bluuebunny/crossref_metadata_2025 huggingface dataset:
Dorsal hippocampal cannabinoid CB1 receptors mediate the interactive effects of nicotine and ethanol on passive avoidance learning in mice
Authors: Alijanpour Sakineh , Rezayof Ameneh , Zarrindast Mohammad‐Reza
Published: October 2011

The present study evaluated the involvement of the dorsal hippocampal cannabinoid CB1 receptors in the combined effect of ethanol and nicotine on passive avoidance learning in adult male mice. The results indicated that pre‐training administration of ethanol (1 g/kg, i.p.) impaired memory retrieval. Pre‐test administration of ethanol (0.5 and 1 g/kg, i.p.) or nicotine (0.5 and 0.7 mg/kg, s.c.) significantly reversed ethanol‐induced amnesia, suggesting a functional interaction between ethanol and nicotine. Pre‐test microinjection of a selective CB1 receptor agonist, ACPA (3 and 5 ng/mouse), plus an ineffective dose of ethanol (0.25 g/kg) or nicotine (0.3 mg/kg) improved memory retrieval, while ACPA by itself could not reverse ethanol‐induced amnesia. Pre‐test intra‐CA1 microinjection of a selective CB1 receptor antagonist, AM251 (0.5–2 ng/mouse), did not lead to a significant change in ethanol‐induced amnesia. However, pre‐test intra‐CA1 microinjection of AM251 prevented the ethanol (1 g/kg) or nicotine (0.7 mg/kg) response on ethanol‐induced amnesia. In order to support the involvement of the dorsal hippocampal CB1 receptors in nicotine response, the scheduled mixed treatments of AM251 (0.1–1 ng/mouse), ACPA (5 ng/mouse) and nicotine (0.3 mg/kg) were used. The results indicated that AM251 reversed the response of ACPA to the interactive effects of nicotine and ethanol in passive avoidance learning. Furthermore, pre‐test intra‐CA1 microinjection of the same doses of ACPA or AM251 had no effect on memory retrieval. These findings show that the cannabinoid CB1 receptors of dorsal hippocampus are important in the combined effect of ethanol and nicotine on passive avoidance learning.
Effect of homozygous deletions at 22q13.1 on alcohol dependence severity and cue‐elicited BOLD response in the precuneus
Authors: Liu Jingyu , Calhoun Vince D. , Chen Jiayu , Claus Eric D. , Hutchison Kent E.
Published: October 2011

Copy number variations (CNVs) can alter the DNA sequence in blocks ranging from kilobases to megabases, involving more total nucleotides than single nucleotide polymorphisms. Yet, its impact in humans is far from fully understood. In this study, we investigate the relationship of genome‐wide CNVs with brain function elicited by an alcohol cue in 300 participants with alcohol use disorders. First, we extracted refined neurobiological phenotypes, the brain responses to an alcohol cue versus a juice cue in the precuneus, thalamus and anterior cingulate cortex (ACC). Then, we correlated the CNVs with incidence frequency > 1% to the neurobiological phenotypes. One CNV region at 22q13.1 was identified to be associated with alcohol dependence severity and the brain response to alcohol cues. Specifically, the 22k base‐pair homozygous deletion at 22q13.1 affects genes APOBEC3a and APOBEC3b. Carriers of this homozygous deletion show a significantly higher score in the alcohol dependence severity (P < 0.05) and increased response to alcohol cues in the precuneus (P < 10−12) than other participants. Tests of a mediation model indicate that the precuneus mediates the association between the homozygous deletions and alcohol dependence severity. Interestingly, the precuneus is not only anatomically and functionally connected to the ACC and thalamus (the main active regions to the alcohol cue), but also has the most predictive power to the alcohol dependence severity. These findings suggest that the homozygous deletion at 22q13.1 may have an important impact on the function of the precuneus with downstream implications for alcohol dependence.
Increased risk of nontuberculous mycobacterial infection in asthmatic patients using long‐term inhaled corticosteroid therapy
Authors: HOJO MASAYUKI , IIKURA MOTOYASU , HIRANO SATOSHI , SUGIYAMA HARUHITO , KOBAYASHI NOBUYUKI , KUDO KOICHIRO
Published: October 2011

Background and objective:  The risk of pneumonia is increased among COPD patients using inhaled corticosteroids (ICS). However, there is uncertainty regarding the association between long‐term use of ICS and exacerbations of respiratory tract infections among asthmatic patients.

Methods:  A case‐control nested cohort study was performed to assess the association of asthma with nontuberculous mycobacterium (NTM) infection.

Results:  Among this cohort of 464 asthmatic patients, 14 experienced complications due to NTM infections, of which eight were caused by Mycobacterium avium‐intracellulare complex, three by M. kansasii, one by M. terrae and the remaining two by unclassifiable scotochromogens. Asthmatic patients with NTM infections were older (67.1 ± 8.6 vs 58.8 ± 12.3 years, P < 0.01) and had more severe airflow limitation (FEV1%, 60.6 ± 10.3 vs 72.3 ± 18.3, P < 0.03) than those without NTM infections. All except one had received ICS treatment for more than 5 years, and 12 of the 14 patients used inhaled fluticasone propionate daily (four patients at a dose of 400 µg/day and eight patients at a dose >800 µg/day).

Conclusions:  These findings suggest that the risk of NTM infection may be greater in asthmatic patients who are older, have more severe airflow limitation and receive higher doses of ICS therapy.
The effect of release method and trial site on recapture rates of adult sterile Queensland fruit fly, Bactrocera tryoni (Froggatt) (Diptera: Tephritidae)
Authors: Reynolds Olivia L , Smallridge Catherine J , Cockington Vanessa G , Penrose Lindsay D
Published: October 2011

The Queensland fruit fly, Bactrocera tryoni (Diptera: Tephritidae) is Australia's worst pest of edible fruit. The Fruit Fly Exclusion Zone (FFEZ) in south‐eastern Australia encompasses some of the country's most valuable horticultural production areas and is recognised nationally and internationally as free of B. tryoni. Outbreaks of B. tryoni in the FFEZ are controlled, in part, with the inundative release of sterile B. tryoni. To determine whether release method and trial site affected trap recapture rates of sterile B. tryoni, four sterile B. tryoni releases were conducted simultaneously at two sites: Wagga Wagga, New South Wales (NSW) and Unley, South Australia (SA) from December 2007 to April 2008, using both a plastic adult rearing container (PARC) and a bin release method. PARC or bin did not affect the number of B. tryoni recaptured. Trap recapture rates of released sterile B. tryoni were higher in NSW than SA throughout the trial, and peak recapture rates occurred 1 week earlier in NSW. Humidity was higher inside the bins compared with the PARCs in three of the four releases; temperature was higher in PARCs compared with bins in two of the releases. For the only fly batch tested, emergence and flight were higher in the PARCs compared with the bins. Quality control and recapture studies showed that dye pigment was not a confounding factor in recapture rates of the main studies.
Transplantation of mature adipocyte‐derived dedifferentiated fat (DFAT) cells improves urethral sphincter contractility in a rat model
Authors: Obinata Daisuke , Matsumoto Taro , Ikado Yuichiro , Sakuma Takahiro , Kano Koichiro , Fukuda Noboru , Yamaguchi Kenya , Mugishima Hideo , Takahashi Satoru
Published: October 2011

Objectives:  To examine the effects of mature adipocyte‐derived dedifferentiated fat (DFAT) cell transplantation on urethral tissue regeneration and sphincter function.

Methods:  Sixteen female Sprague–Dawley rats underwent vaginal distension (VD) for 3 h. Subsequently, green fluorescence protein (GFP)‐labeled DFAT cells (1 × 106 in 20 µL saline, DFAT group, n = 8) or saline (20 µL, control group, n = 8) were injected into paraurethral connective tissue. Two weeks following VD, leak point pressure (LPP) was measured and an immunohistochemical analysis of the urethra was performed to evaluate urethral sphincter regeneration.

Results:  The VD model was characterized by atrophy of the urethral sphincter and showed a decrease in LPP. DFAT cell transplantation resulted in a significant improvement of LPP (DFAT group: 37.3 ± 6.4 vs control group: 21.7 ± 5.7 mmHg, P < 0.01). Immunohistochemistry revealed that the striated muscle thickness and smooth muscle α−actin‐positive area were significantly (P < 0.05) larger in the DFAT group than in the control group. DFAT cell transplantation enhanced macrophage accumulation followed by an increased number of cells in the proliferative state. Transplanted DFAT cells were observed in the damaged smooth muscle layer and showed positive staining for smooth muscle α−actin, suggesting conversion into the smooth muscle cell phenotype.

Conclusions:  DFAT cell transplantation promotes sphincter muscle regeneration and improves LPP in the rat VD model.
Comparisons of pelvic floor muscle performance, anxiety, quality of life and life stress in women with dry overactive bladder compared with asymptomatic women
Authors: Knight Sharon , Luft Janis , Nakagawa Sanae , Katzman Wendy B.
Published: October 2011

Study Type – Therapy (case control)

Level of Evidence 3b

What's known on the subject? and What does the study add?

Abnormal pelvic floor muscle function has been associated with chronic pelvic pain syndromes.

This study adds evidence about pelvic muscle performance in women with dry overactive bladders.

OBJECTIVES

To determine if pelvic floor muscle surface electromyography (sEMG) measurements differed between women with dry overactive bladder (OAB) symptoms and asymptomatic controls.

To determine whether pelvic floor muscle performance was associated with anxiety scores, quality of life and life stress measures

PATIENTS AND METHODS

We enrolled 28 women with urinary urgency and frequency without urinary incontinence, and 28 age‐matched controls.

sEMG was used to assess pelvic muscle performance.

Participants also completed the Beck Anxiety Inventory, Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire and Recent Life Changes Questionnaire.

RESULTS

Anxiety scores were significantly higher in women with dry OAB than in controls.

No significant differences were found in sEMG measures of pelvic muscle contraction or relaxation between the two groups

There was no significant correlation between sEMG pretest resting baseline measurements and the Beck Anxiety Inventory, the Pelvic Floor Distress Inventory, the Pelvic Floor Impact Questionnaire or life stress scores among symptomatic women

As expected, women with dry OAB had significantly higher scores on the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire.

CONCLUSIONS

This study supports a relationship between dry OAB symptoms and anxiety that warrants further exploration.

Resting sEMG baselines were not elevated and did not support the hypothesis that women with dry OAB are unable to relax their pelvic floor muscles.
Ethnic Heterogeneity and Public Support for Welfare: Is the American Experience Replicated in Britain, Sweden and Denmark?
Authors: Larsen Christian Albrekt
Published: October 2011

The link between ethnic heterogeneity and public support for welfare policy is debated. The thesis of a negative relationship is supported by much American research. Historically the race issue has blocked a number of American welfare schemes; across the United States ethnically heterogeneous states have less generous benefits, and citizens having negative attitudes towards blacks often oppose welfare. The research question is: To what extent will increased ethnic heterogeneity in European countries establish the same mechanisms? Three theoretical positions are discussed: the position that the American experience is unique; the position that it is generalisable; and a middle position of it being contingent on institutional settings. The latter position predicts that the American experience can be avoided, especially in social democratic welfare regimes where the ethnicity issue has not been politicised. Empirically the article is based on survey data from the United Kingdom, Sweden and Denmark, in which a number of American items were directly replicated. Despite indications of American uniqueness and welfare‐regime effects, the findings support the position that the in‐group/out‐group mechanisms found in the United States are being replicated in Europe.
The Reform of Health Policy in China – Left Behind in the Race to Industrialize?
Authors: Manning Nick
Published: October 2011

A major programme of health reform was announced in 2009. China is growing fast, and is beginning to engage with the international social policy community to discuss and review the consequences of rapid industrialization. As a specific part of social policy, health policy shares some of the characteristics of a policy area driven by the consequences of industrialization, but it also has its own particular features. This article reviews the general relationship between state and citizens in the health field by way of an introduction before focussing more specifically on Chinese patterns of health inequalities, and the pressures for reform. The 2009 reform of health policy and its dynamics are then presented, and the article concludes that there has been a deterioration in Chinese health policy, which threatens to undermine the benefits of economic growth for Chinese people.
COUNTING THREADS. SAFFRON IN AEGEAN BRONZE AGE WRITING AND SOCIETY
Authors: DAY JO
Published: October 2011

The ideogram for saffron has long been recognized on the Linear B tablets from Knossos. Close examination of this corpus allows a distinction in content to be made between the LM II–LM IIIA1 tablets of the Room of the Chariot Tablets and the later LM IIIA1–2 tablets from the North Entrance Passage. It is suggested here that the later material demonstrates an increasing control over saffron production by the palace, with a greater overall quantity of the spice recorded, larger individual contributions, potential supervisors in charge of collection, and pressure to reach targets. This increase in organization coincides with a dramatic decrease in crocus imagery in other media, and may indicate a deliberate Mycenaean rejection of the symbolic world of Minoan floral iconography, and an interest only in the commercial value of the precious spice. Possible antecedents of the saffron ideogram in Linear A and Cretan Hieroglyphic are also considered.
OLIVE‐MILL WASTEWATER IN ANTIQUITY. ENVIRONMENTAL EFFECTS AND APPLICATIONS
Authors: NIAOUNAKIS MICHAEL
Published: October 2011

The present study examines the results of archaeological research and all the related information retrieved from the writings of ancient Greek and Roman authors on the use and the environmental effects of olive‐mill wastewater since antiquity. The ancients were aware of the negative effects that the uncontrolled disposal of olive‐mill wastewater had on the environment, while the controlled release was considered to be beneficial for the soil.

A predecessor of olive‐mill wastewater isamurca(Latin) oramorge(Greek). Both terms have been used by ancient authors to describe the watery, bitter‐tasting liquid residue obtained when the oil is drained from compressed olives. The role ofamurcaoramorgeis, however, difficult to assess, though it does seem to have been a universal remedy against insects, weeds and plant diseases.

On the basis of production and consumption patterns, an attempt was made to estimate the annual olive oil production during the reign of Augustus, which in turn could provide us with an order of magnitude approach for the generated olive‐mill wastewater (amurca).

Although there is no evidence that the Romans practised any detoxification technique for reducing the pollutant effects of this waste before disposal, several Greek and Roman writers have described the recycling ofamurcainto valuable products. Some of the uses ofamurcaare, in the light of recent research, questionable or not exactly applicable for the present day. However, the pesticidal and fertilizing properties of olive‐mill wastewater have been confirmed by a large number of research studies.
How does the application of different nitrification inhibitors affect nitrous oxide emissions and nitrate leaching from cow urine in grazed pastures?
Authors: Di H. J. , Cameron K. C.
Published: October 2011

Nitrous oxide (N2O) is a potent greenhouse gas, and nitrate () is a water contaminant. In grazed grassland, the major source of both leaching and N2O emissions is nitrogen (N) deposited in animal excreta, particularly in the urine. The objective of this study was to determine the effectiveness of two nitrification inhibitors: (i) a solution of dicyandiamide (DCD) and (ii) a liquid formulation of 3,4‐dimethylpyrazole phosphate (DMPP) for reducing N2O emissions and leaching from urine patch areas in two grazed pasture soils under different environmental conditions. In the Canterbury Templeton soil, the nitrification rate of ammonium from the animal urine applied at 1000 kg N/ha was significantly decreased by the application of DCD (10 kg/ha) and DMPP (5 kg/ha). N2O emissions, measured over a 3‐month period, from dairy cow urine applied to the Canterbury Templeton soil were 1.14 kg N2O‐N/ha, and this was reduced to 0.43 and 0.39 kg N2O‐N/ha by DCD and the liquid DMPP, respectively. These are equivalent to 62–66% reductions in the total N2O emissions. Nitrate leaching losses from dairy cow urine applied to the Waikato Horotiu soil lysimeters were reduced from 628.6 kg ‐N/ha to 400.6 and 451.5 kg ‐N/ha by the application of DCD (10 kg/ha) or DMPP (1 kg/ha), respectively. There was no significant difference between the DCD solution and the liquid DMPP in terms of their effectiveness in reducing N2O emissions or leaching under the experimental conditions of this study. These results suggest that both the liquid formulations of DCD and DMPP have the potential to be used as nitrification inhibitors to reduce N2O emissions and leaching in grazed pasture soils.
The effect of honey‐coated bandages compared with silver‐coated bandages on treatment of malignant wounds—a randomized study
Authors: Lund‐Nielsen Betina , Adamsen Lis , Kolmos Hans Jørn , Rørth Mikael , Tolver Anders , Gottrup Finn
Published: October 2011

Malignant wounds (MWs) occur in 5–10% of all cancer patients. Malodor and exudation are the most common side effects. The aim was to determine the influence of honey‐coated compared with silver‐coated bandages on treatment of MWs. Patients were randomly selected to enter either group A (honey‐coated bandages) or group B (silver‐coated bandages). Parameters were the following: wound size, cleanliness, malodor, exudation, and wound pain. Digital photographs, visual analog scales (VAS), and wound morphology registration were used for measurement at baseline and following the 4‐week intervention. Sixty‐nine patients with MWs and advanced cancer, aged 47–90 (median 65.6), were included. No statistically significant difference was noted between the groups with respect to wound size, degree of cleanliness, exudation, malodor, and wound pain. There was a median decrease in wound size of 15 cm2 and 8 cm2 in group A and B, respectively (p = 0.63). Based on post‐intervention pooled data from the groups, improvement was seen in 62% of the participants with respect to wound size and in 58% (n = 69) with respect to cleanliness. The VAS score for malodor (p = 0.007) and exudation (p < 0.0001) improved significantly post‐intervention.

Patients with reduced wound size had a median survival time of 387 days compared with 134 days in patients with no wound reduction (p = 0.003). The use of honey‐coated and silver‐coated bandages improved the outcome of MWs. No differences were found between the two regimens. Both types of bandages are recommended for use by patients with MWs containing tumor debris and necrosis.
Hunter Syndrome: Resolution of Extensive Typical Skin Lesions After 9 Months of Enzyme Replacement Therapy with Idursulfase
Authors: Marín Laura L. , Gutiérrez‐Solana Luis G. , Fernández Antonio T.
Published: October 2011

Abstract:  A 10‐year‐old boy with Hunter syndrome and extensive typical skin lesions underwent 9 months of enzyme replacement therapy, after which the skin lesions disappeared. We believe that treatment with idursulfase probably removes the cutaneous storage of glucosaminoglycans in Hunter syndrome.
Prevalence of Milia and Palatal and Gingival Cysts in Spanish Newborns
Authors: Monteagudo Benigno , Labandeira Javier , Cabanillas Miguel , Acevedo Antonio , León‐Muiños Elvira , Toribio Jaime
Published: October 2011

Abstract:  We performed a descriptive survey of 1,000 consecutive newborns cared for in the first 3 days of life in the health area of Ferrol (in northwest Spain) to assess the prevalence and most‐frequent locations of oral cysts and milia and to study the influence of different maternal and neonatal parameters in the development of these lesions. Prevalence of palatal, gingival, and cutaneous cysts was 53.7%, 13.4%, and 16.6%, respectively. Milia were predominantly located on the cheeks, chin, and forehead. We found a frequent association between palatal and gingival cysts but not between oral cysts and milia. Neonatal factors such as sex, weight at birth, and gestational age can significantly influence the development of palatal and gingival cysts.
Progressive Macular Hypomelanosis
Authors: Martínez‐Martínez Maria L. , Azaña‐Defez Jose M. , Rodríguez‐Vázquez Maria , Faura‐Berruga Cristina , Escario‐Travesedo Eduardo
Published: October 2011

Abstract:  Progressive macular hypomelanosis (PMH) is a condition of unknown etiology characterized by asymptomatic, hypopigmented macules located predominantly on the trunk. We recorded 12 adolescents with PMH over a 6‐month period. Ten were female, and the mean age was 16.6 years. The average time from the patients first noticing pigment change to diagnosis was 15 months. PMH is probably an underdiagnosed condition.
Pediatric Tinea Faciei in Southern Spain: A 30‐Year Survey
Authors: del Boz Javier , Crespo Vicente , de Troya Magdalena
Published: October 2011

Abstract:  Tinea faciei (TF) is a common clinical form of tinea in children that is frequently misdiagnosed and treated with corticosteroids. No large case series of TF focusing on children have been published. The aim of this study was to analyze the main epidemiologic, clinical, and microbiologic features of TF in children over a period of 30 years and compare these features with those of other tineas. We undertook a retrospective study of 818 cases of tinea in children at a referral hospital in southern Spain, diagnosed between 1977 and 2006, concentrating for this study on TF. Of the 73 cases of TF diagnosed, 50.7% were in girls. Most children (46.6%) were 4 to 9 years old. At the time of diagnosis, 29.2% of the cases had been treated with topical steroids. The most frequently isolated dermatophyte was Trichophyton mentagrophytes, which was isolated significantly more frequently in TF than in the other tineas. Cases of TF in children were not extremely unusual, emphasizing that TF must be considered in children with inflammatory facial eruptions. This consideration and the more‐frequent use of mycologic tests can help achieve the correct diagnosis, when present.
Nevus Sebaceous Revisited
Authors: Moody Megan N. , Landau Jennifer M. , Goldberg Leonard H.
Published: October 2011

Abstract:  Nevus sebaceous of Jadassohn is a hamartoma with a combination of abnormalities of the epidermis, hair follicles, and sebaceous and apocrine glands. Herein, we discuss the results of an extensive literature review on the topic of nevus sebaceous with a particular focus on the debate about the necessity for prophylactic excision. We also focus on the documentation of associated malignant tumors that were reported to develop within NS. In addition to reporting the number and types of neoplasms, we documented the recommendations of all authors for therapeutic handling of these nevi.
Extracting Key Lessons in Service Innovation
Authors: Wooder Stella , Baker Steven
Published: October 2011

This paper describes how Sagentia—working with Vodafone, Safaricom, and other organizations—played a significant role in the creation and delivery of a landmark mobile money transfer and payment service for emerging markets, starting in Kenya. In this profile we examine the organization aspects and approach that contributed to the success of the service: the lessons we learned as the technology provider and how the experience has informed and strengthened our service innovation processes.
Grumpier Old Men: Age and Sex Differences in the Evaluation of New Services
Authors: Schmidt Jeffrey B. , Zayer Linda Tuncay , Calantone Roger J.
Published: October 2011

Little research attention has centered on how age and sex affect consumers' evaluations of new products and services. In this study an individual's age and sex are associated with his or her evaluation of new services, that is, newly released motion pictures. Using data acquired from publicly available and proprietary sources, nearly 2,100 motion pictures released in the United States from 1982 through 2000 were analyzed. The results show that older consumers are more critical of new services and rate them lower after consuming them relative to younger ones. The results also show that women evaluate new services significantly more favorably than men. Interestingly, these results appear robust because women did not rate products that are normally developed and targeted to men (e.g., action/adventure and science‐fiction movies) lower than men evaluated them; no evidence to support the notion of a “chick flick” was found. Implications for conducting marketing research when developing new products and services are offered.
Variations in Ambulance Use in the United States: The Role of Health Insurance
Authors: Meisel Zachary F. , Pines Jesse M. , Polsky Daniel , Metlay Joshua P. , Neuman Mark D. , Branas Charles C.
Published: October 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:1036–1044 © 2011 by the Society for Academic Emergency Medicine

Objectives:  The purpose of this study was to describe the associations between individual health insurance and ambulance utilization using a national sample of patients who receive emergency department (ED) care.

Methods:  The data source was the National Hospital Ambulatory Medical Care Survey, years 2004 through 2006. Noninstitutionalized patients between ages 18 and 65 years were included. The primary dependent variable was ambulance use. Multivariable logistic regression methods were used to assess the associations between health insurance status and ambulance use and to adjust for confounders.

Results:  A total of 61,013 ED visits were included, representing a national sample of approximately 70 million annual ED visits over 3 years. Ambulance transport was used in 11% of private insurance visits, 16% of Medicaid visits, and 13% of uninsured visits. In the adjusted model, visits by patients with Medicaid (adjusted odds ratio [aOR] = 1.60, 99% confidence interval (CI) = 1.37 to 1.86) and the uninsured (aOR = 1.43, 99% CI = 1.23 to 1.66) were more likely to arrive by ambulance than visits by patients with private insurance. Ambulance use among the uninsured was most pronounced in metropolitan areas.

Conclusions:  Ambulance use varies by health insurance status. Medicaid coverage and lack of insurance are each independently associated with increased odds of ambulance use, suggesting a disproportionate role for emergency medical services (EMS) in the care of patients with limited financial resources.
Integrating Emergency Medicine Principles and Experience Throughout the Medical School Curriculum: Why and How
Authors: Tews Matthew C. , Hamilton Glenn C.
Published: October 2011

Academic Emergency Medicine 2011; 18:1072–1080 © 2011 by the Society for Academic Emergency Medicine

The management of acutely ill and injured patients is an essential component of medical student education, yet the formal integration of emergency medicine (EM) into the medical school curriculum has progressed slowly since the inception of the specialty. Medical student interest and the number of resident positions in the National Resident Matching Program are higher than any time in the past, yet students often find access to EM faculty and clinical experience limited to a fourth‐year rotation. Incorporating EM into all years of the undergraduate medical student curriculum can offer unique educational experiences and enhance exposure to the necessary and recommended knowledge and skills students must attain prior to graduation. Academic emergency physicians (EPs) should advocate our specialty’s importance in their medical school curricula using a proactive approach and actively involve themselves in medical student education at all stages of training. The goals of this article are to describe several approaches for EM faculty to expand medical student exposure to the specialty and enhance student experiences in the core principles of EM throughout the undergraduate medical curriculum.
Evaluation of a Novel Wound Closure Device: A Multicenter Randomized Controlled Trial
Authors: Singer Adam J. , Chale Stuart , Giardano Phil , Hocker Michael , Cairns Charles , Hamilton Richard , Nadkarni Milan , Mills Angela M. , Hollander Judd E.
Published: October 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:1060–1064 © 2011 by the Society for Academic Emergency Medicine

Objectives:  A novel wound closure device combining a mesh tape and octylcyanoacrylate (OCA) topical skin adhesive (TSA) was developed to facilitate wound closure and enhance the adhesive’s strength. The objective of this study was to determine whether the incidence of wound dehiscence after laceration repair with the new device was equivalent to that after use of a high‐viscosity OCA. We hypothesized that the rate of complete wound edge apposition would be equivalent for the two closure devices.

Methods:  This was a multicenter, randomized clinical trial in nine academic and community emergency departments (EDs) and urgent care centers. Patients with simple traumatic lacerations were included. Lacerations were randomly closed with a high‐viscosity OCA or mesh tape–OCA combination. The rate of complete wound edge apposition at 14 days, rates of wound infection at 14 and 30 days, and the percentage of optimally appearing scars at 30 days after closure were assessed. Assuming a maximal clinically acceptable difference for equivalence of 8% in the rate of completely apposed wound edges, a sample of at least 138 patients in the tape–OCA group and at least 69 in the OCA‐only group would give 80% power and a one‐sided significance level of 5%.

Results:  During the study period the investigators enrolled 216 subjects, of whom 143 were randomized to the tape–OCA combination and 73 to the OCA‐only group. Most wounds were located on the face and the upper extremities. Mean laceration length was similar in patients in both groups (tape–OCA 2.1 cm vs. OCA‐only 2.0 cm; difference 0.1 cm, 95% confidence interval [CI] = −0.45 to 0.58 cm). The rate of complete wound edge apposition at 14 days was higher in wounds treated with the tape–OCA combination than in wounds treated with OCA alone (86.0% vs. 78.1%). The upper bound of the one‐sided CI was 1.0% for the intention‐to‐treat population, which was less than the predetermined acceptable difference of less than 8%. There were no between‐group differences in rates of infection and optimally appearing scars.

Conclusions:  When compared with OCA alone, the novel tape–OCA combination is equivalent with regard to complete wound edge apposition and cosmetic appearance.
New Arabic‐Christian inscriptions from Udhruḥ, southern Jordan
Authors: al‐Salameen Zeyad , Falahat Hani , Naimat Salameh , Abudanh Fawzi
Published: October 2011

This paper sheds more light on Udhruḥ during the Byzantine and Islamic periods, based on both historical sources and archaeological data. It presents new unpublished Arabic‐Christian inscriptions that were found inside the site’s Byzantine church, which confirm the continuity of Christianity in the region during the Islamic period.
Duplication of the extrahepatic bile duct
Authors: Gupta Vishal , Chandra Abhijit
Published: October 2011

Duplication of the extrahepatic bile duct is an extremely rare anomaly. There are five types of this anomaly, with type V being the least common variant. Only two cases of type V (one each of type Va and type Vb) have been reported. Here we report the second case of type Va duplication of the common bile duct presenting with choledocholithiasis. The patient underwent open choledocholithotomy and T‐tube choledochostomy after failed endoscopic stone clearance. Duplication of the bile duct was detected on T‐tube cholangiogram, which was confirmed by magnetic resonance cholangiopancreaticography (MRCP). No associated pancreaticobiliary maljunction was found on the imaging.
Prenatal diagnosis of osteogenesis imperfecta type II by three‐dimensional computed tomography: The current state of fetal computed tomography
Authors: Akizawa Yoshika , Nishimura Gen , Hasegawa Tomonobu , Takagi Masaki , Kawamichi Yayoi , Matsuda Yoshio , Matsui Hideo , Saito Kayoko
Published: October 2011

We report a case of osteogenesis imperfecta (OI) (OMIM166210) type II, in which a prenatal diagnosis was made by three‐dimensional computed tomography (3D‐CT). Subsequent molecular analysis revealed a recurrent, heterozygous mutation in COL1A2. Fetal CT is a powerful tool for visualizing the fetal skeleton and can provide a definitive diagnosis of fetal skeletal dysplasias; however, whether or not its employment for prenatal diagnosis is warranted in terms of fetal radiation risks remains controversial, both medically and ethically. Based on our experience, we review the current state of fetal CT for the diagnosis of skeletal dysplasias, with a discussion of the relevant literature.
Crystal structure of the catalytic domain of UCHL5, a proteasome‐associated human deubiquitinating enzyme, reveals an unproductive form of the enzyme
Authors: Maiti Tushar K. , Permaul Michelle , Boudreaux David A. , Mahanic Christina , Mauney Sarah , Das Chittaranjan
Published: October 2011

Ubiquitin carboxy‐terminal hydrolase L5 (UCHL5) is a proteasome‐associated deubiquitinating enzyme, which, along with RPN11 and USP14, is known to carry out deubiquitination on proteasome. As a member of the ubiquitin carboxy‐terminal hydrolase (UCH) family, UCHL5 is unusual because, unlike UCHL1 and UCHL3, it can process polyubiquitin chain. However, it does so only when it is bound to the proteasome; in its free form, it is capable of releasing only relatively small leaving groups from the C‐terminus of ubiquitin. Such a behavior might suggest at least two catalytically distinct forms of the enzyme, an apo form incapable of chain processing activity, and a proteasome‐induced activated form capable of cleaving polyubiquitin chain. Through the crystal structure analysis of two truncated constructs representing the catalytic domain (UCH domain) of this enzyme, we were able to visualize a state of this enzyme that we interpret as its inactive form, because the catalytic cysteine appears to be in an unproductive orientation. While this work was in progress, the structure of a different construct representing the UCH domain was reported; however, in that work the structure reported was that of an inactive mutant [catalytic Cys to Ala; Nishio K et al. (2009) Biochem Biophys Res Commun390, 855–860], which precluded the observation that we are reporting here. Additionally, our structures reveal conformationally dynamic parts of the enzyme that may play a role in the structural transition to the more active form.

Database

Protein Data Bank codes: Coordinates and structure factors have been deposited in the PDB under the entries 3RII (UCHL5N228C88S) and 3RIS (UCHL5N240).
International Federation for Emergency Medicine Model Curriculum for Emergency Medicine Specialists
Authors: Hobgood Cherri , Anantharaman Venkataraman , Bandiera Glen , Cameron Peter , Halpern Pinchas , Holliman C James (Jim) , Jouriles Nicholas , Kilroy Darren , Mulligan Terrence , Singer Andrew ,   Core Curriculum and Education Committee for the International Federation for Emergency Medicine
Published: October 2011

To meet a critical and growing need for emergency physicians and emergency medicine resources worldwide, physicians must be trained to deliver time‐sensitive interventions and lifesaving emergency care. Currently, there is no globally recognized, standard curriculum that defines the basic minimum standards for specialist trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine convened a committee of international physicians, health professionals and other experts in emergency medicine and international emergency medicine development to outline a curriculum for training of specialists in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed to provide a framework for educational programmes in emergency medicine. The focus is on the basic minimum emergency medicine educational content that any emergency medicine physician specialist should be prepared to deliver on completion of a training programme. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance physician education in basic emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems, but in particular for developing nations or for nations seeking to expand emergency medicine within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught. This variability will reflect the existing educational milieu, the resources available, and the goals of the institutions' educational leadership with regard to the training of emergency medicine specialists.
Pharmacokinetic–Pharmacodynamic Modelling of Opioids in Healthy Human Volunteers. A MiniReview
Authors: Ing Lorenzini Kuntheavy , Daali Youssef , Dayer Pierre , Desmeules Jules
Published: October 2011

Abstract:  Pain is characterized by its multi‐dimensional nature, explaining in part why the pharmacokinetic/pharmacodynamic (PK/PD) relationships are not straightforward for analgesics. The first part of this MiniReview gives an overview of PK, PD and PK/PD models, as well as of population approach used in analgesic studies. The second part updates the state‐of‐the‐art in the PK/PD relationship of opioids, focusing on data obtained on experimental human pain models, a useful tool to characterize the PD of analgesics. For the so‐called weak opioids such as codeine, experimental human studies showed that analgesia relies mainly upon biotransformation into morphine. However, the time‐course of plasma concentrations of morphine did not always reflect the time‐course of effects, the major site of action being the central nervous system. For tramadol, a correlation has been observed between the analgesic response and the PK of the (+)R‐O‐demethyl‐tramadol metabolite. For ‘stronger’ opioids such as oxycodone, studies assessing the PK/PD of oxycodone suggested that active metabolite oxymorphone also strongly contributes to the analgesia and that analgesia may also be partially related through an action to peripherally located κ‐opioid receptors. Different models have been proposed to describe the time‐course of buprenorphine. An effect‐compartment model was adopted to describe the PK/PD of morphine and its active metabolite, morphine‐6‐glucuronide (M6G). A longer blood‐effect site equilibration half‐life t1/2ke0 was observed for M6G, suggesting a longer onset of action. The studies assessing the PK/PD of fentanyl and its derivatives showed a short t1/2ke0 for analgesia, between 0.2 and 9 min., reflecting a short onset of effect. In conclusion, depending on the speed of transfer between the plasma and the effect site as well as the participation of active metabolites, the time‐course of the analgesic effects can be close to the plasma concentrations (alfentanil and derivates) or observed with a prolonged delay (codeine, buprenorphine, morphine). These PK/PD data can be used to better characterize the differences between opioids, and partly explain the important observed variability among opioids in experimental conditions and should be systematically evaluated during drug development to better predict their selection in specific clinical conditions.
Bed Rest or Mobilization after rt-PA? A Case-Crossover Study of Factors Influencing Clinical Decision Making in Stroke Services
Authors: Ha Jason , Churilov Leonid , Linden Thomas , Bernhardt Julie
Published: October 2011

Background

Acute stroke management is a dynamic field. Treatment with recombinant tissue plasminogen activator is standard care in Australia, but there are no evidence-based practice guidelines about first out of bed activity (mobilization) after recombinant tissue plasminogen activator.

Aims

To identify factors influencing clinicians' decisions to delay or allow mobilization.

Methods

Case-crossover design. Using hypothetical case vignettes, we explored the factors that clinicians consider when deciding to first mobilize a patient after recombinant tissue plasminogen activator. Acute stroke physicians and nurses from Australian hospitals known to treat with recombinant tissue plasminogen activator participated. Information about hospital recombinant tissue plasminogen activator protocols and perceived benefits and harms of mobilization after recombinant tissue plasminogen activator were also captured.

Results

Fifty-four clinicians, 52% senior nurses, and 48% senior physicians from all states of Australia participated. Of the factors influencing decisions about mobilization after recombinant tissue plasminogen activator, neurological decline (0·29; confidence interval 0·12, 0·46; P = 0·001), neurological decline with symptomatic intracerebral hemorrhage (0·41; confidence interval 0·24, 0·59; P < 00001), infection of uncertain cause (0·32; confidence interval 0·14, 0·50; P = 0·001), severe chest infection (0·35; confidence interval 0·16, 0·53; P = 00004), severe stroke (0·29; confidence interval 0·12, 0·46; P = 0·001), drowsiness (0·47; confidence interval 0·29, 0·63; P < 00001), and confusion (0·31; confidence interval 0·15, 0·47; P = 00001) significantly influenced decisions. Falls risk was a common concern (85%).

Conclusion

Growing interest in development of clear protocols that guide first mobilization after recombinant tissue plasminogen activator prompted this study. We have identified factors that may influence decisions about when to allow patients to mobilize after recombinant tissue plasminogen activator. These, combined with emerging evidence of risks and benefits of early mobilization, should help protocol development in the future.
Internationalism and the Invention of the 1st of December Independence Day in Portugal
Authors: Rivero Ángel
Published: October 2011

Portuguese national identity was consciously recreated during the 1860s, and a full programme of national identity socialisation was devised. At the core of this project was the proposal to celebrate the 1st of December as the ‘Restoration of Independence Day’. The goal of the National Association 1st of December 1640, which was founded in 1861, was to combat cosmopolitanism, internationalism, and Iberianism, and highlight to the outside world, in general, and to the Portuguese ‘traitors’ in particular, the determination of the Portuguese people to retain their independence. To fulfil this purpose, it was felt necessary to awaken the soul of the Portuguese people by remembering the sufferings of the nation under the yoke of Spain, which lasted from 1580 and 1640, and the national jubilation that accompanied the restoration of freedom. This article argues that, contrary to what is stated in the vast majority of nationalist literature, the original celebration of the 1st of December should not be seen as a response to the Spanish threat of annexation, but rather as a mechanism to prevent attacks against the royal house and the regime it stood for both at home and abroad.
Ethnic Migration in Central and Eastern Europe: Its Historical Background and Contemporary Flows
Authors: Jennissen Roel
Published: October 2011

This article aims to describe the historical background of international ethnic migration in Central and Eastern Europe. The rise and fall of the Habsburg Empire in Central Europe and the Ottoman Empire in Southeastern Europe has been the underlying cause of many ethnic migration flows in Central and Eastern Europe in the post‐communist era. Moreover, the German Ostkolonisation, border changes after the two World Wars, and interstate migration in the former Soviet Union caused a large pool of potential ethnic migrants. In addition to the description of this historical background, this article contains a description of important contemporary ethnic migration flows that originate from the aforementioned historical developments, and a discussion of future developments of ethnic migration in Central and Eastern Europe.
Incidence and prevalence of idiopathic inflammatory myopathies in South Australia: a 30‐year epidemiologic study of histology‐proven cases
Authors: TAN Ju Ann , ROBERTS‐THOMSON Peter J. , BLUMBERGS Peter , HAKENDORF Paul , COX Sally R. , LIMAYE Vidya
Published: October 2011

Aim:  To describe the epidemiology of biopsy‐proven idiopathic inflammatory myopathies (IIM) in South Australia (SA).

Methods:  Cases of IIM were ascertained by review of all muscle biopsy reports from the Neuropathology Laboratory, Hanson Institute (wherein all adult muscle biopsies in SA are reported) from 1980 to 2009. Clinical correlation of these patients by review of medical records was undertaken. SA population denominator numbers were obtained from the Australian Bureau of Statistics.

Results:  Three hundred and fifty‐two biopsy‐proven cases of IIM were identified between 1980 and 2009. The overall annual incidence of IIM appeared to be rising with a mean incidence of eight cases per million population (95% CI: 7.2–8.9). This corresponded with an increasing annual incidence of inclusion body myositis (IBM) (prevalence of 50.5 cases per million population in 2009, 95% CI: 40.2–62.7). A female preponderance was noted in both dermatomyositis (DM) (F : M = 2.75 : 1.00) and polymyositis (PM) (F : M = 1.55 : 1.00) but gender distribution was almost equal in IBM (F : M = 1.1 : 1.0). Mean age at diagnosis for IBM (67.5 years) was higher than for DM (55.1 years) and PM (59.0 years). A higher proportion of DM patients reported living in urban dwellings and DM patients tended to be predominantly professionals.

Conclusions:  In SA there is an increasing incidence of IBM and the prevalence is one of the highest reported to date. This may reflect an increase in the number of biopsies performed, improved histological techniques or a genuine increase in incidence.