bluuebunny/crossref_metadata_2025 huggingface dataset:
Lactic acidosis following intentional overdose by inhalation of salmeterol and fluticasone
Authors: Manara Alessandro , Hantson Philippe , Vanpee Dominique , Thys Frédéric
Published: July 2016

Salmeterol, a long-acting β2-adrenergic receptor agonist used for the treatment of asthma and chronic obstructive pulmonary disease, has an adverse effects profile that is similar to that of salbutamol and other β2-agonists. We report a sympathomimetic syndrome with metabolic acidosis and hyperlactatemia after intentional inhalation of salmeterol in a suicide attempt. A 16-year-old female patient was admitted to the emergency department approximately 2 hours after having inhaled 60 puffs of a combination of salmeterol xinafoate 25 μg and fluticasone propionate 50 μg. She presented in an anxious state with complaints of palpitations and chest pain. The electrocardiogram demonstrated sinus tachycardia and ST-segment depression in the inferior and anterolateral leads. Laboratory findings showed hypokalemia, hypophosphatemia, and lactic acidosis. Cardiac troponin I and creatine kinase MB remained within the normal range. Treatment was supportive and included intravenous fluids and cautious potassium supplementation. The next day, electrocardiographic and laboratory findings returned to normal. We hypothesize that stimulation of β2-adrenergic receptors by inhalation of salmeterol caused this patient's lactic acidosis. This observation is consistent with the hypothesis that the hyperlactatemia observed during asthma attacks is due in part to the administration of high doses of β2-agonists. Salmeterol overdose by inhalation appears to be sufficient to cause lactic acidosis.
Perceptions of graduates from Africa's first emergency medicine training program at the University of Cape Town/Stellenbosch University
Authors: Wen Leana S. , Geduld Heike I. , Nagurney J. Tobias , Wallis Lee A.
Published: July 2016

Objective:

Africa's first postgraduate training program in emergency medicine (EM) was established at the University of Cape Town/Stellenbosch University (UCT/SUN) in 2004. This study of the UCT/SUN EM program investigated the backgrounds, perceptions, and experiences of its graduates.

Methods:

This was a cross-sectional descriptive study. The study population was the 30 graduates from the first four classes in the UCT/SUN EM program (2007–2010). We employed a scripted interview with a combination of closed and open-ended questions. Data were analyzed using the thematic method of qualitative analysis.

Results:

Twenty-seven (90%) graduates were interviewed. Initial career goals were primarily (78%) to practice EM in a nonacademic clinical capacity. At the time of the interview, 52% held academic positions, 15% had nonacademic clinical positions, and 33% had temporary positions and were looking for other posts. The three most commonly cited strengths of their program were diversity of clinical rotations (85%), autonomy and procedural experience (63%), and importance of being pioneers within Africa (52%). The three most commonly cited weaknesses were lack of bedside teaching in the ED (96%), lack of career options after graduation (74%), and lack of preparation for academic careers (70%).

Conclusions:

The lessons identified from structured interviews with graduates from Africa’s first EM training include the importance of strong clinical training, difficulty of ensuring bedside teaching in a new program, the necessity of ensuring postgraduation positions, and the need for academic training. These findings may be useful for other developing countries looking to start EM training programs.
How does “knowledge translation” affect my clinical practice?
Authors: Lang Eddy S. , Johnson David
Published: July 2016

Knowledge translation is emerging as an increasingly important area of research and practice aiming to remedy the disconnection between evidence-based clinical care and real-life practice. The discipline is informed by a large body of literature and practical tools, which can inform providers and leaders in health care. Front-line clinicians should be aware of the principles of knowledge translation and the evidence that defines successful and suboptimal strategies for introducing evidence-based care at the system level.
Influenza assessment centres: a case study of pandemic preparedness to alleviate excess emergency department volume
Authors: Hall Geoffrey G. , Perry Alexander G. , vanDijk Adam , Moore Kieran M.
Published: July 2016

Objectives:

Influenza assessment centres (IACs) were deployed to reduce emergency department (ED) volumes during the pH1N1 influenza outbreak in the Kingston, Frontenac, Lennox and Addington (KFL&A) public health region of Ontario, Canada, in the fall of 2009. We present a case study for the deployment of IACs to reduce ED visit volume during both periods of pandemic and seasonal communicable disease outbreak.

Methods:

An emergency department syndromic surveillance system was used to trigger the deployment of eight geographically distributed IACs and to time their staggered closure 3 weeks later. We compared actual and expected ED visit volumes in the KFL&A region to neighbouring regions where no IACs operated by time series regression analysis before, during, and after IAC operation.

Results:

The deployment of IACs was triggered with a rise in overall ED volume at the hospitals in the KFL&A region to a level 10% above the 6-month running average. The IACs assessed 2,284 patients during 3 weeks of operation. Thirtythree patients were admitted directly to the hospital from the IACs, bypassing the EDs. During the operation of the IACs, the hospitals in the KFL&A region experienced a modest decrease in daily visits when compared to the 3 previous weeks. Overall ED visit volume in the hospitals in the neighbouring regions increased 105% during the period of IAC operation.

Conclusions:

Operating stand-alone influenza IACs may reduce ED volumes during periods of increased demand, as observed during an anticipated pandemic situation.
Validity and reliability of an in-training evaluation report to measure the CanMEDS roles in emergency medicine residents
Authors: Kassam Aliya , Donnon Tyrone , Rigby Ian
Published: July 2016

Background:

There is a question of whether a single assessment tool can assess the key competencies of residents as mandated by the Royal College of Physicians and Surgeons of Canada CanMEDS roles framework.

Objective:

The objective of the present study was to investigate the reliability and validity of an emergency medicine (EM) in-training evaluation report (ITER).

Method:

ITER data from 2009 to 2011 were combined for residents across the 5 years of the EM residency training program. An exploratory factor analysis with varimax rotation was used to explore the construct validity of the ITER. A total of 172 ITERs were completed on residents across their first to fifth year of training.

Results:

A combined, 24-item ITER yielded a five-factor solution measuring the CanMEDs role Medical Expert/ Scholar, Communicator/Collaborator, Professional, Health Advocate and Manager subscales. The factor solution accounted for 79% of the variance, and reliability coefficients (Cronbach alpha) ranged from α = 0.90 to 0.95 for each subscale and α = 0.97 overall. The combined, 24-item ITER used to assess residents’ competencies in the EM residency program showed strong reliability and evidence of construct validity for assessment of the CanMEDS roles.

Conclusions:

Further research is needed to develop and test ITER items that will differentiate each CanMEDS role exclusively.
Metabolic acidosis in toluene sniffing
Authors: Tuchscherer Jon , Rehman Habib
Published: July 2016

Toluene sniffing, frequently described under the generic category of “glue sniffing,” is a potential cause of normal anion gap metabolic acidosis due to distal renal tubular acidosis. Urine anion gap is used to diagnose metabolic acidosis of a normal anion gap variety; however, pitfalls exist when using urine anion gap in the setting of toluene sniffing. We present the case of a young woman who had a normal anion gap metabolic acidosis due to toluene sniffing and an unexpectedly low urine anion gap. In such a scenario, the urine anion gap will underestimate the rate of ammonia excretion when the conjugate bases of acids other than HCl are excreted in large quantities. Estimation of the urine osmolal gap will provide a more accurate ammonia excretion rate in these circumstances. The challenges in interpretation of the urine anion gap and ammonia excretion in the setting of distal renal tubular acidosis due to toluene toxicity are discussed.
Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?
Authors: Van Zyl Hendrik P. , Bilbey James , Vukusic Alan , Ring Todd , Oakes Jennifer , Williamson Lykke D. , Mitchell Ian V.
Published: July 2016

Objective:

Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine.

Method:

Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists.

Results:

Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25).

Conclusion:

Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.
Developing a Canadian emergency medical services research agenda: a baseline study of stakeholder opinions
Authors: Dainty Katie N. , Jensen Jan L. , Bigham Blair L. , Blanchard Ian E. , Brown Lawrence H. , Carter Alix J.E. , Socha Doug , Morrison Laurie J.
Published: July 2016

Purpose:

This study forms the first phase in the development of the Canadian National EMS Research Agenda. The purpose was to understand the current state of emergency medical services (EMS) research through the barriers and opportunities perceived by key stakeholders in the Canadian system and to identify the recommendations this group had for moving forward.

Methods:

This qualitative study was conducted in the spring of 2011 using one-on-one semistructured telephone interviews. Purposeful sampling was used to recruit a cross section of EMS research stakeholders, representing a breadth of geographic regions and roles. Data were collected until thematic saturation was reached. A constant comparative approach was used to develop a basic coding framework and identify emerging themes.

Results:

Twenty stakeholders were invited to participate, and saturation was reached after 13 interviews. Thematic saturation was used to ensure that the findings were grounded in the data. Four major themes were identified: 1) the need for additional research education within EMS; 2) the importance of creating an infrastructure to support pan-Canadian research collaboration; 3) addressing the complexities of involving EMS providers in research; and 4) considerations for a national research agenda.

Conclusion:

This hypothesis-generating study reveals key areas regarding EMS research in Canada and through the guidance it provides is a first step in the development of a comprehensive national research agenda. Our intention is to collate the identified themes with the results of a larger roundtable discussion and Delphi survey and, in doing so, guide development of a Canadian national EMS research agenda.
Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada
Authors: Buick Jason E. , Lin Steve , Rac Valeria E. , Brooks Steven C. , Kierzek Gérald , Morrison Laurie J.
Published: July 2016

Introduction:

Drowning is a major public health concern, yet little is known about the characteristics of drowning patients. The objectives of this study were to describe the demographic and clinical characteristics of out-of-hospital cardiac arrest (OHCA) attributed to drowning in Ontario and to compare the characteristics of OHCA attributed to drowning to those of presumed cardiac etiology.

Methods:

A retrospective, observational study was carried out of consecutive OHCA patients of drowning etiology in Ontario between August 2006 and July 2011. Bivariate analysis was used to evaluate differences between drowning and presumed cardiac etiologies.

Results:

A total of 31,763 OHCA patients were identified, and 132 (0.42%) were attributed to drowning. Emergency medical services treated 98 patients, whereas the remaining 34 met the criteria for legislative death. Overall, 5.1% of drowning patients survived to hospital discharge. When compared to patients of presumed cardiac etiology, drowning patients were younger and their arrest was more likely to be unwitnessed, present with a nonshockable initial rhythm, occur in a public location, and receive bystander cardiopulmonary resuscitation (CPR). A nonsignificant trend was noted for drowning cases to more frequently have a public access AED applied. There were no significant differences in the gender ratio or paramedic response times. Drowning patients were more likely to be transported to hospital but had a trend to be less likely to arrive with a return of spontaneous circulation. They were also more likely to be admitted to hospital but had no difference in survival to hospital discharge.

Conclusions:

Significant differences exist between OHCA of drowning and presumed cardiac etiologies. Most drownings are unwitnessed, occur in public locations, and present with nonshockable initial rhythms, suggesting that treatment should focus on bystander CPR. Future initiatives should focus on strategies to improve supervision in targeted locations and greater emphasis on bystander-initiated CPR, both of which may reduce drowning mortality.
Variation in the use of skull radiographs by emergency physicians in young children with minor head trauma
Authors: Carrière Benoit , Clément Karine , Gravel Jocelyn
Published: July 2016

Background:

Minor head trauma in young children is a major cause of emergency department visits. Conflicting guidelines exist regarding radiologic evaluation in such cases.

Objective:

To determine the practice pattern among Canadian emergency physicians for ordering skull radiographs in young children suffering from minor head trauma. Physicians were also surveyed on their willingness to use a clinical decision rule in such cases.

Design/Methods:

A self-administered email questionnaire was sent to all members of the Pediatric Emergency Research Canada (PERC) group. It consisted of clinical vignettes followed by multiple-option answers on the management plan. The study was conducted using the principles of the Dillman Tailored Design method and included multiple emailings to maximize the response rate. The research protocol received Institutional Review Board approval.

Results:

A total of 158 of 295 (54%) PERC members responded. Most participants were trained in pediatric emergency medicine and assessed more than 500 children per year. Imaging management for the vignettes was highly variable: 6 of the 11 case scenarios had a proportion of radiograph ordering between 20 and 80%. Ninety-five percent of respondents stated that they would apply a validated clinical decision rule for the detection of skull fracture in young children with minor head trauma. The minimum sensitivity deemed acceptable for such a rule was 98%.

Conclusion:

Canadian emergency physicians have a wide variation in skull radiography ordering in young children with minor head trauma. This variation, along with the need expressed by physicians, suggests that further research to develop a clinical decision rule is warranted.
A randomized, controlled trial of oral versus intravenous fluids for lowering blood glucose in emergency department patients with hyperglycemia
Authors: Arora Sanjay , Probst Marc A. , Andrews Laura , Camilion Marissa , Grock Andrew , Hayward Gregory , Menchine Michael
Published: July 2016

Objectives:

Blood glucose can be lowered via insulin and/or fluid administration. Insulin, although efficacious, can cause hypoglycemia and hypokalemia. Fluids do not cause hypoglycemia or hypokalemia, but the most effective route of fluid administration has not been well described. This study compared the efficacy and safety of oral versus intravenous fluids for reducing blood glucose in patients with hyperglycemia.

Methods:

We conducted a prospective, nonblinded, randomized, controlled trial. Inclusion criteria were blood glucose > 13.9 mmol/L, age > 18 years, and ability to tolerate oral fluids. Subjects were excluded for critical illness, contraindication to fluids, and/or hyperglycemia therapy prior to enrolment. Subjects were randomized to receive oral bottled water or intravenous normal saline (maximum 2 L) over 2 hours. The primary outcome of interest was a change in blood glucose at 2 hours across treatment arms.

Results:

The 48 subjects were randomized. Baseline blood glucose levels and total amount of fluid received were similar between the two groups. The mean decrease in blood glucose at 2 hours was similar for both treatment arms: a mean decrease of 3.4 mmol/L (20.2 mmol/L to 16.8 mmol/L) in the oral fluid group versus a mean decrease of 4.0 mmol/L (19.7 mmol/L to 15.7 mmol/L) in the intravenous fluid group. The mean difference between groups was −0.6 mmol/L (95% confidence interval −2.3–1.2;p= 0.51). No adverse events were observed in either group.

Conclusion:

In this unblinded randomized trial, oral and intravenous fluids were equally efficacious in lowering blood glucose levels in stable hyperglycemic patients and no adverse events were noted. Physicians should be mindful that, although similar, the reduction in blood glucose was modest in both groups.
An inventory of Canadian trauma systems: opportunities for improving access to trauma care
Authors: Evans Christopher C.D. , Tallon J.M. , Bridge Jennifer , Nathens Avery B.
Published: July 2016

Objective:

Despite evidence that patients suffering major traumatic injuries have improved outcomes when cared for within an organized system, the extent of trauma system development in Canada is limited. We sought to compile a detailed inventory of trauma systems in Canada as a first step toward identifying opportunities for improving access to trauma care.

Methods:

We distributed a nationwide online and mail survey to stakeholders intended to evaluate the extent of implementation of specific trauma system components. Targeted stakeholders included emergency physicians, trauma surgeons, trauma program medical directors and program managers, prehospital providers, and decision makers at the regional and provincial levels. A “snowball” approach was used to expand the sample base of the survey. Descriptive statistics were generated to quantify the nature and extent of trauma system development by region.

Results:

The overall response rate was 38.7%, and all levels of stakeholders and all provinces/territories were represented. All provinces were found to have designated trauma centres; however, only 60% were found to have been accredited within the past 10 years. Components present in 50% or fewer provinces included an inclusive trauma system model, interfacility transfer agreements, and a mechanism to track bed availability within the system.

Conclusion:

There is significant variability in the extent of trauma system development in Canada. Although all provinces have designated trauma centres, opportunities exist in many systems to implement additional components to improve the inclusiveness of care. In future work, we intend to quantify the strength of the relationship between different trauma system components and access to definitive trauma care.
Postresuscitation debriefing in the pediatric emergency department: a national needs assessment
Authors: Sandhu Naminder , Eppich Walter , Mikrogianakis Angelo , Grant Vincent , Robinson Traci , Cheng Adam ,   for the Canadian Pediatric Simulation Network (CPSN) Debriefing Consensus Group
Published: July 2016

Objectives:

The objectives of this study were to assess current postresuscitation debriefing (PRD) practices in Canadian pediatric emergency departments (EDs) and identify areas for improvement.

Methods:

A national needs assessment survey was conducted to collect information on current PRD practices and perspectives on debriefing practice in pediatric EDs. A questionnaire was distributed to ED nurses, fellows, and attending physicians at 10 pediatric tertiary care hospitals across Canada. Summary statistics are reported.

Results:

Data were analyzed from 183 participants (48.7% response rate). Although 88.8% of the participants believed that debriefing is an important process, 52.5% indicated that debriefing after real resuscitations occurs less than 25% of the time and 68.3% indicated that no expectation exists for PRD at their institution. Although 83.7% of participants believed that facilitators should have a specific skill set developed through formal training sessions, 63.4% had no previous training in debriefing. Seventy-two percent felt that medical and crisis resource management issues are dealt with adequately when PRD occurs, and 90.4% indicated that ED workload and time shortages are major barriers to effective debriefing. Most responded that a debriefing tool to guide facilitators might aid in multiple skills, such as creating realistic debriefing objectives and providing feedback with good judgment.

Conclusion:

PRD in Canadian pediatric EDs occurs infrequently, although most health care providers agreed on its importance and the need for skilled facilitators.
Effect of prehospital initiation of therapeutic hypothermia in adults with cardiac arrest on time-to-target temperature
Authors: Schenfeld Eric M. , Studnek Jonathan , Heffner Alan C. , Nussbaum Marcy , Kraft Kathi , Pearson David A.
Published: July 2016

Objective: Despite growing adoption, the impact of prehospital initiation of therapeutic hypothermia on outcomes of cardiac arrest patients is unknown. The objective of this study was to determine if prehospital administration of cold intravenous fluids improved the time-to-target temperature.

Methods: All patients enrolled in an institutional post– cardiac arrest treatment pathway were prospectively registered into a quality assurance database. Patients undergoing cooling induction on hospital arrival were compared to those receiving a new treatment protocol initiated during the study period involving prehospital cooling with 4°C (39.2°F) normal saline. The primary outcome was the time-to-target temperature. Secondary outcomes included emergency medicine system transport time metrics, mortality, and neurologic status at discharge and 1 year.

Results: One hundred thirty-two patients were enrolled during the study period. The initial rhythm was ventricular fibrillation/tachycardia in 63% and asystole/pulseless electrical activity in 36%. Eighty patients received prehospital cooling and 52 patients did not and comprised the historical control group. Time-to-target temperatures were not significantly different between prehospital and hospital cooled groups (256 v. 271 minutes, respectively, p=0.64), nor was there any improvement in hospital survival (54% v. 50%, p=0.67), good neurologic outcome (49% v. 44%, p=0.61), or 1- year survival (49% v. 42%, p=0.46) between the two groups. Transport times were longer in the prehospital cooled group.

Conclusions: Out-of-hospital cardiac arrest patients treated with prehospital cooling before arrival at our urban hospital did not have faster time-to-target temperature or improvement in outcomes compared to patients cooled immediately on emergency department arrival. Further research is needed to determine if any benefits exist from prehospital cooling prior to its widespread adoption.
Closing the circle of care: implementation of a web-based communication tool to improve emergency department discharge communication with family physicians
Authors: Hunchak Cheryl , Tannenbaum David , Roberts Michael , Shah Thrushar , Tisma Predrag , Ovens Howard , Borgundvaag Bjug
Published: July 2016

Objective: Postdischarge emergency department (ED) communication with family physicians is often suboptimal and negatively impacts patient care. We designed and piloted an online notification system that electronically alerts family physicians of patient ED visits and provides access to visitspecific laboratory and diagnostic information.

Methods: Nine (of 10 invited) high-referring family physicians participated in this single ED pilot. A prepilot chart audit (30 patients from each family physician) determined the baseline rate of paper-based record transmission. A webbased communication portal was designed and piloted by the nine family physicians over 1 year. Participants provided usability feedback via focus groups and written surveys.

Results: Review of 270 patient charts in the prepilot phase revealed a 13% baseline rate of handwritten chart and a 44% rate of any information transfer between the ED and family physician offices following discharge. During the pilot, participant family physicians accrued 880 patient visits. Seven and two family physicians accessed online records for 74% and 12% of visits, respectively, an overall 60.7% of visits, corresponding to an overall absolute increase in receipt of patient ED visit information of 17%. The postpilot survey found that 100% of family physicians reported that they were ‘‘often’’ or ‘‘always’’ aware of patient ED visits, used the portal ‘‘always’’ or ‘‘regularly’’ to access patients’ health records online, and felt that the web portal contributed to improved actual and perceived continuity of patient care.

Conclusion: Introduction of a web-based ED visit communication tool improved ED–family physician communication. The impact of this system on improved continuity of care, timeliness of follow-up, and reduced duplication of investigations and referrals requires additional study.
Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion
Authors: Abu-Laban Riyad B. , Migneault David , Grant Meghan R. , Dhingra Vinay , Fung Anthony , Cook Richard C. , Sweet David
Published: July 2016

Extracorporeal membrane oxygenation (ECMO) is a method to provide temporary cardiac and respiratory support to critically ill patients. In recent years, the role of ECMO in emergency departments (EDs) for select adults has increased. We present the dramatic case of a 29-year-old man who was placed on venoarterial ECMO for cardiogenic shock and respiratory failure following collapse and protracted ventricular fibrillation cardiac arrest in our ED. Resuscitation efforts prior to ECMO commencement included 49 minutes of virtually continuous cardiopulmonary resuscitation (CPR), 11 defibrillations, administration of numerous medications, including a thrombolytic agent, while CPR was ongoing, percutaneous coronary intervention and stenting for a mid–left anterior descending coronary artery dissection and thrombotic occlusion, inotropic support, and intra-aortic balloon pump counterpulsation. Over the next 48 hours following ECMO commencement, the patient’s cardiorespiratory function rapidly improved, and he was discharged home 9 days after admission with no neurologic sequelae. The history, indications, and increasing role of ECMO in a range of conditions, including cardiac arrest, are reviewed.
Clopidogrel with aspirin versus aspirin alone in prevention of stroke following transient ischemic attack or acute minor stroke
Authors: Seadon Scott , Lang Eddy
Published: July 2016

Clinical question

Following transient ischemic attack or acute minor stroke, does the combination of clopidogrel and aspirin reduce the risk of stroke greater than aspirin alone?

Article chosen

Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013;369:11-9.

Objective

The primary outcome measured in this study was ischemic or hemorrhagic stroke at 90 days of follow-up in groups assigned to treatment with a combination of aspirin and clopidogrel or aspirin alone following transient ischemic attack or acute minor stroke. The secondary outcomes were new clinical vascular events, including vascular death.
Registration of ‘Wirtas’, A New Spring Spelt Cultivar in Poland
Authors: Wiwart Marian , Suchowilska Elżbieta , Packa Danuta , Bieńkowska Teresa , Rutkowska-Łoś Alicja
Published: July 2016

‘Wirtas’ is a spring spelt (Triticum spelta L.) (Reg. No. CV‐1118, PI 677227) cultivar developed at the University of Warmia and Mazury in Olsztyn, Poland. In 2012, the cultivar was tested in pre‐registration experiments and in 2013 to 2014 in experiments required for cultivar registration in Poland. In 2015, Wirtas was placed on the Polish National List of Agricultural Plant Varieties. In 2015, it was submitted for testing to the Community Plant Variety Office to obtain Community Plant Cultivar Right to the cultivar throughout the European Union, and it was entered into the Common Catalogue of Varieties of Agricultural Plant Species. Wirtas was bred by selection from accession PL 21803 of Triticum spelta var. coeruleum from the National Center for Plant Genetic Resources of the Polish Genebank in Radzików. In pre‐registration experiments, Wirtas produced an average spikelet yield of 5.45 t ha−1, which was lower by 16.3% than the grain yield of the reference wheat (T. aestivum L.) cultivar Hewilla. In registration experiments, the spikelet yield of Wirtas was significantly lower than the grain yield of the reference wheat cultivar Tybalt, by 23.6% and 16.2% at 50 and 100 kg N ha−1, respectively. Despite the above, Wirtas's significant resistance to the most dangerous fungal pathogens combined with high grain quality (high protein content, high falling number and sedimentation index) could turn breeders’ attention to Wirtas, particularly in organic farming systems.
Turning Video Resource Management into Cloud Computing
Authors: Kou Weili , Li Hui , Zhou Kailai
Published: July 2016

Big data makes cloud computing more and more popular in various fields. Video resources are very useful and important to education, security monitoring, and so on. However, issues of their huge volumes, complex data types, inefficient processing performance, weak security, and long times for loading pose challenges in video resource management. The Hadoop Distributed File System (HDFS) is an open-source framework, which can provide cloud-based platforms and presents an opportunity for solving these problems. This paper presents video resource management architecture based on HDFS to provide a uniform framework and a five-layer model for standardizing the current various algorithms and applications. The architecture, basic model, and key algorithms are designed for turning video resources into a cloud computing environment. The design was tested by establishing a simulation system prototype.
Influence of Sulfobacillus thermosulfidooxidans on Initial Attachment and Pyrite Leaching by Thermoacidophilic Archaeon Acidianus sp. DSM 29099
Authors: Liu Jing , Li Qian , Sand Wolfgang , Zhang Ruiyong
Published: July 2016

At the industrial scale, bioleaching of metal sulfides includes two main technologies, tank leaching and heap leaching. Fluctuations in temperature caused by the exothermic reactions in a heap have a pronounced effect on the growth of microbes and composition of mixed microbial populations. Currently, little is known on the influence of pre-colonized mesophiles or moderate thermophiles on the attachment and bioleaching efficiency by thermophiles. The objective of this study was to investigate the interspecies interactions of the moderate thermophile Sulfobacillus thermosulfidooxidans DSM 9293T and the thermophile Acidianus sp. DSM 29099 during initial attachment to and dissolution of pyrite. Our results showed that: (1) Acidianus sp. DSM 29099 interacted with S. thermosulfidooxidansT during initial attachment in mixed cultures. In particular, cell attachment was improved in mixed cultures compared to pure cultures alone; however, no improvement of pyrite leaching in mixed cultures compared with pure cultures was observed; (2) active or inactivated cells of S. thermosulfidooxidansT on pyrite inhibited or showed no influence on the initial attachment of Acidianus sp. DSM 29099, respectively, but both promoted its leaching efficiency; (3) S. thermosulfidooxidansT exudates did not enhance the initial attachment of Acidianus sp. DSM 29099 to pyrite, but greatly facilitated its pyrite dissolution efficiency. Our study provides insights into cell-cell interactions between moderate thermophiles and thermophiles and is helpful for understanding of the microbial interactions in a heap leaching environment.
The Sustainable Strategy for Small and Medium Sized Enterprises: The Relationship between Mission Statements and Performance
Authors: Duygulu Ethem , Ozeren Emir , Işıldar Pınar , Appolloni Andrea
Published: July 2016

The study aims to contribute to the literature by empirically examining the relationship between small and medium sized enterprises’ (SMEs) mission statements and their performance in sustainable strategy formulation. Although it seems that there is a relatively vast amount of research with regard to mission statements of companies, very few studies have focused on the relationship between mission statements and performance. When these few studies are taken into consideration, it is difficult to reach any overall conclusion since their findings are mixed and inconclusive. To achieve this aim, 3034 SMEs operating in organized industrial zones in Turkey were examined via a survey approach. In order to investigate the relationships among the variables, nine categories of mission statements as independent variables and four performance indicators (financial, market, production, and overall) as dependent variables were analyzed through logistic regression. This study identified three mission components, (1) survival, growth, and profit; (2) philosophy and values; and (3) public image, as the common independent variables in explaining the performance of SMEs. Survival, growth, and profit is the most frequently observed mission component regardless of the subsector differentiation in the entire sample, which reflects the significance of business sustainability for SMEs in the Turkish manufacturing context. Besides, among all performance indicators, SMEs’ market performance was found to be the lowest when compared to other performance indicators (financial, production, overall). Although the firms were placed in different manufacturing subsectors, similar mission statements were highlighted so that the discourse similarity might be considered as evidence of isomorphism characteristics for SMEs.
Adaptive Image Matching Using Discrimination of Deformable Objects
Authors: Won Insu , Jeong Jaehyup , Yang Hunjun , Kwon Jangwoo , Jeong Dongseok
Published: July 2016

We propose an efficient image-matching method for deformable-object image matching using discrimination of deformable objects and geometric similarity clustering between feature-matching pairs. A deformable transformation maintains a particular form in the whole image, despite local and irregular deformations. Therefore, the matching information is statistically analyzed to calculate the possibility of deformable transformations, and the images can be identified using the proposed method. In addition, a method for matching deformable object images is proposed, which clusters matching pairs with similar types of geometric deformations. Discrimination of deformable images showed about 90% accuracy, and the proposed deformable image-matching method showed an average 89% success rate and 91% accuracy with various transformations. Therefore, the proposed method robustly matches images, even with various kinds of deformation that can occur in them.
Assistive Technology Needs and Measurement of the Psychosocial Impact of Assistive Technologies for Independent Living of Older Hispanics: Lessons Learned
Authors: Orellano-Colón Elsa , Jutai Jeffrey , Santiago Angélica , Torres Víctor , Benítez Keyla , Torres Mayra
Published: July 2016

(1) Knowledge about the assistive technology (AT) needs and psychosocial impact of AT in different populations is needed because the adoption, retention, or abandonment of AT may be influenced by the psychosocial impact that AT has on its users. The aims of this study were to: (a) identify the AT needs of a sample of Hispanic older adults with functional limitations; (b) describe the psychosocial impact of these technologies on the sample’s quality of life; and (c) describe the methodological challenges in using the Puerto Rican version of the Psychosocial Impact of Assistive Device Scale (PR-PIADS) with a Hispanic sample; (2) Methods: This study used a cross-sectional design conducted with a sample of 60 participants. Data was collected using the Assistive Technology Card Assessment Questionnaire (ATCAQ) and the PR-PIADS. Data analyses included descriptive statistics and bivariate analysis; (3) Results: The sample’s most frequently reported needs for AT devices were in the areas of cooking, home tasks, and home safety activities. The sample reported a positive impact of AT use in their quality of life. Several methodological challenges of the PIADS were identified; (4) Conclusions: The sample has unmet needs for using AT devices to overcome difficulties in daily living activities.
Infection Counter: Automated Quantification of in Vitro Virus Replication by Fluorescence Microscopy
Authors: Culley Siân , Towers Greg , Selwood David , Henriques Ricardo , Grove Joe
Published: July 2016

The ability to accurately and reliably quantify viral infection is essential to basic and translational virology research. Here, we describe a simple and robust automated method for using fluorescence microscopy to estimate the proportion of virally infected cells in a monolayer. We provide details of the automated analysis workflow along with a freely available open-source ImageJ plugin, Infection Counter, for performing image quantification. Using hepatitis C virus (HCV) as an example, we have experimentally verified our method, demonstrating that it is equivalent, if not better, than the established focus-forming assay. Finally, we used Infection Counter to assess the anti-HCV activity of SMBz-CsA, a non-immunosuppressive cyclosporine analogue.
Impact Evaluation of Low Flow Showerheads for Hong Kong Residents
Authors: Wong Ling-tim , Mui Kwok-wai , Zhou Yang
Published: July 2016

The voluntary Water Efficiency Labelling Scheme (WELS) on showers for bathing in Hong Kong is a water conservation initiative of the Hong Kong Special Administrative Region (HKSAR) Government. As shower water consumption has been identified as a potential area for carbon emissions reductions, this study examines, from a five-month measurement survey of the showering practices of 37 local residents, a range of showerheads with resistance factors k = 0.54–4.05 kPa·min2·L−2 with showering attributes including hot shower temperature, temperature difference between hot and cold water supply, flow rate and water consumption and shower duration. A Monte Carlo model is proposed for evaluating the water consumption and carbon-reducing impacts of WELS on showers for bathing at confidence intervals with input parameters determined from the measurement survey. The simulation results indicate that full implementation of WELS rated showerheads with k ≥ 4.02 can reduce water consumption by 37%, energy use by 25% and carbon dioxide (CO2) emissions by 26%. This study is also a useful source of reference for policymakers and practitioners to evaluate the impacts of water efficient showerheads on water consumption, energy use, and CO2 emissions.
Ecological distributions, phenological isolation, and genetic structure in sympatric and parapatric populations of theLarrea tridentatapolyploid complex
Authors: Laport Robert G. , Minckley Robert L. , Ramsey Justin
Published: July 2016

PREMISE OF THE STUDY:

Polyploidy is widely recognized as a mechanism of diversification. Contributions of polyploidy to specific pre‐ and postzygotic barriers—and classifications of polyploid speciation as “ecological” vs. “non‐ecological”—are more contentious. Evaluation of these issues requires comprehensive studies that test ecological characteristics of cytotypes as well as the coincidence of genetic structure with cytotype distributions.

METHODS:

We investigated a classical example of autopolyploid speciation,Larrea tridentata, at multiple areas of cytotype co‐occurrence. Habitat and phenological differences were compared between diploid, tetraploid, and hexaploid populations on the basis of edaphic, community composition, and flowering time surveys. Frequency of hybridization between diploids and tetraploids was investigated using a diploid‐specific chloroplast DNA (cpDNA) marker; genetic structure for all cytotypes was assessed using amplified fragment length polymorphisms (AFLPs).

KEY RESULTS:

Across contact zones, we found cytotypes in habitats distinguished by soil and vegetation. We observed modest differences in timing and production of flowers, indicating a degree of assortative mating that was asymmetric between cytotypes. Nonetheless, cpDNA analyses in diploid–tetraploid contact zones suggested that ∼5% of tetraploid plants had hybrid origins involving unilateral sexual polyploidization. Genetic structure of AFLPs largely coincided with cytotype distributions in diploid–tetraploid contact zones. In contrast, there was little structure in areas of contact between tetraploids and hexaploids, suggesting intercytotype gene flow or recurrent hexaploid formation.

CONCLUSIONS:

Diploid, tetraploid, and hexaploid cytotypes ofL. tridentataare segregated by environmental distributions and flowering phenology in contact zones, with diploid and tetraploid populations having corresponding differences in genetic structure.
Improving Peer Grading Reliability with Graph Mining Techniques
Authors: Capuano Nicola , Caballé Santi , Miguel Jorge
Published: July 2016

Peer grading is an approach increasingly adopted for assessing students in massive on-line courses, especially for complex assignments where automatic assessment is impossible and the ability of tutors to evaluate and provide feedback at scale is limited. Unfortunately, as students may have different expertise, peer grading often does not deliver accurate results compared to human tutors. In this paper, we describe and compare different methods, based on graph mining techniques, aimed at mitigating this issue by combining peer grades on the basis of the detected expertise of the assessor students. The possibility to improve these results through optimized techniques for assessors’ assignment is also discussed. Experimental results with both synthetic and real data are presented and show better performance of our methods in comparison to other existing approaches.
EFL Teachers' Knowledge of Technology in China
Authors: Teng Yanjiang
Published: July 2016

Through the lens of teachers of English as a Foreign Language (EFL) in China, this chapter aims to examine what knowledge of technology EFL teachers at all levels possess and how they apply their technological knowledge in teaching practice. The reviewed literature indicated that most EFL teachers hold positive attitudes towards technology. However, there still exists a gap between the curriculum requirement and the reality in terms of technological pedagogy in EFL teaching context. EFL teachers' use of technology in teaching varies in terms of personal preferences, school levels and locations, and administrative support. In addition, this review revealed that several factors influence EFL teachers' integration of technology into their practice and some challenges are still on the way: 1) EFL teachers' knowledge of technology is insufficient; 2) Lack of resources for schools and teachers at less developed areas, and 3) Lack of specific support for EFL teachers' technological needs.
‘Treppie does not like guests’: Xenia in Marlene van Niekerk’s Triomf
Authors: Crous Marius
Published: July 2016

This article investigates aspects of xenia or guest relationships – which forms a central aspect of Homer’s Odyssey – in Marlene van Niekerk’s novel Triomf. Hospitality and the lack thereof form the basis of several scenes in the novel. Examples include the visit of the agents canvassing for the National Party before the elections, the Jehovah’s witnesses, the AWB recruiters, as well as Lambert’s interaction with Sonnyboy and Mary. The latter scene in particular corresponds closely to the guidelines for proper hospitality as delineated by Homer.
Safety and Efficacy of Gadoxetate Disodium-enhanced Liver Mri in Pediatric Patients Aged >2 Months to <18 Years—Results of a Retrospective, Multicenter Study
Authors: Geller James , Kasahara Mureo , Martinez Mercedes , Soresina Annarosa , Kashanian Fran , Endrikat Jan
Published: July 2016

Purpose

To assess the safety and efficacy of gadoxetate disodium-enhanced liver MR imaging in pediatric patients.

Material and Methods

Retrospective, multicenter study including pediatric patients aged >2 months to <18 years who underwent contrast-enhanced liver MRI due to focal liver lesions. A single intravenous bolus injection of 0.025 to 0.05 mmol/kg body weight of gadoxetate disodium was administered. Adverse events (AEs) up to 24 hours after injection were recorded and a one-year follow-up was conducted for all serious and unexpected AEs. Efficacy was defined based on the additional diagnostic information obtained from the combined (pre- and postcontrast) image sets as compared with the precontrast image sets by blinded reading.

Results

A total of 52 patients for safety and 51 patients for efficacy analyses were evaluated. Twenty-two patients (42.3%) reported a total of 51 serious AEs (SAEs) and one AE after one year. No SAE or AE was related to gadoxetate disodium injection. Gadoxetate disodium-related effects on vital signs were not seen. Additional diagnostic information was obtained for 86.3% of patients. The three most improved efficacy variables were lesion-to-background contrast, lesion characterization, and improved border delineation in 78.4%, 76.5%, and 70.6% of patients, respectively.

Conclusion

Gadoxetate disodium in pediatric patients did not raise any clinically significant safety concern. Contrast enhancement provided additional clinically relevant information.