bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency Medical Services Provider Perceptions of the Nature of Adverse Events and Near‐misses in Out‐of‐hospital Care: An Ethnographic View
Authors: Fairbanks Rollin J. , Crittenden Crista N. , O’Gara Kevin G. , Wilson Matthew A. , Pennington Elliot C. , Chin Nancy P. , Shah Manish N.
Published: July 2008

Objectives:  The objectives were to examine the perceptions of emergency medical services (EMS) providers regarding near‐misses and adverse events in out‐of‐hospital care.

Methods:  This study uses qualitative methods (focus groups, interviews, event reporting) to examine the perceptions of EMS providers regarding near‐misses and adverse events in out‐of‐hospital care. Results were reviewed by five researchers; analytic domains were assigned and emerging themes were identified. Descriptive statistics were calculated.

Results:  Fifteen in‐depth interviews (73% advanced life support [ALS], 40% volunteer, and 87% male) resulted in 50 event descriptions. Eleven additional event reports were obtained from the anonymous reporting system. Of the 61 total events, 27 (44%) were near‐misses and 34 (56%) were adverse events. Fourteen (23%) involved a child (<19 years). Types of error included 33 clinical judgment (54%), 13 skill performance (21%), 9 medication event (15%), 3 destination choice (5%), and 3 others (5%). For the 21 cases where the provider discussed the event, 10 (48%) were reported to a physician, and 9 (43%) to a supervisor; 4 (19%) were not reported, and none were reported to the patient. Focus groups supported interview and event report data. Emerging themes included a focus on the errors of others and a “blame‐and‐shame” culture.

Conclusions:  Adverse events and near‐misses were common among the EMS providers who participated in this study, but the culture discourages sharing of this information. Participants attributed many events to systems issues and to inadequacies of other provider groups. Further study is necessary to investigate whether these hypothesis‐generating themes are generalizable to the EMS community as a whole.

ACADEMIC EMERGENCY MEDICINE 2008; 15:1–8 © 2008 by the Society for Academic Emergency Medicine
Race, Ethnicity, and Management of Pain from Long‐bone Fractures: A Prospective Study of Two Academic Urban Emergency Departments
Authors: Bijur Polly , Bérard Anick , Esses David , Calderon Yvette , John Gallagher E.
Published: July 2008

Objectives:  The objective was to test the hypothesis that African American and Hispanic patients are less likely to receive analgesics than white patients in two academic urban emergency departments (EDs).

Methods:  This was a prospective observational study of a convenience sample of patients with long‐bone fractures from April 2002 to November 2006 in two academic urban EDs. Eligibility criteria were age 18–55 years, isolated long‐bone fracture, and race and ethnicity (Hispanic, African American, and white). The primary outcome was receipt of analgesics; secondary outcomes included receipt of opioids, dose, route, time to first analgesic, and change in pain. Logistic regression was used to adjust the risk of receiving analgesics for patients’ initial rating of pain and demographic characteristics.

Results:  Of 1,239 patients with suspected long‐bone fractures, 345 patients were eligible: 177 (51%) were Hispanic, 98 (28%) were African American, and 70 (20%) were white. Administration of analgesics was not associated with race or ethnicity. Sixteen percent (95% confidence interval [CI] = 11% to 22%) of Hispanic, 15% (95% CI = 10% to 24%) of African American, and 14% (95% CI = 8% to 24%) of white patients did not receive any analgesics. Seventy‐four percent of Hispanic (95% CI = 67% to 80%), 66% of African American (95% CI = 57% to 75%), and 69% (95% CI = 57% to 78%) of white patients received opioid analgesics. After adjustment for covariates, there was no evidence of an association between receipt of analgesics or opioid analgesics and the race or ethnicity of the patients. There were no significant differences in time to treatment, dose, route, or change in pain.

Conclusions:  Receipt of analgesics for pain from long‐bone fractures was not associated with patient race or ethnicity in two academic urban EDs.

ACADEMIC EMERGENCY MEDICINE 2008; 15:589–597 © 2008 by the Society for Academic Emergency Medicine
A Rapid Qualitative Test for Suspected Ethylene Glycol Poisoning
Authors: Long Heather , Nelson Lewis S. , Hoffman Robert S.
Published: July 2008

Objectives:  Many hospitals must send out ethylene glycol (EG) samples to a reference laboratory, and delays in diagnosis and treatment may occur. A qualitative colorimetric test (ethylene glycol test [EGT] kit), already in use by veterinarians, gives results in 30 minutes with little expertise or cost. The EGT reliably detects the presence of EG in spiked human serum samples. The objective of this study was to prospectively assess the sensitivity and specificity of the EGT kit in actual clinical samples submitted for EG testing by the criterion standard gas chromatography (GC).

Methods:  Blood samples from patients with suspected toxic alcohol poisoning submitted to a reference laboratory were tested by GC. An investigator blinded to the GC results tested the same sample with the EGT kit following the manufacturer’s instructions and using the internal control. Three physicians also blinded to the GC results categorized the sample as positive for EG, negative, or inconclusive. Interrater reliability was assessed with a kappa statistic (κ). Results of the EGT kit testing were then compared to those from GC testing.

Results:  Data are reported on 24 samples submitted. By GC, 15 samples were confirmed for EG (range 27–281 mg/dL), 5 were confirmed for methanol (ME; range 64–101 mg/dL), and 4 were negative for both alcohols. The EGT was unanimously positive in all confirmed EG samples and negative in all ME samples. In one of the negative samples, an ambiguous result occurred and was counted as a false‐positive. Interobserver agreement with the EGT was high (κ = 0.909; 95% confidence interval [CI] = 0.735 to 1.0). Sensitivity and specificity were 100% (95% CI = 70% to 100%) and 88.8% (95% CI = 52% to 100%), respectively.

Conclusions:  The EGT appears to be a reliable qualitative test in cases of suspected human EG poisoning.

ACADEMIC EMERGENCY MEDICINE 2008; 15:1‐3 © 2008 by the Society for Academic Emergency Medicine
Alignment of Emergency Medicine Research Efforts with Clinical and Translational Science Awards
Authors: Miller Chadwick D. , Kumar Rita , Storrow Alan B.
Published: July 2008

The Clinical and Translational Science Awards (CTSA) represent a major new funding pathway for health science investigators seeking National Institutes of Health (NIH) funds. This new pathway provides institutional‐level support for clinical and translational research and is not tied to one organ system or disease process, fitting well with emergency medicine (EM) research needs. These awards open unique opportunities for advancing EM research. The CTSA mechanism provides institutional support from the NIH to promote both clinical and translational science. Of the 60 expected awards, 38 sites are currently funded. EM investigators can benefit the institutions applying for these awards and simultaneously gain from involvement. Some opportunities for participation provided by the CTSA include research training programs, joining multidisciplinary research teams, seed grant funding, and use of the CTSA‐developed research infrastructure. Involvement of EM can benefit institutions by enhancing acute care research collaboration both within and among institutions. Emergency medicine researchers at institutions either planning to submit a CTSA application or with funded CTSA grants are encouraged to become actively involved in CTSA‐related research programs.

ACADEMIC EMERGENCY MEDICINE 2008; 15:1–5 © 2008 by the Society for Academic Emergency Medicine
Safety of Paramedics with Extended Skills
Authors: Mason Suzanne , Knowles Emma , Freeman Jenny , Snooks Helen
Published: July 2008

Background:  The role of paramedics with extended skills is evolving, enabling them to assess and treat patients in the community. A United Kingdom service led by extended‐role paramedic practitioners (PPs) is aimed at managing minor acute illness and injury among older people in the home when appropriate, avoiding unnecessary transfer to the emergency department (ED).

Objectives:  The objectives were to evaluate the safety of clinical decisions made by PPs operating within the new service.

Methods:  As part of a cluster‐randomized controlled trial, patients aged >60 years contacting the emergency medical services (EMS) with a minor injury or illness were included in the study. The safety of the new PP intervention was compared with standard practice of EMS transfer and ED treatment. Outcomes included unplanned ED attendance within 7 days of the index episode. Clinical records were rated independently by two senior ED clinicians to identify related episodes, avoidable subsequent episodes, and suboptimal care.

Results:  Of the 2,025 patients included in this analysis, 219 (10.9%) went on to have an unplanned ED attendance within 7 days. Of these, 162 (74.0%) re‐presented with a condition related to their index episode. The independent raters agreed on suboptimal care 83.4% of the time. There were 16 agreed upon episodes related to suboptimal care (0.80%). No significant differences were found between intervention and control groups in relation to re‐presentation at hospital within 7 days for a related condition or rates of assessed suboptimal care.

Conclusions:  This study suggests that appropriately trained paramedics with extended skills treating older people with minor acute conditions in the community are as safe as standard EMS transfer and treatment within the ED.

ACADEMIC EMERGENCY MEDICINE 2008; 15:607–612 © 2008 by the Society for Academic Emergency Medicine
The Six‐item Screener to Detect Cognitive Impairment in Older Emergency Department Patients
Authors: Wilber Scott T. , Carpenter Christopher R. , Hustey Fredric M.
Published: July 2008

Background:  Cognitive impairment due to delirium or dementia is common in older emergency department (ED) patients. To prevent errors, emergency physicians (EPs) should use brief, sensitive tests to evaluate older patient’s mental status. Prior studies have shown that the Six‐Item Screener (SIS) meets these criteria.

Objectives:  The goal was to verify the performance of the SIS in a large, multicenter sample of older ED patients.

Methods:  A prospective, cross‐sectional study was conducted in three urban academic medical center EDs. English‐speaking ED patients ≥65 years old were enrolled. Patients who received medications that could affect cognition, were too ill, were unable to cooperate, were previously enrolled, or refused to participate were excluded. Patients were administered either the SIS or the Mini‐Mental State Examination (MMSE), followed by the other test 30 minutes later. An MMSE of 23 or less was the criterion standard for cognitive impairment; the SIS cutoff was 4 or less for cognitive impairment. Standard operator characteristics of diagnostic tests were calculated with 95% confidence intervals (CIs), and a receiver operating characteristic curve was plotted.

Results:  The authors enrolled 352 subjects; 111 were cognitively impaired by MMSE (32%, 95% CI = 27% to 37%). The SIS was 63% sensitive (95% CI = 53% to 72%) and 81% specific (95% CI = 75% to 85%). The area under the receiver operating characteristic curve was 0.77 (95% CI = 0.72 to 0.83).

Conclusions:  The sensitivity of the SIS was lower than in prior studies. The reasons for this lower sensitivity are unclear. Further study is needed to clarify the ideal brief mental status test for ED use.

ACADEMIC EMERGENCY MEDICINE 2008; 15:613–616 © 2008 by the Society for Academic Emergency Medicine
Sixty‐four–slice Computed Tomography of the Coronary Arteries: Cost–Effectiveness Analysis of Patients Presenting to the Emergency Department with Low‐risk Chest Pain
Authors: Khare Rahul K. , Mark Courtney D. , Powell Emilie S. , Venkatesh Arjun K. , Lee Todd A.
Published: July 2008

Objectives: The aim was to use a computer model to estimate the cost–effectiveness of 64‐slice multidetector computed tomography (MDCT) of the coronary arteries in the emergency department (ED) compared to an observation unit (OU) stay plus stress electrocardiogram (ECG) or stress echocardiography for the evaluation of low‐risk chest pain patients presenting to the ED.

Methods: A decision analytic model was developed to compare health outcomes and costs that result from three different risk stratification strategies for low‐risk chest pain patients in the ED: stress ECG testing after OU care, stress echocardiography after OU care, and MDCT with no OU care. Three patient populations were modeled with the prevalence of symptomatic coronary artery disease (CAD) being very low risk, 2%; low risk, 6% (base case); and moderate risk, 10%. Outcomes were measured as quality‐adjusted life years (QALYs). Incremental cost–effectiveness ratios (ICERs), the ratio of change in costs of one test over another to the change in QALY, were calculated for comparisons between each strategy. Sensitivity analyses were conducted to test the robustness of the results to assumptions regarding the characteristics of the risk stratification strategies, costs, utility weights, and likelihood of events.

Results: In the base case, the mean (±standard deviation [SD]) costs and QALYs for each risk stratification strategy were MDCT arm $2,684 (±$1,773 to $4,418) and 24.69 (±24.54 to 24.76) QALYs, stress echocardiography arm $3,265 (±$2,383 to $4,836) and 24.63 (±24.28 to 24.74) QALYs, and stress ECG arm $3,461 (±$2,533 to $4,996) and 24.59 (±24.21 to 24.75) QALYs. The MDCT dominated (less costly and more effective) both OU plus stress echocardiography and OU plus stress ECG. This resulted in an ICER where the MDCT arm dominated the stress echocardiography arm (95% confidence interval [CI] = dominant to $29,738) and where MDCT dominated the ECG arm (95% CI = dominant to $7,332). The MDCT risk stratification arm also dominated stress echocardiography and stress ECG in the 2 and 10% prevalence scenarios, which demonstrated the same ICER trends as the 6% prevalence CAD base case. The thresholds where the MDCT arm remained a cost‐saving strategy compared to the other risk stratification strategies were cost of MDCT, <$2,097; cost of OU care, >$1,092; prevalence of CAD, <70%; MDCT specificity, >65%; and a MDCT indeterminate rate, <30%.

Conclusions: In this computer‐based model analysis, the MDCT risk stratification strategy is less costly and more effective than both OU‐based stress echocardiography and stress ECG risk stratification strategies in chest pain patients presenting to the ED with low to moderate prevalence of CAD.

ACADEMIC EMERGENCY MEDICINE 2008; 15:1–10 © 2008 by the Society for Academic Emergency Medicine
Medical Malpractice: Utilization of Layered Simulation for Resident Education
Authors: Schlicher Nathaniel Ryan , Ten Eyck Raymond P.
Published: July 2008

Objectives:  The authors present a novel approach to the use of simulation in medical education with a two‐event layered simulation. A patient care simulation with an adverse outcome was followed by a simulated deposition.

Methods:  Senior residents in an academic emergency medicine (EM) program were solicited as simulation research volunteers. Other than stating that the research involved adverse outcomes, no identifying information was given. Seven volunteers participated in a simulation involving a forced error (nurse confederate gave an incorrect medication dose). Six weeks later based on the initial simulation, one physician completed a simulated deposition in a teaching conference conducted by a licensed attorney with malpractice experience. The audience, consisting of residents, attendings, and students, watched a recording of the patient care, witnessed the deposition, and evaluated the experience using a 17‐question survey with 5‐point Likert scales.

Results:  Participants felt that overall the training program was a useful educational tool (mean ± standard deviation [SD] Likert score = 4.63 ± 0.49) that would change aspects of their practice (3.31 ± 0.85). Participants stated that they would be more careful in their documentation (3.88 ± 0.60), review high‐risk situations with staff (4.00 ± 0.71), and monitor more carefully for errors (3.95 ± 0.74). There was increased fear of the litigation process (3.95 ± 1.18), but participants felt the experience would help improve the risk profile of their practices (3.71 ± 0.68).

Conclusions:  A novel approach to medical education was successful in changing attitudes and provided an expanded educational experience for participants. Layered simulation can be successfully incorporated into educational programs for numerous issues including medical malpractice.
Substitution of Human for Horse Urine Disproves an Accusation of Doping*
Authors: Díaz Silvina , Kienast Mariana E. , Villegas‐Castagnasso Egle E. , Pena Natalia L. , Manganare Marcos M. , Posik Diego , Peral‐García Pilar , Giovambattista Guillermo
Published: July 2008

Abstract:  In order to detect switching and/or manipulation of samples, the owner of a stallion asked our lab to perform a DNA test on a positive doping urine sample. The objective was to compare the urine DNA profile versus blood and hair DNA profiles from the same stallion. At first, 10 microsatellite markers were investigated to determine the horse identity. No results were obtained when horse specific markers were typed in the urine sample. In order to confirm the species origin of this sample we analyzed the mitochondrial cytochrome b gene. This analysis from blood and hair samples produced reproducible and clear PCR‐RFLP patterns and DNA sequence match with those expected for horse, while the urine sample results were coincident with human. These results allowed us to exclude the urine sample from the questioned stallion and determine its human species origin, confirming the manipulation of urine sample.
Chemical Fingerprinting of Adhesive Tapes by GCMS Detection of Petroleum Hydrocarbon Products
Authors: Aziz Nurhuda , Greenwood Paul F. , Grice Kliti , John Watling R. , Van Bronswijk Wilhelm
Published: July 2008

Abstract:  Pressure‐sensitive adhesive tapes often represent key evidence of crimes such as assault, rape or homicide; thus, the development of analytical techniques able to contribute to a detailed characterization of these materials is of forensic importance. The gas chromatography‐mass spectrometry (GCMS) analysis of the solvent extractable fractions of a suite of electrical and gaffer adhesive tapes spanning a range of colors and manufacturers identified a number of petroleum‐derived hydrocarbons. Molecular and isotopic analyses of hydrocarbon constituents of complex materials have found wide analytical utility including the forensic investigation of oil spills and arson. Here, we investigate the utility of these techniques for characterizing the hydrocarbon composition of pressure‐sensitive adhesive tapes for forensic correlation purposes. Subtle distinction of tape samples was evident in the GCMS distribution of several hydrocarbon groups including alkyl‐naphthalenes, hopane and sterane biomarkers. Linear discriminant analysis of the abundances of these products provided high level differentiation of tape manufacturer. The distinction of different adhesive tape samples was further extended by measurement of their stable carbon isotopic values. The molecular and isotopic differences of the petroleum content of tapes are consistent with the use of different petroleum materials used in the manufacturing process and demonstrate the benefits of the combined use of complementary oil hydrocarbon characterization approaches. This study reveals the forensic potential of using established petroleum characterization methods for characterizing materials with a petroleum‐derived hydrocarbon element.
Binding of Vigna unguiculata vicilins to the peritrophic membrane of Tenebrio molitor affects larval development
Authors: Paes E. V. , Uchôa A. F. , Pinto M. S. T. , Silva C. P. , Fernandes K. V. S. , Oliveira A. E. A. , Xavier‐Filho J.
Published: July 2008

We investigated the effects of vicilins (7S storage proteins) from Vigna unguiculata (L.) Walp. (Fabaceae), cultivars EPACE‐10 [genotype susceptible to the cowpea weevil, Callosobruchus maculatus (Fabricius)] and IT81D‐1045 [cowpea weevil‐resistant genotype], seeds on Tenebrio molitor L. (Coleoptera: Tenebrionidae) larval development. Toxicity of vicilins was investigated through the incorporation of these proteins in artificial diet offered to the larvae. Binding tests of vicilins to the peritrophic membranes (PM) were carried out by in vitro incubation of PM with solutions of vicilins. Bound proteins were desorbed from PM with 100 mm HCl. Desorbed vicilins were analyzed by sodium dodecyl sulfate–polyacrylamide gel electrophoresis followed by immunoprobing on Western blotting using an anti‐vicilin cv. EPACE‐10 antibody. The chitin content of the T. molitor PM was evaluated by the Von Wisselingh color test and presence of chitin in the larval PM was confirmed. Bioassays showed that both vicilins from EPACE‐10 and IT81D‐1045 genotypes were toxic to T. molitor larvae, and in vitro binding assays showed that these seed‐storage proteins were capable of binding to the larval PM.
Leaf surface preference in the cabbage worm, Pieris rapae crucivora, and parasitism by the gregarious parasitoid Cotesia glomerata
Authors: Tagawa J. , Matsushita A. , Watanabe T.
Published: July 2008

Leaf surface preference of the cabbage worm, Pieris rapae crucivora Boisduval (Lepidoptera: Pieridae), for cabbage, Brassica oleracea L. var. capitata (Brassicaceae), and parasitism by the parasitoid Cotesia glomerata (L.) (Hymenoptera: Braconidae) were investigated experimentally in the laboratory. Female butterflies did not discriminate between the adaxial and abaxial surfaces of cabbage leaves when laying eggs on a vertically placed leaf. Larvae also did not discriminate between the adaxial and abaxial surfaces throughout their larval life. However, second and third instars preferred the lower surface of horizontally placed leaves to the upper surface, irrespective of whether they had hatched on the upper or lower side; other instars showed no preference for the lower surface. Parasitism rates of first and second instars on the upper surface were higher than those of larvae on the lower surface. Egg distribution on leaf surfaces and the leaf surface preference by young larvae are discussed in terms of avoidance of parasitism by the parasitoid C. glomerata.
Mediation and Genre
Authors: Hardy Samantha
Published: July 2008

This paper examines the constitutive elements of the genre of melodrama and relates them to typical Western conflict stories. It demonstrates why a conflict narrative based on the genre of melodrama tends to work against the resolution of the conflict and proposes tragedy as a more constructive genre for a conflict narrative. The paper also discusses how the mediation situation itself can constrain the possible genres that can be constructed in the process and explores the implications of those constraints for people in conflict and for the mediators facilitating a resolution.
Peer Consultation for Mediators: The Use of a Holding Environment to Support Mediator Reflection, Inquiry, and Self‐Knowing
Authors: Minkle Beryl , Bashir Anthony S. , Sutulov Claudia
Published: July 2008

In order to help the parties in mediation address their interests, concerns, and responses to the conflict, the mediator must monitor and manage his or her own inner thoughts, emotions, and feelings throughout the process lest they negatively influence the outcomes of the mediation. Peer consultation offers one approach that can be used effectively to support the mediator's inquiry into practice dilemmas and invite self‐knowing that benefits the mediator as well as the parties in the mediation. The effectiveness of a group consultation process, however, depends on the development of “a holding environment” that can provide a safe and confidential space within which such an inquiry can occur. The mediation process is improved when the mediator is able to sustain relational and emotional tension within herself and between the parties long enough for new understandings and actions to develop.
Mega‐Simulations in Negotiation Teaching: Extraordinary Investments with Extraordinary Benefits
Authors: Weiss Stephen E.
Published: July 2008

A mega‐simulation is a complex‐negotiations teaching exercise involving complicated issues and challenging conditions that is undertaken by three or more teams of students. In this article, I draw on two decades of teaching with mega‐simulations in international business negotiation courses to discuss potential learning goals for this type of experiential exercise, effective ways to organize the experience, challenges for the instructor, and the distinctive educational benefits that justify the substantial investment of time and resources required to implement these mega‐simulations. These simulations can help students to develop greater sophistication in basic negotiation skills, become more extensively exposed to complex skill sets, and develop a deeper understanding of negotiation subject matter and complex processes than they would by conducting standard role plays. Mega‐simulations offer major opportunities for students to move to advanced levels of negotiation skill not just in international business, but in diplomacy, law, engineering, and a host of other professional arenas.
Dermal mucin in alopecia areata – tell tale sign or incidental finding?
Authors: Goldberg Lynne J. , Sekhri Vinoo , Bhawan Jag
Published: July 2008

Alopecia areata is an autoimmune disease causing patchy hair loss, which occurs with an increased incidence in patients with lupus erythematosus. We report a 27‐year‐old African‐American female with systemic lupus erythematosus and alopecia areata, whose biopsy showed a marked increase in mucin in the deep dermis and subcutis. Archival biopsies of alopecia areata were then reviewed to see if this finding occurs in patients without systemic lupus. Of 13 recent biopsies diagnostic of alopecia areata, we detected deposition of mucin in 3 (23%), but all mild in degree and in a superficial location. We speculate that the marked deposition of mucin in this patient’s biopsy of alopecia areata may be related to her underlying systemic lupus, and that the presence of marked, deep dermal deposition of mucin might serve as a diagnostic clue for the presence of underlying systemic lupus in patients with alopecia areata.
The use of the OSCE in postgraduate education
Authors: Arnold R. C. , Walmsley A. D.
Published: July 2008

Background:  The Objective Structured Clinical Examination (OSCE) is a method of assessing the clinical skills of undergraduates in medicine, dentistry and other health sciences and is employed increasingly in postgraduate education.

Aim:  To describe the application of the OSCE to the development of Lifelong Learning and Continuing Professional Development (CPD) for General Dental Practitioners (GDPs).

Methods:  A postgraduate course was designed as an OSCE for GDPs. The OSCE comprised 12 stations covering different aspects of general dentistry. After an introductory seminar outlining the aim of the course, the participants spent 7 min at each station. Each question or task required 10 answers and was designed to highlight areas of weakness or interest and to stimulate further study of the presenting topic. Solutions and answers were provided at each station for self‐assessment along with a list of locally presented courses related to that subject. Participants were invited to leave contact details and to make suggestions for future postgraduate courses. The final session consisted of a group discussion and participants were invited to complete an evaluation form to express opinions on the course.

Results:  The evaluation demonstrated that most candidates found participation in the OSCE stimulated their interest in CPD. The OSCE also highlighted areas of weakness in knowledge of certain clinical procedures. Group discussion confirmed that practitioners found the hands‐on component valuable and that they were likely to participate in further OSCEs to enhance their CPD. Suggestions received during the discussion were used to modify the course.

Conclusions:  The OSCE course fulfilled its aim of assisting practitioners to organise their CPD. The reflective nature of the course was helpful in evaluating clinical knowledge and the unique multidisciplinary style fulfilled its objective in promoting thoughts regarding future study.
On the reliability of a dental OSCE, using SEM: effect of different days
Authors: Schoonheim‐Klein M. , Muijtens A. , Habets L. , Manogue M. , Van der Vleuten C. , Hoogstraten J. , Van der Velden U.
Published: July 2008

Aim:  The first aim was to study the reliability of a dental objective structured clinical examination (OSCE) administered over multiple days, and the second was to assess the number of test stations required for a sufficiently reliable decision in three score interpretation perspectives of a dental OSCE administered over multiple days.

Materials and methods:  In four OSCE administrations, 463 students of the year 2005 and 2006 took the summative OSCE after a dental course in comprehensive dentistry. The OSCE had 16–18 5‐min stations (scores 1–10), and was administered per OSCE on four different days of 1 week. ANOVA was used to test for examinee performance variation across days. Generalizability theory was used for reliability analyses. Reliability was studied from three interpretation perspectives: for relative (norm) decisions, for absolute (domain) and pass–fail (mastery) decisions.

As an indicator of reproducibility of test scores in this dental OSCE, the standard error of measurement (SEM) was used. The benchmark of SEM was set at <0.51. This is corresponding to a 95% confidence interval (CI) of <1 on the original scoring scale that ranged from 1 to 10.

Results:  The mean weighted total OSCE score was 7.14 on a 10‐point scale. With the pass–fail score set at 6.2 for the four OSCE, 90% of the 463 students passed.

There was no significant increase in scores over the different days the OSCE was administered. ‘Wished’ variance owing to students was 6.3%. Variance owing to interaction between student and stations and residual error was 66.3%, more than two times larger than variance owing to stations’ difficulty (27.4%). The SEM norm was 0.42 with a CI of ±0.83 and the SEM domain was 0.50, with a CI of ±0.98. In order to make reliable relative decisions (SEM <0.51), the use of minimal 12 stations is necessary, and for reliable absolute and pass–fail decisions, the use of minimal 17 stations is necessary in this dental OSCE.

Conclusions:  It appeared reliable, when testing large numbers of students, to administer the OSCE on different days. In order to make reliable decisions for this dental OSCE, minimum 17 stations are needed. Clearly, wide sampling of stations is at the heart of obtaining reliable scores in OSCE, also in dental education.
A patient‐centred approach to teaching and learning in dental student clinical practice
Authors: Eriksen H. M. , Bergdahl J. , Bergdahl Maud
Published: July 2008

A patient‐centred clinical teaching profile in the undergraduate dental curriculum at The University of Tromsø is described. This teaching profile implies that treatment planning is primarily based on the patients’ perceived needs and the students are trained to retrieve information from the patients in this context. The role of the clinical instructor is primarily as a facilitator rather than an expert. The ‘best interest of the patient’ is not always easy to disclose and consequences related to the patients’ levels of understanding, students competence, educational challenges and professional ethics are topics for discussion through the clinical education programme.
Novel sphingolipid derivatives promote keratinocyte differentiation
Authors: Paragh György , Schling Petra , Ugocsai Peter , Kel Alexander E. , Liebisch Gerhard , Heimerl Susanne , Moehle Christoph , Schiemann Yvonne , Wegmann Michael , Farwick Mike , Wikonkál Norbert M. , Mandl József , Langmann Thomas , Schmitz Gerd
Published: July 2008

Abstract:  Sphingolipids are important components of the water permeability barrier of the skin. Moreover, ceramides were also shown to influence keratinocyte differentiation and regulate cellular signalling. A confluence‐induced differentiation model of normal human keratinocytes was established to allow evaluation of pro‐ and anti‐differentiation effects of exogenous compounds. The effects of phytosphingosine (PS), sphingosine (SO), sphinganine (SA) and their hexanoyl (–C6), stearoyl (–C18) and salicyl (–SLC) derivatives, C12‐alkylamine‐salicylate (C12‐SLC), salicylate (SLC) along with vitamin D3 (VD3) and retinol as control substances were tested in this system. Cytotoxicity assays were carried out to optimize the incubation conditions of compounds and whole genome expression changes were monitored by DNA‐microarray on days 0, 1 and 4. Geometric means of gene expression levels of a subset of known keratinocyte differentiation‐related genes were calculated from the microarray data to compare effects of the sphingolipid derivatives. Compound treatment‐induced transcriptional changes were analysed by the ExPlain™ software (BIOBASE GmbH). Five of the assayed substances (SA, SO‐C6, PS‐C6, SO‐SLC, PS‐SLC) were found to be potent promoters of keratinocyte differentiation compared with VD3, and C12‐SLC revealed potential anti‐differentiation properties. ExPlain™ analysis found a different regulatory profile in the computed transcriptional networks of the sphingoid bases versus their –C6 and especially –SLC derivatives suggesting that the change in their keratinocyte differentiation modifying potential is due to a unique effect of the covalent attachment of the salicylic acid. Taken together, these results demonstrate the gene regulatory potential of sphingolipid species that could be valuable for dermatological or cosmetic applications.
Polymorphisms within the C3 gene are associated with specific IgE levels to common allergens and super‐antigens among atopic dermatitis patients
Authors: Purwar Rahul , Langer Katja , Werfel Thomas
Published: July 2008

Abstract:  Atopic dermatitis (AD) is a chronic inflammatory skin disease. Twin and family studies suggest a strong genetic component of the disease. The keratinocytes secrete high amounts of C3 after stimulation with pro‐inflammatory cytokines, which may play a functional role in skin inflammation. In this study, we genotyped four different single nucleotide polymorphisms (SNPs) by melting curve analysis using sequence specific hybridization probes in a well‐characterized cohort of AD patients. Among four SNPs within C3 gene, higher frequencies of rs10410674 (23.5% vs 12.2%) and rs366510 (13.8% vs 6.5%) were observed in AD patients as compared with control group. None of the tested polymorphisms showed significant association with the risk of the disease phenotype. Analysis of rs10402876 SNP revealed its association with less severe AD disease expression (low SCORAD). Total serum IgE levels were not different among AD patients having any of the four SNPs. However, we observed significantly less serum‐specific IgE levels to common allergens (Dermatophagoides pteronyssinus and birch pollens) and Staphylococcal enterotoxin B in AD patients having rs366510 SNP. Thus, associations of polymorphism within C3 gene with less severe AD disease expression and a weaker sensitization to common allergens suggest the role of these SNPs in the development of AD.
The vitamin D pathway: a new target for control of the skin’s immune response?
Authors: Schauber Jürgen , Gallo Richard L.
Published: July 2008

Abstract:  The surface of our skin is constantly challenged by a wide variety of microbial pathogens, still cutaneous infections are relatively rare. Within cutaneous innate immunity the production of antimicrobial peptides (AMPs) is a primary system for protection against infection. Many AMPs can be found on the skin, and these include molecules that were discovered for their antimicrobial properties, and other peptides and proteins first known for activity as chemokines, enzymes, enzyme inhibitors and neuropeptides. Cathelicidins were among the first familiesf of AMPs discovered on the skin. They are now known to have two distinct functions; they have direct antimicrobial activity and will initiate a host cellular response resulting in cytokine release, inflammation and angiogenesis. Dysfunction of cathelicidin is relevant in the pathogenesis of several cutaneous diseases including atopic dermatitis where cathelicidin induction is suppressed, rosacea, where cathelicidin peptides are abnormally processed to forms that induce cutaneous inflammation and a vascular response, and psoriasis, where a cathelicidin peptide can convert self‐DNA to a potent stimulus of an autoinflammatory cascade. Recent work has unexpectedly identified vitamin D3 as a major factor involved in the regulation of cathelicidin expression. Therapies targeting the vitamin D3 pathway and thereby cathelicidin may provide new treatment modalities in the management of infectious and inflammatory skin diseases.
Effect of 2‐hydroxyethyl‐methacrylate (HEMA) on the phagocytic and respiratory burst activity of human neutrophils and monocytes
Authors: Andersson Jennie , Dahlgren Ulf I.
Published: July 2008

Neutrophils and monocytes/macrophages (MØ), found in oral mucosa and gingival sulcus, phagocytose and kill bacteria using products produced during a respiratory burst. 2‐Hydroxyethyl‐methacrylate (HEMA) is a major component released from resin glass ionomer and dental adhesives. Hence, in pulp and gingiva, phagocytes can come into contact with unpolymerized HEMA monomers. The aim of this study was to examine the effects of exposure to HEMA on neutrophil and monocyte bactericidal function. Blood collected from five female volunteers was exposedin vitroto HEMA for 2 h and then phagocytosis, respiratory burst, and cellular integrity were measured using flow cytometry. Respiratory burst was quantified by measuring fluorescent rhodamine 123 generated via oxidation of dihydrorhodamine 123. Cellular membrane integrity was evaluated by staining with propidium iodide. The respiratory burst activity of the neutrophils was significantly decreased by exposure to 7.5 and 15 mM HEMA. No significant effect of HEMA was seen on the number of granulocytes or monocytes capable of performing respiratory burst. Furthermore, there was no significant effect of HEMA on the phagocytic activity of the monocytes or the granulocytes. In conclusion, HEMA did not affect the phagocytosis activity of neutrophils; however, the ability of the cells to kill internalized prey was significantly reduced.
Ability of different restorative materials to prevent in situ secondary caries: analysis by polarized light‐microscopy and energy‐dispersive X‐ray
Authors: Paradella Thaís Cachuté , Koga‐Ito Cristiane Yumi , Jorge Antonio Olavo Cardoso
Published: July 2008

Secondary caries is the main cause of direct restoration replacement. The purpose of this study was to analyze enamel adjacent to different restorative materials after in situ cariogenic challenge using polarized‐light microscopy (PLM), scanning electron microscopy (SEM) and energy‐dispersive X‐ray analysis (EDS). Twelve volunteers, with a low level of dental plaque, a low level of mutans streptococci, and normal salivary flow, wore removable palatal acrylic appliances containing enamel specimens restored with Z250 composite, Freedom composite, Fuji IX glass‐ionomer cement, or Vitremer resin‐modified glass‐ionomer for 14 days. Volunteers dripped one drop of 20% sucrose solution (n = 10) or distilled water (control group) onto each specimen 8 times per day. Specimens were removed from the appliances and submitted to PLM for examination of the lesion area (in mm2), followed by dehydration, gold‐sputtering, and submission to SEM and EDS. The calcium (Ca) and phosphorus (P) contents were evaluated in weight per cent (%wt). Differences were found between Z250 and Vitremer, and between Z250 and FujiIX, when analyzed using PLM. Energy‐dispersive X‐ray analysis results showed differences between the studied materials regarding Ca %wt. In conclusion, enamel adjacent to glass‐ionomer cement presented a higher Ca %wt, but this material did not completely prevent enamel secondary caries under in situ cariogenic challenge.
Metabolic mode peculiar to Meckel’s cartilage: immunohistochemical comparisons of hypoxia‐inducible factor‐1α and glucose transporters in developing endochondral bones in mice
Authors: Sakakura Yasunori , Shibui Toru , Irie Kazuharu , Yajima Toshihiko
Published: July 2008

The middle portion of Meckel’s cartilage resembles endochondral bone formation accompanied by chondrocyte hypertrophy and death, cartilaginous matrix calcification, and chondroclastic resorption. We examined Meckel’s cartilage specimens from mice mandibles taken on embryonic days 14–16 (E14–E16) using immunohistochemistry for hypoxia‐inducible factor‐1α (HIF‐1α), glucose transporter 1 (GLUT1), glucose transporter 3 (GLUT3), and glucose transporter 5 (GLUT5), and using enzyme histochemistry for glucose‐6‐phosphate isomerase (GPI), lactate dehydrogenase (LDH), and cytochrome oxidase (COX), along with the periodic acid‐Schiff (PAS) reaction, and compared the results with those of endochondral bones from E16 hind limbs. Periodic acid‐Schiff‐positive glycogen, HIF‐1α, and GLUT immunoreactivity, and GPI, LDH, and COX activities were observed in Meckel’s cartilage in E14 and E15 mandibles. In E16 mandibles, hypertrophic chondrocytes showed a transitory loss of HIF‐1α immunoreactivity and consumed glycogen, while those closest to the resorption front showed intense immunoreactivity for HIF‐1, GLUT3, and GLUT5. Hypertrophic chondrocytes of metatarsals possessed HIF‐1α immunoreactivity in the nuclei and diminished COX activity, whereas developing tibias showed weak HIF‐1α immunoreactivity even in hypoxic regions characterized by little or no COX activity. These findings suggest that HIF‐1α becomes stabilized independently of the concentration of oxygen, and largely contributes to the development and resorption of Meckel’s cartilage, probably through shifting the predominant metabolic mode from aerobic to anaerobic glycolysis.
Non‐invasive longitudinal assessment of facial growth in children and adolescents with hypohidrotic ectodermal dysplasia
Authors: Dellavia Claudia , Catti Francesca , Sforza Chiarella , Grandi Gaia , Ferrario Virgilio F.
Published: July 2008

Facial growth patterns in 12 subjects (six boys and six girls) with hypohidrotic ectodermal dysplasia (HED) were analyzed and compared with facial growth patterns obtained in healthy reference peers. All subjects with HED were aged 7 yr (mean age ± standard deviation: 7.08 ± 0.41 yr) at the first examination and 14 yr (mean age ± standard deviation: 14.56 ± 0.34 yr) at the last examination. In each subject, the three‐dimensional coordinates of facial landmarks were collected non‐invasively at eight subsequent years. The volumes of forehead, nose, maxilla and mandible, upper lips, and lower lips were estimated. For each facial volume, differential values between different time points were calculated individually, separately for the ‘childhood’ (7–10 yr) and the ‘adolescence’ (11–14 yr) growth period in both HED and reference subjects. Children and adolescents with HED had a slightly reduced global facial growth in comparison with normal reference peers. The peak mandibular and maxillary development was delayed by approximately 2 yr towards later adolescence. The present non‐invasive system seems to be useful for studying longitudinal changes of facial growth in healthy and syndromic subjects.
Load‐bearing capacity of all‐ceramic three‐unit fixed partial dentures with different computer‐aided design (CAD)/computer‐aided manufacturing (CAM) fabricated framework materials
Authors: Beuer Florian , Steff Bastian , Naumann Michael , Sorensen John A.
Published: July 2008

The purpose of this in vitro study was to compare the load‐bearing capacity of posterior three‐unit fixed dental prostheses (FDP) produced with three different all‐ceramic framework materials: glass‐infiltrated alumina (ICA), glass‐infiltrated alumina strengthened with zirconia (ICZ), and yttria‐stabilized polycrystalline zirconia (YZ). Additionally, the influence on aging of mechanical cyclic fatigue loading and thermal cycling in water were evaluated. A total of 20 frameworks each were fabricated from ICA, ICZ, and YZ by a computer‐aided design (CAD)/computer‐aided manufacturing (CAM) system. The framework designs were identical for all specimens. All frameworks were veneered with porcelain and cemented with glass–ionomer. Prior to fracture testing, 10 FDP of each experimental group were subjected to thermal and mechanical cycling. Additionally, fractographic analysis was performed. Statistical analysis showed that FDP made from YZ had significantly higher load to failure, whereas no difference was found between the other two materials. Aging did not have a significant effect on the fracture load.
The effect of a single nucleotide polymorphism in the matrix metalloproteinase‐1 (MMP‐1) promoter on force‐induced MMP‐1 expression in human periodontal ligament cells
Authors: Huang Sheng‐Fu , Li Yu‐Hong , Ren Yi‐jin , Cao Zheng‐Guo , Long Xing
Published: July 2008

Matrix metalloproteinase‐1 (MMP‐1) 1G/2G (−1,607) polymorphisms have been identified and shown to influence the transcription of the MMP‐1 gene. In order to compare the expression of MMP‐1 with different MMP‐1 gene promoter alleles after force loading, human periodontal ligament (PDL) cells were cultured and genotyped into three alleles by polymerase chain reaction and restriction endonuclease cleavage. The three genotypes of PDL cells were centrifuged and the expression of MMP‐1 mRNA and protein were determined by reverse transcription–polymerase chain reaction and enzyme‐linked immunosorbent assay. The results showed that centrifugal force upregulated the expression of both MMP‐1 mRNA and protein in all three genotypes of PDL cells. The induction of MMP‐1 by force was significantly greater in cells with a 2G/2G genotype or a 1G/2G genotype than in cells homozygous for the 1G allele. The MMP‐1 mRNA and protein levels were significantly higher for cells with the 2G allele than for cells with the 1G/2G allele or the 1G allele. These results suggest that a single nucleotide polymorphism in the −1,607 bp MMP‐1 promoter region might be associated with the difference observed in the endogenous expression of MMP‐1 in PDL cells under mechanical force.