bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing research capacity in health librarians: a review of the evidence
Authors: Rossall Hannah , Boyes Chris , Montacute Kim , Doherty Patrick
Published: August 2008

This critical review considers current issues of research capacity development in UK health care and the role of health librarianship in this context, placing particular focus on the use of research networks. There is a growing literature base recognising the need for librarians to engage more with research. The concepts of evidence‐based health librarianship and clinical librarianship are discussed in the context of research and examples of existing good practice are reviewed. It is suggested that librarians should build on this through better consideration of evidence based methodologies, hierarchies of evidence, improvement of research skills, and a collective endeavour to identify research priorities. The importance research capacity is being given in the Department of Health R&D strategy and the use of networks in achieving this is discussed, and it is suggested that the utilisation of networks and collaboration should be undertaken and explored in more depth in developing research capacity in health librarianship. Areas where librarians currently engage with research and use networks and collaborative practices to contribute to the research base are reviewed. A co‐ordinated approach to developing research capacity is called for and it is argued that the use of networks would be beneficial in assisting the process.
Ischemic insult to cerebellar Purkinje cells causes diminished GABAAreceptor function and allopregnanolone neuroprotection is associated with GABAAreceptor stabilization
Authors: Kelley Melissa H. , Taguchi Noriko , Ardeshiri Ardalan , Kuroiwa Masayuki , Hurn Patricia D. , Traystman Richard J. , Herson Paco S.
Published: August 2008

Cerebellar Purkinje cells (PC) are particularly vulnerable to ischemic injury and excitotoxicity, although the molecular basis of this sensitivity remains unclear. We tested the hypothesis that ischemia causes rapid down‐regulation of GABAAreceptors in cerebellar PC, thereby increasing susceptibility to excitotoxicity. Oxygen‐glucose deprivation (OGD) caused a decline in functional GABAAreceptors, within the first hour of re‐oxygenation. Decreased amplitude of miniature inhibitory post‐synaptic potentials confirmed that OGD caused a significant decrease in functional synaptic GABAAreceptors and quantitative Western blot analysis demonstrated the loss of GABAAreceptor current was associated with a decline in total receptor protein. Interestingly, the potent neuroprotectant allopregnanolone (ALLO) prevented the decline in GABAAreceptor current and protein. Consistent with ourin vitrodata, global ischemia in mice caused a significant decline in total cerebellar GABAAreceptor protein and PC specific immunoreactivity. Moreover, ALLO provided strong protection of PC and prevented ischemia‐induced decline in GABAAreceptor protein. Our findings indicate that ischemia causes a rapid and sustained loss of GABAAreceptors in PC, whereas ALLO prevents the decline in GABAAreceptors and protects against ischemia‐induced damage. Thus, interventions which prevent ischemia‐induced decline in GABAAreceptors may represent a novel neuroprotective strategy.
The Differential Relationship of Feminist Attitudes and Feminist Identity to Self-Efficacy
Authors: Eisele Heather , Stake Jayne
Published: August 2008

Feminist theorists have suggested that feminism provides a number of benefits for women, particularly regarding self-evaluations. However, most studies have conflated feminist attitudes and feminist identity. The main goal of this study was to assess the differential relationships of feminist attitudes and feminist identity to self-efficacy. Four hundred thirty-five students were surveyed at the beginning and end of their women's and gender studies (WGS) classes. In general, feminist attitudes and feminist identity were related to self-efficacy variables at pretest and to change in these variables over time. Feminist identity partially mediated the relationship between feminist attitudes and self-efficacy. Additionally, the results of this study generally support previous findings regarding the effect of WGS classes on students' feminist attitudes, feminist identity, and self-efficacy. Implications of these findings for the importance of feminist identity are discussed.
Media Contributions to African American Girls' Focus on Beauty and Appearance: Exploring the Consequences of Sexual Objectification
Authors: Gordon Maya K.
Published: August 2008

The media are dominated by images of women as sex objects whose value is based on their appearance. These portrayals can potentially limit girls' self-perceptions and influence their attitudes regarding the importance of appearance. However, relatively little is known about how African American adolescent girls are affected by these images. Using data from a survey of 176 African American adolescent girls (mean age = 15), this project examined associations between Black media use and African American girls' focus on beauty and appearance. Results suggest that both exposure to and identification with portrayals of Black women as sex objects contribute to African American adolescent girls emphasizing the importance of appearance in their own lives and for girls in general. When all the media variables were tested together in hierarchical regression analyses, identification with favorite television character, identification with more objectifying female music artists, and identification with less objectifying female artists emerged as the more consistent predictors of the outcomes examined. Findings are discussed in terms of their implications for girls' overall development.
The Affective Consequences of Minimizing Women's Body Image Concerns
Authors: Bosson Jennifer K. , Pinel Elizabeth C. , Thompson J. Kevin
Published: August 2008

We propose that women regularly anticipate and receive messages from others that trivialize the severity of their body image concerns. Moreover, we suggest that these minimizing messages can heighten women's negative affective reactions to body image threats, particularly if they internalize them. Two studies provided support for these ideas. In Study 1, women and men estimated the likelihood that others would minimize the feelings of a woman who felt badly about her body. As expected, women estimated a high likelihood of minimization. In Study 2, women internalized or rejected a message that either minimized or validated the severity of body image concerns before undergoing a body image threat themselves. Women felt heightened negative affect following the threat if they internalized the minimizing message, but they maintained their prethreat affective state if they rejected the minimizing message or internalized the validating message. The discussion focuses on the implications of these findings for research on effective social support and clinical interventions.
Anxiety, Alexithymia, and Depression as Mediators of the Association between Childhood Abuse and Eating Disordered Behavior in African American and European American Women
Authors: Mazzeo Suzanne E. , Mitchell Karen S. , Williams Larry J.
Published: August 2008

This study evaluated structural equation models of the associations among family functioning, childhood abuse, depression, anxiety, alexithymia, and eating disorder symptomatology in a sample of 412 European American and 192 African American female undergraduates. Additionally, the specific roles of anxiety, depression, and alexithymia as mediators were assessed. Each of these variables was a significant mediator of the association between childhood abuse and disordered eating. Finally, a test of invariance between the African American and European American subsamples was significant, highlighting the need for additional cross-cultural eating disorder research.
Theoretical Frameworks for Studying Female Marriage Migrants
Authors: Merali Noorfarah
Published: August 2008

Transnational marriages account for a significant proportion of family-based immigration to North America. An increasing number of immigrant men are choosing to marry women from their countries of origin, and an increasing number of nonimmigrant men are choosing to marry women from other countries. Existing studies on the experiences of foreign brides entering North America have highlighted their vulnerability to spousal maltreatment, including unique forms of immigration abuse (e.g., threats of deportation). Their vulnerability to maltreatment has been attributed to the gender-insensitive nature of family immigration policies, the women's lack of awareness of their rights and immigration status, and their husbands' cultural beliefs about women's roles. This article describes three interrelated theoretical frameworks that can inform further research, practice, and policy development related to female marriage migrants. The frameworks draw on cross-cultural models of gender-based violence, seminal work on the psychology of women, and international human rights research.
Borderline Personality Traits and Intimate Partner Aggression: An International Multisite, Cross-Gender Analysis
Authors: Hines Denise A.
Published: August 2008

Although research has consistently shown that men and women use intimate partner aggression (IPA) at approximately equal rates, there is little empirical research on whether the predictors of IPA are the same for men and women. The current study investigated whether borderline personality (BP) differentially predicted the use of IPA for men and women across 67 university sites from around the world. Results showed that BP predicted several forms of IPA and that gender did not moderate the association between IPA and BP. Although the strength of the association between IPA and BP significantly differed across sites, it was in the predicted direction for the overwhelming majority of sites. Implications of these results and suggestions for future research are discussed.
Are Television Commercials Still Achievement Scripts for Women?
Authors: Yoder Janice D. , Christopher Jessica , Holmes Jeffrey D.
Published: August 2008

Content analyses of television advertising document the ubiquity of traditional images of women, yet few studies have explored their impact. One noteworthy exception is the experiment by Geis, Brown, Jennings, and Porter (1984) . These researchers found that the achievement aspirations of controls and women exposed to traditional images were lower than those of both women who viewed nontraditional replicas and men, leading to the conclusion that women's aspirations were muted by sexist advertising. An updated extension and modification of their study with 185 college women and 96 men did not find an interaction between gender and ad exposure, suggesting some changes over time in women's aspirations, as well as in the content and impact of commercials. Although women's achievement scripts now appear more similar to men's, as well as more resistant to sexist exposure, there are signs in the present data and related research that women's aspirations are not fully impervious to sexism in the media.
A Comparison of Male and Female Directors in Popular Pornography: What Happens when Women are at the Helm?
Authors: Sun Chyng , Bridges Ana , Wosnitzer Robert , Scharrer Erica , Liberman Rachael
Published: August 2008

Pornography is a lucrative business. Increasingly, women have participated in both its production, direction, and consumption. This study investigated how the content in popular pornographic videos created by female directors differs from that of their male counterparts. We conducted a quantitative analysis of 122 randomly selected scenes from 44 top-renting adult videos in 2005 (half male- and half female-directed). Findings revealed that all films shared similar depictions: Verbal and physical aggression was common, women were the primary targets of aggression, and negative responses to aggression were extremely rare. Compared to male-directed films, female-directed films were significantly more likely to portray women-only scenes and sexual acts. Even when controlling for main characters' gender, female-directed films showed significantly more female perpetrators aggressing against female targets and significantly more depictions of women as perpetrators of aggression. We highlight the importance of economic forces, rather than director gender, in dictating the content of popular pornography.
Does Cleavage Work at Work? Men, But not Women, Falsely Believe Cleavage Sells a Weak Product
Authors: Glick Peter , Chrislock Karyna , Petersik Korinne , Vijay Madhuri , Turek Aleksandra
Published: August 2008

We examined whether men, but not women, would be distracted by a female sales representative's exposed cleavage, leading to greater perceived efficacy for a weak, but not for a strong product. A community sample of 88 men and 97 women viewed a video of a female pharmaceutical sales representative who (a) had exposed cleavage or dressed modestly and (b) pitched an ineffective or effective product. Although men were not more distracted or persuaded by cleavage, they gave the cleavage-exposed (versus nonexposed) sales representative more favorable hiring recommendations in the ineffective-drug condition and less favorable ratings in the effective-drug condition. Women generally rated the sales representative similarly regardless of cleavage exposure. On a postexperimental questionnaire, men, but not women, believed that female sales professionals ought strategically to use sex appeal to distract from a weak (but not a strong) product.
PANDEMIC MANAGEMENT AND DEVELOPING WORLD BIOETHICS: BIRD FLU IN WEST BENGAL
Authors: CHAKRABORTI CHHANDA
Published: August 2008

This paper examines the case of a recent H5N1virus (avian influenza) outbreak in West Bengal, an eastern state of India, and argues that poorly executed pandemic management may be viewed as a moral lapse. It further argues that pandemic management initiatives are intimately related to the concept of health as a social ‘good’ and to the moral responsibility of protection from foreseeable social harm from an infectious disease. The initiatives, therefore, have to be guided by special moral obligations towards biorisk reduction, obligations which remain unfulfilled when a public body entrusted with the responsibility fails to manage satisfactorily the prevention and control of the infection. The overall conclusion is that pandemic management has a moral dimension. The gravity of the threat that fatal infectious diseases pose for public health creates special moral obligations for public bodies in pandemic situations. However, the paper views the West Bengal case as a learning opportunity, and considers the lapses cited as challenges that better, more effectively conducted pandemic management can prepare for. It is hoped that this paper will provoke constructive bioethical deliberations, particularly pertinent to the developing world, on how to ensure that the obligations towards health are fulfilled ethically and more effectively.
A thermodynamic analysis of the anaerobic oxidation of methane in marine sediments
Authors: LAROWE D. E. , DALE A. W. , REGNIER P.
Published: August 2008

Anaerobic oxidation of methane (AOM) in anoxic marine sediments is a significant process in the global methane cycle, yet little is known about the role of bulk composition, temperature and pressure on the overall energetics of this process. To better understand the biogeochemistry of AOM, we have calculated and compared the energetics of a number of candidate reactions that microorganisms catalyse during the anaerobic oxidation of methane in (i) a coastal lagoon (Cape Lookout Bight, USA), (ii) the deep Black Sea, and (iii) a deep‐sea hydrothermal system (Guaymas basin, Gulf of California). Depending on the metabolic pathway and the environment considered, the amount of energy available to the microorganisms varies from 0 to 184 kJ mol−1. At each site, the reactions in which methane is either oxidized to , acetate or formate are generally only favoured under a narrow range of pressure, temperature and solution composition – particularly under low (10−10 m) hydrogen concentrations. In contrast, the reactions involving sulfate reduction with H2, formate and acetate as electron donors are nearly always thermodynamically favoured. Furthermore, the energetics of ATP synthesis was quantified per mole of methane oxidized. Depending on depth, between 0.4 and 0.6 mol of ATP (mol CH4)−1 was produced in the Black Sea sediments. The largest potential productivity of 0.7 mol of ATP (mol CH4)−1 was calculated for Guaymas Basin, while the lowest values were predicted at Cape Lookout Bight. The approach used in this study leads to a better understanding of the environmental controls on the energetics of AOM.
The provision of supplementary fresh water improves the breeding success of the globally threatened Northern Bald Ibis Geronticus eremita
Authors: SMITH KEN W. , AGHNAJ ALI , EL BEKKAY MOHAMMED , OUBROU WIDADE , RIBI MOHAMMED , ARMESTO MARIA JIMENEZ , BOWDEN CHRISTOPHER G. R.
Published: August 2008

The Northern Bald Ibis Geronticus eremita is a globally threatened species with its main remaining world population breeding in an area of sea cliffs and coastal semi‐desert steppe near Agadir in southern Morocco. Between 1998 and 2002, we showed experimentally that the small‐scale provision of fresh water near the breeding colonies led to an increase in the productivity of the birds. The increase was greatest in years with low natural rainfall but was positive in all years tested. The supplementary fresh water appears to help buffer productivity against the impacts of low rainfall and its provision is now part of the ongoing conservation measures for this species.
A Preliminary Community Study of Dialectical Behaviour Therapy (DBT) with Adolescent Females Demonstrating Persistent, Deliberate Self‐Harm (DSH)
Authors: James Anthony C. , Taylor Annie , Winmill Louise , Alfoadari Kielly
Published: August 2008

A study of dialectical behaviour therapy (DBT) for 16 older female adolescents with persistent and severe deliberate self‐harm was undertaken. Independent assessments were carried out pre‐ and post‐treatment, and at eight months follow‐up. On average subjects completed more than 78% of sessions. There was a marked reduction in self reported depression (F = 12.8, df = 2, p < .001); hopelessness (F = 15.9, df = 2, p < .001); episodes of deliberate self‐harm (F = 23.9, df = 2, p < .001); alongside an increase in general functioning (F = 22.9, df = 2, p < .001).
The Pyramid Club Primary School‐Based Intervention: Evaluating the Impact on Children's Social‐Emotional Health
Authors: Ohl Maddie , Mitchell Kathryn , Cassidy Tony , Fox Pauline
Published: August 2008

Background: Children with poor social‐emotional health are at risk of failing to reach their potential.

Method: The impact of the Pyramid Club year 3 preventive intervention on children's social‐emotional health was investigated. Children were allocated to an intervention or non‐problem comparison group.

Results: Post‐intervention both groups had improved Total Difficulty scores (Strengths and Difficulties Questionnaire) with the Pyramid group showing a significantly stronger effect size (r = .71) than the non‐problem comparison group (r = .44).

Conclusions: The Pyramid Club intervention improves the social‐emotional health of vulnerable children. The need to evaluate such interventions and to extend research are discussed.
Teaching Mass Casualty Triage Skills Using Immersive Three‐dimensional Virtual Reality
Authors: Vincent Dale S. , Sherstyuk Andrei , Burgess Lawrence , Connolly Kathleen K.
Published: August 2008

Objectives:  Virtual reality (VR) environments offer potential advantages over traditional paper methods, manikin simulation, and live drills for mass casualty training and assessment. The authors measured the acquisition of triage skills by novice learners after exposing them to three sequential scenarios (A, B, and C) of five simulated patients each in a fully immersed three‐dimensional VR environment. The hypothesis was that learners would improve in speed, accuracy, and self‐efficacy.

Methods:  Twenty‐four medical students were taught principles of mass casualty triage using three short podcasts, followed by an immersive VR exercise in which learners donned a head‐mounted display (HMD) and three motion tracking sensors, one for their head and one for each hand. They used a gesture‐based command system to interact with multiple VR casualties. For triage score, one point was awarded for each correctly identified main problem, required intervention, and triage category. For intervention score, one point was awarded for each correct VR intervention. Scores were analyzed using one‐way analysis of variance (ANOVA) for each student. Before and after surveys were used to measure self‐efficacy and reaction to the training.

Results:  Four students were excluded from analysis due to participation in a recent triage research program. Results from 20 students were analyzed. Triage scores and intervention scores improved significantly during Scenario B (p < 0.001). Time to complete each scenario decreased significantly from A (8:10 minutes) to B (5:14 minutes; p < 0.001) and from B to C (3:58 minutes; p < 0.001). Self‐efficacy improved significantly in the areas of prioritizing treatment, prioritizing resources, identifying high‐risk patients, and beliefs about learning to be an effective first responder.

Conclusions:  Novice learners demonstrated improved triage and intervention scores, speed, and self‐efficacy during an iterative, fully immersed VR triage experience.
Academic Emergency Medicine Faculty and Industry Relationships
Authors: Birkhahn Robert H. , Blomkalns Andra L. , Klausner Howard A. , Nowak Richard M. , Raja Ali S. , Summers Richard L. , Weber Jim E. , Briggs William M. , Arkun Alp , Diercks Deborah
Published: August 2008

Objectives:  The authors surveyed the membership of the Society for Academic Emergency Medicine (SAEM) about their associations with industry and predictors of those associations.

Methods:  A national Web‐based survey inviting faculty from the active member list of SAEM was conducted. Follow‐up requests for participation were sent weekly for 3 weeks. Information was collected on respondents’ personal and practice characteristics, industry interactions, and personal opinions regarding these interactions. Raw response rates were reported and a logistic regression was used to generate descriptive statistics.

Results:  Responses were received from 430 members, representing 14% of the 3,183 active members. Respondents were 83% male and 86% white, with 96% holding an MD degree (24% with an additional postdoctoral degree). Most were at the assistant (37%) or associate (25%) professor rank, with 51% holding at least one leadership position. Most respondents (82%) reported some type of industry interaction, most commonly the acceptance of food or beverages (67%). Respondents at the associate professor rank or higher were more likely to receive payments from industry (51% vs. 22%, odds ratio [OR] = 3.7).

Conclusions:  This survey suggests that interactions between industry and academic EM faculty are common and increase with academic rank, but not with years in practice or leadership influence. The number and type of interactions are consistent with those reported by a national sampling of other physician specialties.
Olanzapine versus Droperidol for the Treatment of Primary Headache in the Emergency Department
Authors: Hill Chandler H. , Miner James R. , Martel Marc L.
Published: August 2008

Objectives:  The objective was to determine if there is a difference in pain relief or frequency and severity of side effects in emergency department (ED) patients with primary headache treated with either intramuscular (IM) olanzapine or IM droperidol.

Methods:  This was a prospective, randomized nonblinded clinical trial of adult ED patients undergoing treatment for suspected primary headache. Consenting patients were randomized to receive either droperidol 5 mg IM or olanzapine 10 mg IM. Prior to receiving treatment, patients were asked to complete a 100‐mm visual analog scale (VAS) describing their pain and a 4‐point verbal rating scale (VRS) describing their pain as none, mild, moderate, or severe. Patients also completed a 100‐mm VAS describing their level of nausea. Pain and nausea measurements were repeated 30 and 60 minutes after medication administration. Patients also completed the Barnes Akathisia Scale (BAS) 30 and 60 minutes after medication administration. Descriptive statistics were used as appropriate. Pain relief was compared both in terms of the decrease in VAS scores and in the proportion of patients who reported moderate or severe pain whose report later changed to mild or no pain.

Results:  One‐hundred patients were enrolled; 13 were withdrawn before administration of the study medication, 8 in the droperidol group and 5 in the olanzapine group, leaving 87 patients for analysis. Forty‐two patients received droperidol and 45 received olanzapine. In the droperidol group, 35/40 (87.5%) patients who had reported moderate or severe pain at baseline reported mild or no pain at 60 minutes. In the olanzapine group, 38/44 (86.4%) reported this change (p = 0.89). The mean percent change from baseline VAS pain score at 60 minutes was −37% (95% CI = −84% to 11%) for droperidol and −37% (95% CI = −64% to 10%) for olanzapine (p = 0.30). The mean percent change from baseline for the VAS nausea score was −59% (95% CI = −70% to −47%) for droperidol and −64% (95% CI = −77% to −51%) for olanzapine (p = 0.83). There was no difference in any report of akathisia by the BAS between the groups (p = 0.63).

Conclusions:  Both olanzapine and droperidol are effective treatments for primary headaches in the ED. No significant differences were found between the medications in terms of pain relief, antiemetic effect, or akathisia. Olanzapine may be used to treat primary headache and it is an effective alternative to droperidol.
Simulator Training Improves Fiber‐optic Intubation Proficiency among Emergency Medicine Residents
Authors: Binstadt Emily , Donner Scott , Nelson Jessie , Flottemesch Thomas , Hegarty Cullen
Published: August 2008

Objectives:  The objective was to observe how a workshop using a virtual reality bronchoscopy simulator and computer‐based tutorial affects emergency medicine (EM) resident skill in fiber‐optic intubation.

Methods:  In this observational before‐and‐after study, EM resident performance on three simulated pediatric difficult airway cases was observed before and after a short computer‐based tutorial and 10 minutes of self‐directed practice. The primary outcome was the total time required to place the endotracheal tube (ETT), secondary outcomes included the number of endoscope collisions with mucosa, and a calculated efficiency score measuring the proportion of time participants spent looking at correct central airway structures. Nonparametric Wilcoxon signed rank tests compared performance on the first versus the repeat attempt for each of the three simulated cases. Participants were surveyed regarding their assessments of the experience.

Results:  Significant decreases in median procedure times and number of scope collisions and increases in median efficiency scores were seen for Cases 1 and 2. Case 3 showed no significant changes in outcomes between first and repeat attempts. Participants positively assessed the training and felt that its use would improve clinical practice.

Conclusions:  Participation in a simulation‐based fiber‐optic intubation skill workshop can improve fiber‐optic intubation performance rapidly among EM residents. Future research should evaluate if this enhanced performance translates to improved clinical performance in the emergency department (ED).
The Effect of Emergency Department Crowding on Patient Satisfaction for Admitted Patients
Authors: Pines Jesse M. , Iyer Sanjay , Disbot Maureen , Hollander Judd E. , Shofer Frances S. , Datner Elizabeth M.
Published: August 2008

Objectives:  The objective was to study the association between factors related to emergency department (ED) crowding and patient satisfaction.

Methods:  The authors performed a retrospective cohort study of all patients admitted through the ED who completed Press‐Ganey patient satisfaction surveys over a 2‐year period at a single academic center. Ordinal and binary logistic regression was used to study the association between validated ED crowding factors (such as hallway placement, waiting times, and boarding times) and patient satisfaction with both ED care and assessment of satisfaction with the overall hospitalization.

Results:  A total of 1,501 hospitalizations for 1,469 patients were studied. ED hallway use was broadly predictive of a lower likelihood of recommending the ED to others, lower overall ED satisfaction, and lower overall satisfaction with the hospitalization (p < 0.05). Prolonged ED boarding times and prolonged treatment times were also predictive of lower ED satisfaction and lower satisfaction with the overall hospitalization (p < 0.05). Measures of ED crowding and ED waiting times predicted ED satisfaction (p < 0.05), but were not predictive of satisfaction with the overall hospitalization.

Conclusions:  A poor ED service experience as measured by ED hallway use and prolonged boarding time after admission are adversely associated with ED satisfaction and predict lower satisfaction with the entire hospitalization. Efforts to decrease ED boarding and crowding might improve patient satisfaction.
Echocardiographic Evaluation of a TASER‐X26 Application in the Ideal Human Cardiac Axis
Authors: Ho Jeffrey D. , Dawes Donald M. , Reardon Robert F. , Lapine Anne L. , Dolan Benjamin J. , Lundin Erik J. , Miner James R.
Published: August 2008

Objectives:  TASER electronic control devices (ECDs) are used by law enforcement to subdue aggressive persons. Some deaths temporally proximate to their use have occurred. There is speculation that these devices can cause dangerous cardiac rhythms. Swine research supports this hypothesis and has reported significant tachyarrhythmias. It is not known if this occurs in humans. The objective of this study was to determine the occurrence of tachyarrhythmias in human subjects subjected to an ECD application.

Methods:  This was a prospective, nonblinded study. Human volunteers underwent limited echocardiography before, during, and after a 10‐second TASER X26 ECD application with preplaced thoracic electrodes positioned in the upper right sternal border and the cardiac apex. Images were analyzed using M‐mode through the anterior leaflet of the mitral valve for evidence of arrhythmia. Heart rate (HR) and the presence of sinus rhythm were determined. Data were analyzed using descriptive statistics.

Results:  A total of 34 subjects were enrolled. There were no adverse events reported. The mean HR prior to starting the event was 108.7 beats/min (range 65 to 146 beats/min, 95% CI = 101.0 to 116.4 beats/min). During the ECD exposure, the mean HR was 120.1 beats/min (range 70 to 158 beats/min, 95% CI = 112.2 to 128.0 beats/min) and a mean of 94.1 beats/min (range 55 to 121 beats/min, 95% CI = 88.4 to 99.7 beats/min) at 1 minute after ECD exposure. Sinus rhythm was clearly demonstrated in 21 (61.7%) subjects during ECD exposure (mean HR 121.4 beats/min; range 75 to 158 beats/min, 95% CI = 111.5 to 131.4). Sinus rhythm was not clearly demonstrated in 12 subjects due to movement artifact (mean HR 117.8 beats/min, range 70 to 152 beats/min, 95% CI = 102.8 to 132.8 beats/min).

Conclusions:  A 10‐second ECD exposure in an ideal cardiac axis application did not demonstrate concerning tachyarrhythmias using human models. The swine model may have limitations when evaluating ECD technology.
Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department
Authors: Nordenholz Kristen E. , Mitchell Alice M. , Kline Jeffrey A.
Published: August 2008

Objectives:  Pulmonary embolism (PE) is associated with abnormal concentrations of many proteins involved in inflammation, hemostasis, and vascular injury. The authors quantified the diagnostic accuracy of a battery of protein biological markers for the detection of PE in emergency department (ED) patients.

Methods:  A random and a consecutive sample of ED patients evaluated for PE were prospectively enrolled at two academic EDs between August 2005 and April 2006. A plasma sample was obtained at enrollment, and all patients were followed by telephone and medical record review at 90 days for the development of venous thromboembolism (VTE) defined as PE or deep venous thrombosis (DVT), requiring the consensus of two of three blinded physician reviewers. Measurements of potential biological markers were performed by technicians blinded to the study objectives. The diagnostic accuracy of each biological marker was determined by the area under the receiver operating characteristic (ROC) curve.

Results:  Fifty potential biological markers were measured in 304 ED patients, including 22 patients (7%, 95% confidence interval [CI] = 4% to 10%) with VTE. Fourteen biological markers demonstrated an area under the curve (AUC) with the lower limit of the 95% CI ≥ 0.5. Of these, three demonstrated an AUC ≥ 0.7: D‐dimer (0.90), C‐reactive protein (CRP; 0.78), and myeloperoxidase (MPO; 0.78).

Conclusions:  From 50 candidate biological markers, only D‐dimer, CRP, and MPO demonstrated sufficient diagnostic accuracy to suggest potential utility as biological marker of PE.
Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma
Authors: Gorelick Marc H. , Atabaki Shireen M. , Hoyle John , Dayan Peter S. , Holmes James F. , Holubkov Richard , Monroe David , Callahan James M. , Kuppermann Nathan ,   for the Pediatric Emergency Care Applied Research Network (PECARN)
Published: August 2008

Objectives:  To be useful in development of clinical decision rules, clinical variables must demonstrate acceptable agreement when assessed by different observers. The objective was to determine the interobserver agreement in the assessment of historical and physical examination findings of children undergoing emergency department (ED) evaluation for blunt head trauma.

Methods:  This was a prospective cohort study of children younger than 18 years evaluated for blunt head trauma at one of 25 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). Patients were excluded if injury occurred more than 24 hours prior to evaluation, if neuroimaging was obtained at another hospital prior to evaluation, or if the patient had a clinically trivial mechanism of injury. Two clinicians independently completed a standardized clinical assessment on a templated data form. Assessments were performed within 60 minutes of each other and prior to clinician review of any neuroimaging (if obtained). Agreement between the two observers beyond that expected by chance was calculated for each clinical variable, using the kappa (κ) statistic for categorical variables and weighted kappa for ordinal variables. Variables with a lower 95% confidence limit (LCL) of κ > 0.4 were considered to have acceptable agreement.

Results:  Fifteen‐hundred pairs of observations were obtained. Acceptable agreement was achieved in 27 of the 32 variables studied (84%). Mechanism of injury (low, medium, or high risk) had κ = 0.83. For subjective symptoms, kappa ranged from 0.47 (dizziness) to 0.93 (frequency of vomiting); all had 95% LCL > 0.4. Of the physical examination findings, kappa ranged from 0.22 (agitated) to 0.89 (Glasgow Coma Scale [GCS] score). The 95% LCL for kappa was <0.4 for four individual signs of altered mental status and for quality (i.e., boggy or firm) of scalp hematoma if present.

Conclusions:  Both subjective and objective clinical variables in children with blunt head trauma can be assessed by different observers with acceptable agreement, making these variables suitable candidates for clinical decision rules.
Clerkship Directors in Emergency Medicine: Statement of Purpose
Authors: Wald David A. , Manthey David E. , Lin Michelle , Ander Douglas S. , Fisher Jonathan
Published: August 2008

The Academy of Clerkship Directors in Emergency Medicine (CDEM) provides a forum for the collaborative exchange of ideas among emergency medicine (EM) medical student educators, a platform for the advancement of education, research, and faculty development, and establishes for the first time a national voice for undergraduate medical education within our specialty. CDEM plans to take a leading role in providing medical student educators with additional educational resources and opportunities for faculty development and networking. CDEM will work to foster the professional growth and development of undergraduate medical educators within our specialty. The advancement of undergraduate education within our specialty and beyond will come primarily from the support, hard work, and dedication of the educators. To accomplish our goals, at the departmental, medical school, and national level, we must come together to further promote our specialty across the spectrum of undergraduate medical education. The first step has already been taken with the formation of the Academy of CDEM.
Resident Response to Integration of Simulation‐based Education into Emergency Medicine Conference
Authors: Wang Ernest E. , Beaumont Jennifer , Kharasch Morris , Vozenilek John A.
Published: August 2008

Objectives:  Utilization of simulation‐based training has become increasingly prevalent in residency training. The authors compared emergency medicine (EM) resident feedback for simulation sessions to traditional lectures from an EM residency didactic program.

Methods:  The authors performed a retrospective review of all written EM conference evaluations over a 29‐month period. Evaluation questions were scored on a 1–9 Likert scale.

Results:  Lectures and simulation accounted for 77.6 and 22.4% of the conferences, respectively. Scored means (±standard deviations [SDs]) were as follows: overall, lecture 7.97 ± 0.74 versus simulation 8.373 ± 0.44 (p < 0.01); Question 1, lecture 7.97 ± 0.74 versus simulation 8.40 ± 0.43 (p < 0.005); Question 2, lecture 7.92 ± 0.74 versus simulation 8.34 ± 0.48 (p < 0.01); Question 3, lecture 8.01 ± 0.77 versus simulation 8.26 ± 0.51 (p < 0.15); and Question 4, lecture 8.00 ± 0.75 versus simulation 8.42 ± 0.46 (p < 0.01). There was no longitudinal decay of scores.

Conclusions:  Emergency medicine residents scored simulation‐based sessions higher than traditional lectures. The scores over time suggest that this preference for simulation can be sustainable long term. Residents perceive simulation as more desirable teaching method compared to the traditional lecture format.
Stimulation of osteoblast activity by homocysteine
Authors: Herrmann Markus , Umanskaya Natalia , Wildemann Britt , Colaianni Graziana , Widmann Thomas , Zallone Alberta , Herrmann Wolfgang
Published: August 2008

Homocysteine (HCY) has recently been linked to fragility fractures. Moreover, HCY activates osteoclasts. Little is known about the effect of HCY on activity of human osteoblasts (OBs). We hypothesized that HCY decreases the activity of OBs. Osteoblasts obtained from tra‐becular human bone specimens of eight donors were cultured with conditioned medium. Culture medium was adjusted to 0, 100, 500, 1000 and 2000 μM HCY. After 14 days alkaline phosphatase (AP) activity, pro‐collagen type I N‐terminal peptide (PINP) and osteocalcin (OC) secretion in the supernatant were measured. After 20 days the formation of mineralized matrix was analyzed. HCY‐stimulated AP activity gradually (100 μM HCY: 118%, P= 0.006; 500 μM HCY: 125%, P < 0.001). At 1000 and 2000 μM HCY the increase of AP activity was reversible (1000 μM HCY: 106%, P= 0.317; 2000 μM HCY: 102%, P < 0.737). The PINP secretion was also stimulated by HCY reaching a maximum of 260 ± 154 μg/l at 500 μmol/l versus 205 ± 94 μ,g/l in controls. After 20 days of culture the formation of bone matrix was increased at 100 and 500 μM HCY. OC secretion was not significantly changed. The results of the present study consistently demonstrate a moderate stimulation of primary human OB activity by increasing concentrations of HCY. However, the magnitude of this effect seems to be less pronounced than recent observations on primary human osteoclasts, suggesting a dysbalance between OBs and osteoclasts in favour of osteoclasts
A renin transcript lacking exon 1 encodes for a non‐secretory intracellular renin that increases aldosterone production in transgenic rats
Authors: Peters Jörg , Wanka Heike , Peters Barbara , Hoffmann Sigrid
Published: August 2008

Renin transcripts lacking exon 1 and thus the signal sequence for co‐translational transport to the endoplasmatic reticulum encode for a protein (exon[2‐9]renin), that is confined to the cytoplasm. The function of exon(2‐9)renin is currently unknown. Mitochondrial renin increases under conditions which stimulate aldosterone production. We hypothesized that exon(2‐9)renin (1) is translated into a functionally active protein in vivo, (2) is not secreted but remains within the cytoplasm and (3) stimulates aldosterone production. To test these hypotheses we generated transgenic rats overexpressing exon(2‐9)renin. Four transgenic lines were obtained expressing the transcript in various tissues including the heart and the adrenal gland. Renin was enriched particularly in the cytoplasm of transgenic rats. Renin was not elevated in plasma, indicating that exon(2‐9)renin is produced but not secreted. The ratio of aldosterone to renin concentrations in plasma (PAC/PRC) was elevated in all transgenic lines except line 307, which also did not exhibit elevated cytoplasmatic renin levels in the adrenal gland (PAC/PRC in controls: 2.8±2.3; line 307: 1.9±0.8; n. s.; line 284: 5.8±1.9; P<0.02; line 294: 5.0±2.3; P<0.001; line 276: 10.3±5.1; P<0.001). We conclude that the exon(1A‐9) renin transcript (1) is translated into a functionally active intracellular protein; (2) is targeted to the cytoplasm rather than being sorted to the secretory pathways and (3) is functionally active, regulating aldosterone production. The CX‐(exon2‐9)renin transgenic rat appears to be a useful model to study the role and the mechanisms of action of cytoplasmatic renin derived from exon(1A‐9) transcripts.
DTD, an anti‐inflammatory ditriazine, inhibits angiogenesis in vitro and in vivo
Authors: Martínez‐Poveda Beatriz , Muñoz‐Chápuli Ramón , Riguera Ricardo , Fernández Antonio , Ángel Medina Miguel , Quesada Ana R.
Published: August 2008

The ditriazine derivative DTD (4,10‐dichloropyrido[5,6:4,5]thieno[3,2‐d':3,2‐d]‐1,2,3‐ditriazine) has been previously reported to reduce the degree of granulomatous inflammation and vascular density in a murine air pouch granuloma model. The aim of this study was to test whether DTD affects angiogenesis. Our results show that DTD inhibits in vivo angiogenesis in the chorioallantoic membrane (CAM) assay at doses equal or lower than 0.3 nmol/egg. Different in vitro assays were used to study the potential effects of this compound on key steps of angiogenesis, namely, a colorimetric assay of cell proliferation/viability, a morphogenesis on Matrigel assay, zymographic assays for gelatinases and nuclear morphology and cell cycle analysis for apoptosis induction. Our data indicate that DTD inhibits proliferation but does not induce apoptosis in endothelial cells in vitro. DTD suppresses the endothelial capillary‐like chord formation at concentrations lower than those required to inhibit proliferation. DTD treatment inhibits the matrix metalloproteinase‐2 production in endothelial and fibrosarcoma cells, but does not affect the cyclooxygenase‐2 expression in endothelial cells, as assessed by western blot analysis. Taken together, results here presented indicate that DTD exhibits an anti‐angiogenic activity that is independent of inflammatory processes and make it a promising drug for further evaluation in the treatment of angiogenesis‐related pathologies.
Fate of amnion‐derived stem cells transplanted to the fetal rat brain: migration, survival and differentiation
Authors: Marcus A. J. , Coyne T. M. , Black I. B. , Woodbury D.
Published: August 2008

We have recently characterized a stem cell population isolated from the rodent amniotic membrane termed amnion‐derived stem cells (ADSCs). In vitro ADSCs differentiate into cell types representing all three embryonic layers, including neural cells. In this study we evaluated the neuroectodermal potential of ADSCs in vivo after in utero transplantation into the developing rat brain. A clonal line of green fluorescent protein‐expressing ADSCs were infused into the telencephalic ventricles of the developing embryonic day 15.5 rat brain. At E17.5 donor cells existed primarily as spheres in the ventricles with subsets fused to the ventricular walls, suggesting a mode of entry into the brain parenchyma. By E21.5 green fluorescent protein (GFP) ADSCs migrated to a number of brain regions. Examination at postnatal time points revealed that donor ADSCs expressed vimentin and nestin. Subsets of transplanted ADSCs attained neuronal morphologies, although there was no immunohistochemical evidence of neural or glial differentiation. Some donor cells migrated around blood vessels and differentiated into putative endothelial cells. Donor ADSCs transplanted in utero were present in recipients into adulthood with no evidence of immunological rejection or tumour formation. Long‐term survival may suggest utility in the treatment of disorders where differentiation to a neural cell type is not required for clinical benefit.
Non‐patient related variables affecting levels of vascular endothelial growth factor in urine biospecimens
Authors: Kirk M. J. , Hayward R. M. , Sproull M. , Scott T. , Smith S. , Cooley‐Zgela T. , Crouse N. S. , Citrin D. E. , Camphausen K.
Published: August 2008

Vascular endothelial growth factor (VEGF) is an angiogenic protein proposed to be an important biomarker for the prediction of tumour growth and disease progression. Recent studies suggest that VEGF measurements in biospecimens, including urine, may have predictive value across a range of cancers. However, the reproducibility and reliability of urinary VEGF measurements have not been determined. We collected urine samples from patients receiving radiation treatment for glioblastoma multiforme (GBM) and examined the effects of five variables on measured VEGF levels using an ELISA assay. To quantify the factors affecting the precision of the assay, two variables were examined: the variation between ELISA kits with different lot numbers and the variation between different technicians. Three variables were tested for their effects on measured VEGF concentration: the time the specimen spent at room temperature prior to assay, the addition of protease inhibitors prior to specimen storage and the alteration of urinary pH. This study found that VEGF levels were consistent across three different ELISA kit lot numbers. However, significant variation was observed between results obtained by different technicians. VEGF concentrations were dependent on time at room temperature before measurement, with higher values observed 3–7 hrs after removal from the freezer. No significant difference was observed in VEGF levels with the addition of protease inhibitors, and alteration of urinary pH did not significantly affect VEGF measurements. In conclusion, this determination of the conditions necessary to reliably measure urinary VEGF levels will be useful for future studies related to protein biomarkers and disease progression.