bluuebunny/crossref_metadata_2025 huggingface dataset:
A Candidate Locus Approach Identifies a Long QT Syndrome Gene Mutation
Authors: Beery Theresa A. , Dyment Macaira , Shooner Kerry , Knilans Timothy K. , Benson D. Woodrow
Published: October 2003

Long QT syndrome is an inherited disorder that results in lengthened cardiac repolarization. It can lead to sudden onset of torsades de pointes, ventricular fibrillation, and death. The authors obtained a family history, performed electrocardiograms, and drew blood for DNA extraction and genotyping from 15 family members representing 4 generations of an affected family. Seven individuals demonstrated prolonged QT intervals. The authors used polymorphic short tandem repeat markers at known LQTS loci, which indicated linkage to chromosome 11p15.5 where the potassium channel, KCNQ1, is encoded. Polymerase chain reaction was used to amplify the coding region of KCNQ1. During survey of the KCNQ1 coding region, a G-to-A transition (G502A) was identified. DNA from all clinically affected but from none of the clinically unaffected family members carried the G-to-A transition. The candidate locus approach allowed an efficient mechanism to uncover the potassium channel mutation causing LQTS in this family.
Let's Put our (Post)Cards on the Table
Authors: Kohn Ayelet
Published: October 2003

This article discusses advertisement postcards that are distributed, free of charge, at special stands in public places. In addition to their primary function (they are rarely used, thus defining them as almost `non-post' cards), the postcards serve those who take them as a collector's item, a conversation piece, a sign of belonging to a particular group (being `in') and as a component in structuring cultural and social frameworks. Taking these postcards as an example, the article attempts to define the spatial, social and linguistic characteristics of the discourse of postcards. The author examines the specific nature of the discourse that develops between the creators of these postcards and their audiences. A certain indirect dialogue takes place, almost devoid of feedback, in which the medium revolves and changes its function when different receivers and diverse locations create new definitions for it. The analysis of the audience demonstrates an inclination towards a particular social group of skilful consumers, who consume the `best' advertisements as cultural products in themselves. This group is expressed by virtue of their active decision to detect and choose a specific postcard and use it in a variety of ways.
Children as Photographers: An Analysis of Children's Photographic Behaviour and Intentions at Three Age Levels
Authors: Sharples Mike , Davison Laura , Thomas Glyn V. , Rudman Paul D.
Published: October 2003

We report a systematic study of children as photographers at three age levels across five European countries. 180 children, aged 7, 11 and 15, were given single-use cameras and asked to use them in any way they pleased over a weekend. The children were then interviewed about their photographs and the process of taking them. The photographs and related commentary were analysed by means of specially developed coding schemes for image content and photographer's intentions. The study has identified marked differences in children's understanding, behaviour and intentions as photographers across the three age groups. These have been described from interactional, socio-cultural and control perspectives. Children across the age groups showed an increasing ability to distinguish the properties of the image from the world it represents, and a developing reflective awareness of the equipment, the surroundings, the image and the effect of the act of photography on others. The older children were generally scathing of adults' attempts to produce posed idealized images and they valued authenticity and informality rather than technical proficiency. Thus, children are not simply apprentice adult photographers, but exhibit distinctive intentions and products that vary with age.
How the Medium is the Message in the Unconscious of `America Online'
Authors: Hodge Bob
Published: October 2003

This article explores McLuhan's famous slogan `the medium is the message' as a point of departure for examining current views of the nature of the new electronic media understood as a revolutionary form, associated with a new (`post-modern') stage of society. It argues that this slogan packs into itself more layers of meaning than he was able to articulate in a complex and nuanced theory of the media. It suggests that McLuhan's work constructs a productive idea of a media unconscious. It shows in detail how `messages' are encoded in new visual forms associated with the new electronic media, using the logo of `America Online' (AOL), an internet provider, as exemplary text. This logo carries implicit messages about the nature of these media, in a kind of dialogue with McLuhan. Messages and dialogue alike need a new space in which they can occur: a theory of unconscious dimensions of media.
Introduction
Authors: Jennings Jeremy
Published: October 2003

This short article is an introduction to a collection of essays written to mark the 20th anniversary of the death of Raymond Aron in 1983. Having briefly examined the recent controversy associated with the publication of Daniel Lindenberg's Le Rappel à l'ordre, it discusses the development of political thinking in France over the last 20 years and the place occupied by the revival of interest in liberalism. It concludes by suggesting that the dominance sometimes attributed to liberalism in contemporary France might be misplaced, citing in particular the manner in which the radical left has been able to transform itself and maintain the rhetoric of anti-capitalism. It cites recent opposition to the war in Iraq as an example of patterns of ideological continuity. To that extent, Aron might well have again found himself in the minority.
Raymond Aron and the French Revolution
Authors: Netter Marie-Laurence
Published: October 2003

After a short introduction, this article contains the text of a previously unpublished interview with Raymond Aron in which he discusses what he takes to be the significance and continuing importance, if any, of the French Revolution. In the course of the interview Aron discusses different interpretations of the Revolution. The interview took place in February 1983.
Raymond Aron, the History of Ideas and the Idea of France
Authors: Gowan Richard
Published: October 2003

Raymond Aron's vision of liberalism reflects the paradox that ideologies both fuel and restrict democratic debate. This may be related to the history of French liberalism developed by Albert Thibaudet in the inter-war period. This article considers Aron's use of Thibaudet's ideas in his wartime writings. It suggests that these represented a significant step forward from his pre-war approach to pluralism and set certain parameters for his post-war political thought. It is also suggested that Thibaudet's writings led Aron to study the ideas of the nineteenth-century intellectual Ernest Renan. These contributed to his understanding of international relations. While Aron was to lose interest in Renan and Thibaudet, his wartime debt to them represents an important stage in his intellectual evolution and ties him to a distinctively French (if little known) tradition of pluralist thought.
The Phenomenology of Raymond Aron
Authors: Davis Reed
Published: October 2003

This article reviews the influence of Edmund Husserl's phenomenology on Raymond Aron's philosophy of history. In trying to create an original synthesis of Husserl's phenomenology and Max Weber's neo-Kantianism, Aron fashioned a dialectical logic that ultimately proved to be unstable. This tension accounts for the ambiguity and inconsistencies in some areas of Aron's thinking.
Aron, Marx, and Marxism
Authors: Mahoney Daniel J.
Published: October 2003

Central to his own fruitful study of modern society and politics, of the stakes and twists-and-turns of the dramatic twentieth century, was Raymond Aron's fifty year engagement with `Marx and Marxism'. In a series of lecture courses (and elsewhere) Aron provided a comprehensive, balanced, and judicious exposition and appreciation of Marx's intellectual itinerary. On one hand, Marx helpfully highlighted various tensions in liberal-bourgeois society. On the other hand, however, his apolitical, materialistic explanations of them and, especially, his prediction of capitalism's explosive self-overcoming proved grossly inadequate. In addition to being a special sort of social scientist, Marx was a Promethean humanist who rejected all natural and social limits and who claimed to scientifically predict the coming of the true and real City of Man. Aron's own `balanced social analysis' and his humane, sober, reformist thought stand in stark contrast.
Am I Safe? Reactions of Mexican Americans to September 11
Authors: Rudolph Bonnie , Diaz Luis
Published: October 2003

This exploratory study examines reactions and sense of safety experienced by Mexican American individuals in Laredo, Texas. Two bilingual interviewers conducted structured field interviews with residents of three different communities. Responses were very similar across these stratified samples of convenience. Gender did not influence responses. The authors discuss alternate explanations for the findings, limitations of the study, and further research suggestions. The impact of the interviews on both respondents and researchers is noted.
Puerto Rican Subjective Locations: Definitions and Perceptions of Literacy
Authors: Medina Carmen L.
Published: October 2003

This manuscript addresses the epistemological shift from traditional “objective” and “neutral” forms of perceiving literacy to more complex and subjective perceptions, allowing for traditionally marginalized narratives to become an active part of the dialogue within the field of literacy. It critically examines how the author's definitions of literacy in her scholarly work are shaped by and grow out of her own identity—a Puerto Rican bilingual woman who navigates between the mainland and the island.
The Time of the Butterflies
Authors: De Herron Sandra Aravena
Published: October 2003

This manuscript argues that Julia Alvarez, the author of the novel In the Time of the Butterflies, by immersing herself in both cultures, United States and Dominican, overcomes all the adjustments a foreigner generally faces in becoming multicultural; through this accomplishment, she is able to make self-conscious literary choices to communicate effectively her message to both cultures.
The Prenatal Diagnosis of an Oral Cavity Mass
Authors: Barnette-Wharton Anita J. , Lacroix Stephanie
Published: October 2003

The obstetrical sonography examination includes coronal imaging of facial structures to determine the presence of abnormalities. Enlargement or pathology involving the salivary glands rarely occurs. In this case, a coronal sonographic view between the bottom lip and the tongue showed a mass originating under the tongue. The mass was posterior to the tongue, pushing the tongue superior. Sonography demonstrated the tongue and oral mass extruding forward from the oral cavity. The pathology report diagnosed an enlarged salivary sublingual gland. The sublingual gland is usually the smallest of the four major salivary glands located within the oral cavity.
The Role of Sonography in Breast Conservation Therapy Using Breast Brachytherapy
Authors: Bubb Karen , Hooper Cindy
Published: October 2003

Sonography of the breast is a rapidly expanding specialty area. It is routinely used in conjunction with mammography. The role of sonography in breast examinations primarily consists of a targeted study focusing on a specific abnormality seen on a mammogram. Sonography is also used to evaluate palpable breast masses, dense breast tissue, and breast implants. Sonographic guidance is often used in interventional procedures such as core needle biopsies, fine needle aspirations, needle wire localizations, and handheld mammotomes. Recently, the role of sonography in breast care has expanded. Breast brachy-therapy (internal radiation therapy) is a type of radiotherapy that can be used in breast conservation therapy (BCT). This article is limited to the role of sonography in BCT breast brachy-therapy. The surgical technique, radiation do-simetry, computed tomography, and mammo-graphic roles are not discussed in detail.
Prenatal Diagnosis of Familial Ureteropelvic Junction Obstruction
Authors: Dabra Ajay , Gupta Rakhee , Singh Jeet , Kochhar Suman
Published: October 2003

Ureteropelvic junction obstruction, the most common cause of neonatal hydronephrosis, is well detected by prenatal sonography. It is usually sporadic in presentation, and familial occurrence is rare. The authors present one such case of likely familial hydronephrosis due to ureteropelvic junction obstruction in a mother and fetus that was detected on prenatal sonographic imaging. The importance of prospective fetal screening in mothers at risk for fetal obstructive uropathy is illustrated so as to facilitate timely postnatal management of the disease process.
The Sonographic Evaluation of Lissencephaly
Authors: Sundberg Brandy , Michael Kim , Berg Jody
Published: October 2003

Lissencephaly is a neural disorder characterized by lack of sulcations in the brain. In lissencephaly, the normal migration of the neuron does not occur due to an insult to the fetus early in gestation. This causes a “smooth brain” appearance. Lissencephaly is associated with syndromes such as Walker-Warburg and Miller-Dieker syndromes. Sonographic findings of lissencephaly include agenesis of the corpus collosum, dilated third ventricle, and lack of sulcations. Patients diagnosed with lissencephaly do not usually de-velop intellectually past the three- to five-month age level.
Sonographic Evaluation of a Nonspecific Palpable Lump
Authors: Hosken Linda M. , Schlehr Kimberly S.
Published: October 2003

There are several imaging modalities in the radiology field, and each one has distinct strengths and weaknesses when compared to another. Sonography is a very useful tool in the characterization of a palpable lump. The three modalities of computerized tomography, magnetic resonance imaging, and diagnostic x-ray are a combined force in the evaluation and diagnosis of bone lesions. Sonographers are occasionally the first evaluators of a nonspecific lump that turns out to be a bone neoplasm. Such a case is presented. The discussion is twofold. The basic features of sonographic evaluation of a palpable lump are reviewed as well as the specific lesion known as the aneurysmal bone cyst, which was the final diagnosis in this case study.
The Guanine Nucleotide Exchange Factor ARNO mediates the activation of ARF and phospholipase D by insulin
Authors: Li Hai-Sheng , Shome Kuntala , Rojas Raúl , Rizzo Megan A , Vasudevan Chandrasekaran , Fluharty Eric , Santy Lorraine C , Casanova James E , Romero Guillermo
Published: October 2003

Background

Phospholipase D (PLD) is involved in many signaling pathways. In most systems, the activity of PLD is primarily regulated by the members of the ADP-Ribosylation Factor (ARF) family of GTPases, but the mechanism of activation of PLD and ARF by extracellular signals has not been fully established. Here we tested the hypothesis that ARF-guanine nucleotide exchange factors (ARF-GEFs) of the cytohesin/ARNO family mediate the activation of ARF and PLD by insulin.

Results

Wild type ARNO transiently transfected in HIRcB cells was translocated to the plasma membrane in an insulin-dependent manner and promoted the translocation of ARF to the membranes. ARNO mutants: ΔCC-ARNO and CC-ARNO were partially translocated to the membranes while ΔPH-ARNO and PH-ARNO could not be translocated to the membranes. Sec7 domain mutants of ARNO did not facilitate the ARF translocation. Overexpression of wild type ARNO significantly increased insulin-stimulated PLD activity, and mutations in the Sec7 and PH domains, or deletion of the PH or CC domains inhibited the effects of insulin.

Conclusions

Small ARF-GEFs of the cytohesin/ARNO family mediate the activation of ARF and PLD by the insulin receptor.
Mitigation of Pennyroyal Oil Hepatotoxicity in the Mouse
Authors: Sztajnkrycer Matthew D. , Otten Edward J. , Bond G. Randall , Lindsell Christopher J. , Goetz Robert J.
Published: October 2003

Objectives: Pennyroyal oil ingestion has been associated with severe hepatotoxicity and death. The primary constituent, R‐(+)‐pulegone, is metabolized via hepatic cytochrome P450 to toxic intermediates. The purpose of this study was to assess the ability of the specific cytochrome P450 inhibitors disulfiram and cimetidine to mitigate hepatotoxicity in mice exposed to toxic levels of R‐(+)‐pulegone. Methods: 20‐g female BALB/c mice were pretreated with either 150 mg/kg of cimetidine intraperitoneal (IP), 100 mg/kg of disulfiram IP, or both. After one hour, mice were administered 300 mg/kg of pulegone IP and were killed 24 hours later. Data were analyzed using ANOVA. Post‐hoc t‐tests used Bonferroni correction. Results: There was a tendency for lower serum glutamate pyruvate transaminase in the disulfiram and cimetidine groups compared with the R‐(+)‐pulegone group. The differences were significant for both the cimetidine and the combined disulfram and cimetidine groups compared with the R‐(+)‐pulegone group. Pretreatment with the combination of disulfiram and cimetidine most effectively mitigated R‐(+)‐pulegone–induced hepatotoxicity. Conclusions: Within the limitations of a pretreatment animal model, the combination of cimetidine and disulfiram significantly mitigates the effects of pennyroyal toxicity and does so more effectively than either agent alone. These data suggest that R‐(+)‐pulegone metabolism through CYP1A2 appears to be more important in the development of a hepatotoxic metabolite than does metabolism via CYP2E1.
Development of a Porcine Excisional Wound Model
Authors: Singer Adam J. , McClain Steve A.
Published: October 2003

Objectives: To develop a porcine model for cutaneous tangential excisional wounds. Methods: This was a prospective, longitudinal, blinded experiment on four isoflurane‐anesthetized swine. Forty standardized excisional wounds (1 square inch each) were created with an electric dermatome set at a depth of 300, 600, 750, or 900 μm. Full‐thickness wounds were created with a surgical blade (n= 8 for each depth). Wounds were treated with polyurethane film. Full‐thickness punch biopsies were taken after one, two, three, four, five, and 14 days for blinded histopathological evaluation. The main outcome was the percent wound reepithelialization (REP) calculated by dividing the length of neoepidermis in cross‐section by the specimen's diameter (interobserver correlation = 0.99). Analysis of variance was used to compare percent REP among wound depths. This study had 80% power to detect a 33% difference in REP across groups (two‐tailed α= 0.05). Results: There were significant differences in percent REP across wound depths for days 2–5 (p < 0.001 for all days). The more superficial wounds (300 to 600 μm) were mostly reepithelialized by day 4, whereas wounds ranging in depth from 750 to 900 μm were mostly healed by day 5. Full‐thickness wounds had no evidence of REP even after 14 days. Conclusions: The authors describe an excisional wound model in swine. Rapid reepithelialization occurs within three to five days in wounds <900 μm deep.
Comparison of the Rapid Emergency Medicine Score and APACHE II in Nonsurgical Emergency Department Patients
Authors: Olsson Thomas , Lind Lars
Published: October 2003

Objectives: To improve the Rapid Acute Physiology Score (RAPS) as a predictor of in‐hospital mortality in the nonsurgical emergency department (ED) by including age and oxygen saturation, and to compare this new system, Rapid Emergency Medicine Score (REMS), with the Acute Physiology and Chronic Health Examination (APACHE II) with reference to predictive accuracy. Methods: This was a prospective cohort study. One hundred sixty‐two critically ill patients consecutively admitted to the intensive care unit (ICU) during the period of one year, and 865 nonsurgical patients presenting to an adult emergency department (ED) and admitted to a medical department of a 1,200‐bed university hospital during two months, were enrolled. For all entries to the ED, RAPS was calculated and developed to include noninvasive peripheral oxygen saturation and patient age (REMS), as well as laboratory tests (APACHE II). These scores were calculated for each patient. Results: REMS was found to be superior to RAPS in predicting in‐hospital mortality both in the critically ill patients admitted to the ICU and in the total sample (area under receiver‐operating characteristic curve [AUC] 0.910 ± 0.015 for REMS compared with 0.872 ± 0.022 for RAPS, p < 0.001). An increase of 1 point in the 26‐point REMS scale was associated with an odds ratio of 1.40 for in‐hospital death (95% confidence interval = 1.36 to 1.45, p < 0.0001). The more advanced APACHE II was not found to be superior to REMS (AUC: 0.901 ± 0.015, p = 0.218). Conclusions: RAPS could be improved as a predictor of in‐hospital mortality in the nonsurgical ED by including oxygen saturation and patient age to the system. This new scoring system, REMS, had the same predictive accuracy as the well‐established, but more complicated, APACHE II.
General Competencies Are Intrinsic to Emergency Medicine Training: A Multicenter Study
Authors: Reisdorff Earl J. , Hayes Oliver W. , Reynolds Brian , Wilkinson Keith C. , Overton David T. , Wagner Mary Jo , Kowalenko Terry , Portelli David , Walker Gregory , Carlson Dale
Published: October 2003

Objectives: The Accreditation Council for Graduate Medical Education (ACGME) has promulgated six areas called General Competencies (GCs) that residency programs are required to evaluate. The authors sought to determine if these domains were an intrinsic part of emergency medicine (EM) residency training by using a global assessment evaluation device. Methods: This was an observational, multicenter, cross‐sectional study that compared GC acquisition between first‐, second‐, and third‐year (EM1, EM2, and EM3) residents. Five postgraduate year (PGY) 1 to PGY 3 allopathic EM programs in Michigan participated. A global assessment form using a 1 through 9 ordinal scale with 86 scoring items was given to program directors for each resident in their programs. Analysis of variance (ANOVA) was used to compare the means between EM1, EM2, and EM3 scores. Results: Five EM programs evaluated 150 residents. The GC scores were as follows: Patient Care: EM1 4.92, EM2 5.79, and EM3 6.40; Medical Knowledge: EM1 4.90, EM2 5.80, and EM3 6.46; Practice‐based Learning and Improvement: EM1 4.60, EM2 5.48, and EM3 6.16; Interpersonal and Communication Skills: EM1 4.99, EM2 5.39, and EM3 6.01; Professionalism: EM1 5.43, EM2 5.68, and EM3 6.27; Systems‐based Practice: EM1 4.80, EM2 5.48, and EM3 6.21. ANOVA showed statistically significant differences (p < 0.001) for all GCs. Conclusions: EM residents from several residency programs showed statistically significant progressive acquisition of the ACGME GCs using a global assessment device. This suggests that the GCs may be an intrinsic component in the training of EM residents.
The Overcrowded Emergency Department: A Comparison of Staff Perceptions
Authors: Reeder Timothy J. , Burleson Deeanna L. , Garrison Herbert G.
Published: October 2003

Objectives: To study perceptions of physicians and nursing staff about real‐time demands and capacity of an emergency department (ED). To use ED data to calculate proposed demand ratios called Real‐time Emergency Analysis of Demand Indicators (READI) scores. To compare the READI scores with ED staff perceptions of demand and capacity. Methods: This prospective study used a computerized clinical management system to provide data about ED demand and capacity. Physicians and staff charge nurses were surveyed about perceptions of ED demand and capacity. Results were compared with mathematical READI scores, which are proposed to objectively assess ED demand. Kappa scores were used to measure intrarater reliability between the physicians' and charge nurses' assessment of demand and between the staff assessments and the READI scores. Results: Kappa scores of the perception of excess demand were as follows: between two physician groups, κ= 0.392; between one physician group and charge nurses, κ= 0.453; and between a second physician group and charge nurses, κ= 0.243. Comparing respondents who indicated that demand had or had not exceeded capacity, one of the READI ratios, the Bed Ratio, showed a significant difference in mean, 0.245 (95% confidence interval = 0.153 to 0.336), between groups. Conclusions: Real‐time data may be used to predict ED demand and resource needs. Subjective assessment of excess ED demand did not correlate between physician groups or between physicians and charge nurses. Although there was a trend toward predicting excess demand with one of the READI scores, these scores did not correlate to staff perceptions.
Panic Disorder and Emergency Services Utilization
Authors: Zane Richard D. , McAfee Andrew T. , Sherburne Summer , Billeter Gabrielle , Barsky Arthur
Published: October 2003

Objectives: The characteristics of patients with panic disorder in emergency department (ED) patient populations are unknown. This study compares demographic information and emergency care use among patients identified as having a high likelihood of having panic disorder with that of patients who tested negative on the screening test for panic disorder. Methods: Prospective cross‐sectional study of a convenience sample of patients presenting to an urban ED. Patients were excluded if they were aged 18 years or younger, were unstable, or could not speak English or Spanish. Of 968 patients, 813 agreed to participate. Over a period of 23 days, patients were administered a Diagnostic and Statistical Manual (DSM)‐IV screening questionnaire (PRIME‐MD) for panic disorder along with a survey assessing their use of medical services during the prior year. Results: One hundred patients (12.3%) met PRIME‐MD criteria for having a high likelihood of panic disorder. Patients with Medicare were 2.84 times more likely to have a positive result on the screening test than those without insurance. Patients who had four to seven ED visits or eight or more ED visits in one year were 2.63 and 3.10 times more likely to screen positive on the PRIME‐MD, respectively, compared with those who had one to three visits. Patients who activated 911 two to ten times or 11 or more times in one year were 2.02 and 4.99 times more likely to screen positive for panic disorder, respectively, compared with those who had never activated 911. Conclusions: Patients who screen positive for panic disorder use emergency medical services and ED services more frequently. In addition, the overall prevalence of screening positive for panic disorder in an ED is higher than previously reported.
How Patients and Visitors to an Urban Emergency Department View Clinical Research
Authors: Wilets Ilene , O'Rourke Maria , Nassisi Denise
Published: October 2003

Objectives: To assess views about clinical research, drawing current opinion from an urban, largely minority population within the authors' emergency department (ED). Methods: Two focus groups of ED patients and visitors were conducted. These data informed the development of a 27‐item interview examining views about clinical research and knowledge of human subjects protections. Results: The authors interviewed a total of 172 patients and visitors within an adult ED. Study participants reflected the diverse patient population: 38% were African American, 32% Hispanic, 25% white, and 6% other. When asked why one might choose to participate in medical research, 46% said to benefit mankind, 26% said to improve one's own health, 18% cited access to medical care, 17% said financial incentive, and 11% said curiosity. When asked why one might decline research participation, 38% cited fear, 24% cited lack of interest in research, 10% cited medical mistrust, 9% indicated not wanting to feel like a “guinea pig,” 6% indicated lack of time, and 5% suggested privacy concerns. When asked about the meaning of informed consent, 32% did not know. Many respondents (26%) were unaware that they could withdraw from a study. Although the majority (96%) endorsed a statement about the potential benefit of research for themselves or their loved ones, a sizable proportion of respondents (49%) equated research subjects to “human guinea pigs.”Conclusions: Although many individuals tend to view clinical research favorably, a level of medical mistrust exists. The concerns about human experimentation and the limited understanding of human subject protections underscore the need to improve informed consent.
Neurologic Outcome Score for Infants and Children
Authors: Okada Pamela J. , Young Kelly D. , Baren Jill M. , Raroque Soledad S. , Huff Kenneth R. , Wiebe Jacqueline B. , Stavinoha Peter L. , Lewis Roger J.
Published: October 2003

Objectives: To develop and validate a practical outcome instrument applicable to a broad range of neurologic deficits in children. Methods: Reliability testing of a draft version of the Neurologic Outcome Scale for Infants and Children (NOSIC) in 100 children with a wide range of ages and levels of neurologic function was performed. After review of the reliability data by a panel of experts, the NOSIC was revised. Validity and reliability testing of the final NOSIC was performed in a new population of 157 children, 52 with cerebral palsy, motor delay, or language delay. Interrater reliability was assessed using Spearman rank correlation coefficients of two investigators' scores. NOSIC scores were correlated with scores on criterion‐standard neuropsychological tests to assess validity. Results: The median NOSIC score for normal children was 98, interquartile range 96–100; the median score for abnormal children was 87, interquartile range 58–96. Interrater reliability of the NOSIC scores of 84 patients rated by both raters demonstrated excellent reliability (ρ= 0.77, 95% confidence interval [CI] = 0.62 to 0.88). Correlation of the NOSIC scores of the 127 patients who had neuropsychological testing with applicable criterion standards was ρ= 0.63, 95% CI = 0.50 to 0.74. Conclusions: The NOSIC is a practical, reliable, valid, instrument applicable to infants and children with a broad range of neurologic deficits. It should be a useful research tool when neurologic function is an important outcome measure.
Strategies of Disaster Response in the Health Care System for Tropical Cyclones: Experience Following Typhoon Nari in Taipei City
Authors: Lai Ting‐I , Shih Fuh‐Yuan , Chiang Wen‐Chu , Shen Shih‐Tsuo , Chen Wen‐Jone
Published: October 2003

Natural disasters present significant potential for injuries and death. Unlike the experience of Hurricane Andrew that destroyed a vast surface area in the rural countryside, Typhoon Nari in Taipei proved that significant damages from natural disasters also can happen to modern health care systems in urban areas. To ameliorate such damages, specific structural, nonstructural, and administrative issues must be taken into account. Such issues include the location of the health facility, design of the infrastructure, storage of equipment and machines, maintenance, medical, and nonmedical operations. Specific considerations, such as early evacuation and securing the safety of the patients before a disaster, should be emphasized. Recovery plans that determine how soon medical service can be restored to the community should also be established. Emphasis on emergency‐response preparedness, mitigation procedures, and recovery efforts should all be included in a comprehensive emergency plan against the destruction caused by natural hazards.
Faculty Development: Academic Opportunities for Emergency Medicine Faculty on Education Career Tracks
Authors: Coates Wendy C. , Hobgood Cherri D. , Birnbaum Adrienne , Farrell Susan E.
Published: October 2003

Medical school faculty members who specialize in the scholarship of teaching have unique requirements for academic advancement in universities with clinician‐educator series. While excellence in teaching is the cornerstone of achievement, attention to traditional academic pursuits improves the likelihood of a favorable review by the institution's promotion and tenure committee. The teaching portfolio is an effective means to document performance. Ongoing faculty development and sound mentoring relationships facilitate the academic advancement of clinician‐educators.
Preventive Care in the Emergency Department: Screening for Domestic Violence in the Emergency Department
Authors: Anglin Deirdre , Sachs Carolyn
Published: October 2003

Objectives: The most effective methods for identification and management of domestic violence (DV) victims in health care settings are unknown. The objective of this study was to systematically review screening for DV in the emergency department (ED) to identify victims and decrease morbidity and mortality from DV. Methods: Using the terms “domestic violence” or “partner violence,” and “identification” or “screening,” and “emergency,” the authors searched MEDLINE, the Cochrane Database, and Emergency Medical Abstracts from 1980–2002. They selected articles studying screening tools, interventions, or determining the incidence or prevalence of DV among ED patients. The studies were analyzed using evidence‐based methodology. Results: Three hundred thirty‐nine articles resulted from the literature search. Based on selection criteria, 45 were reviewed in detail and 17 pertained to the ED. From references of these 17 articles, three additional articles were added. Screening can be conducted using a brief verbal screen and existing ED personnel. A randomized, controlled trial did not demonstrate a difference in screening rates between experimental and control hospitals. No studies assessed the effect of ED screening for DV on morbidity or mortality of domestic violence. An ED‐based advocacy program resulted in increased use of shelters and counseling. Conclusions: Because of the paucity of outcomes research evaluating ED screening and interventions, there is insufficient evidence for or against DV screening in the ED. However, because of the high burden of suffering caused by DV, health care providers should strongly consider routinely inquiring about DV as part of the history, at a minimum for all female adolescent and adult patients.
Clinically Important Change in the Visual Analog Scale after Adequate Pain Control
Authors: Lee Jacques Simon , Hobden Elisabeth , Stiell Ian G. , Wells George A.
Published: October 2003

Objectives: To define the minimum clinically important difference (MCID) for the visual analog scale (VAS) of pain severity by measuring the change in VAS associated with adequate pain control. Methods: The authors conducted a prospective, observational study. Adult emergency department (ED) patients with acute pain (<72 hours) were eligible. Patients rated their pain severity on a 100‐mm VAS on presentation and at discharge. Patients were asked if they would accept any analgesic, then if they would accept a parenteral analgesic before treatment. At discharge, they were asked whether they had received adequate pain control. Results: The authors enrolled 143 patients (mean age, 36 years; 54% female). The mean decrease in VAS was −30.0 mm (95% confidence interval [CI] =−36.4 to −23.6) for the 116 of 143 (81%) patients with adequate pain control at discharge vs. −5.7 (95% CI =−11.2 to −0.3) for the 27 with inadequate pain control (p < 0.001). At discharge, the mean VAS was 31.3 mm for those with adequate pain control vs. 55.1 for those without. Mean VAS for the 114 of 143 patients who would accept any analgesics initially was 64.7 vs. 47.1 for the 29 reporting no analgesic need. Initially, 77 patients would accept parenteral analgesics (mean VAS = 72.5 mm). Conclusions: A mean reduction in VAS of 30.0 mm represents a clinically important difference in pain severity that corresponds to patients' perception of adequate pain control. Defining MCID based on adequate analgesic control rather than minimal detectable change may be more appropriate for future analgesic trials, when effective treatments for acute pain exist.
Usefulness of Computerized Pediatric Motor Vehicle Safety Discharge Instructions
Authors: Zonfrillo Mark R. , Mello Michael J. , Palmisciano Lynne M.
Published: October 2003

Objectives: To determine whether providing child motor vehicle safety recommendations on computerized discharge instructions (CDIs) were useful to parents and modified their use of child‐restraint devices (CRDs). Methods: The subjects were guardians of children seen in an urban pediatric emergency department (ED). An intervention group was given computerized ED discharge instructions that included the National Highway Traffic Safety Administration recommendations for motor vehicle CRDs. A control group was given CDIs without the recommendations. All subjects were subsequently called within four days of the ED visit and asked questions about their knowledge and use of CRDs. They also were queried if the recommendations affected their knowledge or changed their behavior. Results: There were 52 subjects in the control group and 58 in the intervention group. Fifty‐seven percent of the intervention group remembered reading a safety tip (p < 0.001, 95% confidence interval [CI] = 0.32 to 0.62), and 82% of that subset correctly identified it pertaining to motor vehicle safety. Forty‐five percent (n= 33) of those who remembered the safety recommendation in the intervention group supported it being educational (p = 0.067, 95% CI = 0.28 to 0.64). Ten percent of the subjects in the intervention group said the CDIs changed their behavior regarding buckling‐up their child, compared with 0% of the control group (p = 0.473, 95% CI = 0.05 to 0.32). Conclusions: Including CRD information on CDIs is a convenient method of educating guardians of patients about motor vehicle safety in a pediatric ED setting. The data suggest that parents find it educational and a smaller subgroup change their behaviors after receiving them.
A computationally efficient piled-foundation model for studying the effects of ground-borne vibration on buildings
Authors: Talbot J P , Hunt H E M
Published: October 2003

Understanding the effects of ground-borne vibration on buildings is becoming increasingly important as pressure grows to construct high-quality buildings on existing urban sites, which are often close to busy roads or railways. The motivation behind the work presented here is the development of a computational model that enables engineers to evaluate the effectiveness of isolating buildings. This paper presents one component of such a model, namely a new three-dimensional model for modelling the propagation of ground-borne vibration through a piled foundation.

A row of piles is considered, with the piles modelled using the solutions for an elastic bar and Euler beam, and the soil represented by an elastic half-space. The model is comprehensive in that it accounts for the longitudinal and transverse motion of the piles due to both external pile-head loads and interaction between neighbouring piles through wave propagation in the surrounding soil. Computational efficiency is achieved by assuming that the row comprises an infinite number of identical piles and using a combination of the boundary element method and periodic structure theory.
Novel non-contact passive damping of structures: An experimental investigation using electromagnetic concepts
Authors: Chakraborty S , Tomlinson G R
Published: October 2003

An experimental investigation has been carried out into the use of a non-contact mechanism to absorb or dissipate energy from a vibrating structure via electromagnetic effects. This paper describes a novel concept whereby the elastic paramters of a ferromagnetic mass within the immediate neighbourhood of a spatially varying magnetic field can be tuned to act as an elastic vibration absorber; if this ferromagnetic mass is sufficiently damped, it can also dissipate energy. The present study highlights some promising empirical observations together with some unusual phenomena arising from the magneto-structural interaction. Structures that are sensitive to modification from conventional damping treatment could benefit from this type of novel non-contact damping technique.
Large deflection of elastoplastic beams with prescribed moving and rotating ends
Authors: Huang X , Yu T X , Lu G , Lippmann H
Published: October 2003

The large deflection of an elastoplastic beam with prescribed moving and rotating end conditions is investigated to simulate its air-bending process. A finite difference model is developed and governing equations in terms of rotations of elements were derived. Due to both geometrical and material non-linearities, only numerical solutions are obtained by using an iteration procedure. Four typical examples with various moving/rotating boundary conditions are shown by graphs. Numerical analyses also show the evolution of the plastic region and the effects of springback and loading path on the deformed profiles.
Energy method for modelling delamination buckling in geometrically constrained systems
Authors: Hicks B J , Mullineux G , Berry C , McPherson C J , Medland A J
Published: October 2003

Delamination buckling analysis of laminates is of considerable interest to the mechanical and materials engineering sectors, as well as having wider applications in geology and civil engineering. With advances in computing power, the ability to model ever increasingly complex problems at more detailed levels becomes more of a reality. However, many of the common finite element packages, with the exception of all but the most specialized, do not perform particularly well where complex non-linear problems are dealt with. In many cases, these packages can fail to determine the full range of solutions or accurately predict the properties and geometry of the final state. This is particularly the case where large deformations and buckling of laminates are considered. Because of this, many researchers prefer to use what they perceive to be more reliable techniques, such as the symbolic computation of the underlying differential equations, rather than finite element approaches. The use of finite element packages is further frustrated by the steep learning curve and implicit restrictions imposed by using third-party software. In this paper, a finite element approach and an energy formulation method are considered and used to model the delamination buckling in a geometrically constrained system. These methods are compared with experimental results and their relative merits are discussed. In particular, the accuracy and the ability to represent the geometry of the buckled system are discussed. Both the finite element approach and the energy formulation are described in detail and the numerical results are compared.
Optimum coefficient of performance and exergetic efficiency of a two-stage vapour compression refrigeration system
Authors: Tiedeman J S , Sherif S A
Published: October 2003

This paper presents the results of an optimization study for a two-stage vapour compression refrigeration system based on the coefficient of performance (COP) and exergetic efficiency. Traditional studies have focused on the first-law performance, while those studies dealing with the second law have primarily been limited to performance analysis as opposed to performance optimization. The results of this study indicate that the use of the common approximation of the geometric mean to find the optimum interstage pressure can lead to significant errors in interstage pressure. However, an optimum COP or exergetic efficiency based on the same interstage pressure has relatively little error. This trend is valid as long as the isentropic compressor efficiencies are ‘reasonable’. Second-law optimization revealed that the optimum data curves themselves have a maxima for each set of conditions tested. This leads to the conclusion that for a given system there is an optimum set of conditions that lead to the lowest amount of exergy destruction for that system. This is shown to occur consistently for reasons that are, as yet, undetermined. Finally, polynomial equations have been fitted to the resultant optimum data for the interstage pressure, COP and exergetic efficiency. These equations allow for the reproduction of optimum points based on high-and low-pressure compressor efficiencies and condenser and evaporator pressures.
Thermal modelling and optimization of heat transfer in a high-temperature theatre luminaire
Authors: Anderson D E , Truslove T E , Kubie J
Published: October 2003

A computational fluid dynamics model has been developed to predict the thermal performance of high-temperature theatre luminaires. The theoretical results are in good agreement with available experimental data. The model has been used to investigate the behaviour of the thermally sensitive areas of the luminaires. The model shows that an appreciable reduction of critical temperatures can be achieved by using extended surfaces at key locations. The model can also be used to evaluate and optimize future designs.
Entropy analysis in relation to laser shortpulse heating of silver
Authors: Yilbas B S
Published: October 2003

Laser shortpulse heating triggers non-equilibrium energy transport in the surface region of the metallic substrate. In this case, volumetric entropy generation is governed by the non-equilibrium energy transport due to coupling of electron and lattice subsystems as well as thermomechanical coupling in the lattice system. In the present study, non-equilibrium energy transport inside the metallic substrate is modelled using an electron kinetic theory approach. Volumetric entropy generation inside the substrate material during non-equilibrium energy transport is formulated. The effect of thermomechanical coupling on the energy transport is included in the analysis. Temperature and volumetric entropy profiles are computed for silver. It is found that an electron temperature well in excess of lattice site temperatures occurs in the surface vicinity of the substrate material. Volumetric entropy generation due to electron-lattice coupling dominates the other sources of entropy generation. Thermomechanical coupling has no significant effect on the volumetric entropy generation due to a small thermal displacement of the irradiated surface, which is in the order of 10-10 m at the centre of the irradiated spot.
Automated error analysis of serial manipulators and servo heads
Authors: Freeman J M , Ford D G
Published: October 2003

This paper presents a general mathematical treatment of serial manipulators, an important example of which is the servo head. The paper includes validation by application to the angle head via comparison with the previously known transformations and a new application to the error analysis of the angle head.

The usual approach to the error analysis of a servo head is to develop a geometrical model by elementary geometrical considerations using trigonometric relationships and various simplifying assumptions. This approach is very error prone, difficult to verify and extremely time consuming. The techniques described here constitute matrix methods that have been programmed in a general way to derive automatically the analytical equations relating the angles of rotation of the head and alignment errors in the head to the position of the tool and errors in that position. The approach is to use rotation and transformation matrices to evaluate the influence of the various errors such as offsets and angular errors. A general approach to the sign convention and notation for angular errors is presented in an attempt to reduce the possibility of errors of definition.