bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating a clinical practice intervention to promote delivery of salbutamol by metered-dose inhalers with holding chambers in a pediatric emergency department
Authors: Hill-Taylor Barbara J. , Hurley Katrina F. , Sketris Ingrid , O'Connell Colleen , Sinclair Douglas , Wing Andrew
Published: July 2016

Objective:

The primary objective of this study was to quantify the impact of a clinical practice intervention to promote the delivery of salbutamol by metered-dose inhaler (MDI) in a pediatric emergency department (PED). A secondary objective was to retrospectively document the components of the intervention.

Methods:

PED inventory data for salbutamol inhalation solution (nebules), MDIs, and holding chambers were obtained from the pharmacy department. Patient data were obtained fromthe hospital's decision support unit. Interrupted time series analysis was used to evaluate trends in salbutamol inventory data, patient triage acuity, and hospital admissions from January 1, 2003, to May 31, 2010. Interviews and administrative documents were used to identify components of the intervention, which began in 2006.

Results:

There was a 1,215% increase in the proportion of salbutamol delivered as MDIs compared to total inhaled salbutamol (MDI plus nebulization solution) following the intervention (95% CI 1,032% to 1,396%,p< 0.001). Increases in salbutamol MDI use were associated with the implementation of an institution-specific asthma care map. A relative decrease of 32% in the hospital admission rate (absolute –7.25%: 95% CI –8.31 to –6.19,p< 0.001) was associated with the change in salbutamol MDI use and the use of the asthma care map.

Conclusions:

A multifaceted intervention, designed and implemented by local PED clinical leaders, resulted in a pronounced change in salbutamol inhalation practice, with an associated decrease in admission rates. This intervention demonstrated many of the criteria for successful health system change. Findings from this research may be contextualized to inform change elsewhere.
Does PowerPoint enhance learning?
Authors: Penciner Rick
Published: July 2016

The ubiquitous nature of PowerPoint begs the question, does PowerPoint enhance learning? This narrative explores the evidence for the effectiveness of PowerPoint and multimedia presentations in learning and information processing. Practical recommendations are provided for presentations.
Thyrotoxic periodic paralysis triggered by β2- adrenergic bronchodilators
Authors: Yeh Fu-Chiang , Chiang Wen-Fang , Wang Chih-Chiang , Lin Shih-Hua
Published: July 2016

Hypokalemic periodic paralysis is the most common form of periodic paralysis and is characterized by attacks of muscle paralysis associated with a low serum potassium (K+) level due to an acute intracellular shifting. Thyrotoxic periodic paralysis (TPP), characterized by the triad of muscle paralysis, acute hypokalemia, and hyperthyroidism, is one cause of hypokalemic periodic paralysis. The triggering of an attack of undiagnosed TPP by β2-adrenergic bronchodilators has, to our knowledge, not been reported previously. We describe two young men who presented to the emergency department with the sudden onset of muscle paralysis after administration of inhaled β2-adrenergic bronchodilators for asthma. In both cases, the physical examination revealed an enlarged thyroid gland and symmetrical flaccid paralysis with areflexia of lower extremities. Hypokalemia with low urine K+ excretion and normal blood acid-base status was found on laboratory testing, suggestive of an intracellular shift of K+, and the patients' muscle strength recovered at serum K+ concentrations of 3.0 and 3.3 mmol/L. One patient developed hyperkalemia after a total potassium chloride supplementation of 110mmol. Thyroid function testing was diagnostic of primary hyperthyroidism due to Graves disease in both cases. These cases illustrate that β2-adrenergic bronchodilators should be considered a potential precipitant of TPP.
Emergency medicine procedural skills: what are residents missing?
Authors: Petrosoniak Andrew , Herold Jodi , Woolfrey Karen
Published: July 2016

Objective:

This study sought to establish the current state of procedural skills training in Canadian Royal College emergency medicine (EM) residencies.

Methods:

A national Web-based survey was administered to residents and program directors of all 13 Canadian-accredited Royal College EM residency programs. Programdirectors rated the importance and experience required for competence of 45 EM procedural skills. EM residents reported their experience and comfort in performing the same procedural skills.

Results:

Thirteen program directors and 86 residents responded to the survey (response rate of 100% and 37%, respectively). Thirty-two (70%) procedures were considered important by > 70% of program directors, including all resuscitation and lifesaving airway procedures. Four procedures deemed important by program directors, including cricothyroidotomy, pericardiocentesis, posterior nasal pack for epistaxis, and paraphimosis reduction, had never been performed by the majority of senior residents. Program director opinion was used to categorize each procedure based on performance frequency to achieve competence. Overall, procedural experience correlated positively with comfort levels as indicated by residents.

Conclusions:

We established an updated needs assessment of procedural skills training for Canadian Royal College EM residency programs. This included program director opinion of important procedures and the performance frequency needed to achieve competence. However, we identified several important procedures that were never performed by most senior residents despite program director opinion regarding the experience needed for competence. Further study is required to better define objective measures for resident competence in procedural skills.
Iatrogenic radial neck fracture on closed reduction of elbow dislocation
Authors: Ellanti Prasad , O'Farrell Dermot
Published: July 2016

Traumatic dislocation of the elbow is rare in children and can most often be managed in the emergency department using procedural sedation and closed reduction with good functional outcome. Radiographs must be evaluated for associated avulsions and fractures around the elbow. We present the case of a 14-year-old girl who sustained a fracture of the radial neck subsequent to repeated attempts at closed reduction of a pure posterior elbow dislocation that was missed on postreduction radiographs. Careful use of reduction techniques and avoidance of repeated forceful manipulations is emphasized.
Implementation and evaluation of a novel research education rotation for Royal College of Physicians and Surgeons emergency medicine residents
Authors: Abu-Laban Riyad B. , Jarvis-Selinger Sandra , Newton Lana , Chung Brian
Published: July 2016

Royal College of Physicians and Surgeons (RCPS) emergency medicine (EM) residents must complete a scholarly project; however, significant variation exists in Canadian EM resident research education and facilitation. We developed and implemented a novel mandatory research education rotation for RCPS EM residents intended to increase knowledge, faculty/resident collaborations, and, ultimately, scholarly output. This 4-week rotation took place in the fall of 2011 and consisted of 37 faculty-led didactic, critical appraisal, and workshop seminars. Exposure to faculty research and resulting opportunities and the development of resident research projects were integrated into the rotation. Twelve participating residents completed daily evaluations and took part in an exit focus group analyzed using a constant comparative method. Knowledge acquisition was assessed with a pre/post comprehensive examination instrument evaluated by a pairedt-test. Evaluations indicated generally high satisfaction throughout the rotation. Focus group analysis indicated that residents felt two important but competing goals existed: developing a research project and developing critical appraisal skills. The research knowledge of all participants improved significantly (mean/SD examination change +35.4%/+10.4%, range +20.0% to +53.6%,p< 0.001), and several new resident/faculty research collaborations arose from the rotation. A rotation of this nature is an efficient and effective means to increase research and critical appraisal knowledge and faculty/resident collaborations. As a result of our positive experience, the rotation will continue annually and has been expanded to include pediatric EM fellows. Longitudinal tracking of the participating trainee cohort will remain ongoing to assess the scholarly output impact of the rotation.
Reliability of the Canadian Triage and Acuity Scale: interrater and intrarater agreement from a community and an academic emergency department
Authors: Fernandes Christopher M.B. , McLeod Shelley , Krause Joel , Shah Amit , Jewell Justine , Smith Barbara , Rollins Lorraine
Published: July 2016

Objectives:

The Canadian Triage and Acuity Scale (CTAS) is a five-level triage tool that is used to help prioritize the order in which emergency department (ED) patients should be seen. The objectives of this study were to determine the interrater and intrarater agreement of the 2008 CTAS guideline revisions by triage nurses and to compare agreement between triage nurses working in a small community ED and an academic ED.

Methods:

Seventy-eight triage nurses assigned CTAS scores and free-text presenting complaints for 10 paper-based case scenarios. For five scenarios, the CTAS score should have remained unchanged from previous guidelines, whereas the other five scenarios should have been triaged differently based on the 2008 CTAS first-order modifiers. Thirty-three participants repeated the questionnaire 90 days later, and intrarater agreement was measured.

Results:

There was a higher level of agreement (κ = 0.73; 95% CI 0.68–0.79) for the five case scenarios, which relied on the older 2004 guidelines compared to the scenarios where the 2008 guidelines would have suggested a different triage level (κ = 0.50; 95% CI 0.42–0.59). For the 10 case scenarios analyzed, the free-text presenting complaints matched the Canadian Emergency Department Information System (CEDIS) list 90.1% of the time (κ = 0.80; 95% CI 0.76–0.84).

Conclusion:

The reliability of CTAS scoring by academic and community ED nurses was relatively good; however, the application of the 2008 CTAS revisions appears less reliable than the 2004 CTAS guidelines. These results may be useful to develop educational materials to strengthen reliability and validity for triage scoring using the 2008 CTAS guideline revisions.
Outcomes of non–acute coronary syndrome patients discharged from the emergency department with troponin positivity
Authors: Brunner Nathan W. , Scheuermeyer Frank X. , Grafstein Eric , Ramanathan Krishnan
Published: July 2016

Background:

Cardiac troponin elevation portends a worse prognosis in diverse patient populations. The significance of troponin elevation in patients discharged from emergency departments (EDs)without inpatient admission is notwell known.

Methods:

Patients without a diagnosis of acute coronary syndrome discharged fromtwo EDs between April 1, 2006, and December 31, 2007, with an abnormal cardiac troponin (troponin positive [TP]) were compared to a troponin-negative (TN) cohort matched for age, sex, and primary discharge diagnosis. Outcomes were obtained by linking with a regional ED and a provincial vital statistics database and adjusted for the following: estimated glomerular filtration rate, do-not-resuscitate status, history of coronary artery disease, Canadian Triage and Acuity Scale, and left ventricular hypertrophy on electrocardiography. The primary outcome was a composite of death or admission to hospital within 1 year.

Results:

Our total cohort (n 5 344) consisted of 172 TP and 172 TN patients. In the univariate analysis, TP patients had a higher rate of the primary outcome (OR 3.2, 95% CI 2.1–5.0, p < 0.001) and both of its components (p < 0.001). After adjusting for covariates, positive troponin remained an independent predictor of the primary outcome (OR 2.1, 95% CI 1.3–3.4, p 5 0.005) and inpatient admission (OR 2.0, 95% CI 1.2–3.4, p 5 0.006). There was no significant difference in death (OR 1.3, 95% CI 0.6–2.9, p 5 0.5) after adjustment.

Conclusions:

A positive troponin assay during ED stay in discharged patients is an independent marker for risk of subsequent admission. Our findings suggest that the prognostic power of an abnormal troponin extends to patients discharged from the ED.
Superior mesenteric artery aneurysm in a patient with infective endocarditis
Authors: Devon Jennifer , Miller Philip
Published: July 2016

Infective endocarditis (IE) is a rare but serious condition. We present a case of endocarditis in a healthy 40-year-old male with no predisposing conditions. His physical examination was suggestive of peripheral microembolization and prompted us to consider the diagnosis of IE and order the appropriate investigations. After treatment, he later presented to the emergency department with abdominal pain, and a superior mesenteric artery aneurysm was discovered. We discuss recent advances in the changing epidemiology and microbiology of IE, review the presentation and diagnosis of IE, and highlight the potential complications of this disease.
Surviving a stressful MIBI scan
Authors: Gooch Robert , Bryski Lisa , Courvoisier-Grzywacz Ewa
Published: July 2016

Dipyridamole/technetium sestamibi scans (more commonly known as MIBI scans, an acronym for methoxyisobutyl isonitrile) are used commonly for the diagnosis and risk stratification of coronary artery disease. Adverse events from MIBI scans are extremely rare. We present the case of a 64-year-old man who was successfully resuscitated after two asystolic episodes following dipyridamole infusion for a MIBI scan. The second asystolic episode occurred in the emergency department 40 minutes after the patient had been transferred from the Cardiac Stress Test Laboratory. To our knowledge, there are no previous reports of patients having two discrete asystolic episodes or an asystolic episode as delayed as we report after a MIBI scan. Our case illustrates why emergency physicians should be aware of the potential for asystole following MIBI scanning and why aminophylline, the antidote for dipyridamole, should be readily available in emergency departments that could see patients after pharmacologic stress testing. Patients who become asystolic following dipyridamole infusion likely require prolonged cardiac monitoring, given the potential for further episodes after periods of hemodynamic stability.
Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review
Authors: Green Robert , Hutton Brian , Lorette Jason , Bleskie Dominique , Mclntyre Lauralyn , Fergusson Dean
Published: July 2016

Objective:

Hemodynamic instability following emergent endotracheal intubation (EETI) is a potentially life-threatening adverse event. The objectives of this systematic literature review were to document the incidence of postintubation hemodynamic instability (PIHI), to determine the definitions for PIHI used in the available literature, and to examine factors associated with PIHI in adult patients who require EETI.

Data Source:

Articles published in Medline (1966–August 2012).

Study Selection:

This systematic review included adult, inhospital studies of EETIs. Studies with nonemergent or pediatric patient populations were excluded.

Data Extraction:

Two authors independently performed data abstraction. Disagreements were resolved by a third party. The methodological quality of included studies was assessed with the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies.

Data Synthesis:

We estimated the pooled prevalence of PIHI across studies using a random effects meta-analysis. Subgroups analyzed included study design, intubation setting, geographic location of the study, physician experience, medications used for sedation, neuromuscular blockade, and definition of PIHI. Eighteen studies were analyzed, with sample sizes from 84 to 2,833 patients. The incidence of PIHI ranged from 5 to 440 cases per 1,000 intubations, with a pooled estimate of 110 cases per 1,000 intubations (95% CI 65–167).

Conclusions:

PIHI was found to occur in 110 cases per 1,000 in-hospital, emergent intubations. However, heterogeneity among the included studies limits the reliability of this summary estimate. Further investigation is warranted.
Root cause analysis of delays to discharge for patients held for serial cardiac troponin levels
Authors: Owen Julian James , Worster Andrew , Waines Barbara Marie , Ward James , Kavsak Peter , Hill Stephen
Published: July 2016

Objective:

Emergency department (ED) patients with symptoms of cardiac ischemia often require a second cardiac troponin (cTn) measurement to rule out non–ST elevation myocardial infarction. We measured the total turnaround time and the component event times following the ordering of the second cTn level to ED discharge to identify root causes of delays.

Methods:

We reviewed a random sample of ED discharges following a second normal cTn measurement and recorded associated event times. The central tendency of time intervals is reported as median and mean number of minutes with interquartile ranges (IQRs) and 95% confidence intervals, respectively.

Results:

From 9,656 eligible cases, we randomly selected 226 for data collection. The median number of minutes for each event are as follows: from ordering the second cTn measurement to the time of ED discharge was 90 minutes (IQR 65–120); for blood collection from the time the collection was ordered for was 0 minutes (IQR 212–0); from blood collection to the time the blood was transported to the laboratory was 9 minutes (IQR 2–19); laboratory process duration was 44 minutes (IQR 39–52); from when the results were available to the time the patient was discharged was 30 minutes (IQR 15–52).

Conclusions:

For ED patients discharged following two normal cTn levels, the laboratory processing time and time from the result being available to the time of ED discharge represent the longest modifiable time periods to reduce ED length of stay.
Computerized interpretation of the prehospital electrocardiogram: predictive value for ST segment elevation myocardial infarction and impact on on-scene time
Authors: de Champlain François , Boothroyd Lucy J. , Vadeboncoeur Alain , Huynh Thao , Nguyen Viviane , Eisenberg Mark J. , Joseph Lawrence , Boivin Jean-François , Segal Eli
Published: July 2016

Introduction:

Computerized interpretation of the prehospital electrocardiogram (ECG) is increasingly being used in the basic life support (BLS) ambulance setting to reduce delays to treatment for patients suspected of ST segment elevation myocardial infarction (STEMI).

Objectives:

To estimate 1) predictive values of computerized prehospital 12-lead ECG interpretation for STEMI and 2) additional on-scene time for 12-lead ECG acquisition.

Methods:

Over a 2-year period, 1,247 ECGs acquired by primary care paramedics for suspected STEMI were collected. ECGs were interpreted in real time by the GEMarquette 12SL ECG analysis program. Predictive values were estimated with a bayesian latent class model incorporating the computerized ECG interpretations, consensus ECG interpretations by study cardiologists, and hospital diagnosis. On-scene time was compared for ambulance-transported patients with (n 5 985) and without (n 5 5,056) prehospital ECGs who received prehospital aspirin and/or nitroglycerin.

Results:

The computer's positive and negative predictive values for STEMI were 74.0% (95% credible interval [CrI] 69.6–75.6) and 98.1% (95% CrI 97.8–98.4), respectively. The sensitivity and specificity were 69.2% (95% CrI 59.0–78.5) and 98.9% (95% CrI 98.1–99.4), respectively. Prehospital ECGs were associated with a mean increase in on-scene time of 5.9 minutes (95% confidence interval 5.5–6.3).

Conclusions:

The predictive values of the computerized prehospital ECG interpretation appear to be adequate for diversion programs that direct patients with a positive result to hospitals with angioplasty facilities. The estimated 26.0% chance that a positive interpretation is false is likely too high for activation of a catheterization laboratory from the field. Acquiring prehospital ECGs does not substantially increase on-scene time in the BLS setting.
Use of diagnostic imaging in the emergency department for cervical spine injuries in Kingston, Ontario
Authors: Pickett William , Kukaswadia Atif , Thompson Wendy , Frechette Mylene , McFaull Steven , Dowdall Hilary , Brison Robert J.
Published: July 2016

Objectives:

This study assessed the use and clinical yield of diagnostic imaging (radiography, computed tomography, and medical resonance imaging) ordered to assist in the diagnosis of acute neck injuries presenting to emergency departments (EDs) in Kingston, Ontario, from 2002–2003 to 2009–2010.

Methods:

Acute neck injury cases were identified using records from the Kingston sites of the Canadian National Ambulatory Care Reporting System. Use of radiography was analyzed over time and related to proportions of cases diagnosed with clinically significant cervical spine injuries.

Results:

A total of 4,712 neck injury cases were identified. Proportions of cases referred for diagnostic imaging to the neck varied significantly over time, from 30.4% in 2002–2003 to 37.6% in 2009–2010 (ptrend= 0.02). The percentage of total cases that were positive for clinically significant cervical spine injury (“clinical yield”) also varied from a low of 5.8% in 2005–2006 to 9.2% in 2008–2009 (ptrend= 0.04), although the clinical yield of neck-imaged cases did not increase across the study years (ptrend= 0.23). Increased clinical yield was not observed in association with higher neck imaging rates whether that yield was expressed as a percentage of total cases positive for clinically significant injury (p= 0.29) or as a percentage of neck-imaged cases that were positive (p= 0.77).

Conclusions:

We observed increases in the use of diagnostic images over time, reflecting a need to reinforce an existing clinical decision rule for cervical spine radiography. Temporal increases in the clinical yield for total cases may suggest a changing case mix or more judicious use of advanced types of diagnostic imaging.
Point-of-care ultrasonography for the diagnosis of small bowel obstruction in the emergency department
Authors: Guttman Joshua , Stone Michael B. , Kimberly Heidi H. , Rempell Joshua S.
Published: July 2016

Small bowel obstruction (SBO) is a common cause of acute abdominal pain presenting to the emergency department (ED). Although the literature is limited, point-of-care ultrasonography (POCUS) has been found to have superior diagnostic accuracy for SBO compared to plain radiography; however, it is rarely used in North America for this. We present the case of a middle-aged man who presented with abdominal pain where POCUS by the emergency physician early in the hospital course expedited the diagnosis of SBO and led to earlier surgical consultation. The application of POCUS for SBO is easily learned and applied in the ED. POCUS for SBO may obviate the need for plain radiography and expedite patient care.
Primary Epithelioid Sarcoma of the Zygomatic Bone
Authors: Tran Henry , Shillingford Nick , Thomas Stefanie , Hammoudeh Jeffrey , Zhou Shengmei
Published: July 2016

Primary epithelioid sarcoma (ES) of bone is extremely rare with only 2 reported cases in the English literature. A previously healthy 18-year-old man presented with a 6-month history of right facial numbness and tingling and right eye diplopia. A computerized tomography scan revealed an ill-defined mass with dense osseous matrix centered in the right zygomatic bone. An outside biopsy was read as osteosarcoma. The resection specimen revealed large epithelioid and spindle cells embedded in a prominent hyalinized matrix with focal metaplastic bone formation. The tumor cells were strongly and diffusely positive for AE1/AE3 and epithelial membrane antigen, but a definitive diagnosis of ES was not immediately reached due to the presence of dense hyalinized matrix and weak expression of SAT2B by tumor cells. Deficient INI1 protein expression by immunohistochemistry and homozygous loss of the SMARCB1 gene by chromosomal microarray analysis ultimately justified this tumor’s designation as ES.
Detection of OXA-181/OXA-48 carbapenemase producing Enterobacteriaceae in Bangladesh
Authors: Khatun Rehana , Shamsuzzaman SM
Published: July 2016

Carbapenem resistant Enterobacteriaceae (CRE) is becoming a major public health concern globally. Detection of carbapenem hydrolyzing enzyme carbapenemase in Enterobacteriaceae is important to institute appropriate therapy and to initiate preventive measures. This study was designed to determine the presence of carbapenemase producers among the CRE isolated from patients at Dhaka Medical College Hospital, Bangladesh. Twenty-nine CRE strains detected by disk diffusion technique were included in the study. Minimum inhibitory concentration of imipenem and tigecycline was determined by agar dilution method. Carbapenemase production was phenotypically detected by Modified Hodge test while MBL producers were detected by combined disk and double disk synergy tests. Genes encoding blaNDM-1, blaOXA-181, blaOXA-48, blaKPC, blaCTX-M-15, blaOXA-1-group were identified by polymerase chain reaction (PCR). Out of 29 CRE, nineteen (65.6%) were positive for carbapenemase by any of the three phenotypic tests namely MHT, CD or DD tests. Those 19 isolates were also positive either for blaNDM-1 or blaOXA-181/blaOXA-48 by PCR. Of the 19 PCR positive isolates, the rate of positivity for blaNDM- 1, blaOXA-181/blaOXA-48 and blaNDM-1+ blaOXA-181/blaOXA-48 was 73.7% (14/19), 57.9% (11/19) and 31.6% (6/19) respectively. Both blaOXA-181 and blaOXA-48 co-existed. All the carbapenemase producing organisms harboured blaCTX-M-15 except one C. freundii strain. The rate of resistance to different classes of antibiotics ranged from 63.2% to 100% except colistin and tigecycline. Organisms positive for OXA-181/OXA-48 had a low level of resistance to carbapenem (MIC 1 - 4 ì g/ml) while with NDM-1 had high level resistance to imipenem (MICs 16 - ? 32 ì g/ ml). Out of 19 carbapenemase positive isolates, 12 (63.16%) were extensively drug-resistant (XDR) and were only sensitive to tigecycline and colistin. The result of this study showed the presence of blaOXA-181/ blaOXA-48, blaNDM-1 positive strains in Bangladesh and colistin and tigecycline were the most effective drugs against carbapenemase producing Enterobacteriaceae (CPE). Epidemiological monitoring of carbapenemase producing organisms in Bangladesh is important to prevent their dissemination.Ibrahim Med. Coll. J. 2015; 9(2): 45-51
Microbial Contamination and Hygiene of Fresh Cow’s Milk Produced by Smallholders in Western Zambia
Authors: Knight-Jones Theodore , Hang’ombe M. , Songe Mwansa , Sinkala Yona , Grace Delia
Published: July 2016

A field study was performed to assess safety of smallholder fresh cow’s milk around Mongu, Western Province, Zambia. This involved observation and sampling of milk along the value chain from milking to point-of-sale and storage. Samples were collected from 86 cows, from 9 farmers, selling through two dairy cooperatives, with additional samples from informal markets. Production was very low; around one litre/day/cow and 10 L/day/herd. The milk was typically transported by bicycle in high ambient temperatures without refrigeration until reaching the point-of-sale (journey times of 30–120 min), where it was sold without pasteurisation despite milk-borne zoonoses being endemic (bovine tuberculosis (bTB) and Brucellosis). Although microbiological contamination was initially low, with geometric mean total bacterial count (TBC) of 425 cfu/mL (cfu = colony forming units) upon arrival at point-of-sale, poor hygiene led to high bacterial loads later on (geometric mean TBC > 600,000 cfu/mL after two days refrigeration), with almost all samples culture positive for Staphylococcus aureus and Escherichia coli. After milking, milk was kept for 100–223 min at temperatures favouring microbial growth (median 34 °C) and sold without a microbial kill step. In this situation limited variation in observed standards of milk hygiene had no significant effect on milk end-product bacterial counts. Options for refrigerated transport are limited. Pasteurisation at the cooperative should be investigated, as this would largely remove pathogenic microbes present in the milk whether resulting from cattle infection or poor hygiene during milking and transportation. As milk is also purchased directly from producers, on-farm milk heating options should also be assessed. Smallholders may benefit from access to national markets by providing milk to large dairies, which have systems for ensuring safety. However, this requires significant investment and an increased and more consistent supply of milk; and many consumers, unable to afford milk sold through formal sectors, would not benefit.
Aluminum Toxicity-Induced Alterations of Leaf Proteome in Two Citrus Species Differing in Aluminum Tolerance
Authors: Li Huan , Yang Lin-Tong , Qi Yi-Ping , Guo Peng , Lu Yi-Bin , Chen Li-Song
Published: July 2016

Seedlings of aluminum-tolerant ‘Xuegan’ (Citrus sinensis) and Al-intolerant ‘sour pummelo’ (Citrus grandis) were fertigated for 18 weeks with nutrient solution containing 0 and 1.2 mM AlCl3·6H2O. Al toxicity-induced inhibition of photosynthesis and the decrease of total soluble protein only occurred in C. grandis leaves, demonstrating that C. sinensis had higher Al tolerance than C. grandis. Using isobaric tags for relative and absolute quantification (iTRAQ), we obtained more Al toxicity-responsive proteins from C. sinensis than from C. grandis leaves, which might be responsible for the higher Al tolerance of C. sinensis. The following aspects might contribute to the Al tolerance of C. sinensis: (a) better maintenance of photosynthesis and energy balance via inducing photosynthesis and energy-related proteins; (b) less increased requirement for the detoxification of reactive oxygen species and other toxic compounds, such as aldehydes, and great improvement of the total ability of detoxification; and (c) upregulation of low-phosphorus-responsive proteins. Al toxicity-responsive proteins related to RNA regulation, protein metabolism, cellular transport and signal transduction might also play key roles in the higher Al tolerance of C. sinensis. We present the global picture of Al toxicity-induced alterations of protein profiles in citrus leaves, and identify some new Al toxicity-responsive proteins related to various biological processes. Our results provide some novel clues about plant Al tolerance.
The Clinical Value of High-Intensity Signals on the Coronary Atherosclerotic Plaques: Noncontrast T1-Weighted Magnetic Resonance Imaging
Authors: Ehara Shoichi , Matsumoto Kenji , Shimada Kenei
Published: July 2016

Over the past several decades, significant progress has been made in the pathohistological assessment of vulnerable plaques and in invasive intravascular imaging techniques. However, the assessment of plaque morphology by invasive modalities is of limited value for the detection of subclinical coronary atherosclerosis and the subsequent prediction or prevention of acute cardiovascular events. Recently, magnetic resonance (MR) imaging technology has reached a sufficient level of spatial resolution, which allowed the plaque visualization of large and static arteries such as the carotids and aorta. However, coronary wall imaging by MR is still challenging due to the small size of coronary arteries, cardiac and respiratory motion, and the low contrast-to-noise ratio between the coronary artery wall and the surrounding structures. Following the introduction of carotid plaque imaging with noncontrast T1-weighted imaging (T1WI), some investigators have reported that coronary artery high-intensity signals on T1WI are associated with vulnerable plaque morphology and an increased risk of future cardiac events. Although there are several limitations and issues that need to be resolved, this novel MR technique for coronary plaque imaging could influence treatment strategies for atherothrombotic disease and may be useful for understanding the pathophysiological mechanisms of atherothrombotic plaque formation.
Investigation of the Self-Healing Behaviors of Microcapsules/Bitumen Composites by a Repetitive Direct Tension Test
Authors: Su Jun-Feng , Yang Peng , Wang Ying-Yuan , Han Shan , Han Ning-Xu , Li Wei
Published: July 2016

The aim of this work was to evaluate the self-healing behaviors of bitumen using microcapsules containing rejuvenator by a modified fracture healing–refracture method through a repetitive tension test. Microcapsules had mean size values of 10, 20 and 30 μm with a same core/shell ratio of 1/1. Various microcapsules/bitumen samples were fabricated with microcapsule contents of 1.0, 3.0 and 5.0 wt. %, respectively. Tension strength values of microcapsules/bitumen samples were measured by a reparative fracture-healing process under different temperatures. It was found that these samples had tensile strength values larger than the data of pure bitumen samples under the same conditions after the four tensile fracture-healing cycles. Fracture morphology investigation and mechanism analysis indicated that the self-healing process was a process consisting of microcapsules being broken, penetrated and diffused. Moreover, the crack healing of bitumen can be considered as a viscosity driven process. The self-healing ability partly repaired the damage of bitumen during service life by comparing the properties of virgin and rejuvenated bitumen.
Fiberglass Grids as Sustainable Reinforcement of Historic Masonry
Authors: Righetti Luca , Edmondson Vikki , Corradi Marco , Borri Antonio
Published: July 2016

Fiber-reinforced composite (FRP) materials have gained an increasing success, mostly for strengthening, retrofitting and repair of existing historic masonry structures and may cause a significant enhancement of the mechanical properties of the reinforced members. This article summarizes the results of previous experimental activities aimed at investigating the effectiveness of GFRP (Glass Fiber Reinforced Polymers) grids embedded into an inorganic mortar to reinforce historic masonry. The paper also presents innovative results on the relationship between the durability and the governing material properties of GFRP grids. Measurements of the tensile strength were made using specimens cut off from GFRP grids before and after ageing in aqueous solution. The tensile strength of a commercially available GFRP grid has been tested after up 450 days of storage in deionized water and NaCl solution. A degradation in tensile strength and Young’s modulus up to 30.2% and 13.2% was recorded, respectively. This degradation indicated that extended storage in a wet environment may cause a decrease in the mechanical properties.
A New Method for the Isolation of Ergosterol and Peroxyergosterol as Active Compounds of Hygrophoropsis aurantiaca and in Vitro Antiproliferative Activity of Isolated Ergosterol Peroxide
Authors: Nowak Renata , Drozd Marta , Mendyk Ewaryst , Lemieszek Marta , Krakowiak Olga , Kisiel Wanda , Rzeski Wojciech , Szewczyk Katarzyna
Published: July 2016

In the present study, ergosterol peroxide and ergosterol were isolated for the first time from fresh fruit bodies of Hygrophoropsis aurantiaca (False Chanterelle). The substances were characterized mainly by spectroscopic methods (1H-NMR, 13C-NMR, DEPT-45, DEPT-90, DEPT-135, 2D-NMR). In our study, a new specific thin layer chromatographic method was developed for determination of ergosterol and ergosterol peroxide in H. aurantiaca extract. The method is based on the separation of n-hexane extract on silica gel (Silica Gel G) TLC plates using the optimized solvent system toluene/ethyl acetate (3:1; v/v). The main advantages of the developed method are the simplicity of operation and the low cost. The in vitro study results revealed the antiproliferative properties of ergosterol peroxide against LS180 human colon cancer cells. The described effect was attributed both to altered mitochondrial activity and decreased DNA synthesis. Additionally, in the same concentration range the investigated compound was not toxic to CCD 841 CoTr human colon epithelial cells. The present study suggests that fruit bodies of H. aurantiaca have great potential for producing substances and extracts with potential applications in medicine.
Novel Improved Synthesis of HSP70 Inhibitor, Pifithrin-μ. In Vitro Synergy Quantification of Pifithrin-μ Combined with Pt Drugs in Prostate and Colorectal Cancer Cells
Authors: McKeon Aoife , Egan Alan , Chandanshive Jay , McMahon Helena , Griffith Darren
Published: July 2016

We describe a novel improved approach to the synthesis of the important and well-known heat shock protein 70 inhibitor (HSP70), pifithrin-μ, with corresponding and previously unreported characterisation. The first example of a combination study comprising HSP70 inhibitor pifithrin-μ and cisplatin or oxaliplatin is reported. We have determined, using the Chou-Talalay method, (i) moderate synergistic and synergistic effects in co-treating PC-3 prostate cancer cells with pifithrin-μ and cisplatin and (ii) significant synergistic effects including strong synergism in cotreating HT29 colorectal cancer cells with oxaliplatin and pifithrin-μ.
Application of Ultrasound in a Closed System: Optimum Condition for Antioxidants Extraction of Blackberry (Rubus fructicosus) Residues
Authors: Zafra-Rojas Quinatzin , Cruz-Cansino Nelly , Quintero-Lira Aurora , Gómez-Aldapa Carlos , Alanís-García Ernesto , Cervantes-Elizarrarás Alicia , Güemes-Vera Norma , Ramírez-Moreno Esther
Published: July 2016

Blackberry processing generates up to 20% of residues composed mainly of peel, seeds and pulp that are abundant in flavonoids. The objective of this study was to optimize the ultrasound conditions, in a closed system, for antioxidants extraction, using the response surface methodology. Blackberry (Rubus fructicosus) residues were analyzed for total phenolics, total anthocyanins, and antioxidant activity by ABTS and DPPH. The selected independent variables were ultrasound amplitude (X1: 80%–90%) and extraction time (X2: 10–15 min), and results were compared with conventional extraction methods. The optimal conditions for antioxidants extraction were 91% amplitude for 15 min. The results for total phenolic content and anthocyanins and antioxidant activity by ABTS and DPPH were of 1201.23 mg gallic acid equivalent (GAE)/100 g dry weight basis (dw); 379.12 mg/100 g·dw; 6318.98 µmol Trolox equivalent (TE)/100 g·dw and 9617.22 µmol TE/100 g·dw, respectively. Compared to solvent extraction methods (water and ethanol), ultrasound achieved higher extraction of all compounds except for anthocyanins. The results obtained demonstrated that ultrasound is an alternative to improve extraction yield of antioxidants from fruit residues such as blackberry.
Antiproliferative Activity and Cellular Uptake of Evodiamine and Rutaecarpine Based on 3D Tumor Models
Authors: Guo Hui , Liu Dongmei , Gao Bin , Zhang Xiaohui , You Minli , Ren Hui , Zhang Hongbo , Santos Hélder , Xu Feng
Published: July 2016

Evodiamine (EVO) and rutaecarpine (RUT) are promising anti-tumor drug candidates. The evaluation of the anti-proliferative activity and cellular uptake of EVO and RUT in 3D multicellular spheroids of cancer cells would better recapitulate the native situation and thus better reflect an in vivo response to the treatment. Herein, we employed the 3D culture of MCF-7 and SMMC-7721 cells based on hanging drop method and evaluated the anti-proliferative activity and cellular uptake of EVO and RUT in 3D multicellular spheroids, and compared the results with those obtained from 2D monolayers. The drugs’ IC50 values were significantly increased from the range of 6.4–44.1 μM in 2D monolayers to 21.8–138.0 μM in 3D multicellular spheroids, which may be due to enhanced mass barrier and reduced drug penetration in 3D models. The fluorescence of EVO and RUT was measured via fluorescence spectroscopy and the cellular uptake of both drugs was characterized in 2D tumor models. The results showed that the cellular uptake concentrations of RUT increased with increasing drug concentrations. However, the EVO concentrations uptaken by the cells showed only a small change with increasing drug concentrations, which may be due to the different solubility of EVO and Rut in solvents. Overall, this study provided a new vision of the anti-tumor activity of EVO and RUT via 3D multicellular spheroids and cellular uptake through the fluorescence of compounds.
Erratum: Liu, H., et al. Radical Scavenging by Acetone: A New Perspective to Understand Laccase/ABTS Inactivation and to Recover Redox Mediator. Molecules 2015, 20, 19907–19913
Authors:   Molecules Editorial Office
Published: July 2016

The Molecules Editorial Ofﬁce wishes to report the following erratum to this paper [1].[...]
Economic Impacts of Power Shortage
Authors: Ou Peng , Huang Ruting , Yao Xin
Published: July 2016

The electricity industry is a basic industry of the national economy. It has experienced several large-scale power shortages, hard power shortage and soft power shortage, which have brought a great threat to China’s sustainable economic development. To solve this problem better, it is necessary to make a quantitative assessment of the economic impacts of power shortage. The CGE model is commonly used for simulating economic shocks and policy effects. It describes supply, demand and equilibrium in different markets by simulating the economic mechanism through a set of equations. Once changed, the exogenous variables will affect a certain part of the system and then the whole system, leading to changes in quantities and prices. The equilibrium state will also change from one to another. A static CGE model is built in this paper, and the Social Accounting Matrix (SAM) of eight sectors of China in 2007 is compiled, in order to simulate the economic impacts of hard power shortage and soft power shortage. Simulation results show that the negative effects of power shortage on economic development are very significant, and the effects vary in different sectors. Especially, under the background of hard power shortage, the industrial sector suffers most. The economic cost of power shortage is considerable, and the main reason for it is the specific administrative pricing system in China. The low electricity price in the long term will lead to insufficient construction and hard power shortage; moreover, that in the short run would result in soft power shortage. In order to solve the problem of power shortage completely, power system reform is inevitable.
Coping with Pluvial Floods by Private Households
Authors: Rözer Viktor , Müller Meike , Bubeck Philip , Kienzler Sarah , Thieken Annegret , Pech Ina , Schröter Kai , Buchholz Oliver , Kreibich Heidi
Published: July 2016

Pluvial floods have caused severe damage to urban areas in recent years. With a projected increase in extreme precipitation as well as an ongoing urbanization, pluvial flood damage is expected to increase in the future. Therefore, further insights, especially on the adverse consequences of pluvial floods and their mitigation, are needed. To gain more knowledge, empirical damage data from three different pluvial flood events in Germany were collected through computer-aided telephone interviews. Pluvial flood awareness as well as flood experience were found to be low before the respective flood events. The level of private precaution increased considerably after all events, but is mainly focused on measures that are easy to implement. Lower inundation depths, smaller potential losses as compared with fluvial floods, as well as the fact that pluvial flooding may occur everywhere, are expected to cause a shift in damage mitigation from precaution to emergency response. However, an effective implementation of emergency measures was constrained by a low dissemination of early warnings in the study areas. Further improvements of early warning systems including dissemination as well as a rise in pluvial flood preparedness are important to reduce future pluvial flood damage.
Analysis of Long-Term Water Level Variation in Dongting Lake, China
Authors: Han Qiaoqian , Zhang Shuanghu , Huang Guoxian , Zhang Rui
Published: July 2016

The water level of Dongting Lake has changed because of the combined impact of climatic change and anthropogenic activities. A study of the long-term statistical properties of water level variations at Chenglingji station will help with the management of water resources in Dongting Lake. In this case, 54 years of water level data for Dongting Lake were analyzed with the non-parametric Mann–Kendall trend test, Sen’s slope test, and the Pettitt test. The results showed the following: (1) Trends in annual maximum lake water level (WLM), annual mean lake water level (WL), and annual minimum lake water level (WLm) increased from 1961 to 2014; however, the three variables showed different trends from 1981 to 2014; (2) The annual change trends in Dongting Lake between 1961–2014 and 1981–2014 were found to be from approximately 0.90 cm/year to −2.27 cm/year, 1.65 cm/year to −0.79 cm/year, and 4.58 cm/year to 2.56 cm/year for WLM, WL, and WLm, respectively; (3) A greater degree of increase in water level during the dry season (November–April) was found from 2003 to 2014 than from 1981 to 2002, but a smaller degree of increase, even to the point of decreasing, was found during the wet season (May–October); (4) The measured discharge data and numerical modeling results showed the operation of Three Gorge Reservoir (TGR) pushed to influence partly the recent inter-annual variation of water level in Dongting Lake region, especially in the flood and dry seasons. The analysis indicated that the water level of Dongting Lake has changed in the long term with decreasing of range between WLM and WLm, and may decrease the probability of future drought and flood events. These results can provide useful information for the management of Dongting Lake.
Correction: Ryu, J., et al. Development of a Watershed-Scale Long-Term Hydrologic Impact Assessment Model with the Asymptotic Curve Number Regression Equation. Water 2016, 8, 153
Authors: Ryu Jichul , Jang Won , Kim Jonggun , Choi Joong , Engel Bernard , Yang Jae , Lim Kyoung
Published: July 2016

The authors wish to make the following corrections to this paper [1]: The author name “Bernard A. Engle” should be “Bernard A. Engel”[...]