bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving Bus Travel Times with Passive Traffic Signal Coordination
Authors: Estrada M. , Trapote C. , Roca-Riu M. , Robusté F.
Published: December 2009

A simulation optimization model is outlined: traffic signal offsets in intersections are calculated to minimize the travel time of bus users in an urban network. The model considers a passive signal priority system and restricts the maximal incremental delay caused to car users. The simulation tool is able to trace discrete trajectories of both buses and cars in a network. It also evaluates potential perturbations that may cause time variations for average performance. Moreover, the optimization tool is based on evolutionary algorithms. The results of applying the traffic signal coordination model to a set of small trial networks are given. It is proved that the algorithm is able to design a sequence of signal offsets that reduces bus travel times by an 8.5% rate in a real network while maintaining the incremental car delay below 5%.
Emergent Curbside Intercity Bus Industry
Authors: Klein Nicholas J.
Published: December 2009

The first study of the emerging curbside intercity bus industry, commonly called the Chinatown bus, is presented. The study of this relatively unknown industry addresses three research questions. First, why and how did the intercity curbside bus industry develop? Second, what services are operated by the curbside carriers and how do these services compare with competing travel options? Finally, how do the economics of operating curbside buses differ from those of traditional bus companies? The research speaks to policy questions about the appropriate role of regulation in transportation and the competition between private and public transportation providers. The findings indicate that in the past 10 years, curbside buses have grown to become an important transportation provider in the Northeast Corridor: more than 2,500 low-fare bus trips per week connect New York City to Washington, D.C.; Philadelphia, Pennsylvania; and Boston, Massachusetts. More than 100 buses depart each week to more than 30 other cities, traveling as far as Atlanta, Georgia, and Toronto, Canada. Traditional bus companies, such as Greyhound Lines and Peter Pan, have begun their own curbside intercity bus services either to mitigate the competition from new companies or because they recognize the competitive advantages of curbside operations. It is found that curbside bus operations offer significant cost savings compared with traditional bus services by lowering labor costs and avoiding terminal fees, although at the cost of limited accessibility for disabled passengers, reduced passenger safety, and other social concerns.
Balancing Urban Driveway Design Demands Based on Stopping Sight Distance
Authors: Dixon Karen , van Schalkwyk Ida , Layton Robert
Published: December 2009

Many roadways in urban areas, especially dense commercial areas, are subjected to on-street and adjacent off-street parking demands; local access through driveways is an essential component of these complex urban corridors. Vehicles entering and exiting these driveways–-and their interaction with parked cars, other moving motorized vehicles, bicycles, and pedestrians–-present challenges for a safe and efficient roadway corridor. The location and the design of these driveways, together with parking and bicycle facilities, generate sight distance challenges that affect pedestrians and bicyclists. This paper investigates the type and nature of impacts–-including conflicts, sight distance, operations, and safety at driveway locations–-as they relate to pedestrians, bicyclists, and drivers. It also analyzes design geometrics that may help to provide adequate sight distance for safety at driveways with and without bicycle lanes present. Parked vehicles often obstruct drivers’ view of approaching motor vehicles and bicycles. In many locations, vehicles exiting driveways must edge out into the active travel way for the driver to have an unobstructed view. Driveway location and design analysis demonstrate the value of bicycle lanes in providing enhanced sight distance. Current practices permit longitudinal placement of on-street parking too close to driveways. For safety reasons, agencies should consider excluding on-street parking on roads with bicycle lanes when speeds exceed 30 mph so as to provide adequate sight distance without creating sporadic on-street parking spacing. Roads without bicycle lanes often do not provide adequate stopping sight distance at on-street parking driveway locations when motor vehicle operating speeds exceed 25 mph.
Inertial Effects during Impact Testing
Authors: Reid John D. , Hascall Jason A. , Sicking Dean L. , Faller Ronald K.
Published: December 2009

Shortcomings were identified in historic dynamic guardrail post testing methods that could overestimate the strength of guardrail posts by a factor of two. This inaccuracy resulted from the influence of inertia that was not previously accounted for during dynamic component testing. The effects of inertia were verified and quantified with several analysis methods including nonlinear finite element analysis, which was used to develop a computer simulation of the dynamic tests. Several alternative testing procedures that could significantly reduce the effects of inertia were identified and investigated. One of these testing alternatives–-use of a crushable impact head–-was shown with computer simulation to reduce the effects of inertia and maintain the benefits of strain rate effects. The use of such an impact head is recommended for all future dynamic post strength testing. The results of the study imply that changes should be made not only in the standard design procedures used for guardrail and other vehicular barriers, which are clearly influenced by inertial effects, but in all designs that are based on dynamic strength testing. Dynamic testing is very common in the field of transportation engineering and care should be taken to ensure that inertial effects are considered when performing such tests.
Midwest Guardrail System with round Timber Posts
Authors: Faller Ronald K. , Reid John D. , Kretschmann David E. , Hascall Jason A. , Sicking Dean L.
Published: December 2009

A modified Midwest Guardrail System (MGS) was developed by using small-diameter round wood posts. The barrier system was configured with three timber species: Douglas fir (DF), ponderosa pine (PP), and southern yellow pine (SYP). Barrier VII computer simulation, combined with cantilever post testing in a rigid sleeve and soil, was used to determine the required post diameter for each species. The recommended nominal sizes were 184 mm (7.25 in.) for DF, 203 mm (8 in.) for PP, and 190 mm (7.5 in.) for SYP. A grading criterion limiting knot size and ring density was established for each species. The recommended knot sizes were limited to 38 mm (1.5 in.) or smaller for DF, 89 mm (3.5 in.) or smaller for PP, and 64 mm (2.5 in.) or smaller for SYP. The minimum ring densities equaled or exceeded 6 rings per inch (rpi) for DF, 6 rpi for PP, and 4 rpi for SYP. Two guardrail systems–-one using DF posts and another using PP posts–-were crash tested according to the Test Level 3 requirements specified in NCHRP Report 350: Recommended Procedures for the Safety Performance Evaluation of Highway Features. Crash testing was not conducted on the SYP system because of the adequacy of previous testing on 184-mm (7.25-in.) diameter SYP posts in a standard W-beam guardrail system and post design strength comparable to that in the other two species. Both crash tests showed that the modified MGS functioned adequately for both wood species. Three round wood post alternatives were recommended as an acceptable substitute for the standard W152×13.4 (W6×9) steel post used in the MGS.
High-Performance Aesthetic Bridge Rail and Median Barrier
Authors: Lechtenberg Karla A. , Bielenberg Robert W. , Rosenbaugh Scott K. , Faller Ronald K. , Sicking Dean L.
Published: December 2009

Design of high-performance concrete barriers for heavy vehicles has advanced little in recent years. Barrier improvements were needed in terms of design aesthetics, safety performance, and economy. Advancement was deemed necessary for improved barrier geometry design to reduce vehicle instability and the potential for occupant head slap on the barrier, improved understanding of impact loads for heavy vehicles and use of these loads to optimize barriers, and improved barrier aesthetics. This paper describes the development of two NCHRP Report 350 Test Level 5 (TL-5) barriers that address these needed advancements. First, a TL-5 open concrete bridge rail was designed with a focus on determining accurate impact loads and providing a barrier geometry with improved safety and aesthetics. Next, a TL-5 concrete median barrier was developed through rigorous analysis of barrier shape options to determine the safest and most economic shape. Structural design of the barrier was also optimized to minimize cost while meeting the design loads for heavy vehicles. The open concrete bridge rail and the concrete median barrier were successfully full-scale crash-tested according to the TL-5 safety requirements set forth in NCHRP Report 350. These designs represent a major advancement in the safety and economy of high-performance concrete barriers.
Guidelines for Implementation of Cable Median Barrier
Authors: Sicking Dean L. , de Albuquerque Francisco Daniel Benicio , Lechtenberg Karla A. , Stolle Cody S.
Published: December 2009

A detailed examination of accidents in Kansas evaluated the need for a cable median barrier. Hard copies of all accident reports from Kansas controlled-access freeways from 2002 to 2006 were reviewed. A total of 525 cross-median events and 115 cross-median crashes were identified. Cross-median encroachment rates were linearly related to traffic volume and cross-median crash rates appeared to have a second-order relationship to volume. Cross-median crashes were much more frequent in winter months and the severity of wintertime crashes was lower. This finding indicates that median barrier warranting criteria may need to be adjusted to accommodate regional climate differences, especially for warranting guidelines based on cross-median crash rates. A relationship was found between cross-median crash rate and traffic volume for Kansas freeways with median widths of 60 ft (18.3 m). This relationship was combined with encroachment rate and lateral extent of encroachment data from the Roadside Safety Analysis Program to develop general guidelines on the use of cable median barriers along Kansas freeways.
L'Observatoire de l'écosystème forestier du canton de Vaud: espace de recherche appliquée | The Forest Ecosystem Observatory in Canton Vaud: a field of applied research
Authors: Hartmann Philippe , Fouvy Patrik , Horisberger Denis
Published: December 2009

The concept of an Observatory of the forest ecosystem in canton Vaud has established itself in the course of a period marked by rapid technical progress and social change whereby the forest has become a multifunctional public amenity. This process has greatly enhanced knowledge of the flora and promoted information concerning the site, all of which has enriched the forestry data bank. The interpretation of this information opens up a vast new field of application in the provision of facilities and in forest management, as reflected in several concrete examples proposed in this special edition of the Swiss Forestry Journal.
Techniques d'interprétation des relevés de végétation forestière: entre rigueur et pragmatisme | Techniques for interpreting forest vegetation surveys: between stringency and pragmatism
Authors: Delarze Raymond , Clot François
Published: December 2009

In order to interpret the 12,000 vegetation survey samples taken in the forests of Canton Vaud, half of which were placed in a systematic grid, it was necessary to develop a complex dichotomous key. This obliged the phytosociologist to specify the criteria identifying each plant community. The most recent version of the automatic dichotomous key provided satisfying results in 90% of all cases, though an expert appraisal can not be entirely dispensed with. A certain need for further improvements on the key was identified.
L'écosystème forestier du canton de Vaud: un pays, quatre régions | The forest ecosystem in Canton Vaud: one territory, four regions
Authors: Horisberger Denis
Published: December 2009

Active in the accumulation of facts concerning the environment, the canton of Vaud has available a forestry data bank which offers abundant information. The most important elements, such as geology, climate and vegetation (the phytosociological and dendrometrical bases), are described in this article. This data bank is available to the entire forestry service. The information comes from four biogeographical regions and the description of these makes it possible to impart a regional structure to the environmental references from forest management and development planning and thus facilitates deliberation and communication.
Aire et gestion des ressources en chêne du canton de Vaud: dossier d'un avenir immédiat | Resource management and distribution area of oak in canton Vaud: an issue for the immediate future
Authors: Horisberger Denis , Meylan Micheline
Published: December 2009

When climatic changes are taken into account in forestry management, the question arises of the choice of tree species in order to adapt the forests to increased temperatures and stress arising from lack of water. The oak could be the main species accommodating itself to the new situation up to an altitude of about 900 m. A maximal development of this genetic inheritance adapted to our soils and the reinstallation of a network of oak forests would in fact give a new boost to the exceptional biodiversity linked to this species. In canton Vaud, the application of a sylviculture favourable to the oak would concern a relatively small and reasonable area of approximately 8,000 hectares, which corresponds to less than 20% of the surface theoretically adapted to this species, with a rhythm of rejuvenation of about 40 hectares a year.
Aberdeen's ‘Toun College’: Marischal College, 1593–1623
Authors: Reid Steven John
Published: December 2009

While debate has arisen in the past two decades regarding the foundation of Edinburgh University, by contrast the foundation and early development of Marischal College, Aberdeen, has received little attention. This is particularly surprising when one considers it is perhaps the closest Scottish parallel to the Edinburgh foundation. Founded in April 1593 by George Keith, fifth Earl Marischal in the burgh of New Aberdeen ‘to do the utmost good to the Church, the Country and the Commonwealth’,1 like Edinburgh Marischal was a new type of institution that had more in common with the Protestant ‘arts colleges’ springing up across the continent than with the papally sanctioned Scottish universities of St Andrews, Glasgow and King's College in Old Aberdeen.2 James Kirk is the most recent in a long line of historians to argue that the impetus for founding ‘ane college of theologe’ in Edinburgh in 1579 was carried forward by the radical presbyterian James Lawson, which led to the eventual opening on 14 October 1583 of a liberal arts college in the burgh, as part of an educational reform programme devised and rolled out across the Scottish universities by the divine and educational reformer, Andrew Melville.3
King Henry IX, or cardinal called York? Henry Benedict Stuart and the reality of kingship
Authors: MacCannell Daniel
Published: December 2009

A picture belonging to the National Portrait Gallery, London, attributed as of 1958 to Pompeo Batoni,1 is now listed as ‘Unknown Cardinal, formerly known as Henry Benedict Maria Clement Stuart, Cardinal York, [by the] circle of Anton Raphael Mengs’ ( Fig. 1 ).2 It is not the identity of the artist that poses the central question of this article, but of the sitter – in this, and in a very different painting: the Scottish National Portrait Gallery's Prince Charles Edward Stuart, by Maurice Quentin de La Tour ( Fig. 2 ).3
A newly discovered Dunkeld seal
Authors: Glenn Virginia
Published: December 2009

The seal impression of Richard of Inverkeithing, bishop of Dunkeld (1250–72) recently discovered in Sens, helps to consolidate our picture of thirteenth-century Scottish religious iconography. The obverse ( Fig. 1 consists of Richard's seal of dignity, which shows him standing facing forward, his crozier in his left hand, his right hand raised in blessing, between two large fleurs de lis. The top of the seal has been damaged and partly broken off, but we know from a complete and sharp impression of 1254 in Durham, that the ground is plain and the whole crowned by an architectural canopy.1
The last students at the Scots College, Douai
Authors: Russell Julian
Published: December 2009

The register of the Scots College, Douai, was printed in Records of the Scots Colleges I, New Spalding Club (Aberdeen, 1906).1 It ends in 1772, but does not contain the names of the secular students after 1765, when the Jesuits were expelled from France. The rector, John Riddoch, S. J., and his students moved to Dinant, taking the register with them, and it is the Dinant register that is printed. The college at Douai re-opened with a secular priest, Robert Grant, as rector, but no register survives for the period from 1765 until the final closure in 1793.2
Royal succession and kingship among the Picts
Authors: Evans Nicholas
Published: December 2009

When we consider the history of the Picts we are faced with the perennial challenge for the early medievalist of deciding whether the fragments of evidence which survive are representative of the reality of Pictish society, or whether they provide us with distortions, based on patterns of survival. This issue is as relevant to the subject of royal succession as it is to other aspects of Pictish history. The debate over whether the Picts practised a matrilineal system, with the son of the previous king's sister becoming the next king, or whether it was a patrilineal system, with the kingship generally passing through the male line, has dominated the discussion of Pictish succession. Until the 1980s, the matriliny thesis was virtually unquestioned, and accepted by scholars including F. T. Wainwright, Marjorie Anderson, and Isabel Henderson1. The bases for this view were the accounts of the Pictish settlement of northern Britain in Bede's ‘Ecclesiastical History of the English People’ and Irish texts written throughout the medieval period, but mainly surviving in versions from the twelfth century or later.2In these sources it was claimed that the Picts went to Ireland before arriving in northern Britain, and that they obtained wives from the Irish, with some versions stating that this was done on condition that the succession went through the female line. Other sources which did not openly discuss the nature of Pictish succession, particularly the Irish chronicles and the Pictish king-lists, were then interpreted by scholars in relation to these accounts and were thought to support them.
Lord Seaforth and Highland estate management in the First Phase of Clearance (1783–1815)
Authors: McKichan Finlay
Published: December 2009

Professor Allan Macinnes coined the phrase and defined ‘The First Phase of Clearance’. He argued that in this period chiefs embraced wholeheartedly the Whig concept of progress and deliberately subordinated, if not threw over, their personal obligations as patrons and protectors of their clansmen and that a result was a gradual but inexorable re-orientation of estates towards the market at the expense of clanship. This article is a case study of First Phase Clearance based on the proprietorship of Francis Humberston Mackenzie of the Seaforth estate in mainland Ross-shire and Lewis. It argues that he was slower than other proprietors in abandoning traditional attitudes and in following the dictates of political economy. It shows that customary, political and commercial pressures pulled him in different directions, which led to ambiguities and contradictions in his policies. In the first part of the article the importance for him of customary concerns, traditional attitudes and political influence and the implications for estate management are examined. However, he also wanted to enjoy the financial benefits of commercialisation and in some respects he undoubtedly acted commercially. This is considered in the second part. The consequences of these competing pressures are discussed in the final part. The article concludes that, while Seaforth reflects many of the characteristics associated with First Phase Clearance proprietors, his estate management policy does not display inexorable adoption of commercialism, but rather confusion and inconsistency under pressure. This was to the detriment of his own interests and those of his family and began the process by which in the nineteenth century most of the Seaforth estate was sold.
The Death of John Comyn: What Was Going On?
Authors: Grant Alexander
Published: December 2009

The aim of this article is to explore in depth what was ‘going on’ - as opposed to simply what ‘happened’ - when John Comyn was killed by Robert Bruce in Dumfries on 10 February 1306, in one of the most dra-matic and pivotal events in Scotland's history. It divides into two parts. The first considers the main medieval sources. These were of course all written after the event, and so are invariably coloured by hindsight and what is nowadays called ‘spin’; hence they are not ‘true’ accounts but constructed narratives. Their treatment here aims to elucidate what each author was trying to present to his intended audience. The article deals with, in turn: the narratives in the English government documents produced in the killing's aftermath; the near-contemporary English chronicle narrratives; the rather later Scottish chronicle narratives; some additional Scottish narra-tives found within certain poems; and finally the lay-authored Scalacronica, which has a significantly different perspective from other English chroni-cles. In general, the narratives are revealingly complex; despite their slants, they are far from being exercises in crude propaganda. And, significantly, the Scottish chronicles (especially Wyntoun) and Scalacronica give emphasis to the fact that the victim of the killing, John Comyn, was the nephew of King John Balliol and grandson of Dervorguilla, lady of Galloway, and thus was a leading member of the senior Scottish royal line. Moreover, close reading of ‘The Scottish poem’ in Liber Extravagans (appended to Bower's Scotichronicon) reveals a contemporary plea for John Comyn to become king of Scots. In the second half of the article, the implications of this ‘Comyn-for-king’ concept are pursued. None of the standard accounts of the period pays serious attention to Comyn's royal descent; discussions of the killing invariably focus on Robert Bruce. Therefore an attempt is made here - despite the understandable absence of hard evidence - to consider the killing more from the victim's point of view. It is argued that, after the de facto collapse of Balliol kingship in 1303-4, John Comyn (because of his own lineage) would never have accepted Robert Bruce (whose line of descent had been declared inferior in 1292) as king. Consequently, political compromise between the two men was obviously out of the question. Therefore, although none of the chronicle narratives can be taken at face value, their consistent presenta-tions of the killing as premeditated are possibly valid after all, despite the denials of the main modern studies. And although (because of the problem of evidence) it is impossible to achieve certainty over this ques-tion, what does become clear is that Comyn's claim to the throne is the crucial factor for understanding what was going on when he was killed.
‘Epoch-Making’ Beginnings to Lingering Death: The Struggle for Control of the Glasgow Police Commission, 1833–46
Authors: Barrie David G.
Published: December 2009

Established in 1800, the Glasgow Police Commission is of great importance in the context of municipal history. As a specialist authority responsible for public services, the Commission was among the most advanced in Britain. Its wide-ranging achievements in law and order and public amenity provision helped create a new range of essential services in a rapidly expanding city. Moreover, the method of electing its representatives on a rotational ward basis provided a model for municipal reform later in the century. Yet, by the 1840s the Commission's incorporation into local government was keenly and successfully sought by those in influential circles after a bitter and prolonged conflict with commissioners and many lower-middle class/skilled working-class ratepayers. This article will analyse the political and social struggle behind the Commission's demise. Of principal benefit to those interested in police control and municipal governance, the study also uncovers a great deal about political and social representation by examining public attitudes, voting behaviour and electoral trends at annual police elections.
Effect of Medicaid Coverage of Tobacco-Dependence Treatments on Smoking Cessation
Authors: Liu Feng
Published: December 2009

Smoking cessation aids (nicotine replacement products and anti-depressant medication) have been proven to double quitting rates compared to placebo in several randomized controlled trials. But the high initial cost of cessation aids might create a financial barrier to cessation for low-income smokers. In the U.S., Medicaid provides health insurance coverage to low-income people, and in some states covers smoking cessation products. This paper uses nationally representative data of the U.S. to examine how the Medicaid coverage of cessation aids affect smoking behavior. The results indicate the Medicaid coverage of cessation products is positively associated with successful quitting among women aged 18–44.
The Chemical Composition and Biological Properties of Coconut (Cocos nucifera L.) Water
Authors: Yong Jean W. H. , Ge Liya , Ng Yan Fei , Tan Swee Ngin
Published: December 2009

Coconut water (coconut liquid endosperm), with its many applications, is one of the world’s most versatile natural product. This refreshing beverage is consumed worldwide as it is nutritious and beneficial for health. There is increasing scientific evidence that supports the role of coconut water in health and medicinal applications. Coconut water is traditionally used as a growth supplement in plant tissue culture/micropropagation. The wide applications of coconut water can be justified by its unique chemical composition of sugars, vitamins, minerals, amino acids and phytohormones. This review attempts to summarise and evaluate the chemical composition and biological properties of coconut water.
Improving Landsat and IRS Image Classification: Evaluation of Unsupervised and Supervised Classification through Band Ratios and DEM in a Mountainous Landscape in Nepal
Authors: Bahadur K.C. Krishna
Published: December 2009

Modification of the original bands and integration of ancillary data in digital image classification has been shown to improve land use land cover classification accuracy. There are not many studies demonstrating such techniques in the context of the mountains of Nepal. The objective of this study was to explore and evaluate the use of modified band and ancillary data in Landsat and IRS image classification, and to produce a land use land cover map of the Galaudu watershed of Nepal. Classification of land uses were explored using supervised and unsupervised classification for 12 feature sets containing the LandsatMSS, TM and IRS original bands, ratios, normalized difference vegetation index, principal components and a digital elevation model. Overall, the supervised classification method produced higher accuracy than the unsupervised approach. The result from the combination of bands ration 4/3, 5/4 and 5/7 ranked the highest in terms of accuracy (82.86%), while the combination of bands 2, 3 and 4 ranked the lowest (45.29%). Inclusion of DEM as a component band shows promising results.
Frequency of Scabies in Iraq: Survey in a Dermatology Clinic
Authors: Alsamarai Abdulghani Mohamad
Published: December 2009

Background: The burden of scabies is highest in tropical countries, but recent data from Iraq are scanty. Objective: To estimate the frequency of scabies in patients of a dermatology clinic in central Iraq. Methodology: The study was conducted in Tikrit (Iraq), between May 2007 and February 2008.  A total of 1,194 patients presenting to a dermatology clinic were included in the study. Results: During the study period, 132 [1.1%] patients with scabies were identified. The frequency was 13.5% in males and 8.6% in females [P = 0.007]. Frequency in children was 15.6% and 9.8% in adults [P = 0.007].  About 91% of cases were younger than 45 years. The treatment of scabies cases with 5% permethrin cream resulted in a cure rate of 80.3% following a single application, and was increased to 95.5% after a second application. Cure was achieved in all cases after a third application. Conclusion: Prevalence of scabies was high in a dermatology clinic, and prisoners were identified as high-risk group. Mass treatment of scabies either by oral ivermectin or topical permethrin is suggested.
Transfusion-transmissible infections among blood donors in Kathmandu, Nepal
Authors: Shrestha Ashish Chandra , Ghimire Prakash , Tiwari Bishnu Raj , Rajkarnikar Manita
Published: December 2009

Background: Screening of transfusion-transmissible infections (TTIs) among blood donors can be a cost-effective approach to monitor the prevalence, distribution, and trends of the infections among healthy-looking individuals. The study aimed to determine the seroprevalence of four TTIs, human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis, among blood donors in Kathmandu, Nepal. Methodology: A total of 21,716 units of blood were tested for the presence of anti-HIV 1/2 IgG/IgM, HBsAg, anti-HCV IgG/IgM, and anti-Treponema pallidum IgG/IgM/IgA using commercial ELISA kits following standard protocols. Statistical analysis was performed using WinPepi Ver 3.8. Results: Seroprevalence of HIV, HBV (HBsAg), HCV and syphilis were observed to be 0.12% (95% CI = 0.08-0.18), 0.47% (95% CI = 0.39-0.57), 0.64% (95% CI = 0.54-0.75) and 0.48% (95% CI = 0.40-0.59) respectively. TTIs were dominant among male blood donors compared to female blood donors. Higher HCV seroprevalence among males compared to females was statistically significant. HIV prevalence was highest among blood donors in the age group 31 to 40 years (P > 0.5). HBV, HCV and syphilis prevalence was highest among blood donors 41 to 50 years age group, 21 to 30 years age group, and 51 to 60 years age group respectively (P < 0.05). HIV and HBV prevalence was relatively higher among first-time donors, whereas HCV and syphilis was relatively higher among the repeated donors (P > 0.05). Conclusions: It is of utmost importance to continue screening donated blood with highly sensitive and specific tests and to counsel donors who are positive to any of the above infections. It is absolutely necessary to avoid the transmission of infection from repeat donors.
Indirect patient expenses for antituberculosis treatment in Tijuana, Mexico: is treatment really free?
Authors: Guzmán-Montes Gema Yolanda , Heras-Ovalles Renata , Laniado-Laborín Rafael
Published: December 2009

Background: One of the main problems faced by the Mexican National Tuberculosis Program is the high rate of patients abandoning treatment. This study aimed to determine the magnitude of unaccounted costs of tuberculosis (TB) treatment in Tijuana, Mexico. Methodology: Subjects were recruited at 21 health centres. Patients had confirmed active pulmonary TB, had been on treatment for more than 12 weeks, and were aged 18 years and older. The questionnaire provided information about demographics, past and current episodes of TB, and various categories of expenses. Results: The study included 180 patients as follows:  48 had been diagnosed with tuberculosis in the past (26.6%) and had either currently relapsed or failed treatment; 160 (88.8%) were under directly observed therapy (DOT); 131 (72.8%) attended a health centre; and the rest received directly observed treatment at home. The daily cost of transportation to the health centre was MXN $25.88 + 3.22 (1 USD = 13 MXN). Thirty-two patients (17.8%) had to buy medication at least once, with a monthly medication expense of MXN $440.5 + 40.3. Patients receiving DOT at the health centre reported daily food and beverages expenses, spending MXN $56.5 + 10.1. Forty-two patients reported laboratory testing expenses, on average MXN $558.8 + 85.8 per month. Eighty patients (42.4%) reported expenses on radiographic/ultrasound studies, on average MXN $562.9 + 72.1 per six-month regimen. Conclusions TB diagnosis and treatment posed a significant economic burden on patients in terms of both cost and affordability; clinic-based DOT may contribute disproportionately to the costs incurred by patients.
Trends in antimicrobial resistance in Shigella species in Karachi, Pakistan
Authors: Khan Erum , Jabeen Kausar , Ejaz Muslima , Siddiqui Jaweriah , Shezad Muhammad Farrukh , Zafar Afia
Published: December 2009

Background: Shigellosis is a common cause of morbidity, especially in the very young and old, in developing countries.  The disease is treated with antibiotics. Surveillance of antimicrobial resistance trends is essential owing to the global emergence of antimicrobial resistance. Methodology: The study involved 1,573 isolates of Shigella species (1996-2007) that were analyzed for trends in antimicrobial resistance. Results: The majority of the specimens (1046; 66.5%) were from the pediatric population, and of these 887 (84.8%) were under 5 years of age (p = 0.001). S. flexineri was the most frequent species (54.5%) isolated. Isolation of S. sonnei increased from 15.4 % (1996) to 39% (2007) (p = 0.001). Although none of the isolates was found sensitive to all the antibiotics tested, 58% (n =9 07) were resistant to ampicillin and 85% (n = 1,338) were resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Out of a total of 198 (12.6%) nalidixic acid resistant isolates, 6 (3.0%) were also resistant to ofloxacin. Overall 1.7 % of isolates were resistant to ofloxacin, 2.4% to ceftriaxone and 2.3% were resistant to combination of ampicillin, nalidixic acid and TMP-SMX. Conclusion: Ofloxacin is still an effective drug for treatment of acute shigellosis in Pakistan. Emergence of resistance to ceftriaxone in Shigella may have grave implications in treatment of severe shigellosis in very young patients.
The Daunting Practicalities of In-office Pediatric Influenza Vaccination: 2009–2010
Authors: Block Stan L.
Published: December 2009

CME Educational Objectives

1.

Identify the key barriers to successful delivery of influenza vaccine in the private office setting.

2.

Assess proven strategies that improve influenza vaccine delivery in the office setting.

3.

Delineate the unique stresses placed on the private office as a result of the need to delivery H1N1 vaccine this influenza season.
Midshaft Clavicle Fractures: Are Surgical Indications Changing?
Authors: Bravman Jonathan T. , Vidal Armando F.
Published: December 2009

Educational Objectives

1.

Explain why historical studies underestimated complication rates with universally applied nonoperative treatment of displaced midshaft clavicle fractures.

2.

Describe the clinical sequelae and patient morbidity encountered in mid-shaft clavicle nonunion and symptomatic malunion.

3.

List the radiographic and patient factors associated with increased risk of nonunion and symptomatic malunion in patients with displaced midshaft clavicle fractures.

4.

Discuss the potential benefits and complications associated with acute fixation of displaced midshaft clavicle fractures
Spontaneous Resolution of a Spinoglenoid Notch Ganglion
Authors: Ayyagari Sudhir , Bancroft Laura W. , Jablonski Michael
Published: December 2009

The case:
A 50-year-old man initially presented with right shoulder pain and difficulty lifting his arm to chest level. The patient reported no history of trauma. Magnetic resonance imaging (MRI) was performed (Figure
1
), and conservative treatment was ineffective. He presented 17 months later with progressive symptoms and a repeat MRI was performed (Figure
2
).
Web-Based Hazard and Near-Miss Reporting as Part of a Patient Safety Curriculum
Authors: Currie Leanne M. , Desjardins Karen S. , Levine Ellen (Sunni) , Stone Patricia W. , Schnall Rebecca , Jianhua Li , Bakken Suzanne
Published: December 2009

As part of a patient safety curriculum, we developed a Web-based hazard and near-miss reporting system for postbaccalaureate nursing students to use during their clinical experiences in the first year of their combined BS-MS advanced practice nurse program. The 25-week clinical rotations included 2 days per week for 5 weeks each in community, medical-surgical, obstetrics, pediatrics, and psychiatric settings. During a 3-year period, 453 students made 21,276 reports. Of the 10,206 positive (
yes
) responses to a hazard or near miss, 6,005 hazards (59%) and 4,200 near misses (41%) were reported. The most common reports were related to infection, medication, environmental, fall, and equipment issues. Of the near misses, 1,996 (48%) had planned interceptions and 2,240 (52%) had unplanned interceptions. Types of hazards and near misses varied by rotation. Incorporating hazard and near-miss reporting into the patient safety curriculum was an innovative strategy to promote mindfulness among nursing students.
Developing Patient-Centered Care Competencies Among Prelicensure Nursing Students Using Simulation
Authors: McKeon Leslie M. , Norris Tommie , Cardell Brittany , Britt Teresa
Published: December 2009

Health care improvement requires collaboration between academia and practice to bridge gaps in nurse education and achievement of quality outcomes. Quality and Safety Education for Nurses identified six domains, including patient-centered care, that should be addressed during prelicensure education. Simulation is a recommended strategy to teach safe clinical practice; however, cost, space, and faculty resources are barriers to its use. Computer-based social simulation is less resource intensive and effective in improving critical-thinking skills. A pilot study was conducted to compare required resources and student learning outcomes for traditional versus computer-based simulation. Fifty-three baccalaureate nursing students participated in the study; 34 completed the computer-based simulation and 31 completed the traditional simulation. Group patient-centered care competency scores improved similarly (
p
< 0.001), although fewer faculty hours were required to administer the computer-based intervention. Findings suggest computer-based simulation is an efficient and effective learning strategy to develop patient-centered care competencies.
Student Learning Outcomes After Integration of Quality and Safety Education Competencies into a Senior-Level Critical Care Course
Authors: Miller Connie L. , LaFramboise Louise
Published: December 2009

Nursing education must respond to reports from the Institute of Medicine and others that health care education must focus more on safety and quality so graduates are empowered to positively impact patient safety. Effective teaching strategies must be developed and tested that result in positive student outcomes. The purpose of this pilot study was to test the effects of structured classroom and clinical content related to safety and quality of health care systems on a group of senior-level nursing students. A mixed-method study was conducted using repeated-measures analysis of variance quantitative data from the Student Perception of Safety and Quality Knowledge, Skills, and Attitudes Questionnaire and content analysis for the qualitative data collected from focus group discussions. Results suggest a combination of classroom and clinical learning activities have the strongest impact on student knowledge, skills, and attitudes related to safety and quality.
The New Fundamentals in Nursing: Introducing Beginning Quality and Safety Education for Nurses' Competencies
Authors: Preheim Gayle J. , Armstrong Gail E. , Barton Amy J.
Published: December 2009

This article describes the redesign of the fundamentals of nursing course using an organizing framework and teaching strategies identified in the Quality and Safety Education for Nurses (QSEN) initiative. Six QSEN competencies (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics) are essential for nursing practice. Beginning knowledge, skills, and attitudes (KSAs) associated with each competency were identified in a preliminary Delphi survey as important to incorporate early in prelicensure nursing curricula. Redesign requires a shift in focus from task-training and psychomotor skills development to incorporation of a systems context, reflecting redefined values and interventions associated with safety, quality, and professional nursing roles.

A course revision, based on the QSEN competencies definitions, selected beginning KSAs, exemplar resources, and teaching strategies, is described. The reframing of fundamentals of nursing is essential to prepare new graduates for contemporary practice.
Ecology of megabenthic bivalve communities from sandy beaches on the south coast of Portugal
Authors: Rufino Marta M. , Gaspar Miguel B. , Pereira Alexandre M. , Maynou Francesc , Monteiro Carlos C.
Published: December 2009

Ecological aspects of 75 megabenthic bivalve species found on the south coast of Portugal (from Vila Real to Sagres) were studied based on the information provided by seasonal bivalve surveys from 2000 to 2007 (8600 hauls, simultaneously using a razor shell dredge and a clam dredge). Of the 75 species identified, 36 occurred less than 30 times, and thus were considered rare in the area. The remaining 39 bivalves were analysed according to their occurrence, bathymetric distribution, geographic preferences, seasonal preferences, burying-depth, beach exposure and river mouth proximity. All species belonging to the Pharidae and Solenidae families (razor shells) and most Tellinidae were significantly more frequent in the razor shell dredge (indicating deeper burying in the sediment), whilst the families Cardiidae and Donacidae were significantly more frequent in the clam dredge (indicating that these species are probably closer to the sediment surface). As for the season, most bivalve species occurred similarly in both seasons (19 sp; 49%), but a large proportion were more abundant during the autumn surveys (17 sp., 44%), whereas only three species were commoner during the spring surveys. Most species belonging to the families Cardiidae and Mactridae were commoner in the autumn surveys. The spatial distribution differed between species and cluster analysis identified four communities with greater geographic affinity. Species belonging to the family Cardiidae were preferably found in the western part (WB) and the eastern part (S) of the study area, whereas the families Donacidae, Mactridae and Tellinidae occurred mainly in the central area (EB) and the eastern (S) coastal sectors. Overall, shallower species (modal depth at 3-6 m) showed greater occurrences and abundances than the deeper ones, and the depth pattern observed did not change between seasons. Donacidae and Mactridae (except Mactra glauca) were represented essentially by shallow species, whereas Cardiidae (except Acanthocardia tuberculata and Cerastoderma edule) included mostly species occurring in deeper waters. Bathymetric sequence of species distribution within some families was observed.
Methods for Imaging Renin-Synthesizing, -Storing, and -Secreting Cells
Authors: Casellas Daniel
Published: December 2009

Renin-producing cells have been the object of intense research efforts for the past fifty years within the field of hypertension. Two decades ago, research focused on the concept and characterization of the intrarenal renin-angiotensin system. Early morphological studies led to the concept of the juxtaglomerular apparatus, a minute organ that links tubulovascular structures and function at the single nephron level. The kidney, thus, appears as a highly “topological organ” in which anatomy and function are intimately linked. This point is reflected by a concurrent and constant development of functional and structural approaches. After summarizing our current knowledge about renin cells and their distribution along the renal vascular tree, particularly along glomerular afferent arterioles, we reviewed a variety of imaging techniques that permit a fine characterization of renin synthesis, storage, and release at the single-arteriolar, -cell, or -granule level. Powerful tools such as multiphoton microscopy and transgenesis bear the promises of future developments of the field.
Plasmid Profiles and Prevalence of Intermediately VirulentRhodococcus equifrom Pigs in Nakhonpathom Province, Thailand: Identification of a New Variant of the 70-kb Virulence Plasmid, Type 18
Authors: Poolkhet Chaithep , Chumsing Suksun , Wajjwalku Worawidh , Minato Chihiro , Otsu Yukiko , Takai Shinji
Published: December 2009

The prevalence of intermediately virulentRhodococcus equiisolates from pig submaxillary lymph nodes from four slaughterhouses in Nakhonpathom province, Thailand, was investigated. The isolates were tested for the presence of virulence plasmids and the 20-kDa virulence-associated protein antigen (VapB) gene by PCR. Of the 734 submaxillary lymph nodes tested, 19 (2.6%) produced positive cultures ofR. equi. All 19 isolates were positive for the VapB gene and contained virulence plasmids that were identified as type 1 (six isolates), type 6 (two isolates), type 7 (one isolate), type 16 (two isolates), and a new variant (eight isolates). Based on the restriction digestion patterns of the plasmid DNAs, we tentatively designated the variant as type 18. Investigation of the prevalence and plasmid profiles of VapB-positiveR. equiin pigs should be extended throughout Thailand to evaluate potential sources of zoonotic infections.
Congenital Hypothyroidism Caused by a PAX8 Gene Mutation Manifested as Sodium/Iodide Symporter Gene Defect
Authors: Jo Wakako , Ishizu Katsura , Fujieda Kenji , Tajima Toshihiro
Published: December 2009

Loss-of-function mutations of the PAX8 gene are considered to mainly cause congenital hypothyroidism (CH) due to thyroid hypoplasia. However, some patients with PAX8 mutation have demonstrated a normal-sized thyroid gland. Here we report a CH patient caused by a PAX8 mutation, which manifested as iodide transport defect (ITD). Hypothyroidism was detected by neonatal screening and L-thyroxine replacement was started immediately. Although I scintigraphy at 5 years of age showed that the thyroid gland was in the normal position and of small size, his iodide trapping was low. The ratio of the saliva/plasma radioactive iodide was low. He did not have goiter; however laboratory findings suggested that he had partial ITD. Gene analyses showed that the sodium/iodide symporter (NIS) gene was normal; instead, a mutation in the PAX8 gene causing R31H substitution was identified. The present report demonstrates that individuals with defective PAX8 can have partial ITD, and thus genetic analysis is useful for differential diagnosis.