreatment (82% greater than or equal to three prior therapies vs 68%, P < 0.001).

Conclusion: Our analysis confirms that bortezomib is safe and effective in relapsed and refractory MM in a real‐life clinical setting.
SCHOOL INSPECTION: Thirty‐five years of school inspection: raising educational standards for children with additional needs?
Authors: Marshall Chris
Published: June 2008

In this invited article, Chris Marshall, teacher, educational psychologist, university lecturer, and a former book reviews editor for BJSE who has been a leading figure in Her Majesty's Inspectorate, examines the inspection of schools over a period reflecting the 35 years during which BJSE has been published. Chris Marshall provides here a history of school inspection as an activity and traces key changes in provision for pupils with special educational needs in England. He examines the purposes of inspection and explores the role that inspectors have played in monitoring the impact of profound changes in legislation and policy upon pupils with special educational needs. He asks searching questions about whether the inspection regime has fulfilled its purposes in respect of these pupils – especially in relation to the vexed question of raising standards. Chris Marshall then provides a critique of inspection methodology – and an overview of the changes that have been introduced in the inspection system as a result. He reviews the contributions that inspection has made to our understanding of how children with special educational needs learn, and looks to the future to consider how inspection could be made to contribute more effectively.
PARTICIPATION IN RESEARCH: Reference, or advisory, groups involving disabled people: reflections from three contrasting research projects
Authors: Lewis Ann , Parsons Sarah , Robertson Christopher , Feiler Anthony , Tarleton Beth , Watson Debby , Byers Richard , Davies Jill , Fergusson Ann , Marvin Claire
Published: June 2008

Increasingly in recent years, the involvement of disabled people as co‐researchers has been regarded as ‘good practice’. This has been informed by growing participatory and emancipatory research paradigms as well as user‐focused policy imperatives. The benefits of these shifts apply to the research itself (improved definition, direction, applicability and impact), to non‐disabled researchers (personal growth and enhanced understanding of the reflexive research process), to people with disabilities involved as researchers or collaborators (personal growth and enhanced opportunities), and (if externally funded) to the funder whose ways of operating are likely to be challenged profoundly. In this paper, Ann Lewis, Sarah Parsons and Christopher Robertson (based at the University of Birmingham), Anthony Feiler, Beth Tarleton and Debby Watson (based at the University of Bristol) and Richard Byers, Jill Davies, Ann Fergusson and Claire Marvin (based at the University of Cambridge) discuss the work of three independent research teams carrying out concurrent projects. The authors share their experiences of trying to take seriously the participation of disabled people in research. All three projects were informed, to a significant degree, by their respective reference groups of disabled people. The work of these groups in each of the three projects is outlined and then discussed in relation to five common themes: formal contracts with members of reference groups; considerations concerning drawing on an established reference group; planning for reference group involvement; style of reference group involvement; and building on good practice.
FOCUS ON PRACTICE: Naturalistic intervention for Asperger syndrome – a case study
Authors: Choi Serene Hyun‐Jin , Nieminen Timo A.
Published: June 2008

On the basis of their cognitive abilities, children with Asperger syndrome are attractive candidates for inclusive education and, in Australia, most are in integrated settings. However, social interaction between children with Asperger syndrome and their peers remains problematic, with the children with Asperger syndrome often being left alone despite being among or near classmates. For classroom teachers, effective interventions in terms of class management are critical to facilitate positive social interaction between these two groups of children, and case studies can tell us a great deal about what works. In practice, a combination of intervention techniques may be best, in case a single one is ineffective, and in order to take advantage of potential synergies. In this article, Serene Choi, of the School of Education at the University of Newcastle (Australia) and Timo Nieminen, of the Centre for Biophotonics and Laser Science in the Department of Physics at the University of Queensland, report a naturalistic multiple‐component intervention used to develop the social skills of a boy with Asperger syndrome in a mainstream school in Australia. This combined intervention, making use of social stories, simple peer modelling and individual lessons, appears to be a practical teaching method for inclusive education.
LITERACY: Meeting the challenge of limited literacy resources for adolescents and adults with intellectual disabilities
Authors: Morgan Michelle F. , Moni Karen B.
Published: June 2008

For adolescents and adults with mild to moderate intellectual disabilities (or, in the UK, learning disabilities or learning difficulties), the achievement of successful engagement with, and construction of meaning from, texts necessitates the implementation and use of specifically designed and adapted teaching strategies and resources. The careful selection and application of appropriate resources is vital to allow learners with intellectual disabilities to engage and participate with texts in positive, enjoyable and meaningful ways. The challenge for teachers of adolescents and adults with intellectual disabilities is to overcome the limited availability of suitable literacy resources for these learners. In this article, Michelle Morgan, who teaches literacy at the University of Queensland, and Karen Moni, director of the secondary programmes in the School of Education at the University of Queensland, identify the literacy needs and reading practices of adolescents and adults with intellectual disabilities based upon findings from an action research investigation. They go on to explore ways in which teachers can meet the challenge of limited resources for these learners through the specific and deliberate adaptation and creation of suitable texts.
RESEARCH SECTION: The impact of a special school placement on student teacher beliefs about inclusive education in Northern Ireland
Authors: Lambe Jackie , Bones Robert
Published: June 2008

This article, by Jackie Lambe, lecturer in education, and Robert Bones, lecturer in psychology, both from the University of Ulster, provides a useful review of the current state of policy, practice and teacher education relating to pupils with special educational needs in Northern Ireland. The authors use this review to launch their account of their own investigation into the attitudes towards inclusion of student teachers who had experience of working in special schools. Jackie Lambe and Robert Bones drew data from the transcripts of online discussions involving the student teachers. Using direct quotations from these discussions, the authors here reveal the positive attitudes that the student teachers developed towards practice in the special school settings; the confused or negative responses of the special school staff towards policy on inclusion; and mixed views on the promotion of enhanced collaboration between mainstream and special schools. Interestingly the student teachers, while continuing to value inclusion policy from a human rights perspective, also seemed to become more convinced, during their placements, of the contribution that specialist settings can make – and less confident that inclusion can be made to work effectively, given the current systems of teacher education and school organisation. The research in this article draws on the views of a small sample of student teachers – but the reported shifts in their perspectives illustrate some of the key issues to be confronted in the ongoing development of a more inclusive educational system.
THE EFFECT OF GRADING PRACTICES ON GENDER DIFFERENCES IN ACADEMIC PERFORMANCE
Authors: Bonesrønning Hans
Published: June 2008

This paper adds to the debate about the sources of the gender gaps in student outcomes by highlighting explanations related to interactions between teachers and students. The evidence comes from the lower secondary school in Norway. The teachers' grading practices are the focal point of the analysis. First, it is shown that girls are exposed to easier grading than boys. Thereafter, evidence is provided that both boys and girls are negatively affected when the teacher practises easy grading. The boys' responses to easy grading are more uniformly negative than the girls' responses. Some exploratory analyses that make use of information about the students' school motivations are provided to make sense of these findings.
ECONOMIC PERFORMANCE AND PUBLIC INFRASTRUCTURE: AN APPLICATION TO GREEK MANUFACTURING
Authors: Mamatzakis Emmanuel Constantine
Published: June 2008

To comprehend the impact of public infrastructure on economic performance this paper provides a measure of productivity growth as derived from duality theory. This productivity growth is decomposed into the components of technical change, returns to scale and the effects of public infrastructure, the variable of our interest. In an application, we opt for Greek manufacturing so as to investigate whether the decline in its growth rate is partly explained by public infrastructure. Despite some variation in the estimation results of shadow shares across industries, public infrastructure asserts a cost saving effect in most industries, though it also appears that traditional labour‐intensive industries with lower level of technological advancement do not benefit from the provision of public infrastructure. The estimation results further demonstrate that while public infrastructure enhanced productivity growth over the sample period for most industries, low infrastructure investment in the 1970s and the 1980s undermined productivity growth.
PLAGIARISM AND ITS IMPACT ON THE ECONOMICS PROFESSION
Authors: Arce Daniel G. , Enders Walter , Hoover Gary A.
Published: June 2008

This paper integrates survey data on economists' experiences and perceptions of plagiarism with a game‐theoretic model of author strategies to investigate whether information is being efficiently transmitted within the profession. The surveys reveal editorial misperceptions of the nature of plagiarism (e.g., plagiarism versus copyright infringement) and narrow assumptions about who bears the cost of plagiarism. Further, a wide disparity in author strategies to protect intellectual property rights exists, due to uncertainty over editorial response. These considerations are shown to lead to a Pareto‐dominated publication process. By contrast, simple measures such as a code of ethics and web‐based anti‐plagiarism software can improve the flow of information.
THE LABOUR MARKET IMPACT OF THE UK DISABILITY DISCRIMINATION ACT: EVIDENCE FROM THE REPEAL OF THE SMALL FIRM EXEMPTION
Authors: Jones Melanie K. , Jones Jonathan
Published: June 2008

This paper uses data from the Quarterly Labour Force Survey in the UK (1997–2006) and changes in the coverage of the Disability Discrimination Act (DDA), that result from the removal of the small firm exemption, to assess the labour market impact of the legislation. The data support a narrowing of the employment gap between the disabled and non‐disabled over the post DDA period. However, the evidence based on small firms does not support this being a direct result of the employment provisions of the DDA.
The impact of maternal depression in pregnancy on early child development
Authors: Deave T , Heron J , Evans J , Emond A
Published: June 2008

Objective  Postpartum depression in mothers is associated with developmental problems in their children. Many women who are depressed following childbirth are also depressed during pregnancy. The aim of this study was to examine the associations between maternal depressive symptoms during pregnancy and child development at 18 months of age.

Design  A prospective cohort study, Avon Longitudinal Study of Parents and Children.

Setting  The former county of Avon, southwest England.

Population  All pregnant women in the defined area with delivery dates between April 1991 and December 1992, 9244 women and their children.

Methods  Data were collected antenatally, at 18 and 32 weeks of gestation and at 8 weeks and 8 months postnatally, through postal questionnaires, including a self‐report measure of depression (Edinburgh Postnatal Depression Scale [EPDS]). By the time their child was 18 months old, women completed five further questionnaires about their children’s health and development.

Main outcome measure  Child development at 18 months using a modified Denver Developmental Screening Test (modified DDST).

Results  Applying the standard 12/13 cutoff, 1565 (14%) women were depressed antenatally but not at either time‐points postnatally. Employing the modified DDST, 893 (9%) children were developmentally delayed at 18 months of age. Persistent depression (EPDS ≥ 10 at both time‐points) is associated with developmental delay (adjusted OR 1.34, 95% CI 1.11–1.62). Applying the 12/13 and 14/15 cutoffs gave similar results. After further adjustment for postnatal depression, the effect sizes were slightly attenuated.

Conclusions  These findings highlight the importance of depression in pregnancy. Some effects on child development attributed to postpartum depression are caused in part by depressive symptoms during pregnancy.
Ethnicity and gestational diabetes in New York City, 1995–2003
Authors: Savitz DA , Janevic TM , Engel SM , Kaufman JS , Herring AH
Published: June 2008

Objective  To characterise the patterns of occurrence of gestational diabetes among a wide range of ethnic groups that reside in New York City.

Design  Birth records and hospital discharge data were linked to more accurately assess the risk of gestational diabetes by ethnicity, compare risk in US‐born to foreign‐born women, and assess time trends.

Setting  New York City.

Population  All singleton live births occurring between 1995 and 2003.

Methods  Multivariable binomial regression analysis of ethnicity and gestational diabetes, yielding adjusted risk ratios with non‐Hispanic white women as the referent.

Main outcome measure  Diagnosis of gestational diabetes on birth certificate or in hospital discharge.

Results  Adjusted relative risks (aRRs) were modestly elevated for African‐Americans and sub‐Saharan Africans and somewhat higher (<2.0) for non‐Hispanic Caribbeans, Hispanic Caribbeans, Central Americans, and South Americans. The aRR was 4.7 (95% CI = 4.6–4.9) for South Central Asians (with an absolute gestational diabetes risk of 14.3%), 2.8 (95% CI = 2.7–3.0) among South‐East Asian and Pacific Islanders, and 2.3 (95% CI = 2.2–2.4) among East Asians. Among South Central Asians, the greatest risks were found for women from Bangladesh (aRR = 7.1, 95% CI = 6.8–7.3). Foreign‐born women consistently had higher risk than US‐born women. Risk for gestational diabetes increased over time among South Central Asians, some Hispanic groups, and African‐Americans.

Conclusions  Risk of gestational diabetes appears to vary markedly among ethnic groups, subject to potential artefacts associated with screening and diagnosis. These differences would have direct implications for health care and may suggest aetiologic hypotheses.
Abortion‐related complications in Cambodia
Authors: Fetters T , Vonthanak S , Picardo C , Rathavy T
Published: June 2008

Introduction  Although termination of pregnancy (termination) has been legal in the Kingdom of Cambodia since 1997, a number of barriers to safe termination services persist and many women continue to induce their own terminations or seek unsafe services that result in complications requiring ‘post‐abortion’ care.

Objective  To describe the complications of miscarriage and failed terminations and document the magnitude of the resulting morbidity in the Cambodian public sector.

Design  Cross‐sectional descriptive study.

Setting  Public sector hospitals and health centres.

Sample  Stratified multistage sampling design included all hospitals (n = 71), 14% of eligible high‐level health centres (n = 58) and 22% of eligible low‐level health centres (n = 57).

Methods  Data collectors used a standardised questionnaire to record information on diagnosis, reproductive history and treatment from 629 women seeking care for termination or miscarriage‐related complications in study facilities over a 3‐week period.

Main outcome measures  Annual estimate of cases, clinical symptoms, severity distribution of morbidity, ratio of complications to live births and incidence of abortion complications for Cambodian public health facilities.

Results  In 2005, an estimated 31 579 women with complications of miscarriage or terminations were treated in Cambodian government facilities; 80% of these women sought care at a health centre. Forty percent of all women seeking care for complications either reported or showed strong clinical evidence of prior attempted terminations. Nearly 17% of these women were in the second trimester of pregnancy and 42% of them presented with high severity complications. The annual incidence of termination and miscarriage complications (abortion complications) was 867 per 100 000 women of reproductive age. The projected ratio of complications was 93 per 1000 live births.

Conclusions  To reduce maternal morbidity in Cambodia, women must be encouraged to seek safe termination services or seek postabortion care without delay. Additionally, providers need further training, and facilities greater commitment, to provide safe terminations and care for complications of unsafe terminations and miscarriage.
Interleukin‐4 −590 (C>T), toll‐like receptor‐2 +2258 (G>A) and matrix metalloproteinase‐9 −1562 (C>T) polymorphisms in pre‐eclampsia
Authors: Fraser R , Walker JJ , Ekbote UV , Martin KL , McShane P , Orsi NM
Published: June 2008

Functional single nucleotide polymorphisms (SNPs) of interleukin (IL)‐4 −590 (C>T), toll‐like receptor (TLR)‐2 +2258 (G>A) and matrix metalloproteinase (MMP)‐9 −1562 (C>T) were examined by polymerase chain reaction–restriction fragment length polymorphism to identify their merit as genetic markers for pre‐eclampsia. One hundred and seventeen pre‐eclamptic women and 146 control subjects with uncomplicated singleton pregnancies participated in this study, conducted at Leeds General Infirmary and St James’s University Hospital. While the TLR‐2 +2258 (G>A) and MMP‐9 −1562 (C>T) SNPs failed to present any significant association with pre‐eclampsia, there was a marked trend for an association between the IL‐4 −590 (C>T) SNP and pre‐eclampsia (χ2= 5.87, P = 0.055), with a prevalence of TT homozygous women in this group (OR 4.455, 95% CI 1.286–15.350).
The natural caesarean: a woman‐centred technique
Authors: Smith J , Plaat F , Fisk NM
Published: June 2008

Although much effort has gone into promoting early skin‐to‐skin contact and parental involvement at vaginal birth, caesarean birth remains entrenched in surgical and resuscitative rituals, which delay parental contact, impair maternal satisfaction and reduce breastfeeding. We describe a ‘natural’ approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother’s chest for early skin‐to‐skin. Studies are required into methods of reforming caesarean section, the most common operation worldwide.
The effect of topical lignocaine gel in pain relief for colposcopic assessment and biopsy: is it useful?
Authors: Wong GCY , Li RHW , Wong TS , Fan SYS
Published: June 2008

We investigated the use of topical ligocaine gel in pain relief for colposcopy and cervical punch biopsy. Ninety women referred for colposcopy due to abnormal cervical cytology were randomised to receive 5 ml of either 2% xylocaine gel or KY jelly to the cervix and the upper part of the vagina for at least 10 minutes prior to the colposcopic procedures. Pain score was obtained at several points of the procedure. Topical lignocaine gel did not significantly relieve pain from cervical punch biopsy and alleviate the stinging sensation from application of acetic acid and Lugol’s iodine to cervix and vagina. However, it may be beneficial to a subgroup of women with prior unpleasant experience towards speculum examination.
Lithium dilution cardiac output and oxygen delivery in conscious dogs with systemic inflammatory response syndrome
Authors: Butler Amy L. , Campbell Vicki L. , Wagner Ann E. , Sedacca Cassidy D. , Hackett Timothy B.
Published: June 2008

Objective:Compare cardiac index (CI) and oxygen delivery index (DO2I) in conscious, critically ill dogs to control dogs; evaluate the association of CI and DO2I with outcome.

Design:Prospective non‐randomized clinical study.

Setting:Veterinary teaching hospital.

Animals:Eighteen client‐owned dogs with systemic inflammatory response syndrome (SIRS) and 8 healthy control dogs.

Measurements and Main Results:CI of dogs with SIRS was measured using lithium dilution at times 0, 4, 8, 16, and 24 hours. Data collected included physical exam, arterial blood gas (ABG) and hemoximetry. CI of control dogs was measured 3 times with 1 measurement of ABG. Mean CI ± SE in SIRS patients was 3.32 ± 0.95 L/min/m2; lower than controls at 4.18 ± 0.22 L/min/m2(P<0.001). Mean DO2I ± SE in SIRS patients was 412.91 ± 156.67 mL O2/min/m2; lower than controls at 785.24 ± 45.99 mL O2/min/m2(P<0.001). There was no difference in CI (P=0.49) or DO2I (P=0.51) for dogs that survived to dischargeversusthose that did not. There was no difference in mean CI (P=0.97) or DO2I (P=0.50) of survivorsversusnon‐survivors for 28‐day survival. Survivors had lower blood glucose (P=0.03) and serum lactate concentrations (P=0.04) than non‐survivors.

Conclusions:CI and DO2I in conscious dogs with SIRS were lower than control dogs, which differs from theories that dogs with SIRS are in a high cardiac output state. CI and DO2I were not significantly different between survivors and non‐survivors. Similar to previous studies, lactate and glucose concentrations of survivors were lower than non‐survivors.
Emergency case admissions at a large animal tertiary university referral hospital during a 12‐month period
Authors: Dolente Brett A. , Lindborg Susan , Russell Gail , Southwood Louise L.
Published: June 2008

Objective: To collate and describe emergency admissions to a large animal tertiary university referral hospital during a 12‐month period.

Design: Prospective clinical study.

Setting: Large animal tertiary university referral hospital.

Animals: Large animal emergency patient admissions.

Interventions: None.

Measurements and main results: Information obtained from the medical record included the presenting complaint, clinical problem, admission time, duration of clinical signs before presentation, diagnostic procedures performed, therapies administered, and therapeutic procedures performed during the first 24 hours following admission, and survival to discharge. The most common category listed for the presenting complaint and clinical problem categories was gastrointestinal. Most emergency cases were admitted during the evening and in late spring, summer, and early fall. Most cases had a duration of clinical signs before presentation of >2 hours and ≤8 hours (27%) or >8 hours and ≤24 hours (29%). The most common diagnostic procedures performed during the first 24 hours were palpation per rectum, ultrasonographic examination, radiographs, and abdominocentesis. Antimicrobials, fluids, and nonsteroidal anti‐inflammatory drugs were the most common therapies administered. Approximately 25% of cases required surgery. An exploratory celiotomy was performed in approximately 15% of cases. Enterotomy, intestinal resection and anastomosis, cesarean section, or joint or sheath lavage was each performed in <5% of cases. Overall survival to discharge was 74%.

Conclusions: Large animal emergency clinicians are required to have knowledge on a wide range of diseases and should be proficient at performing numerous procedures on an emergency basis. Gastrointestinal disease is the most common type of emergency and the diagnostic and therapeutic procedures performed during the first 24 hours following admission are a reflection of this type of case. Only 25% of cases required surgery. Additional research in the form of a multicenter study and surveying both private and university practitioners needs to be performed to further define the necessary skills for an ‘ideal’ large animal emergency clinician.
Non‐coagulopathic spontaneous hemothorax in dogs
Authors: Nakamura Reid K. , Rozanski Elizabeth A. , Rush John E.
Published: June 2008

Objective: To determine the history, clinicopathologic findings, underlying causes, and outcomes for dogs with non‐coagulopathic spontaneous hemothorax.

Design: Retrospective case series.

Setting: University referral hospital.

Animals: Sixteen client‐owned dogs.

Interventions: The medical records database was searched for dogs with hemothorax. Dogs with trauma, secondary coagulopathy, recent thoracic surgery, or pericardial intervention were excluded. For the remaining dogs, signalment, clinical signs, clinicopathologic findings, radiographic findings, histopathologic findings, interventions, and outcome were recorded.

Measurements and main results: The most common presenting signs were tachypnea (n=9) and lethargy (n=5), typically of <1‐week duration. The most common cause of non‐coagulopathic spontaneous hemothorax in dogs was neoplasia, which was diagnosed in 14 patients (88%). Identified malignancies included hemangiosarcoma (n=1), malignant mesothelioma (n=1), metastatic ovarian carcinoma (n=1), osteosarcoma (n=2), and pulmonary carcinoma (n=2). An intrathoracic mass was visualized in 7 other dogs; however, histopathology was not obtained. Pancreatitis and lung lobe torsion were each diagnosed in 1 dog, and survival was prolonged with both surviving at least 1 year post discharge. Only 6 of 14 dogs that were diagnosed with neoplasia were discharged from the hospital. For the 4 dogs with cancer with available outcome data, median survival time was 16 days (range 1–70 days). Two dogs were lost to follow‐up and had unknown survival times.

Conclusions: The development of non‐coagulopathic spontaneous hemothorax warrants a high‐index suspicion for neoplasia, in particular thoracic wall neoplasia.
Evaluation of a thoracic focused assessment with sonography for trauma (TFAST) protocol to detect pneumothorax and concurrent thoracic injury in 145 traumatized dogs
Authors: Lisciandro Gregory R. , Lagutchik Michael S. , Mann Kelly A. , Voges Andra K. , Fosgate Geoffrey T. , Tiller Elizabeth G. , Cabano Nic R. , Bauer Leslie D. , Book Bradley P.
Published: June 2008

Objective: To estimate the relative accuracy of a thoracic focused assessment with sonography for trauma (TFAST) protocol for rapid diagnosis of pneumothorax (PTX) and other thoracic injury in traumatized dogs.

Design: Prospective case series.

Setting: Private veterinary emergency center.

Animals: One hundred and forty‐five client‐owned dogs evaluated within 24‐hours of injury.

Interventions: Thoracic focused assessment with sonography for trauma protocol.

Measurements and Main Results: Traumatized dogs were evaluated with a conventional ultrasound (US) machine using a standardized 4‐point thoracic FAST protocol before thoracic radiography (CXR) and thoracocentesis. PTX was diagnosed by the absence of the ‘glide sign,’ defined as the lack of the normal dynamic interface between lung margins gliding along the thoracic wall during respiration. Concurrent thoracic trauma was diagnosed by the presence of pleural or pericardial fluid or the presence of a ‘step sign,’ defined as an abnormal glide sign. Accuracy of TFAST was calculated relative to CXR findings.

Results: Overall sensitivity (Se), specificity (Sp), and accuracy of TFAST relative to CXR were 78.1% (95% CI; 61.5, 89.9), 93.4% (95% CI; 87.4, 97.1), and 90.0%, respectively. Se and Sp were higher in dogs with penetrating trauma (93.3%, 96.0%) and for the evaluator with the most clinical experience (95.2%, 96.0%); only Se between the most experienced compared with others was statistically significant (P<0.05). TFAST documented other concurrent thoracic injury. Median time for TFAST was 3 minutes.

Conclusions and Clinical Relevance: TFAST has the potential to rapidly diagnose PTX and other thoracic injury and guide therapy, including potentially life‐saving interventions, in traumatized dogs.
Long‐Term Care Facilities: A Cornucopia of Viral Pathogens
Authors: Falsey Ann R. , Dallal Gerard E. , Formica Maria A. , Andolina Gloria G. , Hamer Davidson H. , Leka Lynette L. , Meydani Simin Nikbin
Published: June 2008

OBJECTIVES: To determine the frequency and types of respiratory viruses circulating in Boston long‐term care facilities (LTCFs) during a 3‐year period.

DESIGN: Observational.

SETTING: Thirty‐three Boston‐area LTCFs over a 3‐year period.

PARTICIPANTS: Residents of long‐term care who had previously participated in a trial of vitamin E supplementation and had paired serum samples available for viral analysis.

MEASUREMENTS: Viral antibody titers to eight respiratory viruses (influenza A and B, respiratory syncytial virus (RSV), parainfluenza virus serotype three (PIV‐3), PIV‐2, human metapneumovirus (hMPV), and coronaviruses 229E and OC43) were measured using enzyme immunoassay at baseline and 53 weeks. Infection was defined as a more than quadrupling of viral titers. Clinical data on respiratory illnesses were collected throughout the study period.

RESULTS: A total of 617 persons were enrolled in the trial. Of these, 382 (62%) had sera available for viral analysis. A total of 204 viral infections were documented in 157 subjects. Serological responses to all eight viruses were documented, with hMPV (12.8%) and coronavirus 229E (10.5%) being the most common and PIV‐2 (2.4%) the least common. The occurrence of bronchitis (P=.007), pneumonia (P=.02), and any lower respiratory tract infection (P=.002) was significantly associated with having a viral diagnosis.

CONCLUSION: A wide range of respiratory viruses cocirculates in LTCFs and contributes to respiratory illness morbidity in these populations.
Multidrug‐Resistant Gram‐Negative Bacteria in a Long‐Term Care Facility: Prevalence and Risk Factors
Authors: Pop‐Vicas Aurora , Mitchell Susan L. , Kandel Ruth , Schreiber Robert , D'Agata Erika M. C.
Published: June 2008

OBJECTIVES: To quantify the prevalence, risk factors, and mode of transmission associated with colonization by multidrug‐resistant gram‐negative bacteria (MDRGN) in the long‐term care (LTC) setting.

DESIGN: Cross‐sectional.

SETTING: Four nursing units in a 648‐bed LTC facility in Boston, Massachusetts.

PARTICIPANTS: Eighty‐four long‐term care residents.

MEASUREMENTS: Nasal and rectal swabs were obtained to determine colonization with MDRGN; if present, molecular typing was performed. The prevalence of methicillin‐resistant Staphylococcus aureus (MRSA) and vancomycin‐resistant enterococci (VRE) was also determined. Demographic and clinical characteristics were obtained from the medical record. Multivariable analysis was used to identify factors independently associated with MDRGN colonization.

RESULTS: A total of 51%, 28%, and 4% subjects were colonized with MDRGN, MRSA, and VRE, respectively. After multivariable adjustment, advanced dementia (adjusted odds ratio (AOR)=2.9, 95% confidence interval (CI)=1.2–7.35, P=.02) and nonambulatory status (AOR=5.7, 95% CI=1.1–28.9, P=.04) were the only independent risk factors for harboring MDRGN. Molecular typing indicated person‐to‐person transmission.

CONCLUSION: Colonization with MDRGN is common in the LTC setting. A diagnosis of advanced dementia is a major risk factor for harboring MDRGN.
Development, Implementation, and Evaluation of an Interprofessional Falls Prevention Program for Older Adults
Authors: Banez Carol , Tully Sandra , Amaral Lina , Kwan Debbie , Kung Anita , Mak Kitty , Moghabghab Rola , Alibhai Shabbir M.H.
Published: June 2008

This article describes the development and implementation of an Interprofessional Falls Prevention Program (IFPP) designed for community‐dwelling seniors. The program was a collaborative pilot research study conducted in a retirement home and an outpatient hospital setting. The pilot was successful and was positioned into a permanent falls prevention program. The IFPP aimed at improving physical function and balance and reducing the fear of falling in seniors with a history of falls. The pilot study included an interprofessional falls assessment followed by a 12‐week program of once‐weekly group education and exercise sessions, 3‐ and 6‐month follow‐up visits, and individual counseling. To measure program effectiveness, the Berg Balance Scale, the Timed Up and Go Test, the Falls Efficacy Scale, and the Morse Fall Risk Scale were used at baseline, upon program completion, and at 3‐ and 6‐month follow‐up. Process measures were also collected, including patient satisfaction. Persistent improvements were found in participants' balance, strength, functional mobility, and fear of falling. Patient satisfaction with the program was high. Challenges faced in program implementation are also highlighted.
My Loss Is Your Loss … Sometimes: Loss Aversion and the Effect of Motivational Biases
Authors: Wilson Robyn S. , Arvai Joseph L. , Arkes Hal R.
Published: June 2008

Findings from previous studies of individual decision‐making behavior predict that losses will loom larger than gains. It is less clear, however, if this loss aversion applies to the way in which individuals attribute value to the gains and losses of others, or if it is robust across a broad spectrum of policy and management decision contexts. Consistent with previous work, the results from a series of experiments reported here revealed that subjects exhibited loss aversion when evaluating their own financial gains and losses. The presence of loss aversion was also confirmed for the way in which individuals attribute value to the financial gains and losses of others. However, similar evaluations within social and environmental contexts did not exhibit loss aversion. In addition, research subjects expected that individuals who were unknown to them would significantly undervalue the subjects' own losses across all contexts. The implications of these findings for risk‐based policy and management are many. Specifically, they warrant caution when relying upon loss aversion to explain or predict the reaction of affected individuals to risk‐based decisions that involve moral or protected values. The findings also suggest that motivational biases may lead decisionmakers to assume that their attitudes and beliefs are common among those affected by a decision, while those affected may expect unfamiliar others to be unable to identify and act in accordance with shared values.
An Adjustment Factor for Mode‐of‐Action Uncertainty with Dual‐Mode Carcinogens: The Case of Naphthalene‐Induced Nasal Tumors in Rats
Authors: Bogen Kenneth T.
Published: June 2008

The U.S. Environmental Protection Agency (USEPA) guidelines for cancer risk assessment recognize that some chemical carcinogens may have a site‐specific mode of action (MOA) involving mutation and cell‐killing‐induced hyperplasia. The guidelines recommend that for such dual MOA (DMOA) carcinogens, judgment should be used to compare and assess results using separate “linear” (genotoxic) versus “nonlinear” (nongenotoxic) approaches to low‐level risk extrapolation. Because the guidelines allow this only when evidence supports reliable risk extrapolation using a validated mechanistic model, they effectively prevent addressing MOA uncertainty when data do not fully validate such a model but otherwise clearly support a DMOA. An adjustment‐factor approach is proposed to address this gap, analogous to reference‐dose procedures used for classic toxicity endpoints. By this method, even when a “nonlinear” toxicokinetic model cannot be fully validated, the effect of DMOA uncertainty on low‐dose risk can be addressed. Application of the proposed approach was illustrated for the case of risk extrapolation from bioassay data on rat nasal tumors induced by chronic lifetime exposure to naphthalene. Bioassay data, toxicokinetic data, and pharmacokinetic analyses were determined to indicate that naphthalene is almost certainly a DMOA carcinogen. Plausibility bounds on rat‐tumor‐type‐specific DMOA‐related uncertainty were obtained using a mechanistic two‐stage cancer risk model adapted to reflect the empirical link between genotoxic and cytotoxic effects of the most potent identified genotoxic naphthalene metabolites, 1,2‐ and 1,4‐naphthoquinone. Bound‐specific adjustment factors were then used to reduce naphthalene risk estimated by linear extrapolation (under the default genotoxic MOA assumption), to account for the DMOA exhibited by this compound.
Acculturation and Latino Family Processes: How Cultural Involvement, Biculturalism, and Acculturation Gaps Influence Family Dynamics*
Authors: Smokowski Paul R. , Rose Roderick , Bacallao Martica L.
Published: June 2008

Abstract: This study investigated how adolescent and parent acculturation (culture‐of‐origin and U.S. cultural involvement, biculturalism, acculturation conflicts, and parent‐adolescent acculturation gaps) influenced family dynamics (family cohesion, adaptability, familism, and parent‐adolescent conflict) in a sample of 402 Latino families from North Carolina and Arizona. Multiple regression and hierarchical linear models suggested that culture‐of‐origin involvement and biculturalism were cultural assets related to positive outcomes, whereas acculturation conflict was inversely related to positive family dynamics and positively related to parent‐adolescent conflict. Parent‐adolescent acculturation gaps were inversely associated with family cohesion, adaptability, and familism but were unrelated to parent‐adolescent conflict. Limitations and implications for practice are discussed.
Randomized Study of a Prebirth Coparenting Intervention With Adolescent and Young Fathers*
Authors: Fagan Jay
Published: June 2008

Abstract: This randomized study tested the effects of 2 prebirth interventions, Minnesota Early Learning Design coparenting and childbirth curricula, on young African American and Hispanic fathers and their adolescent partners (N = 154). The coparenting intervention (n = 44) was associated with changing fathers’ perceptions of their coparenting behavior rather than mothers’ perceptions of the fathers’ behavior compared with the childbirth program (n = 46). Fathers and mothers consistently reported fathers’ improved coparenting behavior when the coparenting intervention was compared with a no‐intervention control group (n = 64). Fathers (regardless of residence) and mothers residing with the father reported higher levels of fathers’ engagement with the infant when the father participated in the coparenting intervention compared with fathers who participated in the childbirth intervention.
Child Depressive Symptoms, Spanking, and Emotional Support: Differences Between African American and European American Youth
Authors: Christie‐Mizell C. André , Pryor Erin M. , Grossman Elizabeth R.B.
Published: June 2008

Abstract: Using data from the National Longitudinal Survey of Youth—Mother and Child samples, we explored the relationships among child and adolescent depressive symptoms, spanking, and emotional support offered to youth. We present cross‐sectional and change models for both African Americans and European Americans. Findings showed that regardless of race, spanking is associated with more depressive symptoms in the cross‐sectional analysis but does not appear to maintain this relationship over time. With regard to emotional support, depressive symptoms for African American youth are inversely related to the emotional support their mothers provide for them in cross‐sectional models, but the benefit does not persist in our change models. For European American children and adolescents, emotional support is associated with fewer depressive symptoms in the short term and over time.