bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey on the trends in uterine cervical cancer screening in Japanese women: The efficacy of free coupons in the screening
Authors: Kuroki Hiroko
Published: October 2011

Aims:  In Japan, cytological examination is performed for uterine cervical cancer screening, but the rate of participation in these programs is low. Between October 1, 2009 and March 31, 2010, free coupons for uterine cervical cancer screening were distributed to Japanese women. The Fukuoka Tuberculosis Prevention Center investigated the trends in uterine cervical cancer screening participation of Japanese women in the 6‐month screening program.

Material and Methods:  The subjects were 1523 women who underwent cervical smear cytology at the Fukuoka Tuberculosis Prevention Center between October 1, 2009 and March 31, 2010. A questionnaire survey based on multiple questions was performed to evaluate awareness about uterine cervical cancer screening for women undergoing screening by cervical smear cytology.

Results:  The results of the study showed that the rate of women undergoing repeated screening was high among women who underwent screening as part of health checkups that were paid for by the employer according to the recommendations of the Industrial Safety and Health Act. Women who had not undergone the screening previously were motivated to participate after receiving the free coupons.

Conclusions:  The distribution of free coupons serves as an initial step towards promoting awareness of preventive measures against uterine cervical cancer.
Implementing Carbon Tariffs: A Fool’s Errand?
Authors: Moore Michael O.
Published: October 2011

The absence of a global treaty on climate change abatement raises the chances that jurisdictions across the world will adopt substantially different approaches to greenhouse gas emissions. This further increases the possibility that some governments might consider taxes on imports based on carbon content from countries that have not introduced similarly restrictive climate change policies. Such border taxes certainly appeal to domestic industries facing higher charges for their own carbon emissions. This research demonstrates that there are enormous practical difficulties surrounding such plans. Various policies are evaluated based on the following constraints: adherence to World Trade Organisation compliance, administrative plausibility, help in meeting environmental goals and ability to deal with domestic pressures. The steel industry is used as a case study in this analysis. All considered policies arguably fail to meet at least one of these constraints, bringing into question the plausibility that a carbon border tax can be practical policy.
From Dichotomy to Divergence: Number/Gender Marking on Hebrew Nouns and Adjectives Across School Ages
Authors: Ravid Dorit , Schiff Rachel
Published: October 2011

This study investigates the development of plural adjective agreement in Hebrew, focusing on the consolidation of Hebrew number/gender morphology in children and adolescents across the school years in comparison with adults. A total of 240 Hebrew‐speaking participants in seven consecutive grade levels (kindergarten to sixth grade) plus a group of 30 adults were administered a set of 32 singular noun‐adjective noun phrases, which they had to pluralize. Head nouns were classified by noun gender (masculine and feminine), suffix type (regular and irregular), and stem type (nonchanging and changing). Children's ability to correctly pluralize nouns and adjectives increased markedly from kindergarten to adulthood, whereas reaction time to the correct plural phrase decreased concomitantly. Noun gender, stem, and suffix morphology impacted noun and adjective plural marking as well as reaction time. Results are discussed in view of the critical role of noun gender as a central organizing factor in the development of Hebrew plural marking.
The use of a new portable erosion measuring device for assessing the erodibility of the surface layers of flood embankments
Authors: Boorman L. A. , Hazelden J.
Published: October 2011

When a river overtops its flood banks, water running down the landward side of the bank can rapidly erode the soil surface and scour the bank, sometimes leading to breaches and collapse. A covering of living vegetation, particularly grass, can reduce this risk of water erosion. As part of a project to assess the effectiveness of different management regimes on bank vegetation cover, direct measurements were required of the erodibility of the soil surface. A portable erosion measurement device (EMD) was developed by LAB Coastal with the support of the Environment Agency. This could direct water flowing at known velocities across areas of the flood banks, and it was used to test directly the erosion resistance of vegetated grass banks at three sites. The EMD gave a direct measure of the erodibility of a small sample of flood bank. While measurements of soil strength and assessments of vegetation cover were useful, they did not always correctly characterize the stability of the bank surface as measured directly by the EMD. The EMD and its use are described and the results obtained are discussed. The results indicate that flood banks need to be mown at least once a year to make them less vulnerable to erosion.
Supply chain coordination for a deteriorating item with stock and price‐dependent demand under revenue sharing contract
Authors: Giri B.C. , Bardhan S.
Published: October 2011

This paper deals with an integrated single‐manufacturer single‐retailer supply chain model for a single item. The market demand is assumed to be dependent on both the on‐hand stock and price, and the manufacturer and the retailer are in an agreement of lot‐for‐lot policy. The proposed model is developed under the contract that the retailer offers the manufacturer a percentage of revenue (s)he generates by selling a lot. We determine optimal policies for both the centralized and decentralized coordination systems. A comparison of these policies is made with a numerical example. Sensitivity analysis is performed to examine the stability of the solution.
Variation and evolution of the complex life cycle in Adelgidae (Hemiptera)
Authors: SANO Masakazu , OZAKI Kenichi
Published: October 2011

The family Adelgidae is a small group of insects within Aphidoidea (Hemiptera). Adelgids are typically holocyclic with host‐alternation between the primary and secondary hosts, but some anholocyclic species persist either on the primary or secondary host. Like Aphididae, complexities and variation of adelgid life cycles are good models for understanding the evolution of complex life cycles. In this review, we outline the complex life cycles of adelgids, and current status and recent advances in adelgid life cycle studies. We also discuss the evolution of adelgid life cycles by comparing them to closely related aphid life cycles. A switch from holocycly to anholocycly on the primary host needs evolutionary innovations in gallicola behavior and reproduction. This radical evolution can be explained by mutations in a regulatory system that controls the sequence of gene sets producing phenotypes of one morph. In contrast, anholocycly on the secondary host consists of a series of exulis generations already existing in the holocycle. Thus, it may evolve by loss of primary‐host generations through extinction of the primary host, expansion beyond the geographical range of the primary host, or loss of male‐producing sexuparae that return to the primary host. Although the holocycle and its anholocyclic derivatives have been regarded as different species, morphological, ecological and genetic differences are too subtle to separate them into different species. The holocycle and its anholocyclic derivatives should not be split into different species without clearly identifiable morphological differences.
An Experimental Study of Newtonian and Non‐Newtonian Flow Dynamics in an Axial Blood Pump Model
Authors: Hu Qi‐Hui , Li Jing‐Yin , Zhang Ming‐Yuan , Zhu Xian‐Ran
Published: October 2011

The head curves of a 1.5:1 new axial blood pump model were measured using five working fluids at five rotational speeds. The working fluids were water, a 39 wt% aqueous glycerin solution (GS), and three aqueous xanthan gum solutions (XGSs) with different concentrations. The flow velocities and shear stresses in the mechanical clearance between the casing and rotor were investigated using a laser Doppler velocimeter and hot‐film sensor. At every rotational speed, the experiment in which viscous GS was used in the pump model showed a head curve lower than that obtained using water, whereas the head obtained using viscoelastic XGS was higher than that generated using water. A maximum difference of 65.8% between the heads measured in the 0.06% XGS and GS experiments was detected. The higher head produced by the XGS may have originated from the drag‐reduction effect of XGS viscoelasticity. The measurements showed that a reverse washout flow at a velocity of 0.05–0.11 m/s occurs in the clearance. This reverse washout flow is crucial to preventing flow stagnation and accompanying thrombus formation. The wall shear stress and the Taylor number of the rotating Couette‐like flow in the clearance both indicated that it is a turbulent flow.
Resisting Smoking When a Best Friend Smokes: Do Intrapersonal and Contextual Factors Matter?
Authors: Tucker Joan S. , Edelen Maria Orlando , Go Myung‐Hyun , Pollard Michael S. , Green Harold D. , Kennedy David P.
Published: October 2011

This longitudinal study examines individual differences in the tendency to initiate (N = 4,612) and escalate (N = 2,837) smoking when adolescents gain a best friend who smokes. Potential moderating factors include self‐esteem, depression, problem behavior, school and family bonds, and household access to cigarettes. In addition to acquiring a smoking best friend, initiation was predicted by trouble at school, household access, poorer grades and delinquency, whereas escalation was predicted by depressive symptoms. There was little evidence that the examined individual difference factors moderate the association between gaining a smoking best friend and increased adolescent smoking. Results point to the challenges of identifying factors that may lead adolescents to be more or less susceptible to the influence of pro‐smoking friends.
Technology Sharing in Manufacturing Business Groups
Authors: Sköld Martin , Karlsson Christer
Published: October 2011

Technology represents the primordial force for companies and organizations in securing long‐term competitiveness. In the intensive search to access new technology, organizations are more and more looking beyond the borders of the focal firm and becoming involved in various networks with suppliers, consultants, partners, and others. However, the distinction between the focal firm, on the one hand, and networks, on the other, is in this paper argued to be too extensive without intermediating nuances. Less focus is given to an in‐between perspective configured by business groups or concerns here defined as parent corporations with subsidiary companies. It is this perspective of business groups with characteristics between individual firms and open networks that is of interest in this paper. The focus is on manufacturing business groups in which the companies will typically have individual as well as common technologies.

The research aim is to develop a framework to be used as an analytical tool for understanding and organizing technology sharing in manufacturing business groups. The research approach was to study technology sharing in a natural setting combining multiple in‐depth sources of evidence in a clinical research setting. A prestudy identified key dimensions in classifying cases leading to four clusters of typified cases. Data were gathered from meetings with 24 managers from various research and development (R&D) units who met regularly every other week during seven months, in‐depth interviews, internal documents and protocols, and workshops. Following the clinical field‐study approach, findings are theoretically validated in relation to literature. The analysis identifies and depicts four different types of technology‐sharing scenarios in manufacturing business groups. Each type has particular characteristics of its own. The four scenarios together provide a synthesized portfolio with different types of dimensions. A first dimension makes a distinction between sharing new technology development versus existing technology. Another distinguishes between technologies aimed at the whole business group and those aimed at specific segments. The two dimensions together comprise four different types of technology‐sharing alternatives. Each one of them can be used at the focal firm, and together, they are applicable from a business group perspective comprising technology‐sharing portfolios of manufacturing business groups.
Developing a Third‐year Emergency Medicine Medical Student Curriculum: A Syllabus of Content
Authors: Tews Matthew C. , Wyte Collette Marie Ditz , Coltman Marion , Grekin Peter A. , Hiller Kathy , Oyama Leslie C. , Pandit Kiran , Manthey David E.
Published: October 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:S36–S40 © 2011 by the Society for Academic Emergency Medicine

Emergency medicine (EM) educators have published several curricular guides designed for medical student rotations and experiences. These guides primarily provided brief overviews of opportunities to incorporate EM into all 4 years of the medical student curriculum, with one specific to the fourth year. However, there are no published guidelines specific to third‐year medical students rotating in EM. Given the differences between third‐year and fourth‐year students in terms of clinical experience, knowledge, and skills, the Clerkship Directors in Emergency Medicine (CDEM) established the Third‐year EM Medical Student Curriculum Work Group to create a third‐year curriculum. The work group began this process by developing consensus‐based recommendations for the content of a third‐year medical student EM rotation, which are presented in this syllabus.
Academic Career Selection in American Emergency Medicine Residents
Authors: Burkhardt John , Kowalenko Terry , Meurer William
Published: October 2011

Academic Emergency Medicine 2011; 18:S48–S53 © 2011 by the Society for Academic Emergency Medicine

Background:  The future of academic emergency medicine (EM) is based on the continued successful recruitment and cultivation of new faculty from EM residents. Little data exist as to the current rate of residents initially choosing an academic career path or which residency programs are best situated to result in new faculty.

Objectives:  Our study was designed to initially describe the current career demographics of graduating residents and then through statistical analysis investigate likely programmatic factors that affect academic career selection.

Methods:  Data were collected via an online survey sent to EM residency program directors. Responders were asked to describe their graduates and their program characteristics over the past 5 years. A total of 103 survey responses, with complete data from 65 (76 responses contained enough data for national career selection rates), were received. Relevant covariates were tested for association with academic career entry using t‐tests or analysis of variance. An adjusted multivariable linear regression analysis model was then fitted.

Results:  Survey responses indicated that 26.1% of residents chose an academic career (community 57.1%, fellowship 13.5%, military/Veteran’s Administration [VA] 2.6%, other 0.6%) with an approximately normal distribution. There were no significant differences found between programs when presence of mentorship programs, career track programs, or city size were analyzed. Multivariable linear regression analysis demonstrated significantly greater academic career choice among programs located in the Northeast/Mid‐Atlantic and the Midwest, larger programs (>12 residents/year), and programs with increased resident academic productivity (presentations given, non–peer‐reviewed publications), but did not demonstrate a difference between 3‐ and 4‐year programs. Overall, the model fitted using the above variables accounted for approximately 30% of the variation seen between programs (adjusted R2 = 0.295).

Conclusions:  Our data indicate that program region, size, and research productivity were best associated with academic career selection. Program length was not found to be significantly associated with academic career selection by residents, in contrast to previous studies. While many of these factors are not changeable, academic productivity can be cultivated by decision‐makers wishing to increase their residents’ academic career selection as opposed to changing program length to extend training for an additional year. It is our belief that our model provides a good description of programmatic factors affecting career choice. Additional research is necessary to further validate these findings, as well to provide important context to their general applicability for policy‐makers and program directors.
Subgaleal hemorrhage: risk factors and outcomes
Authors: SWANSON AMY E. , VELDMAN ALEX , WALLACE EUAN M. , MALHOTRA ATUL
Published: October 2011

Subgaleal hemorrhage in the newborn is a serious adverse event that is often unrecognized and under‐appreciated. This retrospective case series aimed to determine perinatal factors associated with subgaleal hemorrhage and subsequent neonatal outcomes. Obstetric and neonatal details of 21 infants with subgaleal hemorrhage over a 10‐year period were collected. The mother was primiparous in 95% cases, 48% had a prolonged second stage (>120 minutes) and 43% had prolonged rupture of membranes (>12 hours). Thirteen infants (62%) were born by instrumental vaginal delivery. Ten infants (48%) required resuscitation at delivery. The severity of subgaleal hemorrhage was mild in four infants (19%), moderate in 10 (48%) and severe in seven (33%). Hypovolemic shock developed in 10 infants (48%), encephalopathy in 13 (62%) and coagulopathy was present in five infants (24%). There were three (14%) deaths. Long‐term outcomes were good in the surviving infants.
A cluster of factor XI‐deficient patients due to a new mutation (Ile 436 Lys) in northeastern Italy*
Authors: Girolami Antonio , Scarparo Pamela , Bonamigo Emanuela , Santarossa Liliana , Cristiani Andrea , Moro Stefano , Lombardi Anna Maria
Published: October 2011

A new mutation (Ile 436 Lys) was found in a cluster of patients in northeastern Italy. The mutation was present in five patients at the homozygote level and in one patient as a compound heterozygote with an already known mutation namely Glu 117 stop. All these patients showed a mild bleeding tendency mainly associated with deliveries or surgery. The first two patients were two sisters, and their parents were consanguineous. The third patient was the only homozygote in the family, and parents apparently were not consanguineous. The fourth and fifth patients were a brother and a sister, and in this case too, parents were not consanguineous. The sixth patient, a compound heterozygote, negated also the existence of consanguinity between his parents. There were also seven heterozygotes among the family members of the patients homozygous for this new mutation (Ile 436 Lys). Finally, there were two heterozygotes for the Glu 117 stop mutation in the family of the sixth patient. The heterozygotes, regardless of the mutation, were asymptomatic. The Ile436Lys mutation is characterized by low factor XI activity and antigen, namely is a cross‐reaction material negative form. Molecular modeling indicates that the Ile436Lys mutation causes a large conformational change within the 432–442 loop. No relation could be traced among the different families; however, all their ancestors were autochthonous of the same two small towns. Furthermore, no Jewish ancestry could be found. The close geographical area in which all these patients were found and the absence of the same mutation in the general population of the area strongly suggests a founder effect and that the mutation is responsible for the defect. The compound heterozygosis with the Glu 117 stop mutation, common among Jews, was not surprising because of the past strict ties of the Republic of Venice with the Middle East.
Evaluation of doctoral nursing programs by doctoral students in Japan: Cross‐sectional questionnaire survey
Authors: MIKI Yuko , GREGG Misuzu F. , ARIMOTO Azusa , NAGATA Satoko , MURASHIMA Sachiyo
Published: October 2011

Aim:  The purpose of this study was to examine the current state and issues of doctoral nursing programs from the perspective of recipients of the educational process.

Methods:  All 46 doctoral nursing programs in Japan in 2008 were asked to participate in this study and 28 programs agreed to participate. The questionnaire had 3 sections that evaluated the quality of doctoral education, which are 17 items on the program features, 12 items on the quality of faculty, and 9 items on resources.

Results:  The questionnaire was distributed to 304 graduate students and 127 students returned by mail. Most of the students agreed that the program goal and curriculum were consistent with the philosophy and mission of the university. The quality of the faculty and of the resources, such as library and computing facilities, were highly rated, while faculty mentorship and support staff for student research were viewed as areas for improvement. Only 30% of the students reported that a periodic assessment of the doctoral program was available in the university, and even when such an assessment did exist, students and graduates were not often involved in the program evaluation.

Conclusions:  To improve the quality of doctoral nursing education in Japan, there is an urgent need for faculty development and the provision of research support services for faculty and students including more technical and support staff. Furthermore, it is imperative to conduct periodic evaluation of doctoral nursing programs in Japan.
“Public” Interests and the Development of Tanzanian Environmental Policy
Authors: ELLIOTT‐TEAGUE GINGER
Published: October 2011

“Public interest” narratives are practical tools for policy makers to justify policy choices and methods of implementation. Few studies have been conducted on the narratives of the public interest in semidemocratic, less‐developed countries, however. In Western scholarship, the public interest has been conceptualized in three ways: as the common good, as the aggregation of public preferences, or as a deliberative process. This article examines how narratives of the public interest were used in the development of environmental policy in Tanzania over more than a decade. Looking at three stages of administrative policy making, the findings suggest that narratives differ according to the audience perceived to be most important to policy makers.

Las narrativas sobre el “interés público” son herramientas prácticas que los legisladores usan para justificar la elección de cierta política y su método de implementación. Sin embargo, se han realizado pocos estudios acerca de las narrativas de interés público en países semidemocráticos y menos desarrollados. En la literatura occidental, el interés público ha sido conceptualizado de tres formas: como el bien común, la agregación de las preferencias públicas, o como un proceso deliberativo. Este artículo examina cómo las narrativas del interés público fueron usadas para el desarrollo de la política ambiental en Tanzania durante más de una década. Observando tres etapas del proceso administrativo, los hallazgos sugieren que las narrativas difieren de acuerdo a la audiencia que los legisladores consideran como más importante.
Curcumin: a potential therapeutic polyphenol, prevents noradrenaline-induced hypertrophy in rat cardiac myocytes
Authors: Ahuja Suchit , Kohli Shrey , Krishnan Shruti , Dogra Deepika , Sharma Dinesh , Rani Vibha
Published: October 2011

Objectives

This study was designed to evaluate the effect of curcumin on H9c2 cardiac cell line and primary rat cardiac myocytes, using purified noradrenaline as a hypertrophy-inducing agent.

Methods

The concentration of curcumin at which cells were treated was determined by MTT (3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay. The effect of this safe dose in preventing noradrenaline-induced cardiac hypertrophy was assessed by biochemical analysis (estimating total protein content), molecular analysis (using RT-PCR to study the expression of fetal genes like ANF), immunological analysis (by determining the nuclear localization of GATA-4) and electrophoretic mobility shift assay (EMSA; to study DNA binding activity of GATA-4).

Key findings

Curcumin at a concentration of 8 µm was found to suppress the increase in cell size, protein content and enhanced marker gene expression (ANF) caused by noradrenaline. Immunocytochemistry and Western blot analysis showed that curcumin suppressed the localization of transcription factor GATA-4 in the nucleus. It also showed a reduced DNA-binding activity in the presence of noradrenaline as confirmed by EMSA.

Conclusions

These findings suggest that curcumin reduces the hypertrophic marker gene expression by inhibiting nuclear localization and DNA binding activity of GATA-4. Thus it has a great anti-hypertrophic potential.
Role of PPARg2 transcription factor in thiazolidinedione-induced insulin sensitization
Authors: Saraf Neha , Sharma Promod K , Mondal Sambhu C , Garg Vipin K , Singh Avnesh K
Published: October 2011

Objectives

Adipose tissue is the key regulator of energy balance, playing an active role in lipid storage and metabolism and may be a dynamic buffer to control fatty acid flux. Peroxisome proliferator-activated receptor gamma isoform-2 (PPARg2), an isoform of the nuclear hormone receptor superfamily, has been implicated in almost all aspects of human metabolic alterations such as obesity, insulin resistance, type-2 diabetes and dyslipidaemia. The PPARg2 isoform is highly present in adipose tissue where it functions as a thrifty phenotype, which promotes adipocyte differentiation and triglyceride storage. Thiazolidinediones, antidiabetic drugs, induce insulin sensitivity by controlling adipokines. The thiazolidinediones bind with PPARg2 in adipocytes and exert an agonist effect by enhancing adipogenesis and fatty acid uptake. Thiazolidinediones stimulate PPARg2, by which they down-regulate tumour necrosis factor-α, leptin, interleukin-6 and plasminogen and also enhance insulin sensitivity. The aim of this work is to define role of PPARg2 transcription factor in thiazolidinedione-induced insulin sensitization.

Key findings

The PPARg2 alters the transcription of the target gene. This altered gene transcription results in the up-regulation of insulin-sensitizing factors and down-regulation of insulin-resistant factors. The variant Pro12Ala of the PPARg2 gene is an important modulator in metabolic control in the body. Thiazolidinediones stimulate PPARg2 transcription factor by which PPARg2 binds to responsive elements located in the promoter regions of many genes and modulates their transcriptive activity. There is a strong mutual relationship between receptor binding and agonism, which is evidence of the insulin-sensitizing target of thiazolidinediones in PPARg2. This evidently increases the biological potency of the glucose-lowering effect of thiazolidinediones in vivo as well as their antidiabetic activity.

Conclusions

PPARg2 transcription factor plays an important role in treatment of type-2 diabetes with thiazolidindiones. The variant Pro12Ala of the PPARg2 gene promotes the activity of thiazolidinediones in minimizing insulin resistance. Transcriptional activity of Pro12Ala variant improves the activity of insulin. Thus thiazolidinediones promote the phosphorylation of PPARg2 to induce insulin sensitivity.
Direct and indirect measures of Level‐2 perspective‐taking in children and adults
Authors: Surtees Andrew D. R. , Butterfill Stephen A. , Apperly Ian A.
Published: October 2011

Studies with infants show divergence between performance on theory of mind tasks depending on whether direct or indirect measures are used. It has been suggested that direct measures assess a flexible but cognitively demanding ability to reason about the minds of others, whereas indirect measures assess distinct processes which afford more efficient but less flexible theory of mind abilities (Apperly & Butterfill, 2009). This leads to the prediction that performance on indirect measures should be subject to signature limits. The current study tested whether the Level‐1/Level‐2 distinction might constitute one such limit. The study adapted a task that has shown evidence of Level‐1 perspective‐taking on both direct and indirect measures (Samson, Apperly, Braithwaite, Andrews, & Bodley‐Scott, 2010). The aim was to test Level‐2 perspective‐taking in a sample of 6‐ to 11‐year‐olds (N = 80) and adults (N = 20). Participants were able to make Level‐2 judgements on the direct measure. In contrast with the findings from Level‐1 perspective‐taking, there was no evidence of automatic processing of Level‐2 perspectives on the indirect measure. This finding is consistent with the view that theory of mind abilities assessed by indirect measures are subject to signature limits. The Level‐1/Level‐2 distinction, suitably refined, marks one way in which efficient but inflexible theory of mind abilities are limited.
Tensile Stress Relaxation Behavior of Thermosetting Polyurethane Solid and Foams: Experiment and Model Prediction
Authors: Barua Bipul , Saha Mrinal C.
Published: October 2011

Stress relaxation behavior of thermosetting polyurethane (PU) solid and foams were investigated in tensile mode using a dynamic mechanical analyzer (DMA). PU solid samples were manufactured in a closed mold to avoid any foam formation, whilst PU foam samples were manufactured inside a woven using a silicone mold. Samples with rectangular cross-section were subjected to a predetermined amount of tensile strain and the tensile force was recorded as a function of time. Relaxation modulus was determined for different temperatures up to near the glass transition temperature. It was found that the viscous part becomes more dominant with increasing test temperature. Although the stress relaxation behavior of PU solid and foam were found similar at lower temperature, the relaxation behavior of the foam was influenced by the cellular structure especially at higher temperature due to the combination of gas expansion and cell wall softening. Different stress relaxation models such as Maxwell model, Burgers model, Generalized Maxwell (GM) model, and Stretched exponential model were employed to predict the relaxation behavior of PU solid and foams. It was found that the GM model (with three or more elements) and the Stretched exponential model were in good agreement with the experimental data in predicting the stress relaxation behavior of both solid and foams. The predicted relaxation time and equilibrium modulus were found to decrease with increase in temperature.
Low Mass Quality Flow Boiling in Microtubes at High Mass Fluxes
Authors: Rafet Özdemir Mehmed , Kaya Alihan , Koşar Ali
Published: October 2011

In this article, an experimental study on boiling heat transfer and fluid flow in microtubes at high mass fluxes is presented. De-ionized water flow was investigated over a broad range of mass flux (1000 kg/m2s–7500 kg/m2s) in microtubes with inner diameters of  ∼ 250 μm and ∼685 μm. The reason for using two different capillary diameters was to investigate the size effect on flow boiling. De-ionized water was used as working fluid, and the test section was heated by Joule heating. Heat transfer coefficients and qualities were deduced from local temperature measurements. It was found that high heat removal rates could be achieved at high flow rates under subcooled boiling conditions. It was also observed that heat transfer coefficients increased with mass flux, whereas they decreased with local quality and heat flux. Moreover, experimental heat flux data were compared with partial boiling correlations and fully developed boiling correlations. It was observed that at low wall superheat values, there was only a small inconsistency between the experimental data and the conventional partial boiling prediction method of Bergles, while the subcooled and low quality fully developed boiling heat transfer correlation of Kandlikar could fairly predict experimental results at high wall superheat values.
Technical Note: Further development of a resolution modification routine for the simulation of the modulation transfer function of digital x‐ray detectors
Authors: Konstantinidis Anastasios C. , Olivo Alessandro , Speller Robert D.
Published: October 2011

Purpose:

This paper proposes the further development of a resolution modification routine which is used to simulate the presampling modulation transfer function (pMTF) of digital x‐ray detectors.

Methods:

It suggests a method to reconstruct anisotropic two dimensional (2D) pMTF matrices from the experimentally measured horizontal and vertical 1D pMTFs. In this study, the horizontal dimension of the detector is 17.3 cm, while the vertical one is 24 cm. This matrix is multiplied with the 2D Fourier transform of the super‐sampled ideal input image to simulate blurring. Then, the restored image is sampled to form the pixels of the digital image. The authors suggest convolution with the comb function instead of the rectangular function to avoid the correction with the sinc function required by the latter. It is demonstrated that this correction is avoided when the comb function is used. Moreover, this study suggests a way to effectively sample the images in the case when the ratio between the “analog” pitch of the super‐sampled input image and the pixel pitch of the digital x‐ray detector is a semi‐integer.

Results:

The validation of the simulation algorithm demonstrated that when the comb function was used the average absolute difference between the pMTF measured from the output images and the input ones was less than 1%, while this was of 13% when the rectangular function was used. When a sinc correction was applied in the latter case the difference decreased again to less than 1%.

Conclusions:

The developed modification routine provides the means to simulate the spatial resolution of digital x‐ray detectors under a wider range of conditions.
A2 Identifying barriers and facilitators to improving prehospital care of asthma: views of ambulance clinicians
Authors: Shaw D , Knowles S , Siriwardena A N
Published: October 2011

Background

In 2008/2009 there were nearly 80 000 emergency hospital admissions for asthma. Current UK guidelines emphasise the importance of evidence-based prehospital assessment and treatment of asthma for improving patient outcomes and reducing hospitalisation, morbidity and mortality. National benchmarking of ambulance clinical performance indicators for asthma have revealed important unexplained variations in care across ambulance services. Little research has been undertaken to understand the reasons for poor levels of care.

Objective

The aim of this study was to gather data on ambulance clinicians' perceptions and beliefs around prevailing and best practice for management of asthma. This was used to identify the factors which prevent or enable better asthma care in ambulance services.

Methods

We used a phenomenological qualitative approach, which addresses how individuals use their experiences to make sense of their world, focusing on participants' lived experiences of care delivery for asthma. We used focus groups of ambulance clinicians to gather data on barriers and facilitators to better asthma care. Recordings and notes were taken, transcribed and then analysed using QSR NVivo 8. A coding framework was developed based on a priori concepts but with emergent themes added during the analysis.

Results

Two focus groups were conducted with eight and five participants respectively. A number of preliminary themes and subthemes were identified. The study identified issues relating to clarity of ambulance guidelines, conflicts between training and guidance, misconceptions about the importance of objective assessment and over reliance on non-objective assessment. Some practitioners believed that hospital staff were not interested in prehospital peak flow assessments.

Conclusion

Our findings will inform improved systems of care for asthma and the effect on indicators will be measured using time series methods. This approach could be used more widely to improve management of specific clinical conditions where quality of care is demonstrated to be suboptimal.
A10 Those in peril on the sea: the maritime work of the UK military SAR
Authors: Dykes L , Thomas M , Hird J
Published: October 2011

Background

At any time, thousands of people are at sea around the UK. We wished to ascertain the nature of maritime emergencies attended by UK military (Royal Air Force/Royal Navy) SAR helicopters.

Methods

All UK military SAR “medrescues” 1 January 2009–13 March 2010 were entered onto a database. Clinical scenarios were extracted from winchmen's reports. Acuity was estimated using the Manchester Triage Score.

Results

Of 907 SAR medrescues during the 15.5-month audit period, 172 (19%) were maritime.

Mean age of casualty 44 years (range 16–87); 90% male.

Of 130 reports with vessel type noted, 28% of casualties were from fishing boats, 20% military ships; 12% dive boats, 11% passenger ferries/cruise ships and 10% oil rigs. The remainder were on boats ranging from small pleasure craft to oil tankers, plus one surfer.

The aircraft was able to land on the vessel in 13% of the 168 jobs where this information was recorded, mainly oil-rigs and military ships. The remaining 87% were winched aboard the aircraft.

7% of cases were diving-related emergencies; 53% medical/surgical and 40% trauma (including drowning/near-drowning).

151/172 cases had sufficient information to enable estimation of Manchester Triage category: 66/151 (44%) were category 1 or 2 and 77/151 (51%) category 3. Only 8/151 (5%) were category 4. None were category 5.

Conclusion

Medical emergencies at sea are surprisingly diverse, with a wide variety of major and minor injuries & illnesses. This series ranges from diving emergencies, major trauma, an elderly cruise ship passenger with a ruptured AAA, and obstetric emergencies. Our data are retrospective and the MTS is not designed for prehospital use, but most maritime cases attended by RAF/RN SAR helicopters appear to be genuinely urgent. Lives would be at risk without the service, which features both winching capability & a technician or HPC-registered paramedic on board.
A12 Patient priorities and decision-making about using 999 EMS? A review of the literature
Authors: Coleman P , Turner J
Published: October 2011

Background

Against a background of increasing demands for emergency ambulances in the UK, there are ongoing concerns about the proportion of users (between 30% and 52%) who are transported to EDs inappropriately or unnecessarily. Less attention has been paid to understanding the factors that influence patients' decisions to use, delay, or not to use an emergency ambulance.

Aims and Objectives

To summarise what is known about patient priorities and decision-making around 999 EMS use, we carried out a rapid review of the literature.

Methods

We initiated searches of MEDLINE from 1996 to the present using a series of MESH terms linking patient self-reports of utilisation of health care AND emergency ambulance. The strategy yielded 84 potential items. To identify recent papers, we limited publications to prospective surveys of user views published after 1999. Eleven papers were reviewed. Two of these were from the UK.

Results

The papers divided into two broad categories: (1) users who delayed contacting an emergency ambulance in medical emergencies, and (2) users whose presenting condition did not require an emergency transportation to an ED. Patients struggled to distinguish the symptoms of a serious medical emergency from a less serious need. Underestimating the progression of symptoms, guilt or potential embarrassment around requesting an ambulance was associated with inappropriate delayed contact or non-use. Other recurring themes associated with use and non-use were: someone else making or sharing the decision, gender, pain, coping strategies, ease of access to other transport and resources, previous experience of the health problem or ambulance use.

Conclusions

Further patient-centred research is required in the UK to increase understanding of the important factors that influence decisions about whether to use an emergency ambulance or not.
A13 The SAR side: the medical work of UK military search & rescue
Authors: Thomas M , Hird J , Dykes L
Published: October 2011

Introduction

Sea King SAR helicopters are a familiar sight to UK mountain users, mariners and fans of TV's “Highland Emergency”! However, their medical activity is not routinely analysed. We wished to assess the nature of cases attended and the equipment/drugs/skills utilised by SAR winchmen, to ensure the applicability of winchman training programmes.

Method

Following every military SAR call-out (RAF/Royal Navy) a formal report is sent to SAR Force Headquarters. These reports for incidents 1 January 2009–31 December 2009 were scrutinised and data extracted.

Results

There were 767 jobs involving medical activity in the 1-year period (plus 31 body recoveries).

Age 6 months–98 years (mean 43, median 42); 71% male

Trauma 57%, Medical 42%, Chemical 1%: some had combined problems.

169/798 (21%) were jointly managed with other agencies (eg, ambulance; Mountain Rescue; Maritime & Coastguard Agency; RNLI)

19% of jobs were at sea; 13% involved >1 casualty

During the 1-year period, winchmen performed 5 needle thoracocenteses, 15 intubations, 181 cannulations, and applied 105 limb splints and 9 pelvic splints.

63/767 (8%) were given IV fluids; 92 (12%) received morphine.

Winchmen cared for 30 casualties given drugs by other providers including midazolam, intranasal diamorphine, pethidine and ketamine.

59 casualties had a documented GCS of 8 or less including 44 in cardiac arrest.

Of the 470 trauma cases (25% of which had fallen from height), 41% had lower limb injuries, 28% possible neck/spinal/back injury, 26% head/facial injuries and 8.5% chest injuries. Of the medical problems, 17% had chest pain, 15% neurological/vascular, 10% abdominal problems, 4% O&G and 4% “medical paeds”.

Conclusion

RAF/RN winchmen deal with a wide variety of cases, of all ages. Considering that, typically, 70% of the 70 winchmen at any time are qualified paramedics (the remainder are technician-level) advanced skills are used moderately frequently.
A15 A case study framework for design and evaluation of a national project to improve prehospital care of myocardial infarction and stroke
Authors: Essam N , Davy Z , Shaw D , Spaight A , Siriwardena A N
Published: October 2011

Background

Cardiovascular disease (CVD) affects 1.8% of the population annually, 0.9% with stroke and 0.8% with coronary heart disease. People suffering from CVD often present acutely to ambulance services with symptoms of acute myocardial infarction or stroke. Early and effective treatment prevents death, improves long term health and reduces future disability.

Objective

Our aim is to develop a rational approach for informing the design and evaluation of a national project for improving prehospital care of myocardial infarction and stroke: the Ambulance Services Cardiovascular Quality Initiative (ASCQI), the first national improvement project for prehospital care.

Methods

We will use a case study methodology initially utilising an evaluation logic model to define inputs (in terms of resources for planning, implementation and evaluation), outputs (in terms of intended changes in healthcare processes) and longer-term outcomes (in terms of health and wider benefits or harms), whether intended or incidental and in the short, medium or long term.

Results

We will present an evaluation logic model for the project. This will be expanded to show the analytical techniques which we will use to explain how and why the project achieves its outcomes. This includes times series analyses, pattern matching, cross case syntheses and explanation building to inform an explanatory logic model. We will discuss how this model will be useful in determining the data that will need to be collected during the course of the project to inform the detailed explanation of how and why the project delivered its outcomes.

Conclusion

The case study approach will enable us to evaluate the impact of this collaborative project in constituent ambulance services as well as the initiative as a whole. It will enable us to show whether and to what extent the project has had an impact, but also how and why this has happened.
A2 The potential and pitfalls of anonymised data linkage for follow-up of patient outcomes in prehospital emergency care research
Authors: Sánchez A , Snooks H , Cheung I , Williams C , Jones K
Published: October 2011

Background

Due to the nature of collection, storage and retrieval of data in emergency prehospital care, following up patient outcomes can be challenging. Data are often of poor quality, data structures within which they are housed complex and difficult to interrogate, and outcome data can be owned by various providers of care. Issues of ethics, consent and research/information governance further complicate matters. The Secure Anonymised Information Linkage (SAIL) databank is currently pioneering a system that collects routine social and heath records from numerous providers and assembles them within one structure that allows patient data to be stored, linked, accessed and analysed for research purposes without the need for individual (identifiable) personal data.

Methods

This system was tested within a cluster Randomised Controlled Trial (RCT) in prehospital emergency care. The Support and Assessment for Fall Emergency Referrals 1 (SAFER 1) trial, is designed to evaluate the use of computerised clinical decision support software to assist paramedics to assess and decide care for older people who have fallen, for whom an ambulance has been called. Primary and secondary outcomes utilise follow-up measures from the ambulance service; hospital trusts (A&E and inpatients) and from the ONS (deaths). Eligible patients are identified from ambulance dispatch and on-scene clinical records and are then tracked anonymously via SAIL to follow-up these outcomes.

Results

The initial matching rate was high at 89% (66/74). Details of unmatched patients were returned for further checking and, where possible, supplementation with identifiers. Results of second stage matching are currently pending.

Conclusions

The unmatched cases are a result of poor quality of dispatch/on-scene data. Lengthy information governance processes within SAIL and a time lag until data are available have meant that follow-up data have not yet been provided. Risk of non-provision within the study period is now being assessed by the study and SAIL teams. Anonymised data linkage offers an attractive alternative to lengthy processes of consent and follow-up of identifiable outcomes across NHS providers. On the question of whether it works within the constraints of an externally funded RCT—the jury is still out.