bluuebunny/crossref_metadata_2025 huggingface dataset:
Higher severity of frontal periventricular white matter and basal ganglia hyperintensities in first‐ever lacunar stroke with multiple silent lacunes
Authors: Grau‐Olivares M. , Arboix A. , Bartrés‐Faz D. , Junqué C.
Published: July 2008

Background and purpose:  We investigated whether patients with a lacunar infarct (LI) syndrome exhibiting unique LI or multiple LI on magnetic resonance imaging (MRI) examinations differed in terms of topography and severity of white matter hyperintensities (WMH) ratings.

Methods:  Forty consecutive patients with a first‐ever acute LI, who presented a lacunar syndrome according to Miller–Fisher’s classification were recruited and were classified into a group presenting isolated LI on MRI (n = 17) or multiple LI (n = 23).

Results:  Despite equivalent demographic, clinical and cognitive characteristics, patients with multiple LI had increased ratings of WMH in frontal, occipital and subcortical regions. No significant correlations could be evidenced between the number of LI and WMH ratings.

Conclusions:  Present findings provide support to previous hypothesis considering single and multiple LI MRI presentations of lacunar infarct patients as distinct entities.
Aseptic meningitis and encephalitis because of herpesviruses and enteroviruses in an immunocompetent adult population
Authors: Frantzidou F. , Kamaria F. , Dumaidi K. , Skoura L. , Antoniadis A. , Papa A.
Published: July 2008

Background and aim:  Human herpesviruses (HHVs) and enteroviruses (EVs) are the major causative agents of CNS viral infections. The aim of the study was to identify the etiology and determine the frequency of aseptic meningitis and encephalitis due to HHVs and EVs in an immunocompetent adult population.

Methods:  Eighty‐one patients (ages ≥15) with aseptic meningitis or encephalitis treated in the Infectious Diseases Hospital of Thessaloniki, Greece, during 2003–2006, were included in the study. Polymerase chain reaction for detection of herpes‐ and enterovirus genome direct in cerebrospinal fluid samples was performed.

Results:  Based on clinical and laboratory data, 36/81 patients had meningitis and 45/81 had encephalitis. Etiology was defined in 11 patients (31%) with aseptic meningitis. EVs were the major causative agents (8/36, 22%), followed by varicella zoster virus (2/36, 5%) and herpes simplex virus‐2 (HSV‐2) (1/36, 3%). Etiology was identified in 8 of 45 (18%) patients with encephalitis, EV (4/45, 9%) and HSV‐1 (4/45, 9%) being the most common pathogens.

Conclusion:  Enteroviruses are the most common cause of adult aseptic meningitis and together with HSV‐1 the main causes of encephalitis.
Body mass index does not change before Parkinson’s disease onset
Authors: Ragonese P. , D’Amelio M. , Callari G. , Di Benedetto N. , Palmeri B. , Mazzola M. A. , Terruso V. , Salemi G. , Savettieri G. , Aridon P.
Published: July 2008

Background and purpose:  Previous studies on the association between Parkinson’s disease (PD) and body mass index (BMI) have reported conflicting results. We investigated the relationship between PD and BMI by a case–control study.

Methods:  PD patients were randomly matched to healthy individuals by sex and age. BMI distribution in cases has been compared with BMI of controls and odd ratios (ORs) with 95% CI were calculated.

Results:  We included 318 PD patients and 318 controls. We observed no association between PD and BMI. BMI distribution in cases and controls was similar also when we adjusted for diabetes, hypercholesterolemia and the time elapsed between PD onset and the interview (OR = 0.99; CI = 0.94–1.03; P = 0.51).

Conclusions:  These results did not confirm the previously reported association between PD and BMI. Population characteristics and methodological issues may partially account for the differences observed between the present study and the others.
Variability in duration of follow up may bias the conclusions of cohort studies of patients with patent foramen ovale
Authors: Benbassat J. , Baumal R.
Published: July 2008

Closure of patent foramen ovale (PFO) is expected to prevent paradoxical emboli. In the absence of randomized trials, its efficacy has been assessed by comparing uncontrolled cohort studies of medically treated patients with those treated by PFO closure. The objective of this study was to highlight a confounder of such studies, namely, the variability in the duration of follow‐up. We searched the literature for cohort studies of patients with ischaemic strokes, including those with PFO. During the first year of follow‐up, recurrence hazards in patients younger than 55 years were 1–4% in those with any ischaemic stroke, 1–6% in medically treated patients with PFO and 0–5% in those after PFO closure. In most studies, the recurrence hazards were highest immediately after the index stroke and declined thereafter. Still, hazards were commonly reported in terms of annual averages over a wide range of follow‐up periods for the various cohort studies, thereby ignoring the possibility that the duration of the follow‐up may in and of itself affect the derived average recurrence hazards. A disregard of the time variance of stroke recurrence may confound the conclusions from comparisons between uncontrolled studies of patients with stroke and PFO.
Ressourcing the Fathers? A Critical Analysis of Catherine Mowry LaCugna's Appropriation of the Trinitarian Theology of the Cappadocian Fathers
Authors: RAITH II CHARLES D.
Published: July 2008

Abstract:  Often as part of the so‐called ‘revival’ in trinitarian theology, the Cappadocian Fathers are ressourced to justify a ‘social’ and ‘relational’ way of thinking about God's triuneness. The goal of this article is to explore this social trinitarian ressourcement of the Cappadocian Fathers by comparing the Cappadocians’ theology to that of Catherine Mowry LaCugna, who claims the Cappadocians articulated a more fully trinitarian theology by emphasizing the plurality of the divine ‘persons’ as ‘relations’. My conclusion is that the ontological and epistemological differences between LaCugna and the Cappadocians, coupled with the opposing purposes of their respective trinitarian theologies, create a discontinuity between the two projects that is too great for LaCugna to ressource the Cappadocians in any positive manner in her own trinitarian theology.
Pemphigus
Authors: Ioannides D , Lazaridou E , Rigopoulos D
Published: July 2008

Pemphigus refers to a group of potentially life‐threatening autoimmune diseases of the skin and mucous membranes, characterized by the formation of blisters and erosions of the skin. An autoimmune process, directed against keratinocyte desmosomal cadherins, interferes with the adhesive function of these molecules. This results in the separation of keratinocytes and clinical manifestation of blistering. Differences in the particular antigens targeted by the antibodies and in the distribution of these antigens in the different regions of the body and in the separate layers of the epidermis result in different clinical manifestations of the disease. Diagnosis of pemphigus is based on three independent groups of criteria: clinical features (flaccid blisters and erosions on skin and oral mucosa), histologic findings (epidermal acantholysis) and immunological tests (circulating and skin‐fixed antibodies against keratinocyte surface antigens). The principle aim of treatment is to reduce inflammatory response and autoantibody production, thereby achieving disease remission. Systemic corticosteroids are still the most useful drugs in the treatment of pemphigus and continue to be the mainstay of therapy for this disease. Adjuvant drugs, such as immunosuppressants, are commonly used in combination, in order to increase efficacy and have a steroid‐sparing effect, thereby allowing reduced maintenance doses and less side effects of systemic corticosteroids. Other options include intravenous immunoglobulin and plasmapheresis. However, more research is needed to develop treatments with the least possible toxicity.
The prevalence of melanocytic naevi among schoolchildren in South Hungary
Authors: Csoma Z , Erdei Z , Bartusek D , Dosa‐Racz E , Dobozy A , Kemeny L , Olah J
Published: July 2008

Background  Malignant melanoma is an increasing public health problem worldwide; accordingly, identification of the constitutional and environmental factors which contribute to the development of the disease, and hence identification of the individuals at high risk of melanoma, is an indispensable step in all primary prevention efforts.

Objectives  This paper aims to assess the prevalence of different pigmented lesions among schoolchildren and to investigate their relationship with phenotypic pigmentary characteristics, sun exposure and other factors.

Patients/methods  A cross‐sectional study was performed in two secondary schools in Szeged, Hungary. A total of 1320 schoolchildren, aged 14 to 18 years, underwent a whole‐body skin examination. A standardized questionnaire was used to collect data on phenotypic, sun exposure and other variables.

Results  One to 10 common melanocytic naevi were found in 27% of the participants, and the naevus numbers were in the range of 10–100 in 67%; 5.4% of them had more than 100 common melanocytic naevi. The prevalence of clinically atypical naevi was 24.3%. Statistically significant associations were found between the number of pigmented lesions and gender, hair colour, eye colour, skin phototype, a history of severe painful sunburns and a family history of a large number of melanocytic naevi.

Conclusion  Our study population displayed a markedly high prevalence of clinically atypical melanocytic naevi. Moreover, a considerable proportion of the investigated individuals had multiple common melanocytic naevi. Since the presence of a large number of melanocytic naevi is a strong predictor for future melanoma development, health educational programmes on melanoma prevention should be aimed at young age groups.
Histone deacetylase 6 interacts with the microtubule‐associated protein tau
Authors: Ding Huiping , Dolan Philip J. , Johnson Gail V. W.
Published: July 2008

Histone deacetylase 6 (HDAC6), a unique cytoplasmic deacetylase, likely plays a role in neurodegeneration by coordinating cell responses to abnormal protein aggregation. Here, we provide in vitro and in vivo evidence that HDAC6 interacts with tau, a microtubule‐associated protein that forms neurofibrillary tangles in Alzheimer’s disease. This interaction is mediated by the microtubule‐binding domain on tau and the Ser/Glu tetradecapeptide domain on HDAC6. Treatment with tubacin, a selective inhibitor of tubulin deacetylation activity of HDAC6, did not disrupt HDAC6–tau interaction. Nonetheless tubacin treatment attenuated site‐specific tau phosphorylation, as did shRNA‐mediated knockdown of HDAC6. Proteasome inhibition potentiated HDAC6–tau interactions and facilitated the concentration and co‐localization of HDAC6 and tau in a perinuclear aggresome‐like compartment, independent of HDAC6 tubulin deacetylase activity. Furthermore, we observed that in Alzheimer’s disease brains the protein level of HDAC6 was significantly increased. These findings establish HDAC6 as a tau‐interacting protein and as a potential modulator of tau phosphorylation and accumulation.
A phase advance of the light‐dark cycle stimulates production of BDNF, but not of other neurotrophins, in the adult rat cerebral cortex: association with the activation of CREB
Authors: Katoh‐Semba Ritsuko , Tsuzuki Masako , Miyazaki Noriko , Matsuda Motoko , Nakagawa Chiaki , Ichisaka Satoshi , Sudo Kaori , Kitajima Satoko , Hamatake Michiko , Hata Yoshio , Nagata Koh‐ichi
Published: July 2008

Circadian variation in the expression of brain‐derived neurotrophic factor (BDNF) indicates that BDNF is involved in the regulation of diurnal rhythms in a variety of biological processes. However, it is still unclear which brain regions alter their BDNF levels in response to external light input. Therefore, in selected brain regions of adult male rats, we investigated diurnal variation, as well as the effects of a single eight‐hour phase advance of the light‐dark cycle, on the levels of BDNF and of other neurotrophins. The cerebellum, hippocampus and cerebral cortex containing visual cortex (VCX) showed diurnal variation in BDNF protein levels and the VCX also in NT‐3 levels. In the VCX and the region containing the entorhinal cortex and amygdala (ECX), BDNF protein levels were increased 12 h after the phase advance, while BDNF mRNA levels were increased significantly in the VCX and slightly in the ECX after 4 h. After one week, however, BDNF protein levels were reduced in eight brain regions out of 13 examined. BDNF levels in the ECX and VCX were significantly different between light rearing and dark rearing, while a hypothyroid status did not produce an effect. Cyclic AMP responsive element‐binding protein (CREB), a transcription factor for BDNF, was greatly activated by the phase advance in the ECX and VCX, suggesting the existence of CREB‐mediated pathways of BDNF synthesis that are responsive to external light input.
JAK/STAT3 pathway is activated in spinal cord microglia after peripheral nerve injury and contributes to neuropathic pain development in rat
Authors: Dominguez Elisa , Rivat Cyril , Pommier Blandine , Mauborgne Annie , Pohl Michel
Published: July 2008

Peripheral nerve lesion leads to the production of interleukin 6 (IL‐6)‐related neuropoietic cytokines involved in nerve protection and regeneration. This family of cytokines mainly signal through the signal transducer and activator of transcription (STAT) pathway that is locally activated in injured nerves. IL‐6 is also involved in pain that frequently arises from peripheral nerve lesion. We investigated the possible activation of this major IL‐6 signaling system in the spinal cord after peripheral nerve injury and its role in neuropathic pain. Ligation of L5–L6 spinal nerves (SNL) evoked an accumulation of active, phosphorylated form of STAT3 in microglial cells of dorsal spinal cord mostly in projection areas of injured nerves. SNL resulted also in a massive induction of IL‐6 mRNA expression in dorsal root ganglia and increased concentration of IL‐6 in dorsal spinal cord. Intrathecal injection of anti‐rat IL‐6 antibodies prevented the SNL‐induced accumulation of phospho‐STAT3 in the spinal cord. STAT3 pathway blockade with Janus kinase 2 inhibitor AG490 attenuated both mechanical allodynia and thermal hyperalgesia in SNL rats. These data show that in response to SNL injury Janus kinase/STAT3 system is activated mainly through IL‐6 signaling in spinal microglia and that this transduction pathway participates in development of pain associated with nerve alteration.
Prg1 is regulated by the basic helix‐loop‐helix transcription factor Math2
Authors: Yamada Misa , Shida Yoshiko , Takahashi Kou , Tanioka Toshihiro , Nakano Yasuko , Tobe Takashi , Yamada Mitsuhiko
Published: July 2008

Math2 (NEX‐1/NeuroD6) is a member of the basic helix‐loop‐helix transcription factor family and is involved in neuronal differentiation and maturation. In this study, we identified the genes targeted by Math2 using DNA microarrays and cultured rat cortical cells transfected with Math2. Of the genes regulated by Math2, we focused on plasticity‐related gene 1 (Prg1). Prg1 expression induced by Math2 was confirmed in cultured rat cortical cells and PC12 cells analyzed by real‐time quantitative PCR. In the promoter region of rat Prg1, we identified four E‐boxes [designated −E1 to −E4 (CANNTG)] recognized by the basic helix‐loop‐helix transcription factor. Using chromatin immunoprecipitation assays, we found that Math2 directly bound to at least one of these E‐boxes. The Prg1 reporter assay showed that −E1 was critical for the regulation of Math2‐mediated Prg1 expression. Investigation of the functional roles of Math2 and Prg1 in PC12 cells revealed that 72 h after transfection with either Math2 or Prg1, neurite length and number were significantly induced. Co‐transfection with Prg1‐siRNA completely inhibited Math2‐mediated morphological changes. Our results suggest that Math2 directly regulates Prg1 expression and that the Math2–Prg1 cascade plays an important role in neurite outgrowth in PC12 cells.
ETHICS BEYOND BORDERS: HOW HEALTH PROFESSIONALS EXPERIENCE ETHICS IN HUMANITARIAN ASSISTANCE AND DEVELOPMENT WORK
Authors: HUNT MATTHEW R.
Published: July 2008

Health professionals are involved in humanitarian assistance and development work in many regions of the world. They participate in primary health care, immunization campaigns, clinic‐ and hospital‐based care, rehabilitation and feeding programs. In the course of this work, clinicians are frequently exposed to complex ethical issues. This paper examines how health workers experience ethics in the course of humanitarian assistance and development work. A qualitative study was conducted to consider this question. Five core themes emerged from the data, including: tension between respecting local customs and imposing values; obstacles to providing adequate care; differing understandings of health and illness; questions of identity for health workers; and issues of trust and distrust. Recommendations are made for organizational strategies that could help aid agencies support and equip their staff as they respond to ethical issues.
CULTURE AND VOLUNTARY INFORMED CONSENT IN AFRICAN HEALTH CARE SYSTEMS
Authors: FRIMPONG‐MANSOH AUGUSTINE
Published: July 2008

This paper discusses how to apply a collective decision model of the principle of voluntary informed consent in African communitarian culture, in a culturally sensitive way, in order to protect research candidates from potential exploitations and abuses. Dismissing cultural and ethical skepticism surrounding the global application of the principle of voluntary informed consent, the paper ultimately concludes that international collaboration on diagnostic and therapeutic medical research in Africa, especially HIV vaccine trials, is a moral imperative.
A PORTRAIT OF CHILD POVERTY IN GERMANY
Authors: Corak Miles , Fertig Michael , Tamm Marcus
Published: July 2008

This paper offers a descriptive portrait of income poverty among children in Germany between the early 1980s and 2004, with a focus on developments since unification in 1991. Data from the German Socio‐Economic Panel are used to estimate poverty rates, rates of entry to and exit from poverty, and the duration of time spent in and out of poverty. The analysis focuses upon comparisons between East and West Germany, by family structure, and citizenship status. Child poverty rates have drifted upward since 1991, and have been increasing more than the rates for the overall population since the mid‐1990s. In part these changes are due to increasing poverty among children from households headed by non‐citizens but also by children living in two‐adult households. Children in single‐parent households are by all measures at considerable risk of living in poverty. There are also differences in child poverty between East and West Germany.
Carbamazepine and phenytoin induced Stevens‐Johnson syndrome is associated with HLA‐B*1502 allele in Thai population
Authors: Locharernkul Chaichon , Loplumlert Jakrin , Limotai Chusak , Korkij Wiwat , Desudchit Tayard , Tongkobpetch Siraprapa , Kangwanshiratada Oratai , Hirankarn Nattiya , Suphapeetiporn Kanya , Shotelersuk Vorasuk
Published: July 2008

Purpose: Previous studies found a strong association between HLA‐B*1502 and carbamazepine (CBZ)‐induced Stevens‐Johnson syndrome (SJS) in Han Chinese, but not in Caucasian populations. Even in Han Chinese, the HLA‐B*1502 was not associated with CBZ‐induced maculopapular eruptions (MPE). This study seeks to identify whether HLA‐B*1502 is associated with CBZ‐ or phenytoin (PHT)‐induced SJS or MPE in a Thai population.

Methods: Eighty‐one Thai epileptic patients between 1994 and 2007 from the Chulalongkorn Comprehensive Epilepsy Program were recruited. Thirty‐one subjects had antiepileptic drug (AED)‐induced SJS or MPE (6 CBZ‐SJS, 4 PHT‐SJS, 9 CBZ‐MPE, 12 PHT‐MPE), and 50 were AED‐tolerant controls.

Results: For the first time, a strong association between HLA‐B*1502 and PHT‐induced SJS was found (p = 0.005). A strong association was also found between the HLA‐B*1502 and CBZ‐induced SJS (p = 0.0005), making Thai the first non‐Chinese population demonstrating such an association. Some patients, who were HLA‐B*1502 and suffered from CBZ‐induced SJS, could be tolerant to PHT and vice versa. This suggests that HLA‐B*1502 may be a common attribute required for a Thai patient to develop SJS from these two AEDs; other different elements, however, are also needed for each AED. In addition, no association between HLA‐B alleles and CBZ‐ or PHT‐induced MPE was found.

Conclusions: CBZ‐ and PHT‐induced SJS, but not MPE, is associated with HLA‐B*1502 allele in Thai population.
Anticonvulsant hypersensitivity syndrome: Is there a role for immunomodulation?
Authors: Cumbo‐Nacheli Gustavo , Weinberger Jarrett , Alkhalil Michel , Thati Neelima , Baptist Alan P.
Published: July 2008

The anticonvulsant hypersensitivity syndrome (AHS) is an idiosyncratic immunologic reaction to certain anticonvulsant medications, in which internal organ involvement may lead to fatal multisystemic failure. This syndrome has been associated with the use of aromatic ring‐containing agents such as phenytoin, carbamazepine, or phenobarbitone. Clinically, this condition presents with the classic triad of fever, rash, and lymphadenopathy. We review the existing literature on AHS pathogenesis and illustrate a case complicated by liver dysfunction where the use of N‐acetylcysteine (N‐AC) and intravenous immunoglobulin (IVIG) may have altered the course of the disease. The rationale of suggesting N‐AC and IVIG for the treatment of this syndrome relies on the theoretical synergistic effects of the two agents. Although treatment for this syndrome remains controversial and relies heavily on anecdotal evidence, the progression of hepatic injury may be prevented by the addition of N‐AC. The scavenging properties of N‐AC may palliate and possibly prevent free radical‐mediated liver damage. In addition, IVIG may effectively modulate the overreactive immune system in AHS. We discuss the possible role of using immunomodulating agents for the treatment of this syndrome and suggest that alternative regimens should be given special consideration especially in those critical clinical situations where supportive measures appear to be unsuccessful.
The Lazy Professor's Guide to Grading: How to Increase Student Learning While Decreasing Professor Homework
Authors: Barringer S.A.
Published: July 2008

ABSTRACT:  The busy instructor wants to help their students learn but is often pressed for time. This article presents 6 grading techniques that help the students learn without taking a lot of time. First, not grading an assignment saves time and can still be valuable as long as the instructor carefully structures it so the students still have an incentive to complete the assignment and still learn from the assignment. Second, students can grade their own assignments and receive immediate feedback on the correct answer using commercially available scratch off sheets. Third, giving team rather than individual grades encourages peer tutoring as long as teams are carefully managed. Fourth, in‐class peer grading lets students learn from each other, by reading how others did the assignment and discussing it with their team. Fifth, doing an in‐class grading lecture over all of the students' assignments at once allows you to give feedback on common mistakes and is especially helpful when students are unclear on the assignment. Sixth, a grading rubric saves time writing comments and helps the students understand exactly what is expected and is the basis for their grade. These techniques can save time in grading while helping the students to learn the material better.
Synthesis and Crystal Structure of a New Layered Carbide ZrAl4C4
Authors: Iwata Tomoyuki , Hattori Eriko , Hashimoto Shinobu , Fukuda Koichiro
Published: July 2008

A new ternary layered carbide, ZrAl4C4, has been synthesized and characterized by X‐ray powder diffraction. The crystal structure was successfully determined using direct methods and further refined by the Rietveld method. The crystal is trigonal (space groupP3m1,Z=2) with lattice dimensionsa=0.332471(3) nm,c=2.19717(2) nm, andV=0.210330(3) nm3. The final reliability indices calculated from the Rietveld refinement wereRwp=6.56% (S=1.58),Rp=4.92%,RB=1.90%, andRF=0.98%. The compound shows an intergrowth structure with NaCl‐type [Zr2C3] thin slabs separated by Al4C3‐type [Al8C7] layers.
High‐Pressure Device for Fluid Extraction from Porous Materials: Application to Cement‐Based Materials
Authors: Cyr Martin , Rivard Patrice , Labrecque Francis , Daidié Alain
Published: July 2008

A high‐pressure device, reaching an axial pressure of 1000 MPa, intended to the extraction of the pore solution of rigid and slightly porous materials, has been developed to improve the efficiency of extraction. This paper gives an application of fluid extraction from mortars made with Portland cement. It includes an experimental study of the performance of the apparatus, and an analysis of the results in terms of efficiency of extraction, repeatability of measurement, and effect of the squeezing pressure on the pore solution composition. Results shows that: (1) the squeezing efficiency using our apparatus is higher than those found in the literature; (2) the measurement uncertainty ranges between 1.5% and 14%; (3) no significant effect of pressure (up to 1000 MPa) is observed for concentrations of Ca, Na, K, and Si. This paper suggests conducting extraction at 1000 MPa, especially on old concrete or concrete made with low W/C ratios.
Preparation of Eu‐Doped β‐SiAlON Phosphors by Combustion Synthesis
Authors: Zhou You , Yoshizawa Yu‐ichi , Hirao Kiyoshi , Lenčéš Zoltán , Šajgalík Pavol
Published: July 2008

Eu‐doped β‐SiAlON phosphor powders were prepared by a highly efficient combustion synthesis method. By adjusting the starting compositions and choosing appropriate reaction conditions, Si6−zAlzOzN8−z:Eu2+ powders having z values ranging from 0.25 to 2.0 could be synthesized within a few minutes. Phase compositions and particle morphologies of the synthesized powders were characterized and their photoluminescence properties were measured. The phosphors could be excited over a broad spectral range in the UV‐visible region and emit green light. Effects of compositions of the β‐SiAlON:Eu2+ phosphors such as z values on the intensity and wavelength of the emission spectra were examined.
Grain Boundary Segregation and High Nonlinear I–V Characteristics in Fe‐Added Strontium Titanate
Authors: Wang Seong‐Min , Kang Suk‐Joong L.
Published: July 2008

The nonlinear current–voltage (I–V) characteristics of SrTiO3 have been improved greatly by inducing nonequilibrium segregation of Fe‐acceptor dopant at grain boundaries. When Fe‐doped SrTiO3 samples with different Fe additions (0, 0.2, 0.5, 1, 2, and 3 mol%) were sintered at 1350°C in H2, metallic Fe particles were precipitated at grain boundaries and triple junctions. During subsequent air‐annealing at 1100°C, the metallic Fe in the H2‐sintered samples oxidized as Fe2O3 and FeO, and the Fe ions diffused along and segregated at the grain boundaries in the surface region of the sample. The annealed samples showed excellent nonlinear I–V characteristics (α≈173), suggesting that an electrical potential barrier was formed at grain boundaries by the air‐annealing. As the amount of Fe increased up to 2 mol%, the nonlinear properties considerably increased as long as the Fe ion diffusion into the bulk grains was not considerable. The present investigation shows the processing and applicability of Fe‐doped SrTiO3 as a new nonlinear device material.
Biocompatibility and In Situ Growth of TiO2 Nanotubes on Ti Using Different Electrolyte Chemistry
Authors: Das Kakoli , Bandyopadhyay Amit , Bose Susmita
Published: July 2008

Titania nanotube array was grown via anodization using different electrolyte chemistry to understand the influence of solution chemistry and pH on nanotube growth kinetics. One of the electrolytes was selected to evaluate the transformation in the surface morphology as a function of anodization time from 5 to 120 min. Contact angles were measured and surface energies were calculated on selected compositions for various duration of anodization time. It was noticed that contact angle decreased and surface energy increased with the onset of nanotube formation. Human osteoblast cell attachment and proliferation were studied using an osteo precursor cell line. Nanotube surface showed enhanced cell spreading, high cell proliferation, and abundant amount of extracellular matrix formation.
Sialon Ceramics Prepared by Using CaH2 as a Sintering Additive
Authors: Cai Yanbing , Shen Zhijian , Grins Jekabs , Esmaeilzadeh Saeid
Published: July 2008

In developing elongated α‐sialon grains, a nitrogen‐rich liquid phase sintering method was introduced by using CaH2 as a sintering aid, so as to vary the N/O ratio of the liquid phase formed in the sintering process while keeping the Si/Al ratios constant. With increasing addition the phase contents changed from single β‐sialon to dual β/α‐sialons and to single Ca‐α‐sialon. At low N/O ratios the microstructures contained mainly equiaxed β‐sialon grains, and at high N/O ratios well faceted elongated Ca‐α‐sialon grains. The improved toughness (KIC=7.8 MPa·m1/2) and hardness (HV10=17.5 GPa) properties can be attributed to the formation of interlocked microstructures. High‐temperature compressive deformation tests indicated that the deformation onset temperature is determined mainly by the Si/Al and N/O ratios, whereas the deformation rate is affected by the microstructure, i.e., the morphology and amounts of elongated α‐sialon grains and residual glass phase, especially for the sialons with low N/O ratios.
Zr‐Modified Pb(Mg1/3Nb2/3)O3 with a Long‐Range Cation Order
Authors: Zhao Xiaohui , Qu Weiguo , Tan Xiaoli
Published: July 2008

The 1:1 structural order and B‐site cation order in Pb(Mg1/3Nb2/3)O3 ceramics was significantly enhanced by Zr4+ substituting Nb5+ according to the chemical formula Pb(Mg1/3Zr2x/3Nb2(1−x)/3)O3−x/3. The enhanced structural and cation order was revealed by both X‐ray diffraction and transmission electron microscopy. The increased charge difference and the introduced oxygen vacancies were suggested to account for the observed long‐range cation order. Typical relaxor ferroelectric behavior was retained even in the ceramics with a high degree of cation order.
Decreasing Lab Turnaround Time Improves Emergency Department Throughput and Decreases Emergency Medical Services Diversion: A Simulation Model
Authors: Storrow Alan B. , Zhou Chuan , Gaddis Gary , Han Jin H. , Miller Karen , Klubert David , Laidig Andy , Aronsky Dominik
Published: July 2008

Background:  The effect of decreasing lab turnaround times on emergency department (ED) efficiency can be estimated through system‐level simulation models and help identify important outcome measures to study prospectively. Furthermore, such models may suggest the advantage of bedside or point‐of‐care testing and how they might affect efficiency measures.

Objectives:  The authors used a sophisticated simulation model in place at an adult urban ED with an annual census of 55,000 patient visits. The effect of decreasing turnaround times on emergency medical services (EMS) diversion, ED patient throughput, and total ED length of stay (LOS) was determined.

Methods:  Data were generated by using system dynamics analytic modeling and simulation approach on 90 separate days from December 2, 2007, through February 29, 2008. The model was a continuous simulation of ED flow, driven by real‐time actual patient data, and had intrinsic error checking to assume reasonable goodness‐of‐fit. A return of complete laboratory results incrementally at 120, 100, 80, 60, 40, 20, and 10 minutes was compared. Diversion calculation assumed EMS closure when more than 10 patients were in the waiting room and 100% ED bed occupancy had been reached for longer than 30 minutes, as per local practice. LOS was generated from data insertion into the patient flow stream and calculation of time to specific predefined gates. The average accuracy of four separate measurement channels (waiting room volume, ED census, inpatient admit stream, and ED discharge stream), all across 24 hours, was measured by comparing the area under the simulated curve against the area under the measured curve. Each channel’s accuracy was summed and averaged for an overall accuracy rating.

Results:  As lab turnaround time decreased from 120 to 10 minutes, the total number of diversion days (maximum 57 at 120 minutes, minimum 29 at 10 minutes), average diversion hours per day (10.8 hours vs. 6.0 hours), percentage of days with diversion (63% vs. 32%), and average ED LOS (2.77 hours vs. 2.17 hours) incrementally decreased, while average daily throughput (104 patients vs. 120 patients) increased. All runs were at least 85% accurate.

Conclusions:  This simulation model suggests compelling improvement in ED efficiency with decreasing lab turnaround time. Outcomes such as time on EMS diversion, ED LOS, and ED throughput represent important but understudied areas that should be evaluated prospectively. EDs should consider processes that will improve turnaround time, such as point‐of‐care testing, to obtain these goals.
A Theme‐based Hybrid Simulation Model to Train and Evaluate Emergency Medicine Residents
Authors: Noeller Thomas P. , Smith Michael D. , Holmes Laura , Cappaert Melissa , Gross Andrew J. , Cole‐Kelly Kathy , Rosen Kathleen R.
Published: July 2008

Objectives:  The authors sought to design an integrated theme‐based hybrid simulation experience to educate and evaluate emergency medicine (EM) residents, to measure the Accreditation Council for Graduate Medical Education (ACGME) competencies using this simulation model, to measure the impact of the simulation experience on resident performance on written tests, and to measure resident satisfaction with this simulation experience.

Methods:  A theme‐based hybrid simulation model that takes advantage of multiple simulation modalities in a concentrated session was developed and executed to both educate and evaluate EM residents. Simulation days took place at an integrated simulation center and replaced one 5‐hour didactic block per quarter. Modified competency checklists were used to evaluate residents based on ACGME competencies. Written tests were administered before, during, and after simulation days. Residents were given the opportunity to evaluate the simulation days using standard residency program evaluation tools.

Results:  The model was proven feasible. Core competencies were measured using the model, which was executed on four occasions in 2007. Most residents met expectations based on objective checklist criteria and subjective assessment by an observing faculty member. Data from the written tests showed no overall difference in scores measured before, during, or after the simulation days. The simulation model was rated highly useful by the residents.

Conclusions:  With the use of a highly developed simulation center and an organized, theme‐based, hybrid simulation model that takes advantage of multiple simulation modalities, the authors were able to successfully develop an educational model to both train and evaluate EM residents with a high degree of resident satisfaction.
Building a Simulation‐based Crisis Resource Management Course for Emergency Medicine, Phase 1: Results from an Interdisciplinary Needs Assessment Survey
Authors: Hicks Christopher M. , Bandiera Glen W. , Denny Christopher J.
Published: July 2008

Introduction:  Emergency department (ED) resuscitation requires the coordinated efforts of an interdisciplinary team. Human errors are common and have a negative impact on patient safety. Although crisis resource management (CRM) skills are utilized in other clinical domains, most emergency medicine (EM) caregivers currently receive no formal CRM training.

Objectives:  The objectives were to compile and compare attitudes toward CRM training among EM staff physicians, nurses, and residents at two Canadian academic teaching hospitals.

Methods:  Emergency physicians (EPs), residents, and nurses were asked to complete a Web survey that included Likert scales and short answer questions. Focus groups and pilot testing were used to inform survey development. Thematic content analysis was performed on the qualitative data set and compared to quantitative results.

Results:  The response rate was 75.7% (N = 84). There was strong consensus regarding the importance of core CRM principles (i.e., effective communication, team leadership, resource utilization, problem‐solving, situational awareness) in ED resuscitation. Problems with coordinating team actions (58.8%), communication (69.6%), and establishing priorities (41.3%) were among factors implicated in adverse events. Interdisciplinary collaboration (95.1%), efficiency of patient care (83.9%), and decreased medical error (82.6%) were proposed benefits of CRM training. Communication between disciplines is a barrier to effective ED resuscitation for 94.4% of nurses and 59.7% of EPs (p = 0.008). Residents reported a lack of exposure to (64.3%), yet had interest in (96.4%) formal CRM education using human patient simulation.

Conclusions:  Nurses rate communication as a barrier to teamwork more frequently than physicians. EM residents are keen to learn CRM skills. An opportunity exists to create a novel interdisciplinary CRM curriculum to improve EM team performance and mitigate human error.
A Comparison of Door‐to‐balloon Times and False‐positive Activations between Emergency Department and Out‐of‐hospital Activation of the Coronary Catheterization Team
Authors: Youngquist Scott T. , Shah Atman P. , Niemann James T. , Kaji Amy H. , French William J.
Published: July 2008

Objectives:  The objectives were to compare the proportion of false‐positive activations and intervention times between emergency department (ED) and field‐based activation of the coronary catheterization laboratory (cath) team for emergency medical services (EMS) patients identified by out‐of‐hospital (OOH) 12‐lead electrocardiogram (ECG) with ST‐segment elevation myocardial infarction (STEMI).

Methods:  This was a retrospective review of prospectively collected continuous quality improvement data at a single, urban, academic medical center. By protocol, weekday activation of the cath team occurred based on OOH notification of a computer‐interpreted OOH ECG indicating potential STEMI. Night and weekend activation occurred at the discretion of the attending emergency physician (EP) after advanced ED notification and after patient arrival and assessment. Basic demographic information and cardiac risk factors were recorded, as well as door‐to‐balloon (DTB) and ultimate diagnosis.

Results:  From May 2007 through March 2008, there were 23 field activations and 33 ED activations. There was no difference in demographic or clinical characteristics between the two groups. In the field activation group, 9/23 (39%) were false‐positives, while 3/33 (9%) were false‐positives in the ED activation group (30% higher absolute difference in the field activation group, 95% confidence interval [CI] = 8% to 52%, p = 0.02). OOH times and time spent in the ED were similar between the two groups. DTB times were 77 minutes for field activation and 68 minutes for ED activation, respectively (difference 9 minutes, 95% CI = −9 to 27).

Conclusions:  Emergency physician activation of the cath team results in a lower proportion of false‐positive activations without clearly sacrificing DTB time when compared to field activation based solely on the results of the OOH ECG.
Predictors of Mortality in Patients with Delirium Tremens
Authors: Khan Ayesha , Levy Phillip , DeHorn Steve , Miller Wendi , Compton Scott
Published: July 2008

Objectives:  The objectives were to identify factors that may help predict mortality for patients with delirium tremens (DT).

Methods:  The authors conducted a 1:1 gender‐ and age‐matched case–control study of patients hospitalized for DT. Using McNemar chi‐square tests and conditional logistic regression (CLR), risk factors for death, including demographics, location of diagnosis, vital sign derangements, treatment methods, and comorbid conditions, were evaluated. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported.

Results:  Thirty‐five patients with DT died between January 2000 and June 2006. The majority (31; 88.6%) were male with a mean (±standard deviation [SD]) age of 51.7 (±7.6) years. Hyperthermia in the first 24 hours of DT diagnosis (OR = 10.0, 95% CI = 2.3 to 42.7), persistent tachycardia (OR = 24.0, 95% CI = 3.3 to 177.4), and use of restraints (OR = 7.50, 95% CI = 1.7 to 32.8) were associated with increased mortality by univariate analysis, while an emergency department (ED) diagnosis of DT (OR = 0.18, 95% CI = 0.05 to 0.6) and use of clonidine (OR = 0.10, 95% CI = 0.01 to 0.78) were associated with decreased mortality. In the CLR model, restraint use and hyperthermia were the only variables that remained significant (OR = 5.8, 95% CI = 1.0 to 32.2; and OR = 6.1, 95% CI = 1.2 to 30.4, respectively).

Conclusions:  The use of restraints and hyperthermia is associated with increased odds of death for patients with DT. This study highlights the need for further research into modifiable factors influencing mortality from DT.
Simulation in Graduate Medical Education 2008: A Review for Emergency Medicine
Authors: McLaughlin Steve , Fitch Michael T. , Goyal Deepi G. , Hayden Emily , Kauh Christine Yang , Laack Torrey A. , Nowicki Thomas , Okuda Yasuharu , Palm Ken , Pozner Charles N. , Vozenilek John , Wang Ernest , Gordon James A. ,   on behalf of the SAEM Technology in Medical Education Committee and the Simulation Interest Group
Published: July 2008

Health care simulation includes a variety of educational techniques used to complement actual patient experiences with realistic yet artificial exercises. This field is rapidly growing and is widely used in emergency medicine (EM) graduate medical education (GME) programs. We describe the state of simulation in EM resident education, including its role in learning and assessment. The use of medical simulation in GME is increasing for a number of reasons, including the limitations of the 80‐hour resident work week, patient dissatisfaction with being “practiced on,” a greater emphasis on patient safety, and the importance of early acquisition of complex clinical skills. Simulation‐based assessment (SBA) is advancing to the point where it can revolutionize the way clinical competence is assessed in residency training programs. This article also discusses the design of simulation centers and the resources available for developing simulation programs in graduate EM education. The level of interest in these resources is evident by the numerous national EM organizations with internal working groups focusing on simulation. In the future, the health care system will likely follow the example of the airline industry, nuclear power plants, and the military, making rigorous simulation‐based training and evaluation a routine part of education and practice.
Fatal Renal Hemorrhage After Extracorporeal Shock Wave Lithotripsy
Authors: Törő Klára , Kardos Magdolna
Published: July 2008

Abstract:  Renal hematoma is one of the most severe complications of extracorporeal shock wave lithotripsy (ESWL). ESWL is used in the noninvasive treatment of urinary calculosis. The shock waves can lead to capillary damage, renal parenchymal or subcapsular hemorrhage. We present a case with fatal complication and the result of the medico‐legal evaluation. A 71‐year‐old woman was treated by ESWL, renal hematoma was detected during the clinical observation, and the patient died. The death occurred despite close clinical observation as a consequence of a rare complication of ESWL. The mechanism of death was hemorrhagic hypovolemic shock due to renal hemorrhage complications due to ESWL for treatment of renal calculi. This therapeutic complication is a known complication of appropriate treatment.
Recovery Efficiencies of Anthrax Spores and Ricin from Nonporous or Nonabsorbent and Porous or Absorbent Surfaces by a Variety of Sampling Methods*
Authors: Frawley Dody A. , Samaan Marian N. , Bull Robert L. , Robertson James M. , Mateczun Alfred J. , Turnbull Peter C. B.
Published: July 2008

Abstract:  The 2001 anthrax letter cases brought into focus the need to establish the most effective environmental sampling procedures. Results are presented from two studies aimed at establishing the best procedures for everyday surfaces likely to be contaminated after the release of environmentally stable bioaggressive agents, as exemplified by anthrax spores and ricin. With anthrax spores, contact plates, with mean retrieval rates of 28–54%, performed better than other methods by a wide margin for flat nonporous, nonabsorbent surfaces. They also proved best on flat porous, absorbent materials, although recoveries were low (<7%). For both agents, dry devices (swabs, wipes, Trace Evidence Collection Filters) had universally poor retrieval efficiencies with no significant differences between them. Among moistened devices (wipes, swabs, and Sample Collection and Recovery Devices), wipes were generally best, albeit with considerable cross‐over among individual readings (highest mean recoveries for anthrax spores and ricin 5.5% and 2.5%, respectively, off plastic).
Calliphora vicina (Diptera: Calliphoridae) Collected from a Human Corpse Above 3400 m in Elevation
Authors: Adair Thomas W.
Published: July 2008

Abstract:  In the summer of 2005 an adult hiker was killed in a fall in Rocky Mountain National Park, Colorado (U.S.A.). His body was subsequently colonized by the blowfly Calliphora vicina (Diptera: Calliphoridae). The body was discovered 9 days later at an elevation of 3475 m (11,400 feet). This is the first report of C. vicina on a human corpse at this elevation in Colorado. This paper provides additional confirmation of this fly colonizing a human corpse at high elevations in Colorado.
How Reliable is Reported Sleeping Position in Cases of Unexpected Infant Death?
Authors: Byard Roger W. , Jensen Lisbeth L.
Published: July 2008

Abstract:  Examination of sudden infant death syndrome (SIDS) deaths in South Australia over a 7‐year period from 2000 to 2006 was undertaken. There were 32 out of 35 cases where details of position when found were known. The data confirmed a marked decline in deaths in the prone position over the past decade, but showed no significant decline in cases reportedly found dead in the supine position. Posterior lividity was present in most cases (n = 30), 10 of whom also had anterior lividity. Posterior lividity was attributable either to the position of the body after death or to the effect of supine postmortem storage. In six cases, however, fixed anterior lividity indicated that death had occurred in the prone position despite statements that the infants had been found on the side (n = 1) and in the supine position (n = 5). This contradiction indicates that caregivers’ descriptions of terminal sleeping positions may not be supported by autopsy findings. The numbers of SIDS deaths reported in the supine position in South Australia may not, therefore, represent a genuine tally, but instead may be a function of inaccurate reporting. This may act as a confounding factor in studies attempting to link sleeping position with other risk factors.