bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of postmenopausal vaginal atrophy with 10-µg estradiol vaginal tablets
Authors: Panay Nick , Maamari Ricardo
Published: March 2012

Postmenopausal estrogen deficiency can lead to symptoms of urogenital atrophy. Individuals with urogenital atrophy have symptoms that include vaginal dryness, vaginal and vulval irritation, vaginal soreness, pain and burning during urination (dysuria), increased vaginal discharge, vaginal odour, vaginal infections, recurrent urinary tract infections, pain associated with sexual activity (dyspareunia) and vaginal bleeding associated with sexual activity. Despite the frequency and effects of vaginal atrophy symptoms, they are often under-reported and, consequently, under-treated. Therefore, care of a menopausal woman should include a physical assessment of vaginal atrophy and a dialogue between the physician and the patient that explores existing symptoms and their effect on vulvovaginal health, sexuality and quality-of-life issues. The development of the ultra-low-dose 10-µg estradiol vaginal tablets is in line with the requirements of regulatory agencies and women's health societies regarding the use of the lowest effective hormonal dose. Because of its effectiveness and safety profiles, in addition to its minimal systemic absorption, the 10-µg estradiol vaginal tablet can offer greater reassurance to health-care providers and postmenopausal women with an annual estradiol administration of only 1.14 mg.
Lesions of uncertain malignant potential (B3) on core biopsy in the NHS Breast Screening Programme: is the screening round relevant?
Authors: Hunt RJ , Steel JR , Porter GJR , Holgate CS , Watkins RM
Published: March 2012

INTRODUCTION

Most women who have screening mammography and undergo subsequent open biopsy following an indeterminate core biopsy result are eventually found to have benign disease. However, a significant number have malignant disease and the rate of malignancy in such cases may be influenced by various factors. This study examined the effect of the type of screening round (prevalent or incident) on the likelihood of breast cancer being present.

METHODS

A total of 199 women who had NHS breast screening mammograms and subsequent indeterminate (B3) core biopsy results followed by excision biopsy over an 11-year period in a single breast screening unit were reviewed.

RESULTS

The rate of malignancy following excision of a lesion graded as B3 on core biopsy was 21% for women in the prevalent screening round compared to 33% in subsequent rounds (Fisher's exact test, p=0.038).

CONCLUSIONS

The incidence of malignancy associated with a B3 core biopsy result appears to be related to the screening round in which the lesion is detected, being approximately 50% higher in the subsequent incident rounds compared to the initial prevalent round. This finding may be useful in formulating management plans for women who have an indeterminate biopsy result.
A quick and effective method of limb preparation with health, safety and efficiency benefits
Authors: Naderi N , Maw K , Thomas M , Boyce DE , Shokrollahi K
Published: March 2012

INTRODUCTION

Pre-operative limb preparation (PLP) usually involves lifting the limb and holding it in a fixed ‘static’ posture for several minutes. This is hazardous to theatre staff. Furthermore, ‘painting’ the limb can be time consuming and difficult areas such as between toes and fingers may remain unsterile. We demonstrate the time efficiency and asepsis achieved using the ‘sterile bag’ preparation technique. An additional advantage is the ability to prepare and anaesthetise a limb prior to theatre, increasing efficiency substantially for units with a large throughput of cases, such as day-case hand surgery lists.

METHODS

We monitored the duration of PLP in 20 patients using the ‘sterile bag’ technique compared to 20 patients using a conventional ‘painting’ method. Additionally, microbiology samples acquired from prepared upper limbs of 27 sequential patients operated on by a single surgeon over a two-month period were sent for culture immediately prior to commencement of surgery.

RESULTS

The mean duration of the ‘sterile bag’ PLP was significantly lower than that of the conventional method (24 seconds vs 85 seconds, p=0.045). The technique can take as little as ten seconds (n=1). Final microbiology reports showed no growth for any of the 27 patients from whom a culture sample was taken.

CONCLUSIONS

The sterile bag technique is effective in achieving asepsis, has the potential to increase theatre efficiency and reduces manual handling hazards compared to the conventional method. It is now taught to all theatre staff in our hospital during manual handling training. It can be undertaken in approximately ten seconds with practice for the upper limb.
A case of triple volvulus
Authors: Elsharif M , Basu I , Phillips D
Published: March 2012

Situs inversus is a rare congenital anomaly that has reportedly been associated with caecal volvulus. We describe a case of partial situs inversus complicated by intestinal obstruction secondary to three simultaneously occurring volvuli of the stomach, caecum and sigmoid colon. To our knowledge, this is the first documented case in the literature of multiple, simultaneously occurring volvuli.
Cervical pneumatocoele following total thyroidectomy
Authors: Liu DSH , Jayaweera S , Fleming W
Published: March 2012

Cervical pneumatocoele following thyroidectomy is rare. Urgent surgical intervention is necessary in the setting of widespread tissue emphysema and respiratory embarrassment. We describe a patient with a large pneumatocoele presenting six weeks after a total thyroidectomy who was managed successfully without surgical re-exploration. We also discuss the aetiology of cervical pneumatocoele as well as the potential indications for operative versus conservative management.
Alcohol skin preparation causes surgical fires
Authors: Rocos B , Donaldson LJ
Published: March 2012

INTRODUCTION

Surgical fires are a rare but serious preventable safety risk in modern hospitals. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm. This study used the National Reporting and Learning Service (NRLS) database at the National Patient Safety Agency to explore whether spirit-based surgical skin preparation fluid contributes to the cause of surgical fires.

METHODS

The NRLS database was interrogated for all incidents of surgical fires reported between 1 March 2004 and 1 March 2011. Each report was scrutinised manually to discover the cause of the fire.

RESULTS

Thirteen surgical fires were reported during the study period. Of these, 11 were found to be directly related to spirit-based surgical skin preparation or preparation soaked swabs and drapes.

CONCLUSIONS

Despite manufacturer's instructions and warnings, surgical fires continue to occur. Guidance published in the UK and US states that spirit-based skin preparation solutions should continue to be used but sets out some precautions. It may be that fire risk should be included in pre-surgical World Health Organization checklists or in the surgical training curriculum. Surgical staff should be aware of the risk that spirit-based skin preparation fluids pose and should take action to minimise the chance of fire occurring.
The power of words: sources of anxiety in patients undergoing local anaesthetic plastic surgery
Authors: Caddick J , Jawad S , Southern S , Majumder S
Published: March 2012

INTRODUCTION

With local or regional anaesthesia being employed for more as well as more complex surgical procedures, an increasing number of patients remain fully conscious during their operation. This is generally perceived as being advantageous to the patient as less time is spent in hospital and the side effects of general anaesthesia are avoided. However, there is no direct measure of the patient experience during ‘awake surgery’, in particular of which aspects of the process may be distressing.

METHODS

Seventy patients undergoing day case plastic surgery under local anaesthesia were asked to complete a short questionnaire immediately following their operation. This was designed to identify specific factors likely to either increase or reduce anxiety during surgery. The questionnaire was initially validated on a pilot group of ten patients.

RESULTS

Unsurprisingly, painful stimuli such as injections were identified as potential stressors. More interestingly, the data highlighted that some commonly used surgical terms such as ‘knife’ and ‘scalpel’ provoke considerable anxiety in the conscious patient. This varied according to age and sex with younger and female patients being most vulnerable. Other events identified as potential stressors, such as casual conversations and movements among theatre staff, were actually shown to be non-stressful and, in some cases, stress relieving.

CONCLUSIONS

Technical jargon used by surgical staff can elevate anxiety levels among patients who are awake for their operation. Careful consideration of the words we use may reduce this, particularly in female patients.
The use of pre-operative computed tomography in the assessment of the acute abdomen
Authors: Weir-McCall J , Shaw A , Arya A , Knight A , Howlett DC
Published: March 2012

INTRODUCTION

While there are a lot of data on the accuracy of computed tomography (CT) in diagnosing specific causes of an acute abdomen, there is very little information on the accuracy of CT in the acute general surgical admissions workload. We look at the diagnostic accuracy of CT in patients presenting with an acute abdomen who ultimately required a laparotomy.

METHODS

Patients who underwent an emergency laparotomy between 2008 and 2010 at Eastbourne District General Hospital with pre-operative CT on the same admission were included in the study. The CT report was compared with the laparotomy and histology findings and, where a discrepancy existed, the original imaging was reviewed by a senior consultant blinded to the original report and laparotomy findings.

RESULTS

A total of 196 emergency laparotomies were performed over the 2–year period, with 112 patients undergoing pre-operative CT. Fifteen patients were excluded from the study due to missing notes. In the remaining 97 patients, 80 CT reports correlated with the final operative diagnosis, giving a diagnostic accuracy of 82%. Of these, the on-call registrar was the initial reporter in 37 scans, with a diagnostic accuracy of 78%. On review of the CT by a second consultant, this increased to 90 correlations, yielding an accuracy of 93%. Delay between CT and the operation did not significantly alter diagnostic accuracy, nor was there any statistically significant reduction in accuracy in reports issued by on-call registrars.

CONCLUSIONS

On first reporting, CT misses 18% of diagnoses that ultimately require operative intervention. Reducing the threshold for obtaining a second consultant radiologist review significantly improves the diagnostic accuracy to 93%.
Septic emboli resulting in an acutely ischaemic lower limb: a case report
Authors: Ahmed M
Published: March 2012

Sources of arterial embolism range from the common, such as cardiac pathology, to less common causes. We present a case of an acutely ischaemic lower limb due to septic emboli from Staphylococcus aureus pneumonia.
Testicular dislocation: the importance of scrotal examination in a trauma patient
Authors: Naseer A , King D , Lee H , Vale J
Published: March 2012

Testicular dislocation after blunt perineal trauma is a rare event and a diagnosis that can be easily overlooked. Careful examination can help facilitate early and appropriate treatment. Timely diagnosis and surgical management are of paramount importance to preserve normal spermatogenic function in the dislocated testicle. We describe a case of testicular dislocation and discuss some of the issues surrounding diagnosis and treatment.
Penile degloving: an unusual presentation of hidradenitis suppurativa
Authors: Kok K , Lahiri A
Published: March 2012

Chronic hidradenitis suppurativa (HS) can cause lymphoedema, leading to novel presentations. We present the case of a man with chronic HS causing penile oedema and subsequent degloving. He underwent direct excision with a good result. Chronic HS patients should be warned about problems related to lymphoedema and reviewed regularly to resolve problems early.
Global ethical culinary fashion and a local dish: Organic hummus in Israel
Authors: Grosglik Rafi
Published: March 2012

Hummus, one of the most common foods in Israel, was appropriated several decades ago as an icon of Israeli culture and nationality. Organic hummus – a recent version of the dish – represents an encounter of the global and the local in consumption, due to global ethical culinary
fashion. In this article I analyze how re-branding local food as organic adds a layer of cosmopolitanism, which is status related. This analysis can be extrapolated from the culinary to a fashion related example in order to make the following arguments:That what appears as the embodiment
of environmental ethics of localism over globalism (cutting down on the carbon footprint and eliminating toxins from the product life cycle for the benefit of both producers and the environment) can actually be seen as its opposite when the local value is transformed into a cosmopolitan one.That
even if organic is interpreted as an ethical watchword, what motivates consumers is often not high-minded ideals but a better consumer experience (taste, prestige, etc.).This article traces the interplay between the global and the local through the example of hummus, which is analogous
to the dynamics of organic and sustainable fashion. It argues that the global socio-economic conditions and ideas embedded in the concept of ‘organic’ allow the imagined re-localization of the dish. Like ethnic fashion, hummus used to represent rootedness, earthiness, and local
simplicity but not fashionability. Nowadays, in its organic version, it wears an economic and symbolic framework of global values superimposed on the original local meanings, demonstrating a symbolic cosmopolitan and fashion-forward identity.
Fashionable dilemmas
Authors: Williams Austin
Published: March 2012

Continuing the approach he developed in his book, The Enemies of Progress: The Dangers of Sustainability with regards to design, Austin Williams takes to task the emerging ethical and sustainability dogma in the area of fashion. While acknowledging the importance of the issues addressed
by the rhetoric of ethics, per se, he takes issue with industries which employ it as a marketing strategy and as a platform to chide the less industrially developed countries. He critiques the attempt to use sustainability arguments in order to block the underdeveloped world from sharing the
fortunes of the developed world's consumption levels. He challenges those who seek to address global problems through the prism of ethics: by blaming individual consumers, or by absolving their guilt through selective purchases. More generally he questions ethical fashion's self-appointed
authority to moralize and in particular to impose on the underdeveloped world the equation that environmental concerns should take priority over poverty alleviation and human development.
Environmental education through art
Authors: Tereso Susana
Published: March 2012

The work presented in this article aims to examine different approaches to experiencing the relationship between art and nature as a model of sustainability. The objectives include the enhancement of sensibility – senses, emotions, feelings, affections – as a way to directly
experience the well-being promoted by joining art and nature, including harmony, beauty and diversity. The importance of the natural cycles is revealed by focusing on the light and colour during the day. Scientific knowledge is associated with the hands-on approach to achieving a superior
consciousness. Different methodologies relating education through art psychopedagogy, the creative workshop and the experience and knowledge of the natural environment are created. The ultimate goal is to generate new ideas and creative procedures for joining individual well-being with global
sustainability. The experiences developed in a natural reserve were applied in rethinking the city as a common space where human beings and local nature are joined to build a superior way of living.
The identities of an arts educator: Comparing discourses in three teacher education programmes in Finland
Authors: Collanus Miia , Kairavuori Seija , Rusanen Sinikka
Published: March 2012

The aim of this research was to find the structures affecting the construction of an arts educators' identity. We compare the subject areas of visual art and textile craft in three different teacher education programmes: the kindergarten teacher, classroom teacher and textile teacher
education at the University of Helsinki. Drawing from critical pedagogy, we approach teacher identity as a subject position constructed discursively in particular social and historical contexts. Our data consisted of 152 essays and portfolios from pre-service teachers. Using articulation as
our research strategy, it was possible to identify two (meta) discourses positioning an arts educator: the discourse of technical knowledge and skills, and the discourse of self-expression. We suggest this tensioned discursive space could serve as a starting point for further research, and
that the critical engagement with meta-level knowledge of the subject areas should be given more attention in teacher education.
CONFERENCE PRECIS
Authors: Christensen Peter , Rajagopalan Mrinalini , Arcak Sinem , O'Meara Simon
Published: March 2012

'"MIDDLE EASTERN" ARCHITECTURE IN CONTEXT', PANEL CONVENED AT THE SOCIETY OF ARCHITECTURAL HISTORIANS (SAH) 64TH ANNUAL MEETING, NEW ORLEANS, APRIL 14, 2011

'UNWRAPPING GIFTS OF THE SULTAN', LOS ANGELES COUNTY MUSEUM OF ART (LACMA), JUNE 10–12, 2011 A symposium in
conjunction with the exhibition 'Gifts of the Sultan: the Arts of Giving at the Islamic Courts' at LACMA from June 5 to September 5, 2011; at the Museum of Fine Arts in Houston from October 23, 2011 to January 15, 2012; and at the Museum of Islamic Art in Doha, Qatar in Spring 2012

'"GOD
IS BEAUTIFUL, HE LOVES BEAUTY": THE OBJECT IN ISLAMIC ART AND CULTURE', FOURTH BIENNIAL HAMAD BIN KHALIFA SYMPOSIUM ON ISLAMIC ART, MUSEUM OF ISLAMIC ART, DOHA, QATAR, OCTOBER 29–31, 2011
Experiencing the Alhambra, An Illusive Site of Oriental Otherness
Authors: Lundström Marie-Sofie
Published: March 2012

Two travellers, the French romantic poet and novelist Thophile Gautier (1811–72) and the Finnish naturalist painter Albert Edelfelt (1854–1905), both visited the Alhambra palace in Granada: Gautier in 1840, Edelfelt in 1881. Their accounts of the palace are strikingly similar,
although forty years separate their travels; written several years later, Edelfelt's narrative is imbued with a romanticism related to Gautier's. The aim is to show that the ambiguity of Gautier's and Edelfelt's statements of the Alhambra is due to their romantic preconceptions. I will compare
their experiences by analysing what they saw during their journeys and how it was expressed in their texts; Gautier published his Voyage en Espagne in 1843, while Edelfelt's impressions are recorded in his letters to his mother. The result is that the Alhambra represented a dream world, which
in many senses did not live up to the visitors' expectations. While Gautier was in constant search for the authenticity of the place, Edelfelt was deeply touched by the magnificence that met him in a labyrinth of fabulous beauty. However, the preconceived mental image they both held resulted
in an experience that in many ways fell short of the idea they had formed of it in advance.
Testosterone and tusks: maturation and seasonal reproductive patterns of live, free-ranging male dugongs (Dugong dugon) in a subtropical population
Authors: Burgess Elizabeth A , Lanyon Janet M , Keeley Tamara
Published: March 2012

Knowledge of male reproductive status and activity in free-ranging animals is vital to understanding reproductive patterns and population dynamics. Until now, almost all information regarding reproductive behavior of the dugong, a cryptic marine mammal, has relied on post-mortem examination. We examined the relationships between body length, tusk eruption (secondary sexual characteristic), seasonality, and group association on fecal testosterone metabolite concentrations in 322 free-ranging dugongs (159 males, 163 females) in subtropical Moreton Bay, Australia. Fecal testosterone concentrations demonstrated biologically meaningful differences in testicular activity between sexes and across reproductive/age classes, and were correlated with circulating concentrations in serum. Male dugongs have a pre-reproductive period that persists until a body length of 240 cm is achieved. Puberty apparently occurs between 240 and 260 cm body length when fecal testosterone levels increase fourfold (>500 ng/g) over juvenile levels, and is associated with tusk eruption. However, social maturity may be delayed until male dugongs are larger than 260 cm with well-developed tusks. In mature males, the lowest (<500 ng/g) fecal testosterone concentrations occur in the austral autumn months with maximal concentrations in September–October, coincident with the onset of a spring mating season. During spring, solitary mature males had fecal testosterone concentrations double those of mature males sampled within groups, potentially suggesting a mating strategy involving roving of reproductively active males. This study demonstrates that single-point physiological data from individuals across a population have value as indicators of reproductive processes. Our approach provides an efficacious non-lethal method for the census of reproductive status and seasonality in live male dugongs.
Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years
Authors: Bonuck Karen , Freeman Katherine , Chervin Ronald D. , Xu Linzhi
Published: March 2012

OBJECTIVES:

Examine statistical effects of sleep-disordered breathing (SDB) symptom trajectories from 6 months to 7 years on subsequent behavior.

METHODS:

Parents in the Avon Longitudinal Study of Parents and Children reported on children’s snoring, mouth breathing, and witnessed apnea at ≥2 surveys at 6, 18, 30, 42, 57, and 69 months, and completed the Strengths and Difficulties Questionnaire at 4 (n = 9140) and 7 (n = 8098) years. Cluster analysis produced 5 “Early” (6–42 months) and “Later” (6–69 months) symptom trajectories (“clusters”). Adverse behavioral outcomes were defined by top 10th percentiles on Strengths and Difficulties Questionnaire total and subscales, at 4 and 7 years, in multivariable logistic regression models.

RESULTS:

The SDB clusters predicted ≈20% to 100% increased odds of problematic behavior, controlling for 15 potential confounders. Early trajectories predicted problematic behavior at 7 years equally well as at 4 years. In Later trajectories, the “Worst Case” cluster, with peak symptoms at 30 months that abated thereafter, nonetheless at 7 years predicted hyperactivity (1.85 [1.30–2.63]), and conduct (1.60 [1.18–2.16]) and peer difficulties (1.37 [1.04–1.80]), whereas a “Later Symptom” cluster predicted emotional difficulties (1.65 [1.21–2.07]) and hyperactivity (1.88 [1.42–2.49]) . The 2 clusters with peak symptoms before 18 months that resolve thereafter still predicted 40% to 50% increased odds of behavior problems at 7 years.

CONCLUSIONS:

In this large, population-based, longitudinal study, early-life SDB symptoms had strong, persistent statistical effects on subsequent behavior in childhood. Findings suggest that SDB symptoms may require attention as early as the first year of life.
Utilizing Improvement Science Methods to Improve Physician Compliance With Proper Hand Hygiene
Authors: White Christine M. , Statile Angela M. , Conway Patrick H. , Schoettker Pamela J. , Solan Lauren G. , Unaka Ndidi I. , Vidwan Navjyot , Warrick Stephen D. , Yau Connie , Connelly Beverly L.
Published: March 2012

OBJECTIVE:

In 2009, The Joint Commission challenged hospitals to reduce the risk of health care–associated infections through hand hygiene compliance. At our hospital, physicians had lower compliance rates than other health care workers, just 68% on general pediatric units. We used improvement methods and reliability science to increase compliance with proper hand hygiene to >95% by inpatient general pediatric teams.

METHODS:

Strategies to improve hand hygiene were tested through multiple plan-do-study-act cycles, first by 1 general inpatient medical team and then spread to 4 additional teams. At the start of each rotation, residents completed an educational module and posttest about proper hand hygiene. Team compliance data were displayed daily in the resident conference room. Real-time identification and mitigation of failures by a hand-washing champion encouraged shared accountability. Organizational support ensured access to adequate hand hygiene supplies. The main outcome measure was percent compliance with acceptable hand hygiene, defined as use of an alcohol-based product or hand-washing with soap and turning off the faucet without using fingers or palm. Compliance was defined as acceptable hand hygiene before and after contact with the patient or care environment. Covert bedside observers recorded at least 8 observations of physicians’ compliance per day.

RESULTS:

Physician compliance with proper hand hygiene improved to >95% within 6 months and was sustained for 11 months.

CONCLUSIONS:

Instituting a hand-washing champion for immediate identification and mitigation of failures was key in sustaining results. Improving physician compliance with proper hand hygiene is achievable and a first step in decreasing health care–associated infections.
Breast Milk and Glucose for Pain Relief in Preterm Infants: A Noninferiority Randomized Controlled Trial
Authors: Bueno Mariana , Stevens Bonnie , de Camargo Patrícia Ponce , Toma Edi , Krebs Vera Lúcia Jornada , Kimura Amélia Fumiko
Published: March 2012

OBJECTIVE:

The study goal was to compare the efficacy of expressed breast milk (EBM) versus 25% glucose on pain responses of late preterm infants during heel lancing.

METHODS:

In a noninferiority randomized controlled trial, a total of 113 newborns were randomized to receive EBM (experimental group [EG]) or 25% glucose (control group [CG]) before undergoing heel lancing. The primary outcome was pain intensity (Premature Infant Pain Profile [PIPP]) and a 10% noninferiority margin was established. Secondary outcomes were incidence of cry and percentage of time spent crying and adverse events. Intention-to-treat (ITT) analysis was used.

RESULTS:

Groups were similar regarding demographics and clinical characteristics, except for birth weight and weight at data collection day. There were lower pain scores in the CG over 3 minutes after lancing (P < .001). A higher number of infants in the CG had PIPP scores indicative of minimal pain or absence of pain (P = .002 and P = .003 on ITT analysis) at 30 seconds after lancing, and the mean difference in PIPP scores was 3 (95% confidence interval: 1.507–4.483). Lower incidence of cry (P = .001) and shorter duration of crying (P = .014) were observed for CG. Adverse events were benign and self-limited, and there was no significant difference between groups (P = .736 and P = .637 on ITT analysis).

CONCLUSIONS:

Results based on PIPP scores and crying time indicate poorer effects of EBM compared with 25% glucose during heel lancing. Additional studies exploring the vol and administration of EBM and its combination with other strategies such as skin-to-skin contact and sucking are necessary.
Interrater Reliability of Clinical Findings in Children With Possible Appendicitis
Authors: Kharbanda Anupam B. , Stevenson Michelle D. , Macias Charles G. , Sinclair Kelly , Dudley Nanette C. , Bennett Jonathan , Bajaj Lalit , Mittal Manoj K. , Huang Craig , Bachur Richard G. , Dayan Peter S. ,   for the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics
Published: March 2012

OBJECTIVE:

Our objective was to determine the interrater reliability of clinical history and physical examination findings in children undergoing evaluation for possible appendicitis in a large, multicenter cohort.

METHODS:

We conducted a prospective, multicenter, cross-sectional study of children aged 3–18 years with possible appendicitis. Two clinicians independently evaluated patients and completed structured case report forms within 60 minutes of each other and without knowing the results of diagnostic imaging. We calculated raw agreement and assessed reliability by using the unweighted Cohen κ statistic with 2-sided 95% confidence intervals.

RESULTS:

A total of 811 patients had 2 assessments completed, and 599 (74%) had 2 assessments completed within 60 minutes. Seventy-five percent of paired assessments were completed by pediatric emergency physicians. Raw agreement ranged from 64.9% to 92.3% for history variables and 4 of 6 variables had moderate interrater reliability (κ > .4). The highest κ values were noted for duration of pain (κ = .56 [95% confidence intervals .51–.61]) and history of emesis (.84 [.80–.89]). For physical examination variables, raw agreement ranged from 60.9% to 98.7%, with 4 of 8 variables exhibiting moderate reliability. Among physical examination variables, the highest κ values were noted for abdominal pain with walking, jumping, or coughing (.54 [.45–.63]) and presence of any abdominal tenderness on examination (.49 [.19–.80]).

CONCLUSIONS:

Interrater reliability of patient history and physical examination variables was generally fair to moderate. Those variables with higher interrater reliability are more appropriate for inclusion in clinical prediction rules in children with possible appendicitis.
Barriers to Conducting Advance Care Discussions for Children With Life-Threatening Conditions
Authors: Durall Amy , Zurakowski David , Wolfe Joanne
Published: March 2012

BACKGROUND AND OBJECTIVE:

Advance care discussions (ACD) occur infrequently or are initiated late in the course of illness. Although data exist regarding barriers to ACD among the care of adult patients, few pediatric data exist. The goal of this study was to identify barriers to conducting ACD for children with life-threatening conditions.

METHODS:

Physicians and nurses from practice settings where advance care planning typically takes place were surveyed to collect data regarding their attitudes and behaviors regarding ACD.

RESULTS:

A total of 266 providers responded to the survey: 107 physicians and 159 nurses (54% response rate). The top 3 barriers were: unrealistic parent expectations, differences between clinician and patient/parent understanding of prognosis, and lack of parent readiness to have the discussion. Nurses identified lack of importance to clinicians (P = .006) and ethical considerations (P < .001) as impediments more often than physicians. Conversely, physicians believed that not knowing the right thing to say (P = .006) was more often a barrier. There are also perceived differences among specialties. Cardiac ICU providers were more likely to report unrealistic clinician expectations (P < .001) and differences between clinician and patient/parent understanding of prognosis (P = .014) as common barriers to conducting ACD. Finally, 71% of all clinicians believed that ACD happen too late in the patient’s clinical course.

CONCLUSIONS:

Clinicians perceive parent prognostic understanding and attitudes as the most common barriers to conducting ACD. Educational interventions aimed at improving clinician knowledge, attitudes, and skills in addressing these barriers may help health care providers overcome perceived barriers.
Nosocomial Rotavirus Infections: A Meta-analysis
Authors: Bruijning-Verhagen Patricia , Quach Caroline , Bonten Marc
Published: March 2012

BACKGROUND AND OBJECTIVES:

Nosocomial rotavirus (nRV) infections represent an important part of rotavirus (RV)-associated morbidity. The incidence of nRV influences the estimated total RV disease burden, an important determinant of cost-effectiveness of RV vaccination programs. Our aim is to summarize the existing evidence and produce reliable estimates of nRV incidence, in pediatric settings in Europe and North America.

METHODS:

We searched electronic databases for studies on nRV incidence among pediatric inpatients. To ascertain complete case reporting, only studies describing active nRV surveillance in their methodology were included. Random effects meta-analysis was performed. Meta-regression was used to obtain results adjusted for important study characteristics.

RESULTS:

Twenty surveillance studies met the quality criteria for inclusion. The pooled unadjusted nRV incidence was 2.9 per 100 hospitalizations (95% confidence interval [CI]: 1.6–4.4). Incidence was significantly influenced by studies' seasonality-months (RV epidemic season only or year-round) and the age range of included patients. Highest nRV incidence was found for children <2 years of age, hospitalized during the epidemic months (8.1/100 hospitalizations; 95% CI: 6.4–9.9). The adjusted year-round nRV incidence estimate without age restriction was 0.4/100 hospitalizations (95% CI: 0.1–2.1) and 0.7 (95% CI: 0.0–1.8) for children <5 years of age.

CONCLUSIONS:

This is the first meta-analysis to summarize results of surveillance studies on nRV incidence. nRV is an important problem among hospitalized infants during the winter months. The lower season and age-adjusted nRV incidence estimate seems more appropriate for application in population-based burden of disease analysis.
Development of a Pragmatic Measure for Evaluating and Optimizing Rapid Response Systems
Authors: Bonafide Christopher P. , Roberts Kathryn E. , Priestley Margaret A. , Tibbetts Kathleen M. , Huang Emily , Nadkarni Vinay M. , Keren Ron
Published: March 2012

OBJECTIVES:

Standard metrics for evaluating rapid response systems (RRSs) include cardiac and respiratory arrest rates. These events are rare in children; therefore, years of data are needed to evaluate the impact of RRSs with sufficient statistical power. We aimed to develop a valid, pragmatic measure for evaluating and optimizing RRSs over shorter periods of time.

METHODS:

We reviewed 724 medical emergency team and 56 code-blue team activations in a children’s hospital between February 2010 and February 2011. We defined events resulting in ICU transfer and noninvasive ventilation, intubation, or vasopressor infusion within 12 hours as “critical deterioration.” By using in-hospital mortality as the gold standard, we evaluated the test characteristics and validity of this proximate outcome metric compared with a national benchmark for cardiac and respiratory arrest rates, the Child Health Corporation of America Codes Outside the ICU Whole System Measure.

RESULTS:

Critical deterioration (1.52 per 1000 non-ICU patient-days) was more than eightfold more common than the Child Health Corporation of America measure of cardiac and respiratory arrests (0.18 per 1000 non-ICU patient-days) and was associated with >13-fold increased risk of in-hospital death. The critical deterioration metric demonstrated both criterion and construct validity.

CONCLUSIONS:

The critical deterioration rate is a valid, pragmatic proximate outcome associated with in-hospital mortality. It has great potential for complementing existing patient safety measures for evaluating RRS performance.
Alcohol Consumption in Movies and Adolescent Binge Drinking in 6 European Countries
Authors: Hanewinkel Reiner , Sargent James D. , Poelen Evelien A. P. , Scholte Ron , Florek Ewa , Sweeting Helen , Hunt Kate , Karlsdottir Solveig , Jonsson Stefan Hrafn , Mathis Federica , Faggiano Fabrizio , Morgenstern Matthis
Published: March 2012

OBJECTIVE:

The goal of this study was to investigate whether the association between exposure to images of alcohol use in movies and binge drinking among adolescents is independent of cultural context.

METHODS:

A cross-sectional survey study in 6 European countries (Germany, Iceland, Italy, Netherlands, Poland, and Scotland) was conducted. A total of 16 551 pupils from 114 public schools with a mean (± SD) age of 13.4 (± 1.18) years participated. By using previously validated methods, exposure to alcohol use in movies was estimated from the 250 top-grossing movies of each country (years 2004−2009). Lifetime binge drinking was the main outcome measure.

RESULTS:

Overall, 27% of the sample had consumed >5 drinks on at least 1 occasion in their life. After controlling for age, gender, family affluence, school performance, television screen time, sensation seeking and rebelliousness, and frequency of drinking of peers, parents, and siblings, the adjusted β-coefficient for lifetime binge drinking in the entire sample was 0.12 (95% confidence interval: 0.10−0.14; P < .001). The crude relationship between movie alcohol use exposure and lifetime binge drinking was significant in all countries; after covariate adjustment, the relationship was still significant in 5 of 6 countries. A sensitivity analysis revealed that the association is content specific, as there was no significant association between lifetime binge drinking and exposure to smoking in movies.

CONCLUSIONS:

The link between alcohol use in movies and adolescent binge drinking was robust and seems relatively unaffected by cultural contexts.
The effect of gonadotropin releasing hormone analogue therapy in girls with idiopathic central precocious puberty
Authors: Ságodi László , Sólyom Enikő , Lombay Béla , Almási Andrea , Vámosi Ildikó
Published: March 2012

It has been proven for more than two decades that gonadotropin releasing hormone analogue therapy is the only choice of treatment in patients with central precocious puberty. Aims: The aim of the authors was to assess the effect of gonadotropin releasing hormone analogue treatment on final height, body mass index, bone mineral density and ovarian function in girls with idiopathic central precocious puberty. Methods: Predicted adult height, target height and achieved height due to therapy was assessed in 15 girls with idiopathic precocious puberty treated with gonadotropin releasing hormone analogue. At the beginning of the treatment, the age of the girls was 7.0±0.8 years (mean±SD) and at the end of the treatment 12±0.8 years. The duration of gonadotropin-releasing hormone analogue treatment was 4.48±0.8 years. At the time of achieving final height, the age of the patients was 18.2±2.0 years and the height was 160.4±7.1 cm. When final height was reached, the authors evaluated bone mineral density Z-score values, levels of bone markers and the function of the hypothalamic-pituitary-gonadal axis. 15 healthy prepubertal girls, 15 pubertal girls and 15 girls who reached final height matched for chronological age were selected as control groups. Results: The majority of the gonadotropin releasing hormone-treated girls reached or almost reached their expected height predicted on the basis of the heights of their parents, but the therapy resulted only in a modest beneficial effect on height gain. Despite the fact that the body weight of patients increased during the treatment, there was no significant difference in their body mass index when they reached their final height as compared to controls. As compared to controls, patients had a decreased bone mineral density at the time when they reached their final height (lumbar spine 2-4 Z score, –0.27±1.2 vs. 0.5±0.7 in controls; p = 0.0377), which could be explained by their overweight that already existed before treatment, lack of exercise and poor calcium uptake. Their menarche occurred 12±4.6 months after discontining the treatment. Conclusions: Gonadotropin releasing hormone analogue therapy exerts a modest beneficial effect on final height gain. There are no detrimental effects on body mass index, bone mineral density and ovarian function after treatment. Side-effects are of minor severity and they are tolerable. Orv. Hetil., 2012, 153, 418–424.
Superoxide-anion production of neutrophil granulocytes in healthy and preeclamptic pregnant women
Authors: Lampé Rudolf
Published: March 2012

Data on respiratory burst activity of granulocytes from healthy and preeclamptic pregnant women are contradictory. To further investigate a possible role of reactive oxygen species in the etiology of preeclampsia, the induced superoxide-anion generation by granulocytes from non-pregnant, healthy pregnant and preeclamptic pregnant women were measured. The reciprocal effects of heat-inactivated and non-inactivated plasma on superoxide production by neutrophils from non-pregnant, healthy pregnant and preeclamptic pregnant subjects were also examined. Superoxide generation was measured by ferricytochrome c reduction. Both phorbol-12.13-dibutirate- and N-formyl-methionyl-leucyl-phenylalanine-induced superoxide production was significantly decreased in normal pregnancy compared to results obtained in non-pregnant and preeclamptic pregnant women. Phorbol-12.13-dibutirate-induced superoxide generation by non-pregnant and preeclamptic neutrophils was significantly inhibited by heat-inactivated and non-inactivated healthy pregnant plasma. N-formyl-methionyl-leucyl-phenylalanine-stimulated superoxide production by non-pregnant and preeclamptic granulocytes was suppressed only by non-inactivated healthy pregnant plasma. Phorbol-12.13-dibutirate-induced superoxide generation of healthy pregnant neutrophils was significantly increased by inactivated and non-inactivated non-pregnant and preeclamptic plasma. N-formyl-methionyl-leucyl-phenylalanine-stimulated superoxide production by healthy pregnant granulocytes was significantly enhanced following treatment of the cells with non-inactivated non-pregnant and preeclamptic pregnant plasma. Deficient superoxide generation in normal pregnancy may be caused by maternal immunosuppressive factors. The failure of reduction in superoxide production in preeclampsia may be partly responsible for endothelial dysfunction. Apart from oxidative stress, a possible role of inefficient maternal immunosuppression should also be considered in the pathogenesis of preeclampsia. Orv. Hetil., 2012, 153, 425–434.
Graphene Adsorbed on Corundum Surface: Clean Interface and Band Gap Opening
Authors: Huang Bing , Xu Qiang , Wei Su-Huai
Published: March 2012

Using advanced first-principles calculations, we have studied the structural and electronic properties of graphene/α-Al2O3 interfaces and show that α -Al2O3 is an ideal gate dielectric material for graphene transistors. Clean interface exists between graphene and Al-terminated (or hydroxylated) Al2O3 and the valence band offsets for these systems are large enough to create injection barrier. Remarkably, a band gap of ~180 meV can be induced in graphene layer adsorbed on Al-terminated surface, which is significantly larger than graphene on other popular substrates.
MBE-Grown IV-VI Semiconductor Structures for Thermal Conductivity Measurements
Authors: McCann Patrick J. , Olona Leonard , Cai Zhihua , Jeffers James D. , Namjou Khosrow
Published: March 2012

IV-VI semiconductor structures grown by molecular beam epitaxy (MBE) have been used to measure the cross-plane thermal conductivity of PbSe and PbSe/PbSnSe/PbSe multiperiod superlattice (SL) materials. Continuous wave photoluminescence (PL) measurements were used to determine epilayer temperatures localized to multiple quantum well (MQW) light emitting layers on top of various IV-VI materials structures. These data combined with finite element analysis (FEA) were used to extract cross-plane thermal conductivity values for different materials designs. Structures consisting of PbSe/PbSnSe/PbSe SL materials with multiple periodicities exhibited cross-plane lattice thermal conductivity values as low as 0.30 W/mK, a significant reduction relative to the 1.9 W/mK value for bulk PbSe. This work shows that lattice thermal conductivity reduction offers a highly viable approach for improving thermoelectric materials performance.
Val De La Mare dam, Jersey: design and installation of a geomembrane lining
Authors: Howard Jonathan
Published: March 2012

Val De La Mare dam is a mass concrete dam 193 m long × 24·3 m high and has suffered from alkali silica reaction for over 50 years. A project was completed in November 2011, to install 3200 m2 of a specialist geomembrane lining to the upstream face by Carpi Tech of Switzerland. This paper describes how the rehabilitation of the dam was carried out.
Safety modifications at Lower Laithe reservoir
Authors: Evans Natalie C
Published: March 2012

Lower Laithe reservoir is located near Stanbury in West Yorkshire. The reservoir retains a volume of 1 275 000 m3 of water when full to its top water level, and as such falls under the legal obligations of the Reservoirs Act 1975. A statutory inspection of Lower Laithe reservoir was carried out in 2008 in accordance with the Act. This inspection revealed potential inadequacies with the ability of the existing overflow arrangement safely to convey the design flood. Mott MacDonald Bentley has subsequently been employed by the reservoir owner to investigate these inadequacies. A flood study and physical model have shown that during the design flood, spill flows in excess of 72 m3/s could be expected, with velocities exceeding 19 m/s. Flows of this magnitude would overtop the walls of the spillway and stilling basin and would be likely to cause extensive damage to the existing masonry lined channel. Remedial works have subsequently taken place at Lower Laithe to protect the overflow arrangement from the design flood. Improvement works to the existing spillway have included lining the structure with concrete and raising the masonry walls. Innovative modifications have taken place in the stilling basin to direct flows to the river channel, thereby protecting the toe of the embankment. In addition it has been necessary to raise the level of the clay core above the design flood. This paper describes these safety improvement works, as well as the stringent flood contingency measures which were required to maintain reservoir safety while completing works on an existing spillway structure.
Aboveground net primary production response of semi‐arid shrublands to chronic experimental dry‐season N input
Authors: Vourlitis George L.
Published: March 2012

Urban chaparral and coastal sage scrub (CSS) shrublands of southern Californian have been exposed to high‐levels of dry‐atmospheric nitrogen (N) deposition for decades. The productivity of these semi‐arid shrublands is reportedly N limited, thus N exposure is hypothesized to cause an increase in aboveground net primary production (NPP). To test this hypothesis the aboveground biomass and litter production of a post‐fire chaparral and a mature CSS stand were measured over an 8 year period in plots exposed to either ambient or elevated N input (ambient + 50 kg N ha−1 y−1). Results support this hypothesis; however, trends in NPP varied over time or were affected by rainfall. For post‐fire chaparral, NPP was initially inhibited by N input, but over time NPP increased consistently in plots exposed to added N. For CSS, the effect of N exposure was positively correlated with annual rainfall and N exposure caused NPP to increase significantly when rainfall exceeded approximately 450 mm year−1. Thus, while N enrichment may increase the NPP of these semi‐arid shrublands, temporal patterns may take years to emerge or be dependent on water availability. These results highlight the importance of long‐term experiments and the potential for interactions between water and nutrients in semi‐arid ecosystems.