bluuebunny/crossref_metadata_2025 huggingface dataset:
Crystallization and Second Harmonic Generation of Lithium Niobium Silicate Glass Ceramics
Authors: Vigouroux Hélène , Fargin Evelyne , Fargues Alexandre , Garrec Bruno Le , Dussauze Marc , Rodriguez Vincent , Adamietz Frédéric , Mountrichas Grigoris , Kamitsos Efstratios , Lotarev Sergey , Sigaev Vladimir
Published: March 2011

An extended study of lithium niobium silicate glass crystallization with the molar composition 35Li2O–25Nb2O5–40SiO2 is presented. Depending on the heat treatments, both surface and/or bulk crystallizations of the LiNbO3 crystalline phase were observed. X‐ray diffraction together with second harmonic generation (SHG) measurements have revealed a net preferred orientation of the ferroelectric crystallites at the surface which is quite different in the bulk. A striking and promising SHG response estimated to be five times larger than α‐quartz has been observed in the bulk.
Spark Plasma Sintering Kinetics of Pure α‐Alumina
Authors: Aman Yann , Garnier Vincent , Djurado Elisabeth
Published: March 2011

The microstructure development of sintered alumina at different stages in the spark plasma sintering process has been investigated. Based on classical kinetics laws and adapted Coble creep models of hot pressing, the densification and grain growth kinetics were analyzed as a function of various parameters such as heating rate, sintering temperature, and dwell duration. It is found that sintering kinetics are greatly influenced by heating rates. The local temperature gradients at interparticle contacts during high heating rate can be from three to 10 times higher than in low heating rate cycles. Plastic yield might lead to instantaneous densification at an early stage of sintering. However, grain‐boundary diffusion probably dominates at low heating rate whereas grain coarsening, in respect of thermal equilibrium establishment, is unavoidable with high heating rate during the initial‐stage sintering at low temperatures. During the final‐stage sintering, fast grain growth mechanisms such as surface diffusion and pore‐controlled grain‐boundary migration may dominate over densification controlled by grain‐boundary sliding or lattice diffusion. The grain size–density trajectory corroborates that low heating rate is much favorable to achieve near full density with fine grain size at low sintering temperatures.
Availability and Potential Effect of Rural Rotations in Emergency Medicine Residency Programs
Authors: Talley Brad E. , Ann Moore S. , Camargo Carlos A. , Rogers John , Ginde Adit A.
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:297–300 © 2011 by the Society for Academic Emergency Medicine

Objectives:  Increased exposure of emergency medicine (EM) residents to rural rotations may enhance recruitment to rural areas. This study sought to characterize the availability and types of rural rotations in EM residency programs and to correlate rotation type with rural practice after graduation.

Methods:  Program directors from all 126 Accreditation Council for Graduate Medical Education (ACGME)‐accredited EM residency programs with at least 2 years of graduates were surveyed. Directors were asked about availability of rural rotations, categorized as: 1) required, 2) elective (with or without predesignated sites), or 3) not available. Completion of rotations and initial practice location after graduation by rotation type were compared.

Results:  The 111 (88%) directors reported 2,380 graduates over the past 2 years. Rural rotations were required by six (5%) programs, elective at 92 (83%), and not available at 13 (12%). Overall, 197 (8%) residents completed a rural rotation during residency, and 160 (7%) selected their initial job in a rural area. More residents completed an elective rural rotation in programs with versus without a predesignated site (7% vs. 4%, respectively). EM residency graduates were more likely to select a rural job when rural rotations were required (22%), compared to other options: predesignated (7%) or no predesignated (6%) elective or not available (7%; p < 0.001).

Conclusions:  Elective rural rotations at predesignated sites increase resident exposure to rural areas compared to programs without predesignated sites, but neither approach was associated with rural practice after graduation. EM residency programs that required a rural rotation had increased resident selection of rural jobs, but only 5% of programs had this requirement.
Academic Emergency Physicians’ Experiences With Patient Death
Authors: Strote Jared , Schroeder Erika , Lemos John , Paganelli Ryan , Solberg Jonathan , Range Hutson H.
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:255–260 © 2011 by the Society for Academic Emergency Medicine

Objectives:  There is a growing awareness of the effects of patient death on physician well‐being, and the importance of cultural and educational changes to improve coping mechanisms. The objective of this study was to explore both the effects of patient death on academic emergency physicians (EPs) and the coping mechanisms they use to deal with these events.

Methods:  Faculty at a convenience sample of four emergency medicine (EM) residency programs were questioned about their responses to patient death in a 15‐question on‐line survey. Descriptive analysis of the data was performed. Independent variables were analyzed for differences in complaints of physical symptoms or consideration of important life changes after patient death.

Results:  Of 207 EPs surveyed, 145 (70%) responded. Patient death was experienced frequently, with 95 (66%) witnessing a death at least every month. No training on coping with patient death had occurred for 35 (24%); 93 (64%) had less than 6 hours of training. The most common coping mechanisms included talking with colleagues (113; 78%) or friends and family (100; 69%), as well as simply continuing to work (89; 61%). Postdeath debriefing occurred rarely or never for 93 (64%) of respondents. Most EPs had experienced physical responses to patient death, the most common being insomnia (54; 37%) and fatigue (21; 14%). Common emotional responses included sadness (112; 70%) and disappointment (55; 38%). No significant differences in response rates for physical symptoms or consideration of life changes were found for any of the variables.

Conclusions:  Patient death was reported to lead to both physical and emotional symptoms in academic EPs. Postdeath debriefing appears to happen infrequently in teaching settings, and most respondents reported that they themselves received limited training in coping with patient death. Further study is needed to both identify coping mechanisms that are feasible and effective in emergency department settings and develop teaching strategies to incorporate this information into EM residency training.
The Influence of Emergency Medical Services Transport on Emergency Severity Index Triage Level for Patients With Abdominal Pain
Authors: Hiestand Brian , Moseley Mark , MacWilliams Bryan , Southwick Jed
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:261–266 © 2011 by the Society for Academic Emergency Medicine

Objectives:  The Emergency Severity Index (ESI) is a prospectively validated, five‐level emergency department (ED) triage system designed to match triage acuity to both patient acuity and appropriate resource allocation. The study hypothesis was that, in practice, there exists an inappropriate bias toward triaging patients with abdominal pain to a higher ESI level based solely upon their mode of arrival to the ED.

Methods:  The authors performed a retrospective case–control study of patients presenting with abdominal pain. Patients were matched on sex, age (±5 years), and date of arrival. Cases were those patients triaged to a Level 2, and controls were those triaged as Level 3. Conditional multiple variable logistic regression was used to evaluate the effect of the following variables on the odds of being triaged as Level 2: mode of arrival, systolic blood pressure (<90 mm Hg; normal, >140 mm Hg), heart rate, severe pain score (≥8 of 10), fever, race, history of cancer, and previous abdominal surgery. Age was also included in the regression modeling to confirm that matching was adequate. One‐hundred cases and 100 controls were necessary to provide adequate sample size. A backward modeling technique was used, requiring a p < 0.05 for retention.

Results:  Of the 200 subjects, 52 arrived by emergency medical services (EMS) and 148 walked in. After matching for sex, age, and date of arrival, and after adjusting for heart rate, cancer diagnosis, and severe pain, the odds ratio (OR) for being triaged ESI Level 2 was 7.19 (95% confidence interval [CI] = 2.75 to 18.8, p < 0.0001) for EMS patients compared to walk‐in patients. The admission rate for Level 2 patients was not different from that of Level 3 patients (49% vs. 35% of Level 3 patients, p = 0.06), but EMS patients were more likely to be admitted, regardless of ESI level assignment (65% vs. 34%, p < 0.001).

Conclusions:  After adjusting for covariates, EMS patients with abdominal pain were more likely to be triaged to a higher acuity level. Triage level was not associated with admission, but patients arriving by EMS were more likely to be admitted. This may indicate that the effect of EMS arrival on triage level assignment is actually appropriate. Further research is necessary to validate whether mode of arrival should be incorporated in the initial ESI triage acuity assignment.
Eligibility and Rate of Treatment for Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Using Different Criteria
Authors: Huang Poyin , Khor Gim‐Thean , Chen Chun‐Hung , Lin Ruey‐Tay , Liu Ching‐Kuan
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:273–278 © 2011 by the Society for Academic Emergency Medicine

Objectives:  The rate of recombinant tissue plasminogen activator (rtPA) use for stroke is low among the Chinese‐Taiwanese. The study objective was to determine if less restrictive exclusion criteria for rtPA would increase eligibility and the rate of treatment.

Methods:  This retrospective before‐and‐after study was conducted from 2006 to 2009. The authors compared stroke patients treated under the old rtPA exclusion criteria (January 2006 to December 2008) with those treated with less restrictive rtPA exclusion criteria (January to December 2009). Rates of eligibility and treatment and reasons for exclusion from rtPA between the two phases were assessed.

Results:  Of 461 eligible patients during the study period, 333 were evaluated by the old criteria and 128 were evaluated by the less restrictive criteria. Minor or improving stroke was the primary exclusion reason in both groups (194/333, 58% vs. 70/128, 55%). Eligibility for rtPA was increased in the less restrictive criteria (35/127, 27%, 95% confidence interval [CI] = 20% to 36%) compared to the old criteria (40/333, 12%, 95% CI = 8.7% to 16%; p = 0.0001). Fewer patients were excluded due to old age in the less restrictive criteria (0/128, 0%) compared to the old criteria (37/333, 11%; p = 0.0001). The rate of consent refusal increased in the less restrictive criteria (27/128, 21%, 95% CI = 14% to 29%) compared to the old criteria (23/333, 6.9%, 95% CI = 4.4% to 10%; p < 0.0001). Rate of rtPA treatment was unchanged between the less restrictive criteria (8/128, 6.3%, 95% CI = 2.7% to 12%) and the old criteria (17/333, 5.1%, 95% CI = 3% to 8%; p = 0.63).

Conclusions:  Increasing eligibility for rtPA does not increase the rate of treatment, possibly due to the high symptomatic intracerebral hemorrhage rate among Chinese‐Taiwanese, which is a major concern among emergency physicians (EPs), neurologists, and patients. Dealing with perceived safety issues of rtPA is crucial before the rate of treatment can be increased.
Risk for Cost‐related Medication Nonadherence Among Emergency Department Patients
Authors: Mazer Maryann , Bisgaier Joanna , Dailey Elizabeth , Srivastava Kavita , McDermoth Monique , Datner Elizabeth , Rhodes Karin V.
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:267–272 © 2011 by the Society for Academic Emergency Medicine

Objectives:  There has been a rapid rise in prescription drug costs over the past decade. As a result, many Americans are unable to afford their medications, especially in the current economic recession. Medication nonadherence is known to have adverse effects on health outcomes. The purpose of this study was to gain a preliminary understanding of cost‐related medication nonadherence (CRMN) disclosure among screened emergency department (ED) patients and to describe the extent to which CRMN is associated with other economic and psychosocial risk factors.

Methods:  This was a prospective, cross‐sectional study of a convenience sample of adult patients presenting to an urban academic ED with 61,962 annual visits in 2009. Nonemergent patients received an optional self‐administered Social Health Survey between May and October 2009. Results were assessed from the sample of anonymous surveys that were completed and collected. Standard statistical methods were used to determine the frequencies and relative risks (RRs) for CRMN with 95% confidence intervals (CIs).

Results:  A total of 384 (25.5%) of the 1,506 adult patients who completed the survey either screened positive for any prior CRMN (20.7%) or disclosed concerns about affording medication (4.8%). Patients were significantly more likely to report risk for CRMN if they used tobacco (RR = 1.8, 95% CI = 1.5 to 2.2) or illicit drugs (RR = 2.0, 95% CI = 1.6 to 2.4), experienced intimate partner violence (IPV; RR = 1.8, 95% CI = 1.5 to 2.2), or reported concerns about overall financial instability (RR = 3.9, 95% CI = 3.2 to 4.7), food insufficiency (RR = 3.7, 95% CI = 3.1 to 4.3), housing problems (RR = 2.5, 95% CI = 2.1 to 2.9), and inadequate health insurance coverage (RR = 7.7, 95% CI = 6.2 to 9.5).

Conclusions:  Risk for medication nonadherence due to cost concerns was identified in a quarter of nonemergent urban ED patients in our sample and was more likely to be reported by patients experiencing other economic and psychosocial risks. These findings indicate a need to include discussions about medication affordability and referrals to social services as part of ED discharge planning.
Cost‐effectiveness of Telemetry for Hospitalized Patients With Low‐risk Chest Pain
Authors: Ward Michael J. , Eckman Mark H. , Schauer Daniel P. , Raja Ali S. , Collins Sean
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:279–286 © 2011 by the Society for Academic Emergency Medicine

Background:  The majority of chest pain admissions originate in the emergency department (ED). Despite a low incidence of cardiac events, limited telemetry availability, and its questionable benefit, these patients are routinely admitted to a monitored setting.

Objectives:  The objectives were to analyze the cost‐effectiveness of admission to telemetry versus admission to an unmonitored hospital bed in low‐risk chest pain patients and explore when the use of telemetry may be cost‐effective.

Methods:  The authors constructed a decision analytic model to evaluate the scenario of an ED admission of an otherwise healthy 55‐year‐old patient with low‐risk chest pain defined as an acute coronary syndrome (ACS) probability of 2%. Costs were estimated from 2009 Medicare data for hospital reimbursement and physician services, as well as published data on disability costs. Published studies were used to estimate the risk of ACS, cardiac arrest, time to defibrillation, survival, long‐term disability, and quality of life.

Results:  In the base case, telemetry was more effective (0.0044 quality‐adjusted life‐years [QALYs]) but more costly ($299.67) than a floor bed, resulting in a high marginal cost‐effectiveness ratio (mCER) of $67,484.55 per QALY. In comprehensive sensitivity analyses, the mCER crossed below the willingness‐to‐pay (WTP) threshold of $50,000 per QALY when the following scenarios were met: the probability of ACS exceeds 3%, the probability of cardiac arrest is greater than 0.4%, the probability of shockable dysrhythmia is above 83%, the probability of delay in telemetry bed availability is below 52%, and the opportunity cost of delay to telemetry bed placement is below $119.

Conclusions:  Telemetry may be a “cost‐effective” use of health care resources for chest pain patients when patients have a probability of ACS above 3% or for patients with a minimal delay and cost associated with obtaining a monitored bed. Further research is needed to better stratify low‐risk chest pain patients to the appropriate inpatient setting and to understand the frequency and costs associated with delays in obtaining monitored beds.
A Prospective Case Series of Single‐syringe Ketamine–Propofol (Ketofol) for Emergency Department Procedural Sedation and Analgesia in Adults
Authors: Andolfatto Gary , Willman Elaine
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:237–245 © 2011 by the Society for Academic Emergency Medicine

Objectives: The objective was to evaluate the effectiveness, recovery time, and adverse event profile of intravenous (IV) mixed 1:1 ketamine–propofol (ketofol) for adult procedural sedation and analgesia (PSA) in the emergency department (ED).

Methods: Prospective data were collected on all PSA events over a 4.5‐year period in a trauma‐receiving suburban teaching hospital. PSAs using a 1:1 single‐syringe mixture of 10 mg/mL ketamine and 10 mg/mL propofol in patients over 21 years of age were analyzed. Physiologic data, drug doses, adverse events, recovery time, patient satisfaction, and staff satisfaction were recorded.

Results: Ketofol PSA was used in 728 patients for primarily orthopedic procedures. Median patient age was 53 years (range = 21 to 99 years, interquartile range [IQR] = 36–70 years). The median dose of ketamine and propofol was 0.7 mg/kg each (range = 0.2 to 2.7 mg/kg, IQR = 0.5–0.9 mg/kg), and median recovery time was 14 minutes (range = 3 to 50 minutes, IQR = 10–17 minutes). PSA was effective in 717 cases (98%). Bag–mask ventilation occurred in 15 patients (2.1%; 95% confidence interval [CI] = 1.0% to 3.1%). Recovery agitation occurred in 26 patients (3.6%; 95% CI = 2.2% to 4.9%), of whom 13 (1.8%; 95% CI = 0.8% to 2.7%) required treatment. One patient experienced vomiting and one patient was admitted to the hospital for monitoring of transient dysrhythmia and hypotension. No sequelae were identified. The median staff satisfaction scores were 10 (IQR = 9–10) on a scale of 1 to 10, and 97% of patients would have chosen the same method of PSA in the future.

Conclusions: Ketofol is an effective PSA agent in adult ED patients. Recovery times are short and adverse events are few. Patients and ED staff were highly satisfied.
Emergency Physician–performed Ultrasound to Diagnose Cholelithiasis: A Systematic Review
Authors: Ross Marshall , Brown Michael , McLaughlin Kyle , Atkinson Paul , Thompson Jenny , Powelson Susan , Clark Steve , Lang Eddy
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:227–235 © 2011 by the Society for Academic Emergency Medicine

Objectives:  The authors sought to determine the diagnostic test characteristics of bedside emergency physician (EP)‐performed ultrasound (US) for cholelithiasis in symptomatic emergency department (ED) patients.

Methods:  A search was conducted of MEDLINE, EMBASE, the Cochrane Library, bibliographies of previous systematic reviews, and abstracts from major emergency medicine conference proceedings. We included studies that prospectively assessed the diagnostic accuracy of emergency US (EUS) for cholelithiasis, compared to a criterion reference standard of radiology‐performed ultrasound (RADUS), computed tomography (CT), magnetic resonance imaging (MRI), or surgical findings. Two authors independently performed relevance screening of titles and abstracts, extracted data, and performed the quality analysis. Disagreements were resolved by conference between the two reviewers. EUS performance was assessed with summary receiver operator characteristics curve (SROC) analysis, with independently pooled sensitivity and specificity values across included studies.

Results:  The electronic search yielded 917 titles; eight studies met the inclusion criteria, yielding a sample of 710 subjects. All included studies used appropriate selection criteria and reference standards, but only one study reported uninterpretable or indeterminate results. The pooled estimates for sensitivity and specificity were 89.8% (95% confidence interval [CI] = 86.4% to 92.5%) and 88.0% (95% CI = 83.7% to 91.4%), respectively.

Conclusions:  This study suggests that in patients presenting to the ED with pain consistent with biliary colic, a positive EUS scan may be used to arrange for appropriate outpatient follow‐up if symptoms have resolved. In patients with a low pretest probability, a negative EUS scan should prompt the clinician to consider an alternative diagnosis.
Identifying Neurocognitive Deficits in Adolescents Following Concussion
Authors: Thomas Danny G. , Collins Michael W. , Saladino Richard A. , Frank Virginia , Raab Jenny , Zuckerbraun Noel S.
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:246–254 © 2011 by the Society for Academic Emergency Medicine

Objectives:  This study of concussed adolescents sought to determine if a computer‐based neurocognitive assessment (Immediate Postconcussion Assessment and Cognitive Test [ImPACT]) performed on patients who present to the emergency department (ED) immediately following head injury would correlate with assessments performed 3 to 10 days postinjury and if ED neurocognitive testing would detect differences in concussion severity that clinical grading scales could not.

Methods:  A prospective cohort sample of patients 11 to 17 years of age presenting to the ED within 12 hours of a head injury were evaluated using two traditional concussion grading scales and neurocognitive testing. ED neurocognitive scores were compared to follow‐up scores obtained at least 3 days postinjury. Postconcussive symptoms, outcomes, and complications were assessed via telephone follow‐up for all subjects.

Results:  Sixty patients completed phone follow‐up. Thirty‐six patients (60%) completed follow‐up testing a median of 6 days postinjury. Traditional concussion grading did not correlate with neurocognitive deficits detected in the ED or at follow‐up. For the neurocognitive domains of verbal memory, processing speed, and reaction time, there was a significant correlation between ED and follow‐up scores trending toward clinical improvement. By 2 weeks postinjury, 23 patients (41%) had not returned to normal activity. At 6 weeks, six patients (10%) still had not returned to normal activity.

Conclusions:  Immediate assessment in the ED can predict neurocognitive deficits seen in follow‐up and may be potentially useful to individualize management or test therapeutic interventions. Neurocognitive assessment in the ED detected deficits that clinical grading could not and correlated with deficits at follow‐up.
Effect of the western pearlshell mussel Margaritifera falcata on Pacific lamprey Lampetra tridentata and ecosystem processes
Authors: Limm Michael P. , Power Mary E.
Published: March 2011

Suspension feeders concentrate organic material from the water column and enhance deposition to the surrounding benthos. On the South Fork of the Eel River (Mendocino, California) two suspension feeders, the freshwater mussel Margaritifera falcata and Pacific lamprey larvae Lampetra tridentata, co‐occur in areas with low flow velocities and boundary sheer stresses. We investigated mussel/lamprey larvae interactions, and their impacts on nutrient and organic matter cycling, in flow‐through enclosures placed where lamprey larvae and mussels naturally occurred. Over the 80‐day study, lamprey larvae grew faster in the presence of mussels and in food addition treatments. Our results suggest that lamprey larvae benefit from native mussels, and that lamprey populations and organic matter retention in rivers may decrease with the rapid decline of native freshwater mussels.
Coevolutionary hotspots and coldspots for host sex and parasite local adaptation in a snail–trematode interaction
Authors: King Kayla C. , Delph Lynda F. , Jokela Jukka , Lively Curtis M.
Published: March 2011

Reciprocal adaptation between interacting species may occur in some regions (coevolutionary ‘hotspots’) and not others (‘coldspots’). In a previous study, we found hotspots and coldspots along a continuous depth gradient in two different New Zealand lakes. Specifically, we found that Microphallus sp. trematodes were locally adapted to Potamopyrgus antipodarum snails collected from shallow‐water margins of the lakes, but not to snails collected from deep‐water habitats. As sexual snails were more common in the shallow water, and asexual snails more common in the deep water, the results were also consistent with the Red Queen hypothesis, which predicts that sex should be favored in environments with coevolving parasites. Here, we repeated our earlier experiment to determine whether the results are robust over time (two years) and space (three lakes). We also tested whether our measure of parasite local adaptation was sensitive to parasite dose. Our results suggest that shallow‐water habitats are temporally stable coevolutionary hotspots, and that the pattern is spatially robust over three lake populations. We also found that, while parasite dose affects the magnitude of local adaptation, it does not obscure the signature of local adaptation in this snail–trematode system.
Reproductive constraints, not environmental conditions, shape the ontogeny of sex‐specific mass–size allometry in roe deer
Authors: Hewison A. J. Mark , Gaillard Jean‐Michel , Delorme Daniel , Van Laere Guy , Amblard Thibaut , Klein François
Published: March 2011

In polygynous mammals, sex‐specific patterns of body growth are linked to divergent selection pressures on male and female body size, resulting in sexual dimorphism (SD). For males, reproductive success is generally linked to body size, hence, males should prioritise early growth. For females, reproductive success is linked to resource availability, so they may adopt a more conservative growth tactic. Using longitudinal monitoring of known‐age animals in two contrasting populations and an allometric approach to disentangle the relative contribution of structural size and physiological condition to SD, we addressed these issues in the weakly polygynous roe deer. Despite very different environmental conditions, we found remarkably similar patterns in the two populations in the mass–size allometric relationship at each life history stage, suggesting that relative allocation to structural size and physiological condition is highly constrained. SD in structural size (indexed by hind foot length) involved sex‐specific growth trajectories governed by a single mass–size allometric relationship during the juvenile stage, such that males were both bigger and heavier than females. In contrast, SD in physiological condition (indexed by the allometric relationship between body mass and hind foot length, expressed as body mass for a given body size) developed markedly during the sub‐adult stage in relation to sex differences in the timing of first reproduction. Among adults, males were heavier for a given size than females, suggesting that, relative to females, males express a capital breeder tactic, accumulating fat reserves to offset reproductive costs. By the senescent stage, SD in physiological condition had disappeared, with both sexes governed by a single allometric relationship, suggesting more rapid senescence in males than females. Individuals born into poor cohorts were generally lighter for a given size, indicating growth priority for skeletal size over physiological condition in both sexes. However, sex differences in cohort effects among sub‐adults resulted in lower size‐specific SD in poor cohorts, indicating that body condition of sub‐adult females is buffered against environmental harshness. We conclude that sex‐differences in reproductive tactics impose constraints on the ontogeny of SD in roe deer, leading to sex‐specific trajectories in structural size and physiological condition.
Testing Moran's theorem in an agroecosystem
Authors: Rosenstock Todd S. , Hastings Alan , Koenig Walter D. , Lyles Danielle J. , Brown Patrick H.
Published: March 2011

The abundance and reproductive effort of populations frequently fluctuate across space and time, a phenomenon known as spatial synchrony. Knowledge of the causes of this behavior underlies the ability to manage species, protect the health of humans and the environment, and increase agricultural sustainability. We used an agroecosystem to test Moran's theorem – spatial synchrony results from environmental entrainment. The controlled conditions of the agroecosystem allowed us to create a highly correlated environment while negating the effects of the alternative hypotheses: dispersal and trophic interactions. Under such conditions, synchrony of fruit production by 4288 trees was high over six years in a 32.5 ha pistachio orchard and occurred at similar temporal frequency as weather patterns demonstrating the Moran effect. The spatial synchrony of fruit production was less than the presumed synchrony of the environment supporting research from microcosms and observational studies showing the Moran effect is degraded by local mechanisms. Indeed even under the homogeneous environment of this system, synchrony declined significantly with distance among trees. We present evidence suggesting that the correlation of the local environment affects intrinsic dynamics to cause these patterns. Our findings demonstrate that the Moran effect is, at minimum, partially responsible for the synchronous fruit production in this system. Agroecosystems are often overlooked in basic ecological research; this experiment provides an example of their comparative advantages for the study of some ecological questions.
Pob1 Ensures Cylindrical Cell Shape by Coupling Two Distinct Rho Signaling Events During Secretory Vesicle Targeting
Authors: Nakano Kentaro , Toya Mika , Yoneda Aki , Asami Yukiko , Yamashita Akira , Kamasawa Naomi , Osumi Masako , Yamamoto Masayuki
Published: March 2011

Proper cell morphogenesis requires the co‐ordination of cell polarity, cytoskeletal organization and vesicle trafficking. TheSchizosaccharomyces pombemutantpob1‐664has a curious lemon‐like shape, the basis of which is not understood. Here, we found abundant vesicle accumulation in these cells, suggesting that Pob1 plays a role in vesicle trafficking. We identified Rho3 as a multicopy suppressor of this phenotype. Because Rho3 function is related to For3, an actin‐polymerizing protein, and Sec8, a component of the exocyst complex, we analyzed their functional relationship with Pob1. Pob1 was essential for the formation of actin cables (by interacting with For3) and for the polarized localization of Sec8. Although neither For3 nor Sec8 is essential for polarized growth, their simultaneous disruption prevented tip growth and yielded a lemon‐like cell morphology similar topob1‐664. Thus, Pob1 may ensure cylindrical cell shape ofS. pombeby coupling actin‐mediated vesicle transport and exocyst‐mediated vesicle tethering during secretory vesicle targeting.
Marathon of eponyms: 17 Quincke oedema (Angioedema)
Authors: Scully C , Langdon J , Evans J
Published: March 2011

Oral Diseases (2011) 17, 342–344

The use of eponyms has long been contentious, but many remain in common use, as discussed elsewhere (Editorial: Oral Diseases. 2009: 15; 185). The use of eponyms in diseases of the head and neck is found mainly in specialties dealing with medically compromised individuals (paediatric dentistry, special care dentistry, oral and maxillofacial medicine, oral and maxillofacial pathology, oral and maxillofacial radiology and oral and maxillofacial surgery) and particularly by hospital‐centred practitioners. This series has selected some of the more recognized relevant eponymous conditions and presents them alphabetically. The information is based largely on data available from MEDLINE and a number of internet websites as noted below: the authors would welcome any corrections. This document summarizes data about Quincke’s oedema.
Association of serum‐soluble CD26 and CD30 levels with asthma, lung function and bronchial hyper‐responsiveness at school age
Authors: Remes Sami T , Delezuch Weronika , Pulkki Kari , Pekkanen Juha , Korppi Matti , Matinlauri Irma H
Published: March 2011

Aim:  There is a need for markers of Th1 and Th2 imbalance in diseases such as asthma. CD30 is an activation marker of Th2 cells, and importance of Th1 marker CD26 was recently found in adult asthma. We studied whether serum‐soluble CD30 (sCD30) or serum‐soluble CD26 (sCD26) could support early diagnosis of asthma in children at school age.

Methods:  sCD26 and sCD30 were measured in 34 children with clinically confirmed asthma, 31 with possible asthma and in 147 controls. In addition, the associations of flow volume spirometry, methacholine inhalation challenge and free running test results with serum sCD26 or sCD30 were analysed.

Results:  Serum sCD30 was significantly higher in children with confirmed asthma (mean 91.5 IU/mL, SD 23.0) than in the controls (78.8 IU/mL, 25.9; p = 0.042). No significant differences were found in serum sCD26 levels between the groups. There was a negative correlation of mean mid expiratory flow values with serum sCD26 (r = −0.22, p = 0.0018). Neither methacholine inhalation challenge nor free running test results were associated with serum sCD26 or sCD30.

Conclusion:  Serum sCD30 was higher in children with asthma. However, marked overlap in serum sCD30 between asthmatic and healthy children limits the usefulness of sCD30 as a diagnostic marker of asthma.
Kinin system activation in vasculitis*
Authors: Kahn Robin , Karpman Diana
Published: March 2011

Vasculitis is a systemic autoimmune inflammatory disease, characterized by inflammation in and around vessel walls leading to perturbed vessel patency and tissue damage. Many different organs may be involved. In this review, pathogenetic mechanisms of vasculitis are discussed, with special reference to activation of the kinin system. Mechanisms of kinin system activation are described, ultimately leading to release of kinins from high molecular weight kininogen. These vasoactive peptides promote inflammation.

Conclusion:  Kinin system activation during vasculitis promotes inflammation.
Emergency treatment of obstructive bronchitis: change from nebulizers to metered dose inhalers with spacers
Authors: Mecklin Minna , Paassilta Marita , Kainulainen Heidi , Korppi Matti
Published: March 2011

Aim:  To evaluate how the change from drug nebulizers to metered dose inhalers (MDI) with spacers succeeded and influenced the hospitalization rate and the length of the emergency room (ER) and hospital stay in wheezing preschool‐aged children.

Methods:  After educating and training the nurses and physicians, the use of MDIs with spacers was started on 1 November 2006 in the ER and acute wards of our hospital. All of the 1‐to‐5‐year‐old patients admitted for bronchial obstruction from 1 November 2004 to 28 February 2005 and from 1 November 2006 to 28 February 2007 were included in this retrospective hospital chart review.

Results:  In 2004–2005, 78% of the children were treated with salbutamol administered by nebulizers, and in 2006–2007, 84% with salbutamol administered by MDIs with spacers. The hospitalization rate was about 50% in both groups, and no difference was seen in the length of the hospital stay. The children treated with the MDIs with spacers stayed in the ER for a longer time.

Conclusion:  The change from drug nebulizers to MDIs with spacers in the treatment of acute bronchial obstruction in 1‐to‐5‐year‐old children was successful after the staff was educated and trained.
Variations in Condom Use by Type of Partner in 13 Sub‐Saharan African Countries
Authors: de Walque Damien , Kline Rachel
Published: March 2011

Using nationally representative data from 13 sub‐Saharan African countries, we reinforce and expand upon previous findings that men report using condoms more frequently than women do and that unmarried respondents report that they use condoms with casual partners more frequently than married individuals report using them with their spouses. Based on descriptive, bivariate, and multivariate analyses, we also demonstrate to a degree not previously shown in the current literature that married men from most countries report using condoms with extramarital partners about as frequently as unmarried men report using them with casual partners. Married women from most of the countries included in the study reported using condoms with extramarital partners less frequently than unmarried women reported using them with casual partners. This result is especially troubling because marriage usually ensures regular sexual intercourse, thereby providing more opportunities for a person to pass HIV infection from an extramarital partner to his or her spouse. These findings about high‐risk behaviors can be used to better target future HIV‐transmission‐prevention efforts.
Contraceptive Discontinuation among Honduran Women Who Use Reversible Methods
Authors: Barden‐O'Fallon Janine , Speizer Ilene S. , Cálix Javier , Rodriguez Francisco
Published: March 2011

A panel study examining the effects of women's individual characteristics, side effects experienced, and service quality on their contraceptive discontinuation was undertaken in four urban areas of Honduras. Data were collected from October 2006 to December 2007. The baseline sample consisted of 800 women aged 15–44 who were new or continuing users of an injectable contraceptive, the IUD, or an oral contraceptive. A total of 671 women (84 percent) were reinterviewed after one year. Life tables and Cox proportional hazards models were used to present discontinuation rates and factors associated with contraceptive discontinuation. Among new users, discontinuation of the baseline method at 12 months was high (45 percent), especially for users of an injectable method (50 percent). In the hazards model, service quality had little effect on discontinuation, whereas individual characteristics and the experience of specific side effects showed significant effects. The results suggest that programs should emphasize continuous contraceptive coverage rather than continuous use of a particular method.
Multiple Transitions and HIV Risk among Orphaned Kenyan Schoolgirls
Authors: Mojola Sanyu A.
Published: March 2011

Why are orphaned girls at particular risk of acquiring HIV infection? Using a transition‐to‐adulthood framework, this study employs qualitative data from Nyanza Province, Kenya, to explore pathways to HIV risk among orphaned and nonorphaned high‐school girls. It shows how simultaneous processes such as leaving their parental home, negotiating financial access, and relationship transitions interact to produce disproportionate risk for orphaned girls. The role of financial provision and parental love in modifying girls' trajectories to risk are also explored. A testable theoretical model is proposed based on the qualitative findings, and policy implications are suggested.
Private Medical Providers' Knowledge and Practices Concerning Medical Abortion in Nigeria
Authors: Okonofua Friday E. , Hammed Afolabi , Abass Tajudeen , Mairiga Abdulkarim Garba , Mohammed Abubakar Bako , Adewale Adeniyi , Garba Danjuma
Published: March 2011

To investigate the knowledge and practices regarding medical abortion and postabortion care in northern Nigeria among private physicians—the principal providers of such services in the area—122 doctors operating separate clinics in five states—Bauchi, Borno, Kaduna, Niger, and Taraba—were interviewed by means of a structured questionnaire. The results showed that 22 percent of the doctors reported that they terminate unwanted pregnancies, whereas nearly all reported that they manage complications of unsafe abortion. Manual vacuum aspiration and dilatation and curettage performed singly or in combination were the most common methods of abortion and postabortion care reported by the doctors. Only one doctor reported exclusive use of medical abortion in the first trimester, and three reported its exclusive use in the second trimester. Only 35 percent of the doctors listed misoprostol as a drug that they knew could be used for abortion and postabortion care, and only 12 percent listed mifepristone. By contrast, 49 percent listed inappropriate or dangerous drugs for use in abortion provision in the first and second trimesters of pregnancy. We conclude that private practitioners in northern Nigeria have limited knowledge of medical abortion and postabortion care, and that a capacity‐building program on the subject should be instituted for them.
Beyond Reasonable Doubt: Catching The Drug Cheats at The London Olympic
Authors: Erotokritou-Mulligan Ioulietta , Sönksen Peter , Holt Richard
Published: March 2011

A drugs-free London Olympic Games in 2012? Statisticians can help make it happen. Ioulietta Erotokritou-Mulligan, Peter Sönksen and Richard Holt explain how statisticians have been working with medics, scientists and lawyers to catch the athletes who abuse growth hormone.
Dare You Buy a Henry Moore on ebay?
Authors: Gastwirth Joseph , Johnson Wesley
Published: March 2011

When the rarefied world of modern art sales meets the digital age, almost anything is possible. You, too, can buy a Henry Moore on eBay. But it is risky. The old, high-commission auction-houses have rivals, but you will need statistics to guide you. Joseph Gastwirth and Wesley Johnson tell you where the fakes may be lurking.
How should we Screen for Breast Cancer?
Authors: Wainer Howard
Published: March 2011

Breast cancer is a killer. Screening for it is commonly seen as a life-saver, and moves to reduce screening programmes are understandably greeted with outrage. But, as Howard Wainer explains, evidence is a great help in deciding such issues.
Too Much or Too Little Scepticism?
Authors: Speed Terry
Published: March 2011

In an uncertain world, how much should we doubt? Terry Speed is not sure.
Multiple Sclerosis: A Cure or a Contradiction?
Authors: Kovalchik Stephanie
Published: March 2011

Multiple sclerosis is a debilitating disease. An Italian study seems to offer a cure. Small wonder that sufferers are queuing for the operation that it suggests – and that some surgeons are offering to perform it and offer “liberation”– for a fee. But are the hopes and operations justified? As Stephanie Kovalchik reports, a statistical contradiction at the heart of the theory has still to be resolved.
Development of a community care research agenda for Australia
Authors: Lewin Gill , Burton Elissa , Sparrow Pat , Carroll Matthew , Kendig Hal
Published: March 2011

Aim:  The purpose of this study was to develop a Community Care Research Agenda to give direction to research across community‐based services for older people, for the next 3–5 years.

Methods:  This study used a four‐round Delphi method to verify, rate and rank research questions and issues identified by sector stakeholders. Thirty panellists were selected to represent all key stakeholder groups within community care.

Results:  The research agenda comprises the 30 questions/topics, in ranked order, considered by the panellists to be of the highest priority. The largest subgroups of issues pertain to approaches to care (30%), program outcomes and effectiveness (13%), funding (10%), and workforce (10%).

Conclusion:  Having a National Community Care Research Agenda will provide focus and direction for researchers, service providers and funders in developing and conducting high priority, high value research that can inform improvements in policy and practice in community care for older people.
Promoting the Implementation of Evidence‐Based Practice: A Literature Review Focusing on the Role of Nursing Leadership
Authors: Sandström Boel , Borglin Gunilla , Nilsson Roland , Willman Ania
Published: March 2011

Objectives:Despite a growing interest in evidence‐based practice (EBP), the implementation into clinical practice of knowledge derived from research has proved to be a cumbersome process. Additionally, the literature seems to present a fragmented picture with research mainly focusing on a few factors of possible importance, among which leadership appears to be one of the more important. Thus, this study aimed to systematically review the literature regarding leadership and its possible influence on the process of implementing EBP.

Approach:A literature review was conducted. Electronic database searches were conducted to identify studies on leadership, administrators, managers, implementation, evidence‐based and nursing. The search identified 43 potentially relevant papers, of which 36 were excluded after an appraisal was performed by two independent reviewers. Results were extracted and synthesised into a narrative text.

Findings:Seven papers were included in the literature review. The findings can be divided into three major areas: (1) characteristics of the leader, (2) characteristics of the organisation and (3) characteristics of the culture. Our findings indicate that leadership is vital for the process of implementing EBP in nursing and also highlights the possible importance of the organisation and the culture in which the leader operates. These factors together with their characteristics were interpreted to be intrinsic in the creation of a nursing milieu that is open and responsive to the implementation of EBP.

Conclusions:Although there seems to be scholarly agreement that leadership is a vital part of the process of implementing EBP, more rigorous research is needed concerning the possible role of the leader. Our findings also indicate that leadership cannot be studied in isolation or without being clearly defined.
Knowledge and Attitudes of Nurses on Pressure Ulcer Prevention: A Cross‐Sectional Multicenter Study in Belgian Hospitals
Authors: Beeckman Dimitri , Defloor Tom , Schoonhoven Lisette , Vanderwee Katrien
Published: March 2011

Background: Evidence‐based guidelines for pressure ulcer prevention have been developed and promoted by authoritative organizations. However, nonadherence to these guidelines is frequently reported. Negative attitudes and lack of knowledge may act as barriers to using guidelines in clinical practice.

Aims: To study the knowledge and attitudes of nurses about pressure ulcer prevention in Belgian hospitals and to explore the correlation between knowledge, attitudes, and the application of adequate prevention.

Methods: A cross‐sectional multicenter study was performed in a random sample of 14 Belgian hospitals, representing 207 wards. Out of that group, 94 wards were randomly selected (2105 patients). Clinical observations were performed to assess the adequacy of pressure ulcer prevention and pressure ulcer prevalence. From each participating ward, a random selection of at least five nurses completed an extensively validated knowledge and attitude instrument. In total, 553 nurses participated. A logistic regression analysis was performed to evaluate the correlation between knowledge, attitudes, and the application of adequate prevention.

Results: Pressure ulcer prevalence (Category I‐IV) was 13.5% (284/2105). Approximately 30% (625/2105) of the patients were at risk (Bradenscore <17 and/or presence of pressure ulcer). Only 13.9% (87/625) of these patients received fully adequate prevention whilst in bed and when seated. The mean knowledge and attitude scores were 49.7% and 71.3%, respectively. The application of adequate prevention on a nursing ward was significantly correlated with the attitudes of the nurses (OR = 3.07, p = .05). No independent correlation was found between knowledge and the application of adequate prevention (OR = 0.75, p = .71).

Conclusions: Knowledge of nurses in Belgian hospitals about the prevention of pressure ulcers is inadequate. The attitudes of nurses toward pressure ulcers are significantly correlated with the application of adequate prevention. No correlation was found between knowledge and the application of adequate prevention.