bluuebunny/crossref_metadata_2025 huggingface dataset:
Low‐dose transdermal buprenorphine – long‐term use and co‐medication with other potentially addictive drugs
Authors: NORDBØ A. , SKURTVEIT S. , BORCHGREVINK P. C. , KAASA S. , FREDHEIM O. M.
Published: October 2011

Introduction

Recently, low‐dose transdermal buprenorphine (LD‐TD‐BUP) was introduced for treatment of patients with chronic non‐malignant pain. The primary aim of this study was to determine the proportion of patients who were prescribed LD‐TD‐BUP for non‐malignant pain who became long‐term users. The secondary aim was to determine the proportion of patients who co‐medicated with other opioids or benzodiazepines during treatment with LD‐TD‐BUP.

Methods

Data were drawn from the Norwegian Prescription Database that covers all prescriptions dispensed at pharmacies to the entire Norwegian population (4.7 million inhabitants). The study population consisted of all patients who were dispensed at least one prescription of LD‐TD‐BUP from its introduction in November 2005 to 31 December 2008. Patients who were dispensed more than 24 patches (≥ 6 months) were defined as long‐term users. Reimbursement codes were used to stratify patients as having cancer pain or non‐malignant pain.

Results

Among new users of LD‐TD‐BUP for non‐malignant pain (n = 13,451), only 22% became long‐term users, while 44% were only dispensed one prescription. Among long‐term users who were opioid naive when LD‐TD‐BUP was initiated, 43% co‐medicated with other opioids or benzodiazepines, compared with 82% of those who previously had used opioids.

Conclusion

Three years after introduction, 0.4% of the Norwegian population had been dispensed LD‐TD‐BUP. Only one‐fifth had become long‐term users. Those who used opioids before the first dispension of LD‐TD‐BUP co‐medicated with other potentially addictive drugs to a much higher degree compared with those who were opioid naive.
Forces applied to the maxillary incisors by video laryngoscopes and the Macintosh laryngoscope
Authors: LEE R. A. , VAN ZUNDERT A. A. J. , MAASSEN R. L. J. G. , WIERINGA P. A.
Published: October 2011

Background

Modern video laryngoscopes (VLSs) provide a superior view of the glottis, facilitating easier intubations. This study evaluates the forces applied to the maxillary incisors when using various VLSs and a Macintosh blade.

Methods

Fifty consecutive surgery patients were randomly assigned to receive laryngoscopy from a pair of four blades investigated in the study – the VLS GlideScope® (Verathon Inc., Bothell, WA, USA), V‐Mac™ Storz® (Karl Storz, Tuttlingen, Germany), and McGrath™ (Aircraft Medical, Edinburgh, United Kingdom); and the classic Macintosh blade also from Storz® (Karl Storz). An endotracheal tube (ETT) was brought into position anterior to the vocal cords, with actual intubation carried out only with the second of the laryngoscopes. Sensors measured the forces directly applied to the patient's maxillary incisors while inserting the ETT. Other common metrics of intubation difficulty (e.g. Mallampati grade, Cormack–Lehane grade, and time) were also recorded.

Results

Only one patient was not intubated within the standard study parameters and was converted to the hospital protocols for difficult intubations. The forces applied to the maxillary incisors were significantly greater with the Macintosh blade compared with all VLSs. There were no differences between the VLSs with regard to the forces. Patient characteristics, including Mallampati grade, were not predictive of the forces applied.

Conclusions

All VLSs considered were safer for the patient than was the Macintosh blade in terms of the forces applied to the maxillary teeth, time, number of insertion attempts, and view achieved of the glottic arch. There is a small, but significant, difference in the time and number of insertion attempts required during laryngoscopy with the different VLSs. There was no difference in the forces applied. The geometry of the respective blades may be an important component in the ease of laryngoscopy.
Gestational diabetes mellitus: A risk factor for non‐elective cesarean section
Authors: Gorgal Rosário , Gonçalves Elisabete , Barros Mónica , Namora Gabriela , Magalhães Ângela , Rodrigues Teresa , Montenegro Nuno
Published: October 2011

Aim:  To assess whether gestational diabetes mellitus (GDM) is associated with non‐elective cesarean section.

Material and Methods:  A retrospective cohort study was conducted at the Department of Obstetrics of a level III hospital. Between January 2004 and November 2007, women admitted in labor or with spontaneous rupture of membranes, at term, and with a singleton cephalic presenting fetus were eligible. From these, 220 women with GDM and 660 glucose‐tolerant women, delivered immediately after, were selected. The association between GDM and non‐elective cesarean was estimated using modified Poisson regression analysis. Relative risks were adjusted for age, pre‐pregnancy body mass index, gestational weight gain, previous cesarean, gestational age at delivery and birthweight.

Results:  Non‐elective cesarean section rate for women with GDM was 19.5% compared to 13.5% for non‐diabetic women. The crude relative risk of cesarean section was 1.45 (95% CI 1.04–2.02) for women with GDM. After adjustment for confounders, the association between GDM and non‐elective cesarean section remained positive and statistically significant (RR = 1.52; 95% CI 1.06–2.16). No significant differences in cesarean indications were found between the two groups.

Conclusion:  GDM was disclosed as a risk factor for non‐elective cesarean section. Knowledge of the condition may have influenced obstetrical practice, favoring cesarean delivery.
Characteristics of patients with subchorionic hematomas in the second trimester
Authors: Yamada Tetsuo , Atsuki Yusuke , Wakasaya Atsushi , Kobayashi Mami , Hirano Yuki , Ohwada Michitaka
Published: October 2011

Aim:  The aim of this study was to investigate the etiological characteristics of patients diagnosed with subchorionic hematoma.

Methods:  A case‐controlled study was performed to compare characteristics of patients and controls. Via ultrasound examination, 47 pregnant patients were found to have subchorionic hematomas and 1075 had no evidence of subchorionic hematomas (controls). In the second trimester, patients were compared with regard to endocervical Chlamydia trachomatis and other vaginal microorganisms.

Results:  The overall incidence of subchorionic hematomas in this pregnant population was 4.2%. Maternal clinical characteristics did not differ between cases and controls. Evaluation of the vaginal flora revealed that the positive rates of coagulase‐negative staphylococci (cases: 12.8%; controls: 4.1%; P < 0.01) and Gardnerella vaginalis (cases: 12.8%; controls: 2.5%; P < 0.001) in the cases were significantly higher than those of the controls. The negative rate of Lactobacillus in the cases was significantly higher than that of the controls (cases: 42.6%; controls: 27.6%; P < 0.05).

Conclusion:  Pregnant women with subchorionic hematoma in the first trimester showed changes in vaginal flora in the second trimester, which suggests a possible association with subchorionic hematoma and vaginal flora change.
Cervical length predicts placental adherence and massive hemorrhage in placenta previa
Authors: Fukushima Kotaro , Fujiwara Arisa , Anami Ai , Fujita Yasuyuki , Yumoto Yasuo , Sakai Atsuhiko , Morokuma Seiichi , Wake Norio
Published: October 2011

Aim:  To evaluate the relationship between cervical length (CL) and obstetrical outcome in women with placenta previa.

Material and Methods:  Eighty uncomplicated, singleton pregnancies with an antenatally diagnosed previa were categorized based on CL of over 30 mm (n = 60) or 30 mm or less (n = 20). A retrospective chart review was then performed for these cases to investigate the relationship between CL and maternal adverse outcomes.

Results:  The mean CL was 38.5 ± 5.4 mm and 26.9 ± 3.2 mm and the mean gestational age at measurement was 29.2 ± 2.7 and 28.5 ± 2.7 weeks of gestation for the longer and shorter CL groups, respectively. The median estimated blood loss at cesarean section (CS) was significantly higher in the shorter CL group (1302 mL vs 2139 mL, P = 0.023) as was the percentage of patients with massive intraoperative hemorrhage (60.0 vs 18.3%, P = 0.001). In the shorter versus longer CL patients, emergent CS before 37 weeks (23.3 vs 50.0%, P = 0.046) and the percentage of patients with placental adherence (6.7 vs 35.0%, P = 0.004) were both significantly more frequent in the shorter CL group. The shorter CL was a risk factor both for massive estimated blood loss (≥2000 mL) (odds ratio 6.34, 95% confidence interval 1.91–21.02, P ≤ 0.01) and placental adherence (odds ratio 6.26, 95% confidence interval 1.23–31.87, P ≤ 0.05) in the multivariate analysis.

Conclusion:  CL should be included in the assessment of a placenta previa given its relationship to emergent CS, cesarean hysterectomy, intraoperative blood loss and placental adherence.
Combined perianal‐intrarectal (PI) lidocaine‐prilocaine (LP) cream and lidocaine‐ketorolac gel provide better pain relief than combined PI LP cream and periprostatic nerve block during transrectal prostate biopsy
Authors: Cormio Luigi , Pagliarulo Vincenzo , Lorusso Fabrizio , Selvaggio Oscar , Perrone Antonia , Sanguedolce Francesca , Bufo Pantaleo , Carrieri Giuseppe
Published: October 2011

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

Study Type – Harm Reduction RCT

Level of Evidence 1b

The combination of perianal‐intrarectal lidocaine‐prilocaine cream and periprostatic nerve block effectively counteracts probe and sampling related pain during transrectal prostate biopsy, but not pain due to periprostatic infiltration.

The novel combination of lidocaine‐prilocaine cream and lidocaine‐ketorolac gel, both administered perianal‐intrarectally, provides the same probe and sampling‐related pain relief than combined perianal‐intrarectal lidocaine‐prilocaine cream and periprostatic nerve block and prevents the non‐negligable pain due to periprostatic infiltration, thus leading to better overall patients' compliance to the procedure.

OBJECTIVE

To compare the efficacy and safety of combined perianal‐intrarectal (PI) lidocaine‐prilocaine (LP) cream and lidocaine‐ketorolac (LK) gel with combined PI LP cream and periprostatic nerve block (PPNB) in relieving pain during transrectal ultrasonography guided prostate biopsy (TPB).

PATIENTS AND METHODS

In all, 200 patients were randomized to receive combined PI LP cream and LK gel (group 1) or combined PI LP cream and PPNB (group 2) before TPB.

The 0–10‐point visual analogue scale (VAS) was used for assessing pain at probe insertion and movements (VAS‐1), periprostatic infiltration (VAS‐2) when applied, and prostate sampling (VAS‐3), as well as maximal procedural pain (MPP).

Complications occurring ≤20 days after the TPB were recorded.

RESULTS

The groups were comparable for patients' age, serum PSA level, prostate volume, and cancer detection rate.

All patients tolerated the procedure well. The two anaesthetic regimens provided almost equal mean VAS‐1 (0.33 vs 0.37; P= 0.701) and VAS‐3 (0.52 vs 0.51; P= 0.954) scores, but patients in group 2 reported significantly greater MPP scores (0.68 vs 1.53; P < 0.001) as periprostatic infiltration was the most painful part of the procedure (mean VAS‐2: 1.33).

Complications rate was similar in the two groups (1% vs 2%; P= 0.38).

CONCLUSIONS

The novel combination of PI LP cream and LK gel provided the same probe‐ and sampling‐ related pain relief as combined PI LP and PPNB; moreover, by preventing the non‐negligible periprostatic infiltration pain, it provided significantly better overall patients' compliance to the procedure.

Being safe and easy to administer, this novel non‐infiltrative regimen has the potential to replace infiltrative anaesthesia in relieving pain during TPB.
TRADE AND ECONOMIC GEOGRAPHY: THE IMPACT OF EEC ACCESSION ON THE UK*
Authors: OVERMAN HENRY G. , WINTERS L. ALAN
Published: October 2011

We combine establishment‐level employment data with trade data by port to examine the impact of accession to the European Economic Community on the spatial distribution of UK manufacturing. We test the predictions from economic geography models of how external trade affects the spatial distribution of employment. We treat accession as a natural experiment which helps mitigate problems of endogeneity. Our results suggest that accession changed the country composition of trade and via the port composition induced an exogenous shock to different locations. In line with theory, we find that better access to export markets and intermediate goods increase employment while increased import competition decreases employment.
Risk of multiple primary cancers following melanoma and non‐melanoma skin cancer
Authors: Stracci F. , Fabrizi V. , D’Alò D. , La Rosa F. , Papini M.
Published: October 2011

Background  The relationship between cutaneous malignancies and successive primary cancers has been studied since several years, but it still remains controversial.

Objective  The aim of this study was to evaluate the excess risk of multiple primary cancer among the population of Umbria, Italy, that survived a skin cancer.

Methods  The data registered in the Umbrian Population Cancer Registry from 1994 to 2006 were collected, recorded, and analysed in accordance to the standard methods recommended for cancer registries. Among skin cancer patients, those with multiple cutaneous and non‐cutaneous cancers were selected. Only sites with a frequency of more than five cases were considered. The expected number of cases was obtained from indirect standardization with regional incidence rates in several sites that incurred in the overall period. The significance of the observed/expected ratios and the corresponding 95% CI were based on the Poisson distribution.

Results  In men, a significant standardized incidence ratio (SIR) was found for melanoma (2.21), non‐melanoma skin cancers (1.86), Hodgkin’s (4.95) and non‐Hodgkin lymphoma (1.82), and tongue/mouth cancer (2.47). In women, melanoma, non‐melanoma skin and breast cancer showed a significant high SIRs (4.13, 1.55 and 1.28 respectively). All other cancers showed a non‐significant SIR. Considering all sites combined and all sites except skin cancers, the analysis showed a significant excess in men, whereas a significant risk was observed in women only when also skin cancers were considered.

Conclusions  Data from the whole of Umbrian population revealed that skin cancer patients experience marked excess risk of further primary cancers. The main risk in both genders is skin melanoma and other skin cancers. The excess of lymphomas and tongue/mouth cancers is also significant in men, and breast cancer in women. These observations prompt us to include a screening for these cancers in the follow‐up of our patients surviving a skin malignancy.
Safety and streamlining of woody shoots in wind: an empirical study across 39 species in tropical Australia
Authors: Butler Don W. , Gleason Sean M. , Davidson Ian , Onoda Yusuke , Westoby Mark
Published: October 2011

See also the Commentary by Anten and Sterck
Prevalence, frequency and problem rating of hot flushes persist in older postmenopausal women: impact of age, body mass index, hysterectomy, hormone therapy use, lifestyle and mood in a cross‐sectional cohort study of 10 418 British women aged 54–65
Authors: Hunter MS , Gentry‐Maharaj A , Ryan A , Burnell M , Lanceley A , Fraser L , Jacobs I , Menon U
Published: October 2011

Please cite this paper as: Hunter M, Gentry‐Maharaj A, Ryan A, Burnell M, Lanceley A, Fraser L, Jacobs I, Menon U. Prevalence, frequency and problem rating of hot flushes persist in older postmenopausal women: impact of age, body mass index, hysterectomy, hormone therapy use, lifestyle and mood in a cross‐sectional cohort study of 10 418 British women aged 54–65. BJOG 2012;119:40–50.

Objective  Hot flushes and night sweats (HFs/NSs) are the main menopausal symptoms, but few studies have been adequately powered to examine the dimensions or predictors of experiencing HFs/NSs. We report on these variables in a large UK cohort of postmenopausal women.

Design  Cross‐sectional cohort study.

Setting  UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) cohort.

Population  A cohort of 202 638 postmenopausal women, aged 50–74 years, without oophorectomy, recruited to UKCTOCS between 2001 and 2005.

Methods  Women completed a follow‐up questionnaire, and those aged 54–65 years were mailed a survey in July 2008.

Main outcome measures  Hot flush prevalence and hot flush rating scale.

Results  Of the 15 000 women mailed, 10 418 returned completed questionnaires; 90% had previously had HFs/NSs. Despite being on average 10 years postmenopausal, 54% experienced HFs/NSs (frequency of 33 per week with mean problem rating 4/10) that persisted across the age range. Past hysterectomy (OR 1.50, 95% CI 1.19–1.86), ever having smoked (OR 1.27, 95% CI 1.11–1.46) and alcohol consumption (current units) (OR 1.05, 95% CI 1.01–1.09) predicted ever having had HFs/NSs. Anxiety (OR 3.09, 95% CI 2.57–3.72), hysterectomy (OR 2.74, 95% CI 2.32–3.25), depressed mood (OR 1.57, 95% CI 1.24–1.99), years since last menstrual period (OR 0.95, 95% CI 0.94–0.96) and education (above and below 18 years) (OR 0.98, 95% CI 0.97–0.99) predicted the current prevalence of HFs/NSs. Few predictors of frequency were identified, but problem rating was associated with depressed mood, hysterectomy, skirt size increase and frequency of HFs/NSs. Past hormone therapy users who had discontinued treatment were more likely to have HFs/NSs that were more frequent and problematic.

Conclusions  To date, this is the largest UK study of the experience of HFs/NSs amongst older postmenopausal women. HFs/NSs are more prevalent in this age band than has previously been assumed. These findings and the associations of smoking, hysterectomy, anxiety, depressed mood and hormone therapy use with the experience of HFs/NSs have implications for prevention and symptom management.
Reconstructing range dynamics and range fragmentation of European bison for the last 8000 years
Authors: Kuemmerle Tobias , Hickler Thomas , Olofsson Jörgen , Schurgers Guy , Radeloff Volker C.
Published: October 2011

Aim  Understanding what constituted species’ ranges prior to large‐scale human influence, and how past climate and land use change have affected range dynamics, provides conservation planners with important insights into how species may respond to future environmental change. Our aim here was to reconstruct the Holocene range of European bison (Bison bonasus) by combining a time‐calibrated species distribution models (SDM) with a dynamic vegetation model.

Location  Europe.

Method  We used European bison occurrences from the Holocene in a maximum entropy model to assess bison range dynamics during the last 8000 years. As predictors, we used bioclimatic variables and vegetation reconstructions from the generalized dynamic vegetation model LPJ‐GUESS. We compared our range maps with maps of farmland and human population expansion to identify the main species range constraints.

Results  The Holocene distribution of European bison was mainly determined by vegetation patterns, with bison thriving in both broadleaved and coniferous forests, as well as by mean winter temperature. The heartland of European bison was in Central and Eastern Europe, whereas suitable habitat in Western Europe was scarce. While environmentally suitable regions were overall stable, the expansion of settlements and farming severely diminished available habitat.

Main conclusions  European bison habitat preferences may be wider than previously assumed, and our results suggest that the species had a more eastern and northern distribution than previously reported. Vegetation and climate transformation during the Holocene did not affect the bison’s range substantially. Conversely, human population growth and the spread of farming resulted in drastic bison habitat loss and fragmentation, likely reaching a tipping point during the last 1000 years. Combining SDM and dynamic vegetation models can improve range reconstructions and projections, and thus help to identify resilient conservation strategies for endangered species.
Inhalation of LPS induces inflammatory airway responses mimicking characteristics of chronic obstructive pulmonary disease
Authors: Korsgren Magnus , Linden Margareta , Entwistle Neil , Cook Jason , Wollmer Per , Andersson Morgan , Larsson Bengt , Greiff Lennart
Published: October 2011

Aim:  Inhalation of lipopolysaccharide (LPS) produces both systemic and pulmonary inflammatory responses. The aim of this study was to further characterize the response to LPS in order to develop a human model suitable for early testing of drug candidates developed for the treatment for chronic obstructive pulmonary disease (COPD).

Materials:  Blood and induced sputum were obtained 4, 24 and 48 h following inhalation of saline and LPS (5 and 50 μg). Blood was analysed for C‐reactive protein (CRP), α1‐antitrypsin and neutrophils/leucocytes, and sputum was analysed for biomarkers of neutrophil inflammation and remodelling activities, i.e. neutrophil elastase (NE) protein/activity and α1‐antitrypsin. Levels of tumour necrosis factor‐α (TNFα) were measured in both blood and sputum. Urine was collected 0–24 and 24–48 h postchallenge, and desmosine, a biomarker of elastin degradation, was measured.

Results:  Lipopolysaccharide inhalation induced dose‐dependent flu‐like symptoms and increases in plasma CRP and α1‐antitrypsin as well as increases in blood neutrophil/leucocyte numbers. Furthermore, LPS produced increases in sputum TNFα and sputum NE activity. Urine levels of desmosine were unaffected by the LPS challenge. All subjects recovered 48 h postchallenge, and indices of inflammatory activity were significantly lower at this observation point cf 24 h postchallenge.

Conclusion:  Inhalation of LPS in healthy volunteers can be used as a safe and stable model of neutrophil inflammation. Blood/plasma and sputum indices can be employed to monitor the response to LPS. We suggest that this model may be used for initial human studies of novel COPD‐active drugs.
Dependence regulation in newlywed couples: A prospective examination
Authors: DERRICK JAYE L. , LEONARD KENNETH E. , HOMISH GREGORY G.
Published: October 2011

According to the risk regulation model (S. L. Murray, J. G. Holmes, & N. L. Collins, 2006), people need to trust in their partner's regard before they risk interdependence. This study prospectively examines the association between perceived regard and levels of dependence in newlywed couples over 9 years of marriage. Analyses demonstrate that changes in perceived regard predict levels of dependence, changes in dependence do not predict perceived regard, and alternative explanations cannot account for these effects. Further, changes in perceived regard prospectively predict divorce, and levels of dependence mediate this association. Results are discussed in terms of the dependence regulation component of the risk regulation model.
Illiberis (Primilliberis) rotundata Jordan (Lepidoptera: Zygaenidae: Procridinae) male sex attractant: Optimization and use for seasonal monitoring
Authors: SUBCHEV Mitko A. , KOSHIO Chiharu , TOSHOVA Teodora B. , EFETOV Konstantin A.
Published: October 2011

Illiberis (Primilliberis) rotundata Jordan, 1907 (Lepidoptera: Zygaenidae) is an orchard pest distributed in Honshu, Shikoku and Kyushu in Japan and also in China, Korea, Mongolia and Russia (south‐eastern Siberia and Far East). For optimizing a known sex attractant lure containing sex pheromone components of the species (2R)‐butyl (7Z)‐dodecenoate and (2R)‐butyl (9Z)‐tetradecenoate, field work was organized in three cherry tree plots in Naruto, Tokushima in 2009 and 2010. As a result, the mixture of (2R)‐butyl (7Z)‐dodecenoate and (2R)‐butyl (9Z)‐tetradecenoate in a ratio of 30:100–50:100 (130–150 µg, respectively) was found to be the most attractive for the males of this pest. The seasonal flight of I. rotundata in Naruto, Japan as estimated by pheromone traps started at the end of May and lasted up to the end of June with a mass flight at the very end of May to first week of June.
Attachment Style, Vagal Tone, and Empathy During Mother–Adolescent Interactions
Authors: Diamond Lisa M. , Fagundes Christopher P. , Butterworth Molly R.
Published: October 2011

We tested associations among empathic responsiveness, attachment style, and vagal tone (a physiologic index of emotion regulation) in 103 mother–adolescent dyads. Dyads discussed positive and negative topics and then separately reviewed a videotape of the interaction and rated their own and the other person's affect at one‐minute intervals. We used multilevel modeling to analyze the association between one's rating of the other person's affect and the other person's affect (empathic sensitivity), and the association between one's rating of the other person's affect and one's own affect (perceived concordance). Adolescents’ empathic responsiveness was predicted by attachment style, vagal tone, and interactions between them. Adolescents with the greatest empathic responsiveness had low levels of attachment insecurity and high levels of vagal tone.
Clarifying Types of Uncertainty: When Are Models Accurate, and Uncertainties Small?
Authors: Cox, Jr. Louis Anthony (Tony)
Published: October 2011

Professor Aven has recently noted the importance of clarifying the meaning of terms such as “scientific uncertainty” for use in risk management and policy decisions, such as when to trigger application of the precautionary principle. This comment examines some fundamental conceptual challenges for efforts to define “accurate” models and “small” input uncertainties by showing that increasing uncertainty in model inputs may reduce uncertainty in model outputs; that even correct models with “small” input uncertainties need not yield accurate or useful predictions for quantities of interest in risk management (such as the duration of an epidemic); and that accurate predictive models need not be accurate causal models.
Emergency Medicine Directors’ Perceptions on Professionalism: A Council of Emergency Medicine Residency Directors Survey
Authors: Sullivan Christine , Murano Tiffany , Comes Jim , Smith Jessica L. , Katz Eric D.
Published: October 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:S97–S103 © 2011 by the Society for Academic Emergency Medicine

Objectives:  The Accreditation Council for Graduate Medical Education requires residency training programs to teach and assess professionalism in residents; however, programs may struggle to successfully remediate residents not meeting professionalism standards. To assist programs with this complex issue, a Professionalism Remediation Task Force was formed by the Council of Emergency Medicine Residency Directors (CORD‐EM), which surveyed program directors (PDs) concerning their experiences. The purpose of this study is to report survey results regarding the identification and rating of unprofessional behaviors and challenges in the evaluation and remediation of professionalism.

Methods:  In June 2010, the task force sent an anonymous survey via the CORD‐EM listserv to PDs with active EM programs.

Results:  Fifty percent (77/154) of eligible PDs responded to the survey. Most PDs rated the unprofessional behaviors of interpersonal/communication conflicts, lack of responsibility during patient care, lack of respect of coworkers, and reports of impairment as “critical”; repeated tardiness, incomplete work, poor ability to accept feedback, poor attitude, and repetitive unresponsiveness to aid colleagues were rated as “very serious”; frequent missed deadlines were “serious”; and repetitive failure to complete medical records was rated as “mildly serious.” A resident with “less serious” professionalism issues was also felt to be likely to have “serious” or “critical” issues “often” (33.8% of respondents) or “always” (6.5%). The most common methods of assessment were clinical/advisor evaluations. However, existing assessment methods were described as inadequate in identifying serious professionalism issues by 50.7% of responding PDs. Unprofessionalism was most commonly discovered by unofficial faculty complaint (54.5%). Eighty percent report that professionalism is more difficult to remediate than other core competencies. Resident ownership of the problem was reported as most critical to remediation success (84.4%). PDs perceived the greatest challenges in residency remediation to be lack of resident insight or responsibility for the problem (45.2%) and personality/behavioral issues (32.9%).

Conclusions:  Identification and remediation of professionalism in EM residents is challenging. A future goal is to create a system by which PDs can use standardized pathways as a guide to identify and remediate unprofessional conduct.
Education Research: A Primer for Educators in Emergency Medicine
Authors: Yarris Lalena M. , Deiorio Nicole M.
Published: October 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:S27–S35 © 2011 by the Society for Academic Emergency Medicine

As medical educators strive to adopt an evidence‐based, outcomes‐driven approach to teaching, education research in emergency medicine (EM) is burgeoning. Many educational challenges prompt specific research questions that are well suited to investigative study, but educators face numerous barriers to translating exciting ideas into research publications. This primer, intended for educators in EM, provides a brief overview of the current scope and essential elements of education research. We present an approach to identifying research problems and conceptual frameworks and defining specific research questions. A common approach to curricular development is reviewed, as well as a fundamental overview of qualitative and quantitative methods that can be applied to educational research questions. Finally, suggestions for disseminating results and overcoming common barriers to conducting research are discussed.
Irrigation, organic fertilization and species successional stage modulate the response of woody seedlings to herbaceous competition in a semi‐arid quarry restoration
Authors: Soliveres Santiago , Monerris Jorge , Cortina Jordi
Published: October 2011

Question

Is the response of woody plants to herbaceous competition affected by the level of irrigation and organic fertilization? Does the magnitude and the sign of this response depend on the successional status of woody species?

Location

A limestone quarry in a semi‐arid Mediterranean area inSE Spain.

Methods

We studied seedling survival and growth of six woody species with contrasting ecological strategies (early‐successional vs late‐successional) and their associated herbaceous layer under different irrigation and organic fertilization levels

Results

Elevated water supply, but not organic fertilization, increased herbaceous cover. The response of woody seedlings and changes in herbaceous cover to a contrasting resource supply was species‐specific. Seedling survival and growth of late‐successional species increased at high levels of irrigation. Pioneer species showed the opposite trend, suggesting that increases in water availability may outweigh the deleterious effect of increased herbaceous competition in late‐successional species but not in early‐successional species.

Conclusions

Our study provides further insights into the role of techniques such as irrigation and organic fertilization, which are commonly used in conjunction with hydroseeding, in defining woody plant establishment and successional trajectories in semi‐arid areas under restoration. Our results will contribute to improve restoration success by reconciling two major objectives of restoration: soil protection and secondary succession. We recommend a new approach for the restoration of limestone quarries. This approach comprises the planting of late‐successional species on randomly distributed nutrient‐rich patches of high availability of water and nutrients, and the use of pioneer species in the surrounding nutrient poor and drier matrix. This approach should promote optimal ecosystem functioning, including soil protection, while increasing biodiversity and fostering secondary succession.
“New Style” Campaigning, Citizen Knowledge, and Sources of Legitimacy for State Courts: A Case Study in Texas
Authors: MCKENZIE MARK JONATHAN , UNGER MICHAEL A.
Published: October 2011

In this study, we explore whether perceptions of the Texas Supreme Court's legitimacy are influenced by “new style” judicial campaigns and levels of political sophistication. Using a statewide survey of Texas registered voters, we find that knowledge about the Texas judiciary and politics more generally is associated with higher levels of support for the state's supreme court. However, an embedded experiment manipulating a judicial candidate's party and issue positions does not alter individuals' perceptions of the Texas court. These results suggest that concerns over the effect of increasingly politicized judicial elections on judicial legitimacy, at least in Texas, may be exaggerated.

En este estudio, exploramos si las percepciones sobre la legitimidad de la Suprema Corte de Justicia de Texas son influenciadas por el “nuevo estilo” de las campañas judiciales y los niveles de sofisticación política. Usando una encuesta estatal de votantes registrados en Texas, encontramos que un mayor conocimiento político y judicial en Texas es generalmente asociado con mayores niveles de apoyo a la Suprema Corte del Estado. Sin embargo, un experimento en el que se manipuló el partido al que el candidato judicial está afiliado y postura respecto a un asunto no alteró las percepciones individuales acerca de la Corte de Texas. Estos resultados sugieren que las preocupaciones sobre los efectos de elecciones judiciales cada vez más politizadas en la legitimidad judicial, por lo menos en Texas, pueden ser exageradas.
Novel Antibody Capture Assay for Paraffin‐Embedded Tissue Detects Wide‐Ranging Amyloid Beta and Paired Helical Filament–Tau Accumulation in Cognitively Normal Older Adults
Authors: Postupna Nadia , Rose Shannon E. , Bird Thomas D. , Gonzalez‐Cuyar Luis F. , Sonnen Joshua A. , Larson Eric B. , Keene C. Dirk , Montine Thomas J.
Published: October 2011

Quantifying antigens in formalin‐fixed tissue is challenging and limits investigation in population‐based studies of brain aging. To address this major limitation, we have developed a new technique that we call “Histelide”: immunohistochemistry (HIST‐) and enzyme‐linked immunosorbent assay (ELISA) (‐EL‐) performed on a glass slide (‐IDE). We validated Histelide in sections of prefrontal cortex from 20 selected cases: 12 subjects with clinically and neuropathologically diagnosed Alzheimer's disease (AD), either autosomal dominant or late‐onset forms, and 8 clinical and neuropathologic controls. AD cases had significantly increased amyloid beta (Aβ) peptide and paired helical filament– (PHF‐) tau per area of neocortex that was proteinase K‐sensitive, and significantly decreased amount of synaptophysin. We next investigated prefrontal cortex from 81 consecutive cases of high‐cognitive performers from the Adult Changes in Thought (ACT) study, a population‐based study of brain aging and incident dementia. As expected, latent AD was common in this group; however, our results quantified widely individually varying levels of Aβ peptides and PHF‐tau among these high‐cognitive performers. This novel approach obtains quantitative data from population‐based studies, and our initial studies with high‐cognitive performers provide important quantitative insights into latent AD that should help guide expectations from neuroimaging and prevention studies.
Thermal Performance Analysis of Geologic High-Level Radioactive Waste Packages
Authors: Lee Si Y. , Hensel Steve J. , Bock Chris De
Published: October 2011

The engineering design of disposal of the high level waste (HLW) packages in a geologic repository requires a thermal analysis to forecast the temperature history of the packages. Calculated temperatures are used to demonstrate compliance with criteria for waste acceptance into the geologic disposal gallery system and as input to assess the transient thermal characteristics of the vitrified HLW Package. The objective of the work was to evaluate the thermal performance of the supercontainer containing the vitrified HLW in a nonbackfilled and unventilated underground disposal gallery. In order to achieve the objective, transient computational models for a geologic vitrified HLW package were developed by using a computational fluid dynamics method, and calculations for the HLW disposal gallery of the current Belgian geological repository reference design were performed. An initial simplified two-dimensional model was used to conduct some parametric sensitivity studies to better understand the geologic system’s thermal response. The effect of heat decay, number of codisposed supercontainers, domain size, humidity, thermal conductivity, and thermal emissivity were studied. A more accurate three-dimensional model was also developed by considering the conduction–convection cooling mechanism coupled with radiation, and the effect of the number of supercontainers was studied in more detail, as well as a bounding case with zero heat flux at both ends. The modeling methodology and results of the sensitivity studies will be presented.
Twin Matter Waves for Interferometry Beyond the Classical Limit
Authors: Lücke B. , Scherer M. , Kruse J. , Pezzé L. , Deuretzbacher F. , Hyllus P. , Topic O. , Peise J. , Ertmer W. , Arlt J. , Santos L. , Smerzi A. , Klempt C.
Published: October 2011

An entangled state of up to 10,000 atoms is used to enhance the resolution of an atomic interferometer.
Correction of Sickle Cell Disease in Adult Mice by Interference with Fetal Hemoglobin Silencing
Authors: Xu Jian , Peng Cong , Sankaran Vijay G. , Shao Zhen , Esrick Erica B. , Chong Bryan G. , Ippolito Gregory C. , Fujiwara Yuko , Ebert Benjamin L. , Tucker Philip W. , Orkin Stuart H.
Published: October 2011

Manipulation of a transcriptional repressor promotes expression of protective fetal globin genes.
Torsional Carbon Nanotube Artificial Muscles
Authors: Foroughi Javad , Spinks Geoffrey M. , Wallace Gordon G. , Oh Jiyoung , Kozlov Mikhail E. , Fang Shaoli , Mirfakhrai Tissaphern , Madden John D. W. , Shin Min Kyoon , Kim Seon Jeong , Baughman Ray H.
Published: October 2011

Carbon nanotube yarns are used to make fast, multirotational torsional actuators.
Electronic health record-based surveillance of diagnostic errors in primary care
Authors: Singh Hardeep , Giardina Traber Davis , Forjuoh Samuel N , Reis Michael D , Kosmach Steven , Khan Myrna M , Thomas Eric J
Published: October 2011

Background

Diagnostic errors in primary care are harmful but difficult to detect. The authors tested an electronic health record (EHR)-based method to detect diagnostic errors in routine primary care practice.

Methods

The authors conducted a retrospective study of primary care visit records ‘triggered’ through electronic queries for possible evidence of diagnostic errors: Trigger 1: A primary care index visit followed by unplanned hospitalisation within 14 days and Trigger 2: A primary care index visit followed by ≥1 unscheduled visit(s) within 14 days. Control visits met neither criterion. Electronic trigger queries were applied to EHR repositories at two large healthcare systems between 1 October 2006 and 30 September 2007. Blinded physician–reviewers independently determined presence or absence of diagnostic errors in selected triggered and control visits. An error was defined as a missed opportunity to make or pursue the correct diagnosis when adequate data were available at the index visit. Disagreements were resolved by an independent third reviewer.

Results

Queries were applied to 212 165 visits. On record review, the authors found diagnostic errors in 141 of 674 Trigger 1-positive records (positive predictive value (PPV)=20.9%, 95% CI 17.9% to 24.0%) and 36 of 669 Trigger 2-positive records (PPV=5.4%, 95% CI 3.7% to 7.1%). The control PPV of 2.1% (95% CI 0.1% to 3.3%) was significantly lower than that of both triggers (p≤0.002). Inter-reviewer reliability was modest, though higher than in comparable previous studies (к=0.37 (95% CI 0.31 to 0.44)).

Conclusions

While physician agreement on diagnostic error remains low, an EHR-facilitated surveillance methodology could be useful for gaining insight into the origin of these errors.
The relative role of environmental, spatial, and land-use patterns in explaining aquatic macrophyte community composition
Authors: Mikulyuk Alison , Sharma Sapna , Van Egeren Scott , Erdmann Eric , Nault Michelle E. , Hauxwell Jennifer
Published: October 2011

Quantifying the relative role of environmental and spatial factors to understand patterns in community composition is a fundamental goal of community ecology. We applied a tested and repeatable point-intercept sampling method to aquatic macrophyte assemblages in 225 Wisconsin lakes to understand the ability of environmental, land-use, and spatial patterns to explain aquatic plant distribution and abundance. Using a variation partitioning framework in conjunction with Moran eigenvector maps we found that environmental, land-use, and spatial patterns explained 31% of total adjusted variation in aquatic macrophyte assemblages across the landscape. Environmental factors were the most important (contributing 34% of the total explained variation), but all sources of variation were statistically significant. Community composition varied from north to south along a gradient of alkalinity and from disturbed to undisturbed lakes, diverging according to whether disturbance was urban or agricultural. The large amount of shared variation among predictor variables suggests causal relationships are complex and emphasizes the importance of considering space and land-use in addition to environmental factors when characterizing macrophyte assemblages. This work is the first to examine the joint and unique effects of environment, land-use, and spatial patterns on aquatic plant communities.
The 6-min walk test: responses in healthy Canadians aged 45 to 85 years
Authors: Hill Kylie , Wickerson Lisa M. , Woon Lynda J. , Abady Afshin Heidar , Overend Tom J. , Goldstein Roger S. , Brooks Dina
Published: October 2011

We sought to describe responses to the 6-min walk test (6MWT) in healthy Canadian adults in order to facilitate interpretation of its results in patient populations. Seventy-seven healthy Canadians aged 45 to 85 years (65 ± 11 years, 40 females) completed this study. During a single visit, three 6MWTs were undertaken. The main outcome measure was 6-min walk distance (6MWD). Age, gender, height, and weight were recorded. In 61 (79%) participants, cardiorespiratory variables were collected during the third 6MWT using a calibrated portable gas analysis system. The 6MWD increased between the first and second test (615 ± 96 to 639 ± 98 m; p < 0.001) with no further improvement on the third test (638 ± 99 m; p = 0.945). The best 6MWD from the first 2 tests was 640 ± 99 m (range 416 to 880 m). A greater 6MWD was achieved by males compared with females (672 ± 94 vs. 611 ± 93 m; p = 0.005). The following equation accounted for 49% of the variance in 6MWD: 6MWD = 970.7 + (–5.5 × age) + (56.3 × gender), where females = 0, males = 1. The 6MWT elicited large cardiorespiratory responses with minimal symptoms. The rate of oxygen uptake measured at test-end was associated with the 6MWD (r = 0.802; p < 0.001). These data allow the 6MWD achieved in Canadian adults to be expressed as a percentage of the predicted value and provide researchers and clinicians with values for the expected cardiorespiratory responses in a healthy adult population for the purpose of comparison with patient populations.
Borg’s scales in strength training; from theory to practice in young and older adults
Authors: Buckley John P. , Borg Gunnar A.V.
Published: October 2011

This study is the first to apply Borg’s psychophysical equation to measuring responses to strength training with weights machines. Theoretical constructs of Borg’s scales were assessed in younger and older adults to estimate the appropriate load and number of repetitions required to meet recommended practice guidelines. A younger group (YG; 20 males, 20 females; aged 19–38 years) and older group (OG; 13 males, 13 females; aged 50–75 years) participated in 3 experiments. Experiment 1: YG performed 2-repetitions of incremented loads during triceps–elbow extensions and knee extensions to level 7 on Borg’s CR10 Scale. Experiment 2: YG (n = 16) then performed 12-repetitions at the loads from experiement 1 that elicited CR10 ratings 1.5, 3.0, and 5.0. Experiment 3: OG performed 15-repetitions of “lat-pull” and leg press at 15-repetition maximum (RM) load. In experiments 2 and 3, CR10 or Borg RPE were measured every 2 repetitions. Experiment 1 revealed classic psychophysical response growth exponents between 1.1 and 1.8, which were greater in arms than legs (p < 0.001) and in females (p < 0.001). Theoretical estimates of 1RM were derived from the growth curves for the weights eliciting CR10 ratings of 1.5, 3, and 5. CR10 ratings of 3 to 6 fell within estimates of 40%–70% 1RM. Experiments 2 and 3 revealed, for constant load exercise “over time” (12 and 15 repetitions) from an initial CR10 rating of 4 to 6, a linear increase of 1 scale point for every 3 to 4 repetitions. In conclusion, Borg’s equation has been used to set theoretical estimates of a %1RM. Relevant to current practice guidelines was the ability to set appropriate loads in relation to performing recommended numbers of repetitions (e.g., if the CR10 rating is >6 after 2 repetitions, the weight is likely be too heavy to complete 12 to 15 repetitions).
Volume, intensity, and timing of muscle power potentiation are variable
Authors: Chaouachi Anis , Poulos Nick , Abed Fathi , Turki Olfa , Brughelli Matt , Chamari Karim , Drinkwater Eric J. , Behm David G.
Published: October 2011

Whereas muscle potentiation is consistently demonstrated with evoked contractile properties, the potentiation of functional and physiological measures is inconsistent. The objective was to compare a variety of conditioning stimuli volumes and intensities over a 15-min recovery period. Twelve volleyball players were subjected to conditioning stimuli that included 10 repetitions of half squats with 70% of 1-repetition maximum (RM) (10 × 70), 5 × 70, 5 × 85, 3 × 85, 3 × 90, 1 × 90, and control. Jump height, power, velocity, and force were measured at baseline, 1, 3, 5, 10, and 15 min. Data were analysed with a 2-way repeated measure ANOVA and magnitude-based inferences. The ANOVA indicated significant decreases in jump height, power, and velocity during recovery. This should not be interpreted that no potentiation occurred. Each dependent variable reached a peak at a slightly different time: peak jump height (2.8 ± 2.3 min), mean power (3.6 ± 3.01 min), peak power (2.5 ± 1.8 min), and peak velocity (2.5 ± 1.8 min). Magnitude-based inference revealed that both the 5 × 70 and 3 × 85 protocol elicited changes that exceeded 75% likelihood of exceeding the smallest worthwhile change (SWC) for peak power and velocity. The 10 × 70 and the 5 × 70 had a substantial likelihood of potentiating peak velocity and mean power above the SWC, respectively. Magnitude-based inferences revealed that while no protocol had a substantial likelihood of potentiating the peak vertical jump, the 5 × 70 had the most consistent substantial likelihood of increasing the peak of most dependent variables. We were unable to consistently predict if these peaks occurred at 1, 3, or 5 min poststimulation, though declines after 5 min seems probable.