bluuebunny/crossref_metadata_2025 huggingface dataset:
Race/ethnicity and disease severity in IgA nephropathy
Authors: Hall Yoshio N , Fuentes Eloisa F , Chertow Glenn M , Olson Jean L
Published: September 2004

Background

Relatively few U.S.-based studies in chronic kidney disease have focused on Asian/Pacific Islanders. Clinical reports suggest that Asian/Pacific Islanders are more likely to be affected by IgA nephropathy (IgAN), and that the severity of disease is increased in these populations.

Methods

To explore whether these observations are borne out in a multi-ethnic, tertiary care renal pathology practice, we examined clinical and pathologic data on 298 patients with primary glomerular lesions (IgAN, focal segmental glomerulosclerosis, membranous nephropathy and minimal change disease) at the University of California San Francisco Medical Center from November 1994 through May 2001. Pathologic assessment of native kidney biopsies with IgAN was conducted using Haas' classification system.

Results

Among individuals with IgAN (N = 149), 89 (60%) were male, 57 (38%) white, 53 (36%) Asian/Pacific Islander, 29 (19%) Hispanic, 4 (3%) African American and 6 (4%) were of other or unknown ethnicity. The mean age was 37 ± 14 years and median serum creatinine 1.7 mg/dL. Sixty-six patients (44%) exhibited nephrotic range proteinuria at the time of kidney biopsy. The distributions of age, gender, mean serum creatinine, and presence or absence of nephrotic proteinuria and/or hypertension at the time of kidney biopsy were not significantly different among white, Hispanic, and Asian/Pacific Islander groups. Of the 124 native kidney biopsies with IgAN, 10 (8%) cases were classified into Haas subclass I, 12 (10%) subclass II, 23 (18%) subclass III, 30 (25%) subclass IV, and 49 (40%) subclass V. The distribution of Haas subclass did not differ significantly by race/ethnicity. In comparison, among the random sample of patients with non-IgAN glomerular lesions (N = 149), 77 (52%) patients were male, 51 (34%) white, 42 (28%) Asian/Pacific Islander, 25 (17%) Hispanic, and 30 (20%) were African American.

Conclusions

With the caveats of referral and biopsy biases, the race/ethnicity distribution of IgAN differs significantly from that of other major glomerulonephridities. However, among individuals undergoing native kidney biopsy, we see no evidence of a race/ethnicity association with severity of disease in IgAN by clinical and IgAN-specific histopathologic criteria. Further studies are needed to identify populations at higher risk for progressive disease in IgAN.
HER2 expression in cervical cancer as a potential therapeutic target
Authors: Chavez-Blanco Alma , Perez-Sanchez Victor , Gonzalez-Fierro Aurora , Vela-Chavez Teresa , Candelaria Myrna , Cetina Lucely , Vidal Silvia , Dueñas-Gonzalez Alfonso
Published: September 2004

Background

Trastuzumab, a humanized monoclonal antibody against the HER2 receptor is currently being used in breast and other tumor types. Early studies have shown that a variable proportion of cervical carcinoma tumors overexpress the HER2 receptor as evaluated by diverse techniques and antibodies. Currently it is known that a tumor response to trastuzumab strongly correlates with the level of HER2 expression evaluated by the Hercep Test, thus, it seems desirable to evaluate the status of expression of this receptor using the FDA-approved Hercep Test and grading system to gain insight in the feasibility of using trastuzumab in cervical cancer patients.

Methods

We analyzed a series of cervical cancer cell lines, the primary tumors of 35 cases of cervical cancer patients and four recurrent cases, with the Hercep Test in order to establish whether this tumor type overexpress HER2 at level of 2+/3+ as trastuzumab is currently approved for breast cancer having such level of expression.

Results

The results indicate that only 1 out of 35 primary tumors cases overexpress the receptor at this level, however, two out of four recurrent tumors that tested negative at diagnosis shifted to Hercep Test 2+ and 3+ respectively.

Conclusions

The low frequency of expression in primary cases suggests that trastuzumab could have a limited value for the primary management of cervical cancer patients, however, the finding of "conversion" to Hercep Test 2+ and 3+ of recurrent tumors indicates the need to further evaluate the expression of HER2 in the metastatic and recurrent cases.
Survival of patients with metastatic breast cancer: twenty-year data from two SEER registries
Authors: Tai Patricia , Yu Edward , Vinh-Hung Vincent , Cserni Gábor , Vlastos Georges
Published: September 2004

Background

Many researchers are interested to know if there are any improvements in recent treatment results for metastatic breast cancer in the community, especially for 10- or 15-year survival.

Methods

Between 1981 and 1985, 782 and 580 female patients with metastatic breast cancer were extracted respectively from the Connecticut and San Francisco-Oakland registries of the Surveillance, Epidemiology, and End Results (SEER) database. The lognormal statistical method to estimate survival was retrospectively validated since the 15-year cause-specific survival rates could be calculated using the standard life-table actuarial method. Estimated rates were compared to the actuarial data available in 2000. Between 1991 and 1995, further 752 and 632 female patients with metastatic breast cancer were extracted respectively from the Connecticut and San Francisco-Oakland registries. The data were analyzed to estimate the 15-year cause-specific survival rates before the year 2005.

Results

The 5-year period (1981–1985) was chosen, and patients were followed as a cohort for an additional 3 years. The estimated 15-year cause-specific survival rates were 7.1% (95% confidence interval, CI, 1.8–12.4) and 9.1% (95% CI, 3.8–14.4) by the lognormal model for the two registries of Connecticut and San Francisco-Oakland respectively. Since the SEER database provides follow-up information to the end of the year 2000, actuarial calculation can be performed to confirm (validate) the estimation. The Kaplan-Meier calculation for the 15-year cause-specific survival rates were 8.3% (95% CI, 5.8–10.8) and 7.0% (95% CI, 4.3–9.7) respectively. Using the 1991–1995 5-year period cohort and followed for an additional 3 years, the 15-year cause-specific survival rates were estimated to be 9.1% (95% CI, 3.8–14.4) and 14.7% (95% CI, 9.8–19.6) for the two registries of Connecticut and San Francisco-Oakland respectively.

Conclusions

For the period 1981–1985, the 15-year cause-specific survival for the Connecticut and the San Francisco-Oakland registries were comparable. For the period 1991–1995, there was not much change in survival for the Connecticut registry patients, but there was an improvement in survival for the San Francisco-Oakland registry patients.
An outbreak of Salmonella Enteritidis phage type 34a infection associated with a Chinese restaurant in Suffolk, United Kingdom
Authors: Badrinath Padmanabhan , Sundkvist Torbjorn , Mahgoub Hamid , Kent Richard
Published: September 2004

Background

On 30th July 2002, the Suffolk Communicable Disease Control Team received notifications of gastrointestinal illness due to Salmonella Enteritidis in subjects who had eaten food from a Chinese restaurant on 27th July. An Outbreak Control Team was formed resulting in extensive epidemiological, microbiological and environmental investigations.

Methods

Attempts were made to contact everybody who ate food from the restaurant on 27th July and a standard case definition was adopted. Using a pre-designed proforma information was gathered from both sick and well subjects. Food specific attack rates were calculated and two-tailed Fisher's exact test was used to test the difference between type of food consumed and the health status. Using a retrospective cohort design univariate Relative Risks and 95% Confidence Intervals were calculated for specific food items.

Results

Data was gathered on 52 people of whom 38 developed gastrointestinal symptoms; 16 male and 22 female. The mean age was 27 years. The mean incubation period was 30 hours with a range of 6 to 90 hours. Food attack rates were significantly higher for egg, special and chicken fried rice. Relative risk and the Confidence interval for these food items were 1.97 (1.11–3.48), 1.56 (1.23–1.97) and 1.48 (1.20–1.83) respectively. Interviews with the chef revealed that many eggs were used in the preparation of egg-fried rice, which was left at room temperature for seven hours and was used in the preparation of the other two rice dishes. Of the 31 submitted stool specimens 28 tested positive for S Enteritidis phage type 34a and one for S Enteritidis phage type 4.

Conclusion

In the absence of left over food available for microbiological examination, epidemiological investigation strongly suggested the eggs used in the preparation of the egg-fried rice as the vehicle for this outbreak. This investigation highlights the importance of safe practices in cooking and handling of eggs in restaurants.
Is acupuncture a useful adjunct to physiotherapy for older adults with knee pain?: The "Acupuncture, Physiotherapy and Exercise" (APEX) study [ISRCTN88597683]
Authors: Hay Elaine , Barlas Panos , Foster Nadine , Hill Jonathan , Thomas Elaine , Young Julie
Published: September 2004

Background

Acupuncture is a popular non-pharmacological modality for treating musculoskeletal pain. Physiotherapists are one of the largest groups of acupuncture providers within the NHS, and they commonly use it alongside advice and exercise. Conclusive evidence of acupuncture's clinical effectiveness and its superiority over sham interventions is lacking. The Arthritis Research Campaign (arc) has funded this randomised sham-controlled trial which addresses three important questions. Firstly, we will determine the additional benefit of true acupuncture when used by physiotherapists alongside advice and exercise for older people presenting to primary care with knee pain. Secondly, we will evaluate sham acupuncture in the same way. Thirdly, we will investigate the treatment preferences and expectations of both the participants and physiotherapists participating in the study, and explore the effect of these on clinical outcome. We will thus investigate whether acupuncture is a useful adjunct to advice and exercise for treating knee pain and gain insight into whether this effect is due to specific needling properties.

Methods/Design

This randomised clinical trial will recruit 350 participants with knee pain to three intervention arms. It is based in 43 community physiotherapy departments in 21 NHS Trusts in the West Midlands and Cheshire regions in England. Patients aged 50 years and over with knee pain will be recruited. Outcome data will be collected by self-complete questionnaires before randomisation, and 6 weeks, 6 months and 12 months after randomisation and by telephone interview 2 weeks after treatment commences. The questionnaires collect demographic details as well as information on knee-related pain, movement and function, pain intensity and affect, main functional problem, illness perceptions, self-efficacy, treatment preference and expectations, general health and quality of life. Participants are randomised to receive a package of advice and exercise; or this package plus real acupuncture; or this package plus sham acupuncture. Treatment details are being collected on a standard proforma. Interventions are delivered by experienced physiotherapists who have all received training in acupuncture to recognised national standards. The primary analysis will investigate the main treatment effects of real or sham acupuncture as an adjunct to advice and exercise.

Discussion

This paper presents detail on the rationale, design, methods, and operational aspects of the trial.
Improving prescribing of antihypertensive and cholesterol-lowering drugs: a method for identifying and addressing barriers to change
Authors: Fretheim Atle , Oxman Andrew D , Flottorp Signe
Published: September 2004

Background

We describe a simple approach we used to identify barriers and tailor an intervention to improve pharmacological management of hypertension and hypercholesterolaemia. We also report the results of a post hoc exercise and survey we carried out to evaluate our approach for identifying barriers and tailoring interventions.

Methods

We used structured reflection, searched for other relevant trials, surveyed general practitioners and talked with physicians during pilot testing of the intervention. The post hoc exercise was carried out as focus groups of international researchers in the field of quality improvement in health care. The post hoc survey was done by telephone interviews with physicians allocated to the experimental group of a randomised trial of our multifaceted intervention.

Results

A wide range of barriers was identified and several interventions were suggested through structured reflection. The survey led to some adjustments. Studying other trials and pilot testing did not lead to changes in the design of the intervention. Neither the post hoc focus groups nor the post hoc survey revealed important barriers or interventions that we had not considered or included in our tailored intervention.

Conclusions

A simple approach to identifying barriers to change appears to have been adequate and efficient. However, we do not know for certain what we would have gained by using more comprehensive methods and we do not know whether the resulting intervention would have been more effective if we had used other methods. The effectiveness of our multifaceted intervention is under evaluation in a randomised controlled trial.
Recombinant antigen-based antibody assays for the diagnosis and surveillance of lymphatic filariasis – a multicenter trial
Authors: Lammie Patrick J , Weil Gary , Noordin Rahmah , Kaliraj Perumal , Steel Cathy , Goodman David , Lakshmikanthan Vijaya B , Ottesen Eric
Published: September 2004

The development of antifilarial antibody responses is a characteristic feature of infection with filarial parasites. It should be possible to exploit this fact to develop tools to monitor the progress of the global program to eliminate lymphatic filariasis (LF); however, assays based on parasite extracts suffer from a number of limitations, including the paucity of parasite material, the difficulty of assay standardization and problems with assay specificity. In principle, assays based on recombinant filarial antigens should address these limitations and provide useful tools for diagnosis and surveillance of LF. The present multicenter study was designed to compare the performance of antibody assays for filariasis based on recombinant antigens Bm14, WbSXP, and BmR1. Coded serum specimens were distributed to five participating laboratories where assays for each antigen were conducted in parallel. Assays based on Bm14, WbSXP, or BmR1 demonstrated good sensitivity (>90%) for field use and none of the assays demonstrated reactivity with specimens from persons with non-filarial helminth infections. Limitations of the assays are discussed. Well-designed field studies are now needed to assess sampling methodology and the application of antibody testing to the monitoring and surveillance of LF elimination programs.
Liver sinusoidal endothelial cell modulation upon resection and shear stress in vitro
Authors: Braet Filip , Shleper Maria , Paizi Melia , Brodsky Sergey , Kopeiko Natalia , Resnick Nitzan , Spira Gadi
Published: September 2004

Background

Shear stress forces acting on liver sinusoidal endothelial cells following resection have been noted as a possible trigger in the early stages of hepatic regeneration. Thus, the morphology and gene expression of endothelial cells following partial hepatectomy or shear stress in vitro was studied.

Results

Following partial hepatectomy blood flow-to-liver mass ratio reached maximal values 24 hrs post resection. Concomitantly, large fenestrae (gaps) were noted. Exposure of liver sinusoidal endothelial cells, in vitro, to physiological laminar shear stress forces was associated with translocation of vascular endothelial cell growth factor receptor-2 (VEGFR-2) and neuropilin-1 from perinuclear and faint cytoplasmic distribution to plasma membrane and cytoskeletal localization. Under these conditions, VEGFR-2 co-stains with VE-cadherin. Unlike VEGFR-2, the nuclear localization of VEGFR-1 was not affected by shear stress. Quantification of the above receptors showed a significant increase in VEGFR-1, VEGFR-2 and neuropilin-1 mRNA following shear stress.

Conclusion

Our data suggest a possible relation between elevated blood flow associated with partial hepatectomy and the early events occurring thereby.
Simultaneous suppression of disturbing fields and localization of magnetic markers by means of multipole expansion
Authors: Hilgenfeld Bernd , Haueisen Jens
Published: September 2004

Background

Magnetically marked capsules serve for the analysis of peristalsis and throughput times within the intestinal tract. Moreover, they can be used for the targeted disposal of drugs. The capsules get localized in time by field measurements with a superconducting quantum interference device (SQUID) magnetometer array. Here it is important to ensure an online localization with high speed and high suppression of disturbing fields. In this article we use multipole expansions for the simultaneous localization and suppression of disturbing fields.

Methods

We expand the measurement data in terms of inner and outer multipoles. Thereby we obtain directly a separation of marker field and outer disturbing fields. From the inner dipoles and quadrupoles we compute the magnetization and position of the capsule. The outer multipoles get eliminated.

Results

The localization goodness has been analyzed depending on the order of the multipoles used and depending on the systems noise level. We found upper limits of the noise level for the usage of certain multipole moments. Given a signal to noise ratio of 40 and utilizing inner dipoles and quadrupoles and outer dipoles, the method enables an accuracy of 5 mm with a speed of 10 localizations per second.

Conclusion

The multipole localization is an effective method and is capable of online-tracking magnetic markers.
The Menopause Rating Scale (MRS) scale: A methodological review
Authors: Heinemann Klaas , Ruebig Alexander , Potthoff Peter , Schneider Hermann PG , Strelow Frank , Heinemann Lothar AJ , Thai Do Minh
Published: September 2004

Background

This paper compiles data from different sources to get a first comprehensive picture of psychometric and other methodological characteristics of the Menopause Rating Scale (MRS) scale. The scale was designed and standardized as a self-administered scale to (a) to assess symptoms/complaints of aging women under different conditions, (b) to evaluate the severity of symptoms over time, and (c) to measure changes pre- and postmenopause replacement therapy. The scale became widespread used (available in 10 languages).

Method

A large multinational survey (9 countries in 4 continents) from 2001/ 2002 is the basis for in depth analyses on reliability and validity of the MRS. Additional small convenience samples were used to get first impressions about test-retest reliability. The data were centrally analyzed. Data from a postmarketing HRT study were used to estimate discriminative validity.

Results

Reliability measures (consistency and test-retest stability) were found to be good across countries, although the sample size for test-retest reliability was small.

Validity: The internal structure of the MRS across countries was astonishingly similar to conclude that the scale really measures the same phenomenon in symptomatic women. The sub-scores and total score correlations were high (0.7–0.9) but lower among the sub-scales (0.5–0.7). This however suggests that the subscales are not fully independent.

Norm values from different populations were presented showing that a direct comparison between Europe and North America is possible, but caution recommended with comparisons of data from Latin America and Indonesia. But this will not affect intra-individual comparisons within clinical trials.

The comparison with the Kupperman Index showed sufficiently good correlations, illustrating an adept criterion-oriented validity. The same is true for the comparison with the generic quality-of-life scale SF-36 where also a sufficiently close association has been shown.

Conclusion

The currently available methodological evidence points towards a high quality of the MRS scale to measure and to compare HRQoL of aging women in different regions and over time, it suggests a high reliability and high validity as far as the process of construct validation could be completed yet.
Mohmmar Qadaffi, Open Access, and Retrovirology
Authors: Jeang Kuan-Teh
Published: September 2004

Retrovirology has been publishing as an Open Access online journal for approximately six months. In this editorial, I review the reasons for and the advantages of Open Access publishing, update our progress to date, and summarize where we intend to go with this journal.
Genetically distant American Canine distemper virus lineages have recently caused epizootics with somewhat different characteristics in raccoons living around a large suburban zoo in the USA
Authors: Lednicky John A , Dubach Jean , Kinsel Michael J , Meehan Thomas P , Bocchetta Maurizio , Hungerford Laura L , Sarich Nicolene A , Witecki Kelley E , Braid Michael D , Pedrak Casandra , Houde Christiane M
Published: September 2004

Background

Mortality rates have differed during distemper outbreaks among free-ranging raccoons (Procyon lotor) living around a large Chicago-area zoo, and appeared higher in year 2001 than in 1998 and 2000. We hypothesized that a more lethal variant of the local Canine distemper virus (CDV) lineage had emerged in 2001, and sought the genetic basis that led to increased virulence. However, a more complex model surfaced during preliminary analyses of CDV genomic sequences in infected tissues and of virus isolated in vitro from the raccoons.

Results

Phylogenetic analyses of subgenomic CDV fusion (F) -, phosphoprotein (P) -, and complete hemagglutinin (H) – gene sequences indicated that distinct American CDV lineages caused the distemper epizootics. The 1998 outbreak was caused by viruses that are likely from an old CDV lineage that includes CDV Snyder Hill and Lederle, which are CDV strains from the early 1950's. The 2000 and 2001 viruses appear to stem from the lineage of CDV A75/17, which was isolated in the mid 1970's. Only the 2001 viruses formed large syncytia in brain and/or lung tissue, and during primary isolation in-vitro in Vero cells, demonstrating at least one phenotypic property by which they differed from the other viruses.

Conclusions

Two different American CDV lineages caused the raccoon distemper outbreaks. The 1998 viruses are genetically distant to the 2000/2001 viruses. Since CDV does not cause persistent infections, the cycling of different CDV lineages within the same locale suggests multiple reintroductions of the virus to area raccoons. Our findings establish a precedent for determining whether the perceived differences in mortality rates are actual and attributable in part to inherent differences between CDV strains arising from different CDV lineages.
Regulation of FeLV-945 by c-Myb binding and CBP recruitment to the LTR
Authors: Finstad Samantha L , Prabhu Sudha , Rulli Karen R , Levy Laura S
Published: September 2004

Background

Feline leukemia virus (FeLV) induces degenerative, proliferative and malignant hematologic disorders in its natural host, the domestic cat. FeLV-945 is a viral variant identified as predominant in a cohort of naturally infected animals. FeLV-945 contains a unique sequence motif in the long terminal repeat (LTR) comprised of a single copy of transcriptional enhancer followed by a 21-bp sequence triplicated in tandem. The LTR is precisely conserved among independent cases of multicentric lymphoma, myeloproliferative disease and anemia in animals from the cohort. The 21-bp triplication was previously shown to act as a transcriptional enhancer preferentially in hematopoietic cells and to confer a replicative advantage. The objective of the present study was to examine the molecular mechanism by which the 21-bp triplication exerts its influence and the selective advantage responsible for its precise conservation.

Results

Potential binding sites for the transcription factor, c-Myb, were identified across the repeat junctions of the 21-bp triplication. Such sites would not occur in the absence of the repeat; thus, a requirement for c-Myb binding to the repeat junctions of the triplication would exert a selective pressure to conserve its sequence precisely. Electrophoretic mobility shift assays demonstrated specific binding of c-Myb to the 21-bp triplication. Reporter gene assays showed that the triplication-containing LTR is responsive to c-Myb, and that responsiveness requires the presence of both c-Myb binding sites. Results further indicated that c-Myb in complex with the 21-bp triplication recruits the transcriptional co-activator, CBP, a regulator of normal hematopoiesis. FeLV-945 replication was shown to be positively regulated by CBP in a manner dependent on the presence of the 21-bp triplication.

Conclusion

Binding sites for c-Myb across the repeat junctions of the 21-bp triplication may account for its precise conservation in the FeLV-945 LTR. c-Myb binding and CBP recruitment to the LTR positively regulated virus production, and thus may be responsible for the replicative advantage conferred by the 21-bp triplication. Considering that CBP is present in hematopoietic cells in limiting amounts, we hypothesize that FeLV-945 replication in bone marrow may influence CBP availability and thereby alter the regulation of CBP-responsive genes, thus contributing to altered hematopoiesis and consequent hematologic disease.
Advanced Statistics: The Propensity Score—A Method for Estimating Treatment Effect in Observational Research
Authors: Newgard Craig D. , Hedges Jerris R. , Arthur Melanie , Mullins Richard J.
Published: September 2004

Observational studies assessing the effect of a particular treatment or exposure may be subject to bias, which can be difficult to eliminate using standard analytic techniques. Multivariable models are commonly used in observational research to assess the relationship between a certain exposure or treatment and an outcome, while adjusting for important variables necessary to ensure comparability between the groups. Large differences in the observed covariates between two study groups may exist in observational studies in which the investigator has no control over who was allocated to each treatment group, and these differences may lead to biased estimates of treatment effect. When there are large differences in important prognostic characteristics between the treatment groups, adjusting for these differences with conventional multivariable techniques may not adequately balance the groups, and the remaining bias may limit valid causal inference. Use of a propensity score, described as a conditional probability that a subject will be “treated” based on an observed group of covariates, may better adjust covariates between the groups and reduce bias. The purpose of this article is to describe the use of propensity scores to adjust for bias when estimating treatment effects in observational research and to compare use of this technique with conventional multivariable regression. The authors present three methods for integrating propensity scores into observational analyses using a database collected on head‐injured trauma patients. The article details the methods for creating a propensity score, analyzing data with the score, and explores differences between propensity score methods and conventional multivariable methods, including potential benefits and limitations. Graphical representations of the analyses are provided as well.
Glasgow Coma Scale Score and QTc Interval in the Prognosis of Organophosphate Poisoning
Authors: Grmec Štefek , Mally Štefan , Klemen Petra
Published: September 2004

Objectives: The aim of this study was to assess the applicability of the Glasgow Coma Scale (GCS) score and the Q‐T interval corrected for heart rate (QTc interval) in predicting outcome and complications in patients with organophosphate (OP) poisoning. Methods:This prospective, observational study included 65 patients older than 18 years. In the out‐of‐hospital setting, the end‐tidal carbon dioxide (ETCO2), oxygen saturation (SaO2), QTc interval, and GCS score were monitored in each patient. A statistical comparison was then made between the group with respiratory failure and the group without this complication. Results: The group with complications had significantly different values of measured parameters—a longer QTc interval and a lower GCS score, a higher number of intubations, and worse outcomes (p < 0.05). The two measures, GCS score and QTc interval, have been shown to be equally good in predicting respiratory failure and hospital mortality in patients with OP poisoning. Conclusions: In the initial out‐of‐hospital care of patients with OP poisoning, it is essential to monitor QTc interval and GCS score. These measures help with prognosis, and may suggest when to initiate precautions to prevent complications (i.e., respiratory failure). The simplicity and promptness of these methods allow providers to perform early and effective triage.
The Effect of Emergency Medicine Residency Format on Pursuit of Fellowship Training and an Academic Career
Authors: Lubavin Boris V. , Langdorf Mark I. , Blasko Barbara J.
Published: September 2004

Objectives: To determine the association between emergency medicine (EM) program format (postgraduate year [PGY] 1–3, 2–4, or 1–4) and two dependent variables: fellowship training and academic career. Methods:The authors conducted a mailed survey of 122 program directors (PDs) of U.S. EM residencies regarding the number of graduates from 1995 to 2000 who pursued fellowships, community practice, academics, or an advanced degree. The survey asked for initial postresidency position, as well as position three to five years later. Results: Of those contacted, 67.2% of the programs responded regarding 3,521 graduates (70.4% of all graduates); 18.6% of 1–3‐year program graduates chose academics versus 28.5% for 2–4 and 34.2% for 1–4. A greater proportion of four‐year‐format graduates pursued academics (PGY 2–4 vs. PGY 1–3, odds ratio [OR] = 1.74; 95% confidence interval [95% CI] = 1.44 to 2.11, PGY 1–4 vs. PGY 1–3, OR = 2.28; 95% CI = 1.81 to 2.85). The PGY 1–4 format was associated with academic practice versus the PGY 2–4 format (OR = 1.31; 95% CI = 1.02 to 1.67). The aggregate of the PGY 2–4 and 1–4 formats was associated with initial academics versus PGY 1–3 programs (OR = 1.92; 95% CI = 1.63 to 2.26). Of PGY 1–3 residents, 4.3% pursued fellowships versus 5.6% of 2–4 and 8.6% of 1–4. The PGY 1–4 format was associated with more common fellowship pursuit versus both 2–4 (OR = 1.59; 95% CI = 1.01 to 2.51) and 1–3 (OR = 2.08; 95% CI = 1.41 to 3.10). For 1995–1997 graduates, 74.2% (271/365) who started out in academics remained there three to five years later. Of all graduates, 5.2% pursued fellowships and 23.1% pursued academics initially. Sixty‐seven of 271 (24.7%) academic physicians from the 1995–1997 classes were fellowship‐trained. Conclusions: Four‐year formats, especially 1–4, were associated with more common pursuit of fellowships and academics than the 1–3 format. Fellowship pursuit was uncommon (4% to 9% of graduates), whereas 18% to 34% initially chose academics.
Predicting Asthma Morbidity in Harlem Emergency Department Patients
Authors: Pesola Gene R. , Xu Feng , Ahsan Habibul , Sternfels Pamela , Meyer Ilan H. , Ford Jean G.
Published: September 2004

Objectives: To determine predictors of asthma morbidity in African American patients with asthma. Proxies for asthma morbidity were emergency department (ED) visits for asthma and hospitalizations for asthma. Methods:This was a prospective observational study that evaluated baseline predictors of asthma morbidity in adults in an urban, predominantly African American community in New York City. Potential predictors of asthma morbidity evaluated were education, gender, employment status, current smoking status, asthma severity, duration of asthma, daily use of a peak flow meter, presence or absence of pets at home, presence or absence of a significant other, presence or absence of medical insurance, and previous hospitalization for asthma in the past year. Follow‐up consisted of a repeat questionnaire obtained between nine and 15 months after the baseline questionnaire. Follow‐up data collection was limited to the last three‐month history of ED visits or hospitalizations before the follow‐up visit. At follow‐up, the baseline predictors were related to the presence or absence of ED visits for asthma or hospitalizations for asthma. All predictors were evaluated individually (crude odds ratio [OR]) and simultaneously (adjusted OR) in a logistic regression model with the dichotomous outcome variable ED visits or hospitalization. Results: Return ED visits on follow‐up were more likely to occur in asthma patients hospitalized in the previous year (adjusted OR, 3.9; 95% confidence interval [CI] = 1.7 to 9.0) and were less likely to occur in asthma patients with pets (OR, 0.4; 95% CI = 0.2 to 0.9). Patients with moderate/severe asthma, relative to patients with mild asthma, were more likely to be seen in the ED on follow‐up on initial analysis (crude OR, 2.4; 95% CI = 1.1 to 1.5), but the adjusted OR was not significant. Follow‐up hospitalizations were significantly more likely to occur only in subjects reporting daily use of a peak flow meter (OR, 6.8; 95% CI = 1.3 to 34.5). Subjects hospitalized for asthma in the previous year were more likely to be hospitalized subsequently on initial analysis (crude OR, 2.9; 95% CI = 1.0 to 8.1), but the adjusted OR was not significant. Conclusions: It appears that African American patients with asthma who had previous hospitalizations for asthma within the past year or use a peak flow meter daily (a marker for more severe asthma) are more likely to visit the ED in the future or to be hospitalized for asthma, respectively. These patients need to be targeted and treated more aggressively to improve asthma care and decrease morbidity. The apparent protective effect of the presence of pets on reducing ED visits is unclear at this time, and the findings need to be replicated and evaluated further.
Loss of Paramedic Availability in an Urban Emergency Medical Services System during a Severe Acute Respiratory Syndrome Outbreak
Authors: Verbeek P. Richard , McClelland Ian W. , Silverman Alexis C. , Burgess Robert J.
Published: September 2004

Objectives: To describe the loss of paramedic availability to Toronto Emergency Medical Services during a biphasic (SARS‐1 and SARS‐2) outbreak of severe acute respiratory syndrome (SARS). Methods:During the SARS outbreak, a dedicated paramedic surveillance and quarantine program was developed. The authors determined the number of paramedics on quarantine each day, the type of quarantine (either home quarantine [HQ] or work quarantine [WQ]), and the development of SARS‐like symptoms. Results: During the SARS outbreak, there were five cases of probable SARS and three cases of suspect SARS. SARS‐1 lasted 30 days, during which 234 paramedics were placed on HQ. The total number of HQ days was 1,615. During the five peak days of SARS‐1, the total number of HQ days was 664. SARS‐2 lasted 18 days, during which 292 paramedics were placed on either HQ or WQ, for a combined number of quarantine days of 1,637. During the five peak days of SARS‐2, the combined number of quarantine days was 910. Of these, paramedics were available for duty on 708 days (78%) due to the WQ program. The primary reason for quarantine was unprotected exposure to a health care institution experiencing a SARS outbreak. Under quarantine, SARS‐like symptoms developed in 68 paramedics, including cough (53 [78%]), myalgia (33 [48%]), fatigue (30 [44%]), headache (29 [43%]), fever (11 [16%]), and shortness of breath (7 [10%]). Conclusions: Paramedics were among the health care workers who developed SARS. During SARS‐2, WQ optimized the number of days on which paramedics were available for duty. Many paramedics developed SARS‐like symptoms without being diagnosed as having SARS. A dedicated paramedic surveillance and quarantine program provided a useful means to manage the paramedic resource during the SARS outbreak.
Electrocardiogram Interpretation Training and Competency Assessment in Emergency Medicine Residency Programs
Authors: Pines Jesse M. , Perina Debra G. , Brady William J.
Published: September 2004

Objectives: To determine the type of electrocardiogram (ECG) interpretation instruction in emergency medicine (EM) residency programs, the use and perceived value of teaching modalities and resources, and the methods used to assess competency of ECG interpretation. Methods:An interactive survey instrument was posted on the Internet using SurveySuite, Inc., software and e‐mailed to program directors (PDs) of all 125 Accreditation Council for Graduate Medical Education–approved U.S. EM residency programs. Responses are reported in total numbers and percentages. Results: Ninety‐nine of 125 PDs completed the online survey (response rate, 79.2%). Emergency department instruction (99%), case‐based lectures (98%), and didactic lectures (98%) were most commonly used to teach interpretation of ECGs, followed by computer‐based instruction (34%) and ECG laboratory (12%). The majority of programs (53%) spent more than eight hours on formal ECG lectures per year, while 11% spent less than three hours. Observation during clinical time (99%), lecture time (76%), and hypothetical cases (57%) were the most common ways to determine competency in reading ECGs, while clinical observation and hypothetical cases were perceived as the most valuable. The most commonly used resource was personal or departmental ECG files (91%), and this had the highest perceived value. The majority of PDs were comfortable with residents' abilities to read ECGs by the third year (96%) and fourth year (91%) of residency. Conclusions: These data suggest that EM PDs believe that EM residency is adequately preparing graduates to interpret ECGs. This goal is achieved through a variety of methods.
Gender and the Council of Emergency Medicine Residency Directors Standardized Letter of Recommendation
Authors: Girzadas Daniel V. , Harwood Robert C. , Davis Nancy , Schulze Laura
Published: September 2004

Objectives: Until 2002, the Council of Emergency Medicine Residency Directors standardized letter of recommendation (SLOR) prompted authors to predict how an applicant would rank on their match list. A ranking of guaranteed match (GM) was identified as the least common superlative response on the SLOR. That knowledge allowed precise identification of the best SLORs. The authors correlated GM with every possible author/applicant gender combination. Methods:This was a retrospective, observational study of 835 SLORs submitted in the 1998–1999 and 1999–2000 application cycles to one emergency medicine residency program. A standardized data collection instrument was used. Author/applicant gender combinations (M/M, M/F, F/F, F/M, M/M + F/F, and M/F + F/M) were analyzed with respect to GM by chi‐square test, odds ratios with 95% confidence intervals, and logistic regression. Results: There was a statistically significant association between a female‐authored/female‐applicant SLOR and GM, with a female applicant two times more likely to get a GM from a female author than any other author/applicant gender combination (odds ratio, 2.0; 95% confidence interval = 1.1 to 3.8; p = 0.023). No other combination was significantly associated with GM. Conclusions: Female applicants to the authors' emergency residency program had a two times better chance of receiving a GM recommendation on a SLOR written by a female faculty member compared with any other possible gender combination of applicants and letter authors. Although the choice of GM has now been eliminated from the SLOR, the role of gender in relation to the SLOR merits further study.
The Effect of Magnesium on Length of Stay for Pediatric Sickle Cell Pain Crisis
Authors: Brousseau David C. , Scott J. Paul , Hillery Cheryl A. , Panepinto Julie A.
Published: September 2004

Objectives: To determine the effect of intravenous (IV) magnesium sulfate on the length of stay (LOS) for children admitted with sickle cell pain crisis. Methods:This was a single arm study, with historical controls. Hemoglobin SS or Hemoglobin Sβ° children admitted for pain crisis were eligible. Two sequential treatment protocols of IV magnesium sulfate were added to standard inpatient therapy of IV fluids, opioids, and nonsteroidal anti‐inflammatory drugs. The initial 12 children received 40 mg/kg (maximum of 1.5 g) of IV magnesium in the emergency department (ED), and eight and 16 hours later. Seven subsequent children received 40 mg/kg (maximum of 2.5 g) of IV magnesium in the ED, and every eight hours for up to four inpatient days. The main outcome measure was LOS, measured in days. Differences in LOS were analyzed between the admission with magnesium, and the two previous admissions meeting the same criteria, using a Wilcoxon signed‐rank test for nonparametric paired data. Results: Nineteen children were enrolled. The results of the two protocols were combined for the analysis. A shorter LOS was found on study admissions (median LOS, 3.0 days compared with 5.0 and 4.0 days for the previous two admissions; p = 0.006). Conclusions: IV magnesium appears to decrease the LOS for children with sickle cell pain crisis.
Inaccuracies on Applications for Emergency Medicine Residency Training
Authors: Roellig Martha S. , Katz Eric D.
Published: September 2004

Objectives: Studies have shown erroneous claims of authorship by medical students applying for residency. Authors have hypothesized that investigation of advanced degrees, Alpha Omega Alpha (AOA) status, and peer‐reviewed publications all show important rates of inaccuracy. Methods:A retrospective review of all applicants offered an interview for the authors' emergency medicine (EM) residency (entering class of 2002), excluding foreign medical graduates and current residents, was conducted. After verifying peer‐reviewed publications by MEDLINE search and journal review, errors were tabulated as follows: reference not found, not referenced as an abstract, incorrect author list, or clerical error. AOA status was verified by the AOA organization. Advanced degrees were verified by the awarding institutions. Results: Of 194 applications screened (58.3% of applications), 21 (10.8%) were excluded (9 foreign medical graduates, 12 current residents). Multiple inaccuracies on a single application were counted separately. Of the 173 remaining applications, 23 (13.3%; 95% confidence interval [95% CI] = 8.8% to 19.5%) had at least one misrepresentation and seven of 173 (4.0%; 95% CI = 1.8% to 8.5%) had two or more. Authorship of at least one peer‐reviewed article was claimed by 47 of 173 (27.2%), with ten of 47 (21.3%; 95% CI = 11.2% to 36.1%) having one inaccuracy and six of 47 (12.8%, 95% CI = 5.3% to 26.4%) having two or more. AOA membership was claimed by 14 applicants (8.1%), but five claims (35.7%, 95% CI = 14.0% to 64.4%) were inaccurate. Advanced degrees were claimed by 15 (8.7%); four (26.7%, 95% CI = 8.9% to 55.2%) were in error. Conclusions: Applications for EM residency contain frequent inaccuracies in publications listed, AOA status, and advanced degrees. Careful review of applications is necessary to ensure appropriate credit is given for claims of these types.
Solution Properties of a Novel Polysaccharide Derivative
Authors: Ihara Takeshi , Nishioka Tohru , Kamitani Hiroshi , Kitsuki Tomohito
Published: September 2004

A novel self-assembly polysaccharide derivative; hydrophobically (stearyl alkyl group) and hydrophilically (sulfonic acid salt group) modified hydroxyethylcellulose (HHM-HEC), has the unique rheological properties in aqueous solutions.
Synthesis of the Sterically Fixed Biliverdin Derivative Bearing the Z-anti C/D-Ring Component
Authors: Hammam Mostafa A S , Murata Yasue , Kinoshita Hideki , Inomata Katsuhiko
Published: September 2004

A sterically locked biliverdin derivative was synthesized by developing an efficient method for the preparation of Z-anti C/D-ring component toward investigation of the stereochemistry and function of the phytochrome chromophores.
Self-assembly of Tetramethylated Resorcin[4]arene to Form Molecular Capsules Incorporating Methanol, Ethanol, and Imidazole: A Comparison with the Unsubstituted Resorcin[4]arene System
Authors: Aoki Katsuyuki , Nagae Toshiki , Matsubara Rei , Fujisawa Ikuhide
Published: September 2004

Tetramethylated resorcin[4]arene (MRCT) forms ‘head-to-head’ arranged self-dimers incorporating neutral guest molecules methanol, ethanol, and imidazole within the cavity, with the MRCT:guest composition of 2:2, while unsubstituted resorcin[4]arene forms 1:1 monomers, showing the significance of the methyl substituents of the MRCT rings in the capsule formation through methyl···methyl hydrophobic interactions between the facing substructures, as evidenced by X-ray diffraction.
Self-assembly of a Novel Manganiferous Coordination Polymer with Mixed Ligands
Authors: Yao Youwei , Cai Qiang , Kou Huizhong , Li Hengde , Wang Dan , Yu Ranbo , Chen Yunfa , Xing Xianran
Published: September 2004

A novel coordination polymer, [(NA)(ONA) Mn(II)]n (HNA = nicotinic acid; H2ONA = 2-hydroxynicotinic acid) has been hydrothermally synthesized. Its structure is constructed by mixed-ligands and chains of hexa-coordinated Mn(II) linkers: ONA groups bridge Mn ions to give the right-handed and left-handed helical [(ONA)Mn]n chains running along (010). The helical chains are further held together by NA groups to form a novel 3-D framework.
Insulinomimetic Vanadyl–Hydroxythiazolethione Complexes with VO(S2O2) Coordination Mode: The Correlation between the Activity and Hammett’s Substituent Constant
Authors: Katoh Akira , Yamaguchi Mika , Saito Ryota , Adachi Yusuke , Sakurai Hiromu
Published: September 2004

Four kinds of vanadyl–hydroxythiazolethione complexes with VO(S2O2) coordination mode were newly synthesized, and demonstrated for the first time that the insulinomimetic activity apparently correlates to the Hammett’s substituent constant of the ligands.
New Approach for the Recovery of Bisphenol A from Water Using Inclusion Complex with Quinoline Derivatives
Authors: Hatano Bunpei , Aikawa Akiko , Tagaya Hideyuki , Takahashi Hiroki
Published: September 2004

The simple inclusion complex of bisphenol A (3) with quinoline (4) was obtained from the several solutions, and this method was useful for the recovery of 3 from the water solution.
Microwave Assisted Facile One-Pot Synthesis of 188Re-Complex Using a Tetrahydroborate Exchange Resin. A Bifunctional Chelating Agent for Radiopharmaceuticals
Authors: Park Sang Hyun , Gwon Hui Jeong , Park Kyung Bae
Published: September 2004

A facile one-pot synthesis of 188Re-complex as a bifunctional chelating agent for the preparation of therapeutic radiopharmaceuticals was accomplished with good labeling yields and radiochemical purity by using a tetrahydroborate exchange resin as a reducing agent for a disulfide ligand as well as the [188Re]perrhenate ion under microwave irradiation.