bluuebunny/crossref_metadata_2025 huggingface dataset:
Accuracy of Blood Pressure Measurement Devices in Pregnancy
Authors: Bello Natalie A. , Woolley Jonathan J. , Cleary Kirsten Lawrence , Falzon Louise , Alpert Bruce S. , Oparil Suzanne , Cutter Gary , Wapner Ronald , Muntner Paul , Tita Alan T. , Shimbo Daichi
Published: December 2017

The accurate measurement of blood pressure (BP) in pregnancy is essential to guide medical decision making that affects both mother and fetus. The aim of this systematic review was to determine the accuracy of ambulatory, home, and clinic BP measurement devices in pregnant women. We searched Ovid MEDLINE, The Cochrane Library, EMBASE, CINAHL EBSCO, ClinicalTrials.gov, International Clinical Trials Registry Platform, and dabl from inception through August 3, 2017 for articles that assessed the validity of an upper arm BP measurement device against a mercury sphygmomanometer in pregnant women. Two independent investigators determined eligibility, extracted data, and adjudicated protocol violations. From 1798 potential articles identified, 41, that assessed 28 devices, met the inclusion criteria. Most articles (n=32) followed a standard or modified American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization, British Hypertension Society, or European Society of Hypertension validation protocol. Several articles described the results of validation studies performed on >1 device (n=7) or in >1 population of pregnant women (n=12), comprising 64 pairwise validity assessments. The device was validated in 61% (32 of 52) of studies which used a standard or modified protocol. Only 34% (11 of 32) of the studies wherein the device was successfully validated were performed without a protocol violation. Given the implications of inaccurate BP measurement in pregnant women, healthcare providers should be aware of and try to use the BP measurement devices which have been properly validated in this population.
Prospective Study of Fasting Blood Glucose and Intracerebral Hemorrhagic Risk
Authors: Jin Cheng , Li Guohong , Rexrode Kathryn M. , Gurol Mahmut E. , Yuan Xiaodong , Hui Ying , Ruan Chunyu , Vaidya Anand , Wang Yanxiu , Wu Shouling , Gao Xiang
Published: December 2017

Background and Purpose—

Although diabetes mellitus is an established independent risk factor for ischemic stroke, the association between fasting blood glucose and intracerebral hemorrhage (ICH) is limited and inconsistent. The objective of the current study was to examine the potential impact of long-term fasting blood glucose concentration on subsequent risk of ICH.

Methods—

This prospective study included 96 110 participants of the Kailuan study, living in Kailuan community, Tangshan city, China, who were free of cardiovascular diseases and cancer at baseline (2006). Fasting blood glucose concentration was measured in 2006, 2008, 2010, and 2012. Updated cumulative average fasting blood glucose concentration was used as primary exposure of the current study. Incident ICH from 2006 to 2015 was confirmed by review of medical records.

Results—

During 817 531 person-years of follow-up, we identified 755 incident ICH cases. The nadir risk of ICH was observed at fasting blood glucose concentration of 5.3 mmol/L. The adjusted hazard ratios and their 95% confidence intervals (CIs) of ICH were 1.59 (95% CI, 1.26–2.02) for diabetes mellitus or fasting blood glucose ≥7.00 mmol/L, 1.31 (95% CI, 1.02–1.69) for impaired fasting blood glucose (fasting blood glucose, 6.10–6.99 mmol/L), 0.98 (95% CI, 0.78–1.22) for fasting blood glucose 5.60 to 6.09 mmol/L, and 2.04 (95% CI, 1.23–3.38) for hypoglycemia (fasting blood glucose, <4.00 mmol/L), comparing with normal fasting blood glucose 4.00 to 5.59 mmol/L. The results persisted after excluding individuals who used hypoglycemic, aspirin, antihypertensive agents, or anticoagulants, and those with intracerebral hemorrhagic cases occurred in the first 2 years of follow-up.

Conclusions—

In this large community-based cohort, low (<4.0 mmol/L) and high (≥6.1 mmol/L) fasting blood glucose concentrations were associated with higher risk of incident ICH, relative to fasting blood glucose concentrations of 4.00 to 6.09 mmol/L.
A Reflection on China’s Economic Reform from the Perspective of Catholic Social Teaching
Authors: Gao Zhe
Published: December 2017

It has been nearly four decades since China initiated its economic reform in 1978. In spite of the fact that this reform has brought unprecedented economic growth to China, it is viewed by many (including myself) as problematic and has recently been caught in a tension between recession and inequity. This article explores the structural flaws of China’s economic reforms in the light of modern Catholic social teaching, with particular reference to the basic theological principles it applies within the political-economic spheres. On the basis of the Catholic understanding of economic liberty, market, government, and equity, this article furnishes a public theological agenda for China’s economic reforms, in order to help resolve the problems they are facing. Meanwhile, based on the same theological standpoint, it also provides a critical assessment of the New Left’s negation of the liberal economy.
The Influence of Inter-Cultural Engagement on the Perceptions of Mendicant Friars in the Thirteenth Century Concerning Islam and Muslims
Authors: Lette Rickie
Published: December 2017

A commonly accepted interpretation of how Christians and Muslims perceived and responded to each other during the medieval period remains elusive. While broad surveys have established the existence of dominant perspectives and trends, smaller-scale studies are revealing that responses could be much more complex and nuanced. This article attempts to negotiate a middle ground to examine the perceptions of Islam and Muslims of three mendicant friars. The study demonstrates that direct encounters with Muslims, and their customs, practices, and beliefs, or active engagement with Greco-Arabic philosophy, or both, provided these three men with new means to rationalise the reality of Islam and its followers, breaking the bonds of traditional ideological responses and enabling them to produce novel and more informed perspectives on both. It indicates the potential impact that inter-cultural engagement may have had on the inter-religious perceptions of mendicant friars in the latter part of the thirteenth century.
Tradition in Transition: Mudejar Art and the Emergence of the Illuminated Sephardic Bible in Christian Toledo
Authors: Shalev-Eyni Sarit
Published: December 2017

From their early beginnings, around 1260, Sephardic Bibles were illuminated with carpet pages bearing vegetal and geometric patterns associated with mudejar art. In the early literature, the Muslim-like decoration of the biblical codices was regarded as a possible indication for the existence of local schools of Hebrew Bible decoration in Al-Andalus before the reconquista, a period from which no example has survived. In more recent literature, this assumption has been rejected, and the choice of mudejar is interpreted as a new and conscious preference. This article seeks to revisit the phenomenon through a fresh analysis of the emergence of the Sephardic illuminated Bible in Christian Toledo. The discussion reveals the importance of this first stage for an understanding of the whole phenomenon. It exposes the special connection between mudejar art and biblical codices and the cultural and social circumstances in which this connection was first crystallized and turned into a local tradition.
Fascism 2.0: Twitter Users’ Social Media Memories of Hitler on his 127th Birthday
Authors: Fuchs Christian
Published: December 2017

This article analyses how Twitter users communicated about Hitler on his 127th birthday. It employs an empirical critique informed by critical Marxist theories of fascism. The analysis is based on a dataset of 4,193 tweets that were posted on 20 April 2016, and that used hashtags such as #Hitler, #AdolfHitler, #HappyBirthdayAdolf, #HappyBirthdayHitler. The results provide indications about how fascism 2.0 works. There are various strategies that fascism 2.0 uses, such as online authoritarianism, online nationalism, an online friend-enemy scheme, and online patriarchy and naturalism. The growth of fascism 2.0 is a consequence of a ‘fascism-producing’ crisis of society that requires adequate anti-fascist responses and strategies.
Contextualizing Events in Imagined Communities
Authors: Shah Sarah , Acevedo Gabriel A. , Ruiz Andrea Liza
Published: December 2017

The ongoing denigration of Arabs in the media, the Western democratic political shifts away from Muslim religious freedom, and increasing anxiety about Muslim radicalization prompt the question: How do Arabs respond to global events when the Muslim and Western worlds are perceived to clash? Our study draws on the theory of imagined communities to examine the extent to which exogenous world events influence attitudes towards out-group members in the Egyptian context. We apply a “pre-post” quasi-experimental design using the World Values Survey, and examine the influence the events of September 11th, 2001 had on Egyptian perceptions of Jews and non-Arabs. Results suggest that intolerance towards both Jews and ethnic minorities decreased after the attacks. Results also suggest a complex, dynamic association between religiosity and tolerance towards out-group members. We conclude by discussing the theoretical contributions of this paper by highlighting the significance of context and religion when framing imagined communities.
Historic Migration in China: Chang Tang, from Wilderness to Inhabited Frontier Society
Authors: Bleie Tone , Tsering Dawa
Published: December 2017

This article addresses migration in the late seventeenth and the eighteenth century from Eastern Tibet to Chang Tang, the enormous high-plateau in Western Tibet. Evidence is presented about the rise of an intriguingly well-regulated nomadic society, questioning the dominant, environmentally framed narrative of Chang Tang as an uninhabited wilderness. The article examines why people started migrating, sheds light on specific migratory events and their cumulative effects. The article examines nomads’ adaptation to a sacred mountain landscape, an inhospitable climate, established customary practices and contending centralised sources of religious and political authority, while drawing on their own martial ethos and diverse skill sets. In order to explain causes and outcomes of specific events, the article employs an interdisciplinary theoretical approach. This approach unravels Chang Tang as pastoral realm, sacred landscape and contested frontier – sought controlled by the lords of distant Lhasa and empires of the Western Himalayas and Central Asia.
Dialogue and Heritage in the Cultural Strategy of unesco
Authors: Spivak Dimitri
Published: December 2017

unesco is a scientific, educational, and cultural branch – or specialized agency, to speak in technical terms – of the United Nations organization, which has for the latest seventy years been instrumental in setting standards, promoting scientific research and societal discussions, and supporting innovations, both nationally and internationally. Intercultural dialogue has invariably served as a focal point of its manifold activities. Tracing back some of the basic issues in the elaboration of intercultural dialogue as well as the most actual trends in its development forms the main objective of the present paper. This account comes from years of experience as head of one of the well-known and respected unesco research and educational chairs: Comparative Studies of Spiritual Traditions, their Specific Cultures and Interreligious Dialogue.1
A new species of Bhatia (asexual ascomycetes) and new records from Brazil
Authors: MONTEIRO JOSIANE SANTANA , CARMO LUANA TEIXEIRA DO , SOTÃO HELEN MARIA PONTES
Published: December 2017

A new species and new records of asexual ascomycetes from Brazil were documented during field trips in the National Forest of Amapá, Amapá State, in the Amazon Forest biome. Bhatia laevispora sp. nov., collected on decaying leaflets of Astrocaryum murumuru (Arecaceae), is described and illustrated. It differs from the type species by monoblastic conidiogenous cells with percurrent extensions and bigger, smooth conidia with brown to dark brown apical cells, paler central cells and pale brown to subhyaline basal cell. Cirrenalia donnae is a new record for the Neotropical region, and Balaniopsis kirkii and Dictyosporium pandani are new records for the American continent. Taxonomic information including descriptions, geographical distribution, comments and illustrations are provided. The genera Balaniopsis, Bhatia and Cirrenalia constitute new additions to the Brazilian mycobiota. This work expands the geographic range of these species to Brazil
Seed morphology of Epilobium and Chamaenerion (Onagraceae) in Turkey
Authors: COŞKUNÇELEBİ KAMİL , MAKBUL SERDAR , OKUR SEDA
Published: December 2017

Macro- and micro-morphological features of seeds belonging to 26 taxa from Turkey were observed under the light and scanning electron microscopy. Present findings partly agree with segregation of Epilobium and Chamerion at generic level. The members of the genus Epilobium were distinguished by seeds with conical, semispherical, cylindrical or crest-like papillae or without papillae, granulate periclinal surfaces, papillae with parallel, radial, irregular or spirally furrow and the members of Chamerion were distinguished by seeds crest-like papillae or without papillae and without granulate periclinal surfaces and without furrow. The results also showed that seed shape, presence/absence of papillae and beak, papillae shape and ornamentation, and periclinal wall features are valuable for delimiting the examined taxa specific level within both genera. A key to Turkish Epilobium and Chamerion taxa based on seed morphology is presented for the first time
Taxonomy of calcareous sponges (Porifera, Calcarea) sampled on artificial substrates of a recreational marina in the Tropical Northeastern Brazilian coast
Authors: CHAGAS CLÉSLEI , CAVALCANTI FERNANDA F.
Published: December 2017

Several specimens of calcareous sponges were sampled on artificial substrates of a recreational marina in Salvador, Bahia state, on the northeastern coast of Brazil. They belong to four species, two of which are new: Leucandra serrata, Paraleucilla incomposita, Sycon bellum sp. nov., and S. avus sp. nov. Leucandra serrata is recorded for the first time at the coast of Bahia, filling a large gap in the geographical distribution of this species, while the description of the specimens of P. incomposita revealed new characters that had previously been overlooked. Finally, the new species of Sycon described here differ from all the previously known species of the genus due to their skeletal organisation and spicule size. Our results increase the number of species known in Bahia from 13 to 17 and emphasise that areas with a large amount of artificial hard substrates can potentially harbour an interesting and unknown diversity of calcareous sponges.
Description of the larva and pupa of Phileurus truncatus (Palisot de Beauvois, 1806) (Coleoptera: Scarabaeidae: Dynastinae: Phileurini) with a key to described third instars of New World Phileurini
Authors: ARGUEZ KATHERINE M. , MOORE MATTHEW R. , BRANHAM MARC A.
Published: December 2017

The third instar and pupa of Phileurus truncatus (Palisot de Beauvois, 1806) (Coleoptera: Scarabaeidae: Dynastinae: Phileurini) is described for the first time based on specimens from Florida, United States of America. An identification key to the third instars of New World Phileurini is also provided.
Periclimenoides tyrannodentatus, a new species of symbiotic shrimps (Crustacea: Decapoda: Palaemonidae) from Taiwan
Authors: ŠOBÁŇOVÁ ANNA , LIN CHIA-WEI , ĎURIŠ ZDENĚK
Published: December 2017

A new species of sponge-endosymbiotic shrimps, Periclimenoides tyrannodentatus, is described and illustrated. The species is remarkable for its stout subspatulate first pereiopods chelae with lateral fan-shaped pectination on their dactyli. Due to this character and simple ambulatory dactyli, the new species is similar to the type species of the genus, P. odontodactylus. Another remarkable character is in the unique shape of the minor chela of the second pereiopods; the distal cutting edges of its compressed fingers are distinctly expanded and armed with quite impressive dentitions. An identification key to the three currently recognised species of the genus Periclimenoides is provided. The new species represents the first record of the genus Periclimenoides from Taiwan.
Description of a new species, Setaleyrodes machili Dubey, sp. nov. (Hemiptera: Aleyrodidae) infesting Machilus odoratissima Nees (Lauraceae) in Western Himalaya, India
Authors: DUBEY ANIL KUMAR
Published: December 2017

A new species of whitefly, Setaleyrodes machili Dubey sp. nov. found infesting Machilus odoratissima Nees (Lauraceae) is described from Kufri in Himachal Pradesh and Dhanaulti and Nainital in Uttarakhand, India. The diagnostic characteristics of puparia and habitus, are illustrated with line drawings and scanning electron microphotographs. Sexual dimorphism and variation in pigmentation during the transformation of instars are noted. An identification key to puparia of Setaleyrodes species so far described is presented.
Lightning Prediction for Australia Using Multivariate Analyses of Large-Scale Atmospheric Variables
Authors: Bates Bryson C. , Dowdy Andrew J. , Chandler Richard E.
Published: December 2017

Lightning is a natural hazard that can lead to the ignition of wildfires, disruption and damage to power and telecommunication infrastructures, human and livestock injuries and fatalities, and disruption to airport activities. This paper examines the ability of six statistical and machine-learning classification techniques to distinguish between nonlightning and lightning days at the coarse spatial and temporal scales of current general circulation models and reanalyses. The classification techniques considered were 1) a combination of principal component analysis and logistic regression, 2) classification and regression trees, 3) random forests, 4) linear discriminant analysis, 5) quadratic discriminant analysis, and 6) logistic regression. Lightning-flash counts at six locations across Australia for 2004–13 were used, together with atmospheric variables from the ERA-Interim dataset. Tenfold cross validation was used to evaluate classification performance. It was found that logistic regression was superior to the other classifiers considered and that its prediction skill is much better than using climatological values. The sets of atmospheric variables included in the final logistic-regression models were primarily composed of spatial mean measures of instability and lifting potential, along with atmospheric water content. The memberships of these sets varied among climatic zones.
On Boussinesq Dynamics near the Tropopause
Authors: Asselin Olivier , Bartello Peter , Straub David N.
Published: December 2017

The near-tropopause energy spectrum closely follows a −5/3 power law at mesoscales. Most theories addressing the mesoscale spectrum assume unbalanced dynamics but ignore the tropopause (near which the bulk of the data were collected). Conversely, it has also been proposed that the mesoscale spectrum results from tropopause-induced alterations of geostrophic turbulence. This paper seeks to reconcile these a priori mutually exclusive theories by presenting simulations that permit both unbalanced motion and tropopause-induced effects. The model integrates the nonhydrostatic Boussinesq equations in the presence of a rapidly varying background stratification profile (an idealized tropopause). Decaying turbulence simulations were performed over a wide range of Rossby numbers. In the limit of weak flow (U ≲ 1 m s−1), the essential features of the Boussinesq simulations are well captured by a quasigeostrophic version of the model: secondary roll-ups of filaments and shallow spectral slopes are observed near the tropopause but not elsewhere. However, these tropopause-induced effects rapidly disappear with increasing flow strength. For flow strengths more typical of the tropopause (U ~ 10 m s−1), the spectrum develops a shallow, near −5/3 tail associated with fast-time-scale, unbalanced motion. In contrast to weak flows, this spectral shallowing is evident at any altitude and regardless of the presence of a tropopause. Diagnostics of the fast component of motion reveal significant inertia–gravity wave activity at large horizontal scales (where the balanced flow dominates). However, no evidence points to such activity in the shallow range. That is, the mesoscale of the model is dominated by unbalanced turbulence, not waves. Implications and limitations of these findings are discussed.
A Pilot Climate Sensitivity Study Using the CEN Coupled Adjoint Model (CESAM)
Authors: Stammer D. , Köhl A. , Vlasenko A. , Matei I. , Lunkeit F. , Schubert S.
Published: December 2017

A pilot coupled climate sensitivity study is presented based on the newly developed adjoint coupled climate model, Centrum für Erdsystemforschung und Nachhaltigkeit (CEN) Earth System Assimilation Model (CESAM). To this end the components of the coupled forward model are summarized, and the generation of the adjoint code out of the model forward code through the application of the Transformation of Algorithms in FORTRAN (TAF) adjoint compiler is discussed. It is shown that simulations of the intermediate-complexity CESAM are comparable in quality to CMIP-type coupled climate models, justifying the usage of the model to compute adjoint sensitivities of the northern Europe near-surface temperature to anomalies in surface temperature, sea surface salinity, and sea ice over the North Atlantic and the Arctic on time scales of up to one month. Results confirm that on a time scale of up to a few days surface temperatures over northern Europe are influenced by Atlantic temperature anomalies just upstream of the target location. With increasingly longer time lapse, however, it is the influence of SSTs over the central and western North Atlantic on the overlying atmosphere and the associated changes in storm-track pattern that dominate the evolution of the surface European temperature. Influences of surface salinity and sea ice on the northern European temperature appear to have similar sensitivity mechanisms, invoked indirectly through their influence on near-surface temperature anomalies. The adjoint study thus confirms that the SST’s impact on the atmospheric dynamics, notably storm tracks, is the primary cause for the influence of northern European temperature changes.
Spatial and Seasonal Variations of Submesoscale Eddies in the Eastern Tropical Pacific Ocean
Authors: Wang Shengpeng , Jing Zhao , Liu Hailong , Wu Lixin
Published: December 2017

The spatial and seasonal variations of submesoscale eddy activities in the eastern tropical Pacific Ocean (2°–12°N, 95°–165°W) are investigated based on a 1/10° ocean general circulation model (OGCM). In the studied region, it is found that motions shorter than 500 km are subject to submesoscale dynamics with an O(1) Rossby number and Richardson number and a −2 spectral slope for kinetic energy, suggesting that submesoscale eddies there can be well resolved by the model. Enhanced submesoscale eddy kinetic energy (SMKE) is found in the surface mixed layer centered at 5°N. A complete SMKE budget analysis suggests that the submesoscale eddies in the surface mixed layer are generated mainly by the barotropic instability and secondarily by the baroclinic instability. The nonlinear interactions lead to a significant forward energy cascade in the submesoscale range and play an important role in balancing the energy budget. As a response to the change of energy input through barotropic instability, the SMKE exhibits a pronounced seasonal cycle with the largest and smallest values occurring in boreal autumn and spring. Furthermore, the strong seasonal cycle plays an important role in modulating the seasonality of mixed layer depth (MLD). In particular, the restratification induced by the strong submesoscale eddies between July and October makes important contribution to the shoaling of MLD in this season.
An Efficient State–Parameter Filtering Scheme Combining Ensemble Kalman and Particle Filters
Authors: Ait-El-Fquih Boujemaa , Hoteit Ibrahim
Published: December 2017

This work addresses the state–parameter filtering problem for dynamical systems with relatively large-dimensional state and low-dimensional parameters’ vector. A Bayesian filtering algorithm combining the strengths of the particle filter (PF) and the ensemble Kalman filter (EnKF) is proposed. At each assimilation cycle of the proposed EnKF–PF, the PF is first used to sample the parameters’ ensemble followed by the EnKF to compute the state ensemble conditional on the resulting parameters’ ensemble. The proposed scheme is expected to be more efficient than the traditional state augmentation techniques, which suffer from the curse of dimensionality and inconsistency that is particularly pronounced when the state is a strongly nonlinear function of the parameters. In the new scheme, the EnKF and PF interact via their ensembles’ members, in contrast with the recently introduced two-stage EnKF–PF (TS–EnKF–PF), which exchanges point estimates between EnKF and PF while requiring almost double the computational load. Numerical experiments are conducted with the Lorenz-96 model to assess the behavior of the proposed filter and to evaluate its performances against the joint PF, joint EnKF, and TS–EnKF–PF. Numerical results suggest that the EnKF–PF performs best in all tested scenarios. It was further found to be more robust, successfully estimating both state and parameters in different sensitivity experiments.
The Falls of Satan, Eve, and Adam in John Milton’s Paradise Lost: A Study in Insincerity
Authors: Urban David V.
Published: December 2017

This article examines the falls of Satan, Eve, and Adam in Milton’s Paradise Lost, arguing that these characters demonstrate neither sincere theology nor genuinely sincere behavior in their initial transgressions and continued unrepentant behavior. In analyzing matters of sincerity concerning these characters, this article interacts with numerous voices in the history of Paradise Lost criticism, particularly those critics who, advocating a Romantic understanding of sincerity against traditional Christianity, have defended the decisions of Satan, Eve, and Adam to transgress against God’s commands. This article also examines Adam and Eve’s sincere repentance later in Milton’s epic.
w/Sincerity, Part I: The Drama of the Will from Augustine to Milton
Authors: Smith Matthew J.
Published: December 2017

Studies of secularism and modern selfhood locate a transition in the early modern period toward the moral explanatory power of the self, by itself. In this essay, I challenge this view first by locating a distinct form of moral autonomy (sincerely sinning) in the work of Augustine, Anselm, and Scotus, and second by demonstrating this development’s fraught legacy in early Protestant forms of conscience. Finally, I apply this history of sincerity to readings of Milton and Shakespeare, writers who illustrate the thematic potential of competing forms of sincerity and of the drama of the will.
Spontaneous Pneumomediastinum ‐ an Uncommon Disease Presenting as a Common Complaint
Authors: Fan KP , Kun WM , Tung WK
Published: December 2017

Spontaneous pneumomediastinum is a relatively uncommon, infrequently reported entity. In this condition, there is presence of air or gas within the mediastinum that occurs spontaneously. We report a patient with spontaneous pneumomediastinum who presented with complaint of sore throat. There was no other obvious chest symptoms and no known risk factors identified. He was managed conservatively and recovered uneventfully. We undertake to discuss the clinical feature, pathogenesis and management of spontaneous pneumomediastinum.
Paracetamoloverdose Presenting to an Accident & Emergency Department of a Regional Hospital in Hong Kong
Authors: Lam M , Fung HT , Kam CW
Published: December 2017

We carried out a review of the patient resuscitation records and hospital notes of paracetamol overdose patients initially treated in the Accident and Emergency Department of Tuen Mun Hospital during the period starting from January 1998 to April 1999. Altogether there were 42 patients but 46 cases were recruited in the study because 4 patients had overdose twice. Ten (22%) were male, 36 (78%) were female and young female constituted the majority of the patients Forty‐three cases (93%) took an overdose of paracetamol as a means of committing suicide and 20 cases (43%) ingested 10 grams or more of paracetamol. The most common provoking causes were adjustment disorder (18 cases, 39.1%) and acute stress reaction (8 cases 17.4%). The majority of the cases presented early and within 8 hours after the overdose. Two cases had impaired liver function, 3 had prolonged prothrombin time and 5 had transient metabolic acidaemia in the absence of liver failure. All patients recovered uneventfully. Forty one cases (89%) were given N‐acetylcysteine (NAC) infusion, of these 6 had toxic paracetamol level, 24 had non‐toxic level because NAC was given before the availability of paracetamol level in many cases and it was undetermined for the other 11 cases. Hypersensitivity reaction to NAC infusion was common (8 cases, 21%) but there was no long term sequelae. Highly variable approach in the use of NAC was noted, we suggest to set a clinical check‐list for the management of paracetamol overdose especially concerning the time to check the serum level and the initiation of NAC.
Knowledge Base of Doctors and Nurses Participating in a Trauma Workshop
Authors: Wong TW , Lau CC , Yong BH , Tan IKS , Kong JHB
Published: December 2017

Objective

To identify the knowledge base of doctors and nurses attending a trauma workshop. Methods: All participants of a trauma workshop were distributed a pre‐test questionnaire with 30 type A questions. Questions on patient assessment and the management of airway, breathing and circulation were included. Scores were analysed with regard to the specialty and years since graduation. The difficulty and discrimination indices of individual question were analysed.

Results

95 participants (33 were doctors) took the test. The participants were from the departments of surgery (41%), orthopaedics (24%), anaesthesia (20%) and emergency medicine (9%). The mean years from graduation of the participants were 3.22 (SD 3.77) for doctors and 3.56 (SD 6.06) for nurses. The mean score was 54% (SD 17%) for the whole group. The mean score of doctors was 68%, which was significantly higher than the nurses' score of 46%. (P<0.001) The mean score of Emergency Department doctors (82%) was highest among the four groups but the differences were not statistically significant. Non‐surgical trainees (anaesthesia, emergency medicine) had statistically significant better scores than surgical trainees (surgery, orthopaedics, neurosurgery) in airway (p = 0.02) and breathing (p = 0.03) There were no statistically significant differences among the four doctor groups in the other sub‐scores. For the doctors, only 3 questions had a correct response rate of less than 40%. On the contrary, for the nurse group, 13 questions attracted a correct response rate of less than 40%.

Conclusions

A pre‐test was useful in helping us understand more about the knowledge base of different groups of participants.
Treatment of Acute Atrial Fibrillation: Ventricular Rate Control and Restoration of Sinus Rhythm
Authors: Fung HT , Kam CW
Published: December 2017

Atrial fibrillation (AF) is a familiar arrhythmia seen in the emergency department and the general population. In the past it was treated in the majority of cases by controlling the ventricular rate, whether the AF is acute or chronic. However, ventricular rate control alone does not address the underlying problem and the patients still remain in AF, cardiac output and symptoms have not been optimally corrected. There is definite risk of thromboembolism. Restoration of sinus rhythm is the only way of resuming the normal conduction physiology of the heart and correcting these problems This article provides a review of the two major principles of rhythm treatment of acute AF: rate control and restoration of sinus rhythm. Transthoracic electrical cardioversion is the mainstay of treatment in haemodynamically unstable AF, whereas in stable AF, there is a choice between rate control and restoration of sinus rhythm, or they can be carried out in conjunction with each other.
Severe Headache as a Chief Presentation of Theophylline Intoxication
Authors: Cheung LCC , Tsoi LCH , Chung CCH
Published: December 2017

We describe a case of acute on chronic theophylline intoxication with severe headache as the chief complaint in a Chronic Obstructive Pulmonary Disease (COPD) patient. Headache is a non‐specific symptom. The intensity of headache is unusually severe in our patient, and is much worse than the headache commonly encountered by an experienced emergency physician.
Paediatric Patients who Absconded from the Emergency Department - A 9-Month Prospective Study
Authors: Lim Yh , Anantharaman V
Published: December 2017

Study objectives

To determine the main causes and consequences of abscondment of paediatric patients from the Emergency Department (ED) before obtaining appropriate treatment.

Methods

Records of all paediatrics patients (age group 0–12 years) who absconded from the ED of a tertiary level acute care hospital were traced and telephone interviews were conducted. The duration of study was from 1st July 1995 to 31st March 1996.

Results

177 out of 19,556 registered paediatrics patients absconded before obtaining adequate medical care. 139 (78.5%) patients had telephone interviews conducted. 81 (58.3%) patients absconded because of long waiting for medical attention. 26 (18.7%) patients left because their parents/guardians felt that the patient's condition had improved. 32 (23%) patients left the department for various other reasons. 94 (67.6%) patients subsequently sought medical attention elsewhere and 5 (3.6%) patients required in-patient treatment.

Conclusion

The paediatric abscondment rate was low. Most of these patients absconded from the ED because of relatively long waiting for medical attention. A large proportion of these patients could have been adequately treated in a primary care facility in the first instance.
A Case of Angioedema Involving the Tongue and Uvula
Authors: Wong Ays , Wong Tw , Lau Cc
Published: December 2017

A case of late-onset life threatening angioedema because of upper airway obstruction after long term use of angiotensin-converting enzyme inhibitor was reported. The clinical presentation, pitfalls in diagnosis, incidence, current practice in airway management and prognosis were reviewed.
Drugs Can Harm
Authors: Leung Lp
Published: December 2017

Adverse drug reaction is a major clinical problem. Many patients present to hospitals because of the drugs they take. Case history of four such patients seen at an Accident & Emergency department in Hong Kong over the last three months are presented. The definition, classification and clinical implication of adverse drug reaction are reviewed. Preventive strategies with reference to the local scenario are discussed.
Survey on Plantar Puncture Injury in the Emergency Department
Authors: Siu AYC , Wong TW , Lau CC
Published: December 2017

Objective

This survey aimed at identifying the characteristics of plantar puncture injury in our locality.

Methods

This was a prospective consecutive case study. All patients presenting with plantar puncture injury were recruited and the characteristics of the injury were documented.

Results

64 patients (M: 50; F:14) suffering from plantar puncture injury were recruited from 1st July 1998 to 30th November 1998. Forty nine (76.6%) cases involved metallic nails and 40 (62.5%) cases occurred in construction site. Forefoot and hindfoot were the parts where injuries were usually found. There were signs suggestive of infection in 10 patients (15.6%) on presentation. No bone infection was found. The patients were prescribed 3 days of prophylactic or a full course of therapeutic antibiotics. Fourteen patients (22%) turned up for follow up after one week and no infective complications were identified.

Conclusions

Serious complications due to plantar puncture injury were uncommon in our group of subjects. Plantar puncture injuries were most prevalent at construction sites. Construction site workers should be better educated in the occupational protection and first aid of such injuries.
A Case of Chuanwu and Fuzi Poisoning
Authors: So YT , Fung HT , Chung KL , Hung CY , Kam CW
Published: December 2017

A 70‐year‐old man developed ventricular tachycardia after consumption of a self‐prescribed dose of Chinese herbal medicine containing Chuanwu and Fuzi. He made a good recovery after initial resuscitation in Accident and Emergency department (A&E) as well as supportive treatment in CCU. This case report demonstrates the initial resuscitation of patient with Chuanwu poisoning, discuss its pathophysiology and variety of treatment.
QT Prolongation Due to Organophosphate Poisoning
Authors: Siu AYC , Tsoi LCH , Lo WCB , Chung CCH
Published: December 2017

Organophosphate poisoning is a life‐threatening condition. The toxicity is due to the irreversible inactivation of cholinesterase. Apart from the enhanced muscarinic and nicotinic activities, cardiac toxicity is also possible. We present a case of organophosphate poisoning in which the electrocardiogram showed QT prolongation. The literature related to the topic is also reviewed.
Implementation of a Comprehensive Program for the Bereaved in the Accident and Emergency (A&E) Department
Authors: Chan Isf
Published: December 2017

This article describes the establishment of a program for the bereaved of sudden death in the Accident and Emergency (A&E) department using a multi-disciplinary approach. Based on the traumatic grief model in tackling the psychosocial need of the bereaved, the detail from the first contact to their leaving of the hospital is covered. Practical protocols and guidelines are designed for guiding the assessment and intervention. Special issues are highlighted and controversy is discussed in this paper. These include breaking bad news, handling extreme grief reaction, the presence of relatives during resuscitation, volunteer involvement in the acute grief handling, and the outcome measures of the program.
Bicycle-Related Injuries: a Local Scene
Authors: Ng Cp , Siu Ayc , Chung Ch
Published: December 2017

To determine the profile of bicycle injury and possible risk factors for severe injuries, we studied patients with bicycle-related accidents attending the Accident and Emergency Department of North District Hospital between 1 May 1999 to 31 October 1999. Of the 424 patients, 52 (12.3%) were admitted and one (0.24%) died. Comparing to those not admitted, significantly more of the admitted cases suffered from major injuries, rode on rainy days and involved in collision with motor vehicles. A total of 160 patients (37.8%) had documented head injuries. However the extremely low utilisation rates of helmet at the time of injury implied that action should be taken in this direction to reduce bicycle-related morbidity and mortality.
Thyrotoxic Periodic Paralysis: A Case of Two Brothers
Authors: Wong Rhk , Ng F
Published: December 2017

In this article, we describe the presentation of thyrotoxic periodic paralysis of two brothers at the same time. A positive family history in this condition is rare. Early identification and cautious potassium supplementation in this entity prevents complications arising from potassium shifts. (Hong Kong j.emerg. med. 2001;8:159–162)
Erythema Nodosum as the First Presenting Complaint of Asymptomatic Pulmonary Tuberculosis
Authors: Wong Sk , Yeung Sd
Published: December 2017

Tender erythematous swelling on the front of legs, erythema nodosum, is a common symptom that result in patient seeking medical attention. It has multiple aetiologies. Tuberculosis is a recognised cause. In here, we describe a case of erythema nodosum as the presenting complaint of undiagnosed asymptomatic pulmonary tuberculosis.
A Young Man with Sudden Unilateral Blindness and Hemiparesis
Authors: Sia YS , Wong YT , Kan PG , Day W , Fan YW
Published: December 2017

Head and neck injuries are very common in Hong Kong, especially resulting from assaulted or traffic accidents. Delayed manifestation of post-traumatic carotid thrombo-embolism and aneurismal formation are known pitfalls that emergency physicians and neurosurgeons may encounter. We present a patient with blunt neck injury with the complication of traumatic dissection of the extracranial internal carotid artery.
What Will be the Percentage Drop in Attendance of Accident & Emergency Department after Implementation of Charges?
Authors: Chan JTS
Published: December 2017

The attendance of Accident & Emergency (A&E) departments in Hong Kong increased from 1.1 million in 1990 to 2.3 million in 2000. The statistics of Hospital Authority showed that about 75% of the attendance belonged to the semi-urgent or non-urgent cases. It is expected that the A&E attendance will drop after implementation of A&E charges. A cross-sectional study was done using the database of a typical medium size A&E department in Hong Kong to analyse this impact. The result of statistical analysis showed that there would be about 30% drop in A&E attendance. Other factors, however could affect the results and these were discussed. After adjustment, it was concluded that there would be about 20% drop in attendance after the implementation of A&E charges.
An Opinion Survey on Patient Acceptance of a Two-Day Medication Supply Policy in Emergency Departments
Authors: Tang Wf , Chung Ch , Wu Tsf , Lai Kk
Published: December 2017

Objective

To obtain an idea on patient acceptance of a two-day medication supply policy in emergency departments, an opinion survey was carried out at the Accident & Emergency (A&E) department of North District Hospital.

Methods

Questionnaire were distributed to 200 ambulatory patients attending the A&E department on 4 April 2000, asking for their opinions on the reasonable duration of medication supply and its possible impact on emergency department misuse. The questionnaires were collected and the data analysed.

Results

A total of 78 questionnaires (39%) were returned. Forty-nine respondents (62.8%) accepted that dispensing two days of medications from emergency departments reasonable. Ten out of the 27 patients who disagreed on two-day supply (37.0%) considered that a three-day supply would be optimal. More than half of the respondents (52.6%) agreed with the hypothesis that a two-day supply policy would discourage misuse of emergency department service.

Conclusion

The great majority of patients attending A&E departments supported the prescription of two to three days supply of medication. This policy has important resource implication. However, its possible impact on misuse of emergency department service is controversial. (Hong Kong j.emerg.med. 2002;9:3–9)
A Retrospective Review of Patients with Necrotizing Fasciitis Presenting to an Emergency Department in Hong Kong
Authors: Sin Fp , Yuen Mc , Lam Kw , Wu Cw , Tung Wk
Published: December 2017

Background

Necrotizing fasciitis is a soft tissue gangrenous infection that require early diagnosis, radical debridement and broad-spectrum antibiotics.

Aim

To review the clinical spectrum and outcome of necrotizing fasciitis in Kwong Wah Hospital during a period of 18 months.

Method

Cases of necrotizing fasciitis were identified from discharge statistics for the period January 1999 to June 2000. Accident and Emergency Department (AED) notes and clinical records after admission were reviewed for clinical features, predisposing factors, microbiology, histology, treatment and outcome.

Results

Fifteen cases of necrotizing fasciitis were found but two of them had wrong diagnosis made. Of the thirteen cases, ten were male and three were female. The average age was 61.7 years old. Most of them presented with different combinations of swelling, pain, erythema and fever. They attended the emergency department with an interval of 3.5 days from the onset of symptoms. Risk factors were identified in 64% of patients, with diabetes mellitis (DM) and hypertension (HT) being the most common. Monomicrobial and polymicrobial infections were equally common in our study. Streptococcus pyogene was the most common pathogen. Only two NF (18%) were diagnosed in AED. Six patients were admitted to either surgical or orthopaedic wards and all of them underwent operations within 24 hours although two of them died. Other five patients were managed in medical ward and four of these patients underwent delayed operations but survived whilst one of them died despite of early surgical intervention. Overall mortality was 23%.

Conclusions

This condition affects a wide age group and have associated morbidities. It is often a fatal disease. Early recognition, high dose antibiotics and surgical debridement are important in its management.
The Effectiveness of Catheter Aspiration in the Treatment of Spontaneous Pneumothorax
Authors: Tang Syh , Lau Hl , Chan Jts
Published: December 2017

Catheter aspiration is a simple and minimal invasive method to treat spontaneous pneumothorax. It was recommended by British Thoracic Society in 1993 as the treatment for spontaneous pneumothorax. This study was designed to evaluate the effectiveness of catheter aspiration in the treatment of spontaneous pneumothorax. The protocol involved catheter placement by using Seldinger technique and serial chest X-rays were used to document the degree of lung re-expansion. We report a case series study in which eight patients were recruited into the study. All patients' pneumothorax re-expanded well after the initial attempt of aspiration. However, during the observation period, 5 patients had recurrence of pneumothorax requiring further aspiration. Despite that, these 5 patients finally required chest drain insertion. The remaining 3 patients were discharged after aspiration and were followed up on the following day. Two patients had recurrent pneumothorax and required further intervention. One patient had uneventful recovery.

Conclusion

catheter aspiration was effective in relieving spontaneous pneumothorax but with a high recurrence rate.
Case Report: Blast Injury
Authors: Leung Sh , Cheung Ky , Yau Hh , Kam Cw
Published: December 2017

A case of blast injury with tympanic perforation and limb laceration is reported. The classification (into four types), mechanism and pathogenesis of blast injury are discussed. Detection of early air embolism, especially on site, can be very difficult. Victims who appear to have only superficial secondary injuries (by missile fragments) should not be discharged without a careful examination since overt air embolism can occur later. To prevent or reduce air embolism, mechanical ventilation should be avoided.
The use of Injectable Nonsteroidal Anti-Inflammatory Drugs in Local Accident & Emergency Practice
Authors: Chung CH
Published: December 2017

Objective

To review the utilization of injectable NSAID in local A&E practice.

Materials and Methods

NSAID utilization data, in relation to type and specialty, were retrieved through the hospital and central pharmacy computer systems of the Hospital Authority.

Results

A&E departments were the main users of injectable NSAID. Their expenditure exceeded other forms of NSAID and narcotic analgesics.

Conclusion

It seems that the use of injectable NSAID in local A&E practice may be excessive. The oral route should be the first consideration, as fast acting oral preparations are now available. As there are risks of severe local complications, stringent justifications should be confirmed before intramuscular administration.