bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of a ‘discharge time-out’ on the quality of hospital discharge summaries
Authors: Mohta Namita , Vaishnava Prashant , Liang Cathy , Ye Kye , Vitale Matt , Dalal Anuj , Schnipper Jeff
Published: May 2012

Background

High-quality discharge summaries are a key component of a safe transition in care. The purpose of this study was to determine the effects of standardised feedback and a ‘discharge time-out’ (DTO) on the quality of discharge summaries.

Methods

During 2006–2007, the authors trained hospitalists to provide two interventions at their discretion: (1) feedback on one discharge summary to each intern using a standardised form and (2) a DTO, modelled after the surgical time-out, in which key questions about the patient's hospital course and discharge plan are answered verbally by the intern during rounds on the day of discharge. To evaluate these interventions, trained clinicians, blinded to group assignment, performed an explicit review of two discharge summaries before and after intervention implementation. The authors used a mixed linear model to evaluate relative improvement over time.

Results

The authors compared 14 interns who only received a 1-h lecture and a small-group resident-led training session with 13 interns who also received feedback and 12 interns who received feedback and a DTO. Save greater improvement in the documentation of tasks to be completed after discharge (39% vs 8% absolute improvement, p=0.05) by interns receiving an intervention, most domains were unaffected by having received a DTO and/or feedback.

Conclusion

These results suggest that standardised feedback and a DTO integrated into attending rounds have limited potential to improve discharge summaries as currently designed. This study stresses the need for developing and refining interventions that can improve the narrative flow of discharge summaries.
The H-PEPSS: an instrument to measure health professionals' perceptions of patient safety competence at entry into practice
Authors: Ginsburg Liane , Castel Evan , Tregunno Deborah , Norton Peter G
Published: May 2012

Background

Enhancing competency in patient safety at entry to practice requires introduction and integration of patient safety into health professional education. As efforts to include patient safety in health professional education increase, it is important to capture new health professionals' perspectives of their own patient safety competence at entry to practice. Existing instruments to measure patient safety knowledge, skills and attitudes have been developed largely to examine the impact of specific patient safety curricular initiatives and the psychometric analyses of the instruments used thus far have been exploratory in nature.

Methods

Confirmatory factor analytic approaches are used to extensively test theHealth Professional Education in Patient Safety Survey (H-PEPSS), a newly designed survey rooted in a patient safety competency framework and designed to measure health professionals' self-reported patient safety competence around the time of entry to practice. The H-PEPSS focuses primarily on the socio-cultural aspects of patient safety including culture, teamwork, communication, managing risk and understanding human factors.

Results

Results support a parsimonious six-factor measurement model of health professionals' perceptions of patient safety competency. These results support the validity of a reduced version of the H-PEPSS and suggest it can be appropriately used at or near training completion with a variety of health professional groups.

Conclusions

Given increased demands for patient safety competency among health professionals at entry to practice and slow, but emerging changes in health professional education, ongoing research to understand the extent of patient safety competency among health professionals around the time of entry to practice will be important.
Identifying and categorising patient safety hazards in cardiovascular operating rooms using an interdisciplinary approach: a multisite study
Authors: Gurses Ayse P , Kim George , Martinez Elizabeth A , Marsteller Jill , Bauer Laura , Lubomski Lisa H , Pronovost Peter J , Thompson David
Published: May 2012

Background

Cardiac surgery is a complex, high-risk procedure with potential vulnerabilities for patient safety. The evidence base describing safety hazards in the cardiovascular operating room is underdeveloped but is essential to guide future safety improvement efforts.

Objective

To identify and categorise hazards (anything that has the potential to cause a preventable adverse patient safety event) in the cardiovascular operating room.

Methods

An interdisciplinary team of researchers used prospective methods, including direct observations, contextual inquiry and photographs to collect hazard data pertaining to the cardiac surgery perioperative period, which started immediately before the patient was transferred to the operating room and ended immediately after patient handoff to the post-anaesthesia/intensive care unit. Data were collected between February and September 2008 in five hospitals. An interdisciplinary approach that included a human factors and systems engineering framework was used to guide the study.

Results

Twenty cardiac surgeries including the corresponding handoff processes from operating room to post-anaesthesia/intensive care unit were observed. A total of 58 categories of hazards related to care providers (eg, practice variations), tasks (eg, high workload), tools and technologies (eg, poor usability), physical environment (eg, cluttered workspace), organisation (eg, hierarchical culture) and processes (eg, non-compliance with guidelines) were identified.

Discussion

Hazards in cardiac surgery services are ubiquitous, indicating numerous opportunities to improve safety. Future efforts should focus on creating a stronger culture of safety in the cardiovascular operating room, increasing compliance with evidence-based infection control practices, improving communication and teamwork, and developing a partnership among all stakeholders to improve the design of tools and technologies.
Emergency care provision at the 2009 Special Olympics Great Britain
Authors: Williamson Timothy , Wheeler Patrick , Stephens Catherine , Ferguson Mike
Published: May 2012

Background

The Special Olympics Great Britain (SOLGB) summer games 2009 were held in Leicester between 25 and 31 July. They involved 2413 athletes that were engaged in 21 different sports across 19 different locations. The onsite healthcare was provided by a specialist medical team. The hospital services available were at the local emergency department (ED) and the co-located urgent care centre (UCC).

Aim

To assess the on-site provision required to support a large multisport event for people with learning disabilities and to ascertain the impact on the local hospital services.

Methods

On-site consultations were documented on SOLGB medical record forms. Referrals to the local ED and UCC were identified from the SOLGB medical notes or from the ED/UCC attendance codes, as a specific code was applied to all patients related to the games.

Results

581 on-site consultations were documented at SOLGB 2009, of which 95% of these were for athletes. 477 treatments were completed in total, of which 444 were undertaken on-site (93%). 20 people attended the ED; there were no documented attendances at the UCC. 17 of the 20 attendances at the ED were athletes competing.

Conclusion

Allocation of the healthcare team was appropriate, with the exception of one sport, where a doctor was moved from a nearby event to consult on 13 occasions. Attendances to the local ED and UCC were minimal. Therefore, the model of on-site medical care that was used, which led to minimal impact on NHS resources, will support the arrangements of medical requirements at future SOLGB games.
Association between admission delay and adverse outcome of emergency medical patients
Authors: Junhasavasdikul Detajin , Theerawit Pongdhep , Kiatboonsri Sumalee
Published: May 2012

Aim

To determine whether admission delay (lead-time) and other factors are associated with hospital mortality rates of emergency medical patients.

Methods

Patients presenting with emergency conditions during August to November 2009, and admitted to medical wards, including intensive care units, were enrolled. The time each patient spent in the ED, and other parameters were recorded. The primary outcome was the association between lead-time and hospital mortality. The secondary outcome was the association between lead-time and delta Modified Early Warning Score (MEWS) (MEWS at ward − MEWS at ED).

Results

381 cases were analysed. The overall mortality rate was 8.9%. By univariate analysis, the significant factors associated with mortality outcome were lead-time, ECOG (Eastern Cooperative Oncology Group) score, MEWS at ED, delta MEWS and sepsis. By multivariate analysis, the remaining significant factors were MEWS at ED, delta MEWS and sepsis. There was no significant relationship between delta MEWS and lead-time. In a sub-group of patients admitted to intensive care units, however, there was a positive correlation between lead-time and delta MEWS.

Conclusion

MEWS, delta MEWS and sepsis were predictors of hospital mortality in emergency medical patients. Lead-time was not associated with mortality, which could be due to benefits of various treatments initiated in the ED. In patients requiring intensive care, however, the longer lead-time probably led to higher MEWS and mortality.
Can training improve laypersons helping behaviour in first aid? A randomised controlled deception trial
Authors: Van de Velde Stijn , Roex Ann , Vangronsveld Karoline , Niezink Lidewij , Van Praet Koen , Heselmans Annemie , Donceel Peter , Vandekerckhove Philippe , Ramaekers Dirk , Aertgeerts Bert
Published: May 2012

Background

There is limited evidence indicating that laypersons trained in first aid provide better help, but do not help more often than untrained laypersons. This study investigated the effect of conventional first aid training versus conventional training plus supplementary training aimed at decreasing barriers to helping.

Methods

The authors conducted a randomised controlled trial. After 24 h of conventional first aid training, the participants either attended an experimental lesson to reduce barriers to helping or followed a control lesson. The authors used a deception test to measure the time between the start of the unannounced simulated emergency and seeking help behaviour and the number of particular helping actions.

Results

The authors randomised 72 participants to both groups. 22 participants were included in the analysis for the experimental group and 36 in the control group. The authors found no statistically or clinically significant differences for any of the outcome measures. The time until seeking help (geometrical mean and 95% CI) was 55.5 s (42.9 to 72.0) in the experimental group and 56.5 s (43.0 to 74.3) in the control group. 57% of the participants asked a bystander to seek help, 40% left the victim to seek help themselves and 3% did not seek any help.

Conclusion

Supplementary training on dealing with barriers to helping did not alter the helping behaviour. The timing and appropriateness of the aid provided can be improved.

Trial registration

The authors registered this trial at ClinicalTrials.gov asNCT00954161.
Observational cadaveric study of emergency bystander cricothyroidotomy with a ballpoint pen by untrained junior doctors and medical students
Authors: Neill Andrew , Anderson Philip
Published: May 2012

Objective

Apart from case reports and anecdotes, there are no published studies on the feasibility of using non-medical devices for emergency bystander cricothyroidotomy. This study evaluated the ability of non-trained junior doctors and medical students to place an emergency cricothyroidotomy on an embalmed cadaver using only a blade and a ballpoint pen.

Methods

Participants were junior doctors with no prior experience of surgical airways and second year medical students at the end of their head and neck anatomy course. Nine participants were asked to place an emergency cricothyroidotomy in an undissected embalmed cadaver using only a No 26 scalpel and a dismantled ballpoint pen (Papermate Flexigrip Ultra, external diameter 8.9 mm; internal diameter 7.0 mm). Times were recorded and direct visualisation by dissection was used to assess placement and complications.

Results

Nine participants performed a total of 14 separate cricothyroidtomies on separate cadavers. Landmarks were palpable by researchers in 10 of the 14 cadavers. Eight of 14 (57%) procedures were deemed successful. No major vascular injury occurred. Injuries to the thyroid and cricoid cartilages were common; four of 14 (29%) of these injuries were fractures.

Conclusions

In embalmed cadavers, inexperienced junior doctors and medical students with no prior training were able to place a successful cricothyroidotomy slightly more than half the time. It suggests that surgical cricothyroidotomy with a ballpoint pen and blade is a feasible option in extremis. It is unknown whether junior doctors from other specialties, such as emergency medicine, would perform better.
Usefulness of imprint and brushing cytology in diagnosis of lung diseases with flexible bronchoscopy
Authors: Michels Guido , Topalidis Theodoros , Büttner Reinhard , Engels Marianne , Pfister Roman
Published: May 2012

Background

To increase the diagnostic yield in pulmonary diseases, histopathology, imprint cytology and brushing cytology are assessed in combination during flexible bronchoscopy. However, the individual diagnostic discrimination of the three methods is unclear.

Methods

The authors performed the three sampling techniques in 102 consecutive patients with suspected pulmonary pathologies and compared the definitive diagnosis with those of histopathology, imprint and brushing cytology for their diagnostic values regarding evidence of malignancy.

Results

33.3% of all histopathological specimens, 31.4% of all imprints and 26.5% of brush biopsy specimens were positive for malignancy. The values for sensitivities were 94% for histopathology, 89% for imprint cytology and 75% for brushing cytology, respectively. Although brushing cytology had limited sensitivity, in two cases a malignant lung tumour was only diagnosed from cytological examination of brushing.

Conclusion

In conclusion, routine imprint cytology does not increase the diagnostic sensitivity, whereas routine brushing cytology should be used in combination with histopathology to obtain the highest diagnostic rate of yield.
Relationship between the achievement of successive periodic health examinations and the risk of dying. Appraisal of a prevention scheme
Authors: Henny Joseph , Paulus Amélie , Helfenstein Michel , Godefroy Thierry , Guéguen René
Published: May 2012

Background

In the field of Periodic Health Examination (PHE), few studies brought information on their efficiency, both on morbidity and mortality.

Objective

The association between the reduction of mortality and a regular participation in PHE has been estimated.

Methods

This study concerned 50 116 persons 40–59 years old, of European origin, examined at the Centre of Preventive Medicine, Nancy, France, between 1 January 1980 and 31 December 1985 with a maximum duration of follow-up reaching 25 years. The risk of dying according to the number of examination was compared (Cox regression Model). The reduction in mortality (all causes as well as cancer and cardiovascular diseases) was significant for persons whose practice of the PHE continued for at least 10 years or more. The second approach used a propensity score. After stratification on the propensity score, the relative mortality risk of those who returned at least once (compared with never) for a new check-up was 0.75 (95% CI 0.69 to 0.82) in men and 0.89 (95% CI 0.78 to 1.02) in women.

Conclusion

The survival analysis evidenced a significant reduction of all-cause mortality, as well as of cancer and cardiovascular-related mortality, in men and women having benefited from several PHEs. On the other hand, the Cox model by class of propensity score allowed to show a reduction in mortality only in men who returned at least once, in particular that of a higher health interest among the regular beneficiaries of PHE.
Sexual behaviour and risk reduction strategies among a multinational sample of women who have sex with women
Authors: Schick Vanessa , Rosenberger Joshua G , Herbenick Debby , Reece Michael
Published: May 2012

Objectives

The development of safer sex recommendations for women who have sex with women (WSW) remains challenging given a limited understanding of sexual behaviour between women. The present study was conducted in order to investigate the sexual repertoires of WSW and the safer sex methods they use to reduce the likelihood of sexually transmitted infection acquisition.

Methods

An online survey targeted towards women with desire, attraction or previous sexual behaviour with women was distributed globally. Women (N=3116) who engaged in at least one sexual act with a woman in the previous year and were currently living in the USA, UK, Canada or Australia were included in the present study. Questions were based upon previously validated items in nationally representative studies.

Results

Participants indicated a wide diversity of sexual behaviours with the majority of women reporting a history of genital rubbing (99.8%), vaginal fingering (99.2%), genital scissoring (90.8%), cunnilingus (98.8%) and vibrator use (74.1%). Barrier use was reported by a minority (<25%) of the participants.

Conclusions

The variety of sexual acts reported by the sample points to the need for the development of more contextually appropriate sexual health guidelines for WSW.
EFFECT OF THE PARTICLE-NUMBER SYMMETRY RESTORATION ON ROOT MEAN SQUARE RADII OF EVEN–EVEN NEUTRON-DEFICIENT NUCLEI IN THE ISOVECTOR PAIRING CASE
Authors: DOUICI M. , ALLAL N. H. , FELLAH M. , BENHAMOUDA N. , OUDIH M. R.
Published: May 2012

The effect of the particle-number symmetry restoration on the root mean square (rms) proton and neutron radii of neutron-deficient nuclei is studied in the isovector pairing case. As a first step, an expression of the nuclear radii which includes the neutron–proton pairing effects and which strictly conserves the particle-number has been established using the SBCS (Sharp BCS) method. It is shown that this expression generalizes the one obtained in the pairing between like-particles case. As a second step, the proton and neutron rms radii are numerically evaluated for even–even nuclei such as 16⩽Z⩽56 and 0⩽(N-Z)⩽4 using the single-particle energies of a Woods–Saxon mean-field. The results are compared with experimental data when available and with the results obtained when one considers only the pairing between like-particles.
THE FORM FACTOR OF ργ*→π0IN THE FINITE-WIDTH LIGHT-CONE LOCAL DUALITY SUM RULE
Authors: LI MINGHAI , LIU JUEPING
Published: May 2012

The form factor of the transition ργ*→π0is investigated by analyzing the γγ*→π0transition in the framework of the light-cone local duality quantum chromodynamics sum rules. Both finite- and zero-width forms for the low-energy physical absorptive part of the γγ*→π0transition are considered. The numerical results for the transition form factor Fρπ(Q2) in the asymptotic form and the CZ one of the pion distribution amplitude are obtained respectively, the difference between the finite- and zero-width form is not big but still distinguishable. It is found that the results for the form factor Fρπ(Q2) from CZ, asymptotic and the flat pion DAs are compatible with the predictions of perturbative QCD. Our results will be helpful to distinguish the shape of the pion DA of twist-two, when the concrete information of the experimental data for the transition ργ*→π0are provided.
"ARE WE THERE YET?" ASSESSING THE CONTRIBUTION OF INSPIRE TO EIA AND SEA STUDIES
Authors: CRAGLIA MAX , PAVANELLO LARA , SMITH ROBIN S.
Published: May 2012

This paper reports the findings of a survey in 2009 of European practitioners who face problems related to accessing and using spatial data when preparing reports for Environmental Impact Assessments (EIAs) and Strategic Environmental Assessments (SEAs). The survey was designed to be comparable to the one undertaken in 2002–03 and reported by Vanderhaegen and Muro (2005). The 2009 survey showed that problems persist and additional costs to practitioners due to data access problems were at least €150 million p.a. in Europe, providing evidence for the need for ongoing investment in the INSPIRE Directive, which aims to support spatial and environmental data-sharing for EIA/SEA studies as well as other environmental policies. The survey also indicated that although EIA and SEA reports now take less time and are, on average, cheaper to prepare, the variability of their quality is still of concern.
Appetitive changes during salt deprivation are paralleled by widespread neuronal adaptations in nucleus accumbens, lateral hypothalamus, and central amygdala
Authors: Tandon Shashank , Simon Sidney A. , Nicolelis Miguel A. L.
Published: May 2012

Salt appetite is a goal-directed behavior in which salt-deprived animals ingest high salt concentrations that they otherwise find aversive. Because forebrain areas such as the lateral hypothalamus (LH), central amygdala (CeA), and nucleus accumbens (NAc) are known to play an important role in this behavior, we recorded from these areas while water-deprived (WD) and salt-deprived (SD) rats performed a two-bottle choice test between 0.5 M salt (NaCl) and 0.4 M sucrose. In the SD state, the preference ratio for high molar salt markedly increased. Electrophysiological recordings analyzed with respect to the onset of licking clusters revealed the presence of both excitatory and inhibitory neuronal responses during salt and/or sucrose consumption. In the NAc, putative medium spiny neurons and tonically active neurons exhibited excitatory and inhibitory responses. In all areas, compared with those recorded during the WD state, neurons recorded during the SD state showed an increase in the percentage of salt-evoked excitatory responses and a decrease in the percentage of sucrose-evoked inhibitory responses, suggesting that a subset of the neuronal population in these areas codes for the increased motivational and/or hedonic value of the salt solution. In addition, in the SD state, the firing of excitatory neurons in LH and CeA became more synchronized, indicating a greater functional connectivity between salt-responsive neurons in these areas. We propose that plastic changes in the feeding-related neuronal populations of these forebrain areas arise when changes in metabolic state alter the hedonic and motivational value of a particular taste stimulus.
Mixed-Ligand Nickel(II) Complexes Containing Sulfathiazole and Cephalosporin Antibiotics: Synthesis, Characterization, and Antibacterial Activity
Authors: Anacona J. R. , Lopez Maried
Published: May 2012

Nickel(II) reacts with cephalosporins plus sulfathiazole (Hstz) to form the following mixed-ligand complexes of general formulae [Ni(L)(stz)(H2O)x]n
(L1,4, x=1; L2,3, x=0; L = monoanion of cefazolin HL1, cephalothin HL2, cefotaxime HL3, ceftriaxone HL4) and [Ni(L5)(stz)]Cl (cefepime L5), which were characterized by physicochemical and spectroscopic methods. Their spectra indicated that cephalosporins are acting as multidentate chelating agents, via the lactam carbonyl and carboxylate and N-azomoieties. The complexes are insoluble in water and common organic solvents but soluble in DMSO, where the [Ni(L5)(stz)]Cl complex is 1 : 1 electrolyte. They probably have polymeric structures. They have been screened for antibacterial activity, and the results are compared with the activity of commercial cephalosporins.
Excess Early Postnatal Weight Gain Leads to Increased Abdominal Fat in Young Children
Authors: Evelein Annemieke M. V. , Visseren Frank L. J. , van der Ent Cornelis K. , Grobbee Diederick E. , Uiterwaal Cuno S. P. M.
Published: May 2012

Background. Increased childhood weight gain has been associated with later adiposity. Whether excess early postnatal weight gain plays a role in childhood abdominal fat is unknown.Design. In the ongoing Wheezing Illnesses Study Leidsche Rijn (WHISTLER), birth cohort weight and length from birth to age 3 months were obtained. In the first 316 five-year-olds, intra-abdominal and subcutaneous fat were measured ultrasonographically. Individual weight and length gain rates were assessed in each child. InternalZ-scores of weight for length gain (WLG) were calculated. Multiple imputation was used to deal with missing covariates.Results. Per-1-unit increase inZ-score WLG from birth to 3 months, BMI, waist circumference, and subcutaneous fat were significantly higher; 0.51 kg/m2, 0.84 cm, and 0.50 mm, respectively. After multiple imputation, a trend towards significance was observed for intra-abdominal fat as well (0.51 mm/SD). In the associations with 5-year adiposity, no interaction between postnatalZ-score WLG and birth size was found.Conclusion. Excess early postnatal weight gain is associated with increased general and central adiposity, characterized by more subcutaneous and likely more intra-abdominal fat at 5 years of age.
Advancements in Laparoscopic Partial Nephrectomy: Expanding the Feasibility of Nephron-Sparing
Authors: Pietzak Eugene J. , Guzzo Thomas J.
Published: May 2012

Partial nephrectomy (PN) offers equivalent oncologic outcomes to radical nephrectomy (RN) but has greater preservation of renal function and less risk of chronic kidney disease and cardiovascular disease. Laparoscopic PN remains underutilized likely because it is a technically challenging operation with higher rates of perioperative complications compared to open PN and laparoscopic RN. A review of the latest PN literature demonstrates that recent advancements in laparoscopic approaches, imaging modalities, ischemic mitigating strategies, renorrhaphy techniques, and hemostatic agents will likely allow greater utilization of LPN and expand its usage to increasingly more complex tumors.
The Relationship between Heart Rate Variability and Adiposity Differs for Central and Overall Adiposity
Authors: Windham B. Gwen , Fumagalli Stefano , Ble Alessandro , Sollers John J. , Thayer Julian F. , Najjar Samar S. , Griswold Michael E. , Ferrucci Luigi
Published: May 2012

While frank obesity is associated with reduced HRV, indicative of poorer autonomic nervous system (ANS) function, the association between body mass index (BMI) and HRV is less clear. We hypothesized that effects of adiposity on ANS are mostly mediated by visceral fat and less by subcutaneous fat; therefore, centrally distributed adipose tissue, that is, waist circumference (WC), should be more strongly associated with HRV than overall adiposity (BMI). To examine this hypothesis, we used data collected in a subset of the Baltimore Longitudinal Study of Aging to compare strength of association between HRV and WC to that of HRV and BMI. Time domain HRV variables SDNN (standard deviation of successive differences in normal-to-normal (N-N) intervals) and RMSSD (root mean square of successive differences in N-N intervals) were calculated from 24-hour Holter recordings in 159 participants (29–96 years). Increasing WC was associated with decreasing SDNN and RMSSD in younger but not older participants (Pvalue for WC-by-age interaction = 0.003). BMI was not associated with either SDNN or RMSSD at any age. In conclusion, central adiposity may contribute to sympathetic and parasympathetic ANS declines early in life.
Sonographic Lobe Localization of Alveolar-Interstitial Syndrome in the Critically Ill
Authors: Stefanidis Konstantinos , Dimopoulos Stavros , Kolofousi Chrysafoula , Cokkinos Demosthenes D. , Chatzimichail Katerina , Eisen Lewis A. , Wachtel Mitchell , Karakitsos Dimitrios , Nanas Serafim
Published: May 2012

Introduction. Fast and accurate diagnosis of alveolar-interstitial syndrome is of major importance in the critically ill. We evaluated the utility of lung ultrasound (US) in detecting and localizing alveolar-interstitial syndrome in respective pulmonary lobes as compared to computed tomography scans (CT).Methods. One hundred and seven critically ill patients participated in the study. The presence of diffuse comet-tail artifacts was considered a sign of alveolar-interstitial syndrome. We designated lobar reflections along intercostal spaces and surface lines by means of sonoanatomy in an effort to accurately localize lung pathology. Each sonographic finding was thereafter grouped into the respective lobe.Results. From 107 patients, 77 were finally included in the analysis (42 males with mean age=61±17years, APACHE II score=17.6±6.4, and lung injury score=1.0±0.7). US exhibited high sensitivity and specificity values (ranging from over 80% for the lower lung fields up to over 90% for the upper lung fields) and considerable consistency in the diagnosis and localization of alveolar-interstitial syndrome.Conclusions. US is a reliable, bedside method for accurate detection and localization of alveolar-interstitial syndrome in the critically ill.
Cystic Fibrosis: Brazilian ENT Experience
Authors: Sih Tania , Godinho Ricardo , Franco Leticia Paiva , Piltcher Otávio
Published: May 2012

Most published studies about Cystic Fibrosis (CF) are European or North American. There are still few publications about the characteristics of fibrocystic populations in developing countries. The incidence of cystic fibrosis (CF) in Brazil varies among different regions (1 : 10,000 in Minas Gerais, 1 : 9,500 in Paraná, 1 : 8,700 in Santa Catarina, and 1 : 1600 in Rio Grande do Sul). The prevalence of the DF508 mutation also varies according to population: 33% in Sao Paulo, 49% in Rio Grande do Sul, 27% in Santa Catarina, and 52% in Minas Gerais. Cough and nasal obstruction are the most common symptoms. The variation in nasal polyposis prevalence may be explained by population genotypic characteristics in a country that spans a continent. Findings on nasal endoscopy and computed tomography (CT) have better correlation than do this information compared with surgical and clinical history. Microbiologic studies suggest a high level of early contamination of the airways. Sensorineural hearing loss (SNHL) occurs in these patients as a result of ototoxic antibiotics. The data compiled in this paper is useful, but also lead to the general agreement that more research would be welcome due to the unique characteristics of this country.
L-Arginine and Asymmetric Dimethylarginine Are Early Predictors for Survival in Septic Patients with Acute Liver Failure
Authors: Brenner Thorsten , Fleming Thomas H. , Rosenhagen Claudia , Krauser Ute , Mieth Markus , Bruckner Thomas , Martin Eike , Nawroth Peter P. , Weigand Markus A. , Bierhaus Angelika , Hofer Stefan
Published: May 2012

Dysfunctions of the L-arginine (L-arg)/nitric-oxide (NO) pathway are suspected to be important for the pathogenesis of multiple organ dysfunction syndrome (MODS) in septic shock. Therefore plasma concentrations of L-arg and asymmetric dimethylarginine (ADMA) were measured in 60 patients with septic shock, 30 surgical patients and 30 healthy volunteers using enzyme linked immunosorbent assay (ELISA) kits. Plasma samples from patients with septic shock were collected at sepsis onset, and 24 h, 4 d, 7 d, 14 d and 28 d later. Samples from surgical patients were collected prior to surgery, immediately after the end of the surgical procedure as well as 24 h later and from healthy volunteers once. In comparison to healthy volunteers and surgical patients, individuals with septic shock showed significantly increased levels of ADMA, as well as a decrease in the ratio of L-arg and ADMA at all timepoints. In septic patients with an acute liver failure (ALF), plasma levels of ADMA and L-arg were significantly increased in comparison to septic patients with an intact hepatic function. In summary it can be stated, that bioavailability of NO is reduced in septic shock. Moreover, measurements of ADMA and L-arg appear to be early predictors for survival in patients with sepsis-associated ALF.
Correlation of Oxidative Stress with Serum Trace Element Levels and Antioxidant Enzyme Status in Beta Thalassemia Major Patients: A Review of the Literature
Authors: Shazia Q. , Mohammad Z. H. , Rahman Taibur , Shekhar Hossain Uddin
Published: May 2012

Beta thalassemia major is an inherited disease resulting from reduction or total lack of beta globin chains. Patients with this disease need repeated blood transfusion for survival. This may cause oxidative stress and tissue injury due to iron overload, altered antioxidant enzymes, and other essential trace element levels. The aim of this review is to scrutinize the relationship between oxidative stress and serum trace elements, degree of damage caused by oxidative stress, and the role of antioxidant enzymes in beta thalassemia major patients. The findings indicate that oxidative stress in patients with beta thalassemia major is mainly caused by tissue injury due to over production of free radical by secondary iron overload, alteration in serum trace elements and antioxidant enzymes level. The role of trace elements like selenium, copper, iron, and zinc in beta thalassemia major patients reveals a significant change of these trace elements. Studies published on the status of antioxidant enzymes like catalase, superoxide dismutase, glutathione, and glutathione S-transferase in beta thalassemia patients also showed variable results. The administration of selective antioxidants along with essential trace elements and minerals to reduce the extent of oxidative damage and related complications in beta thalassemia major still need further evaluation.
Magnetic and Magnetoelectric Properties of Rare Earth Molybdates
Authors: Ponomarev B. K. , Zhukov A.
Published: May 2012

We present results on ferroelectric, magnetic, magneto-optical properties and magnetoelectric effect of rare earth molybdates (gadolinium molybdate, GMO, and terbium molybdate, TMO, and samarium molybdate, SMO), belonging to a new type of ferroelectrics predicted by Levanyuk and Sannikov. While cooling the tetragonal β-phase becomes unstable with respect to two degenerate modes of lattice vibrations. The β-β′ transition is induced by this instability. The spontaneous polarization appears as a by-product of the lattice transformation. The electric order in TMO is of antiferroelectric type. Ferroelectric and ferroelastic GMO and TMO at room temperature are paramagnets. At low temperatures GMO and TMO are antiferromagnetic with the Neel temperatures TN=0.3 K (GMO) and TN=0.45 K (TMO). TMO shows the spontaneous destruction at 40 kOe magnetic field. Temperature and field dependences of the magnetization in TMO are well described by the magnetism theory of singlets at 4.2 K ≤ T ≤ 30 K. The magnetoelectric effect in SMO, GMO and TMO, the anisotropy of magnetoelectric effect in TMO at T = (1.8–4.2) K, the Zeeman effect in TMO, the inversion of the electric polarization induced by the laser beam are discussed. The correlation between the magnetic moment of rare earth ion and the magnetoelectric effect value is predicted. The giant fluctuations of the acoustic resonance peak intensity near the Curie point are observed.
An IMS/ATP Assay for the Detection ofMycobacterium tuberculosisin Urine
Authors: Hunter Dawn M. , Lim Daniel V.
Published: May 2012

Background. Although sputum smears are the gold standard for diagnosis of tuberculosis, sensitivity in HIV/TB coinfection cases is low, indicating a need for alternative methods. Urine is being increasingly evaluated.Materials and Methods. A novel method for detectingMycobacterium tuberculosis(MTB) in synthetic urine using a combined IMS/ATP assay was evaluated. Preliminary work established standard ATP conditions and the sensitivity and specificity of the MTB antibody. Eighty-four blinded samples in four replicate assays were evaluated for the presence of MTB using labeled immunomagnetic beads for capture. Beads were separated, washed, and resuspended in broth and added to a microtiter plate. Bioluminescent output was measured and signal-to-noise ratios were calculated. All samples were plated on Middlebrook 7H10 agar or trypticase soy agar to determine limit of detection and recoveries.Results and Conclusions. MTB was distinguished from common bacteriuria isolates and other nontarget bacteria by its ATP results. IMS/ATP successfully detected 19 of 28 samples of MTB in synthetic urine with a limit of detection of 104 CFU/ml. Sensitivity and specificity were 67.9% and 82.1%, respectively. This assay offers a possible rapid screening method for HIV-positive patients with suspected coinfection to improve MTB diagnosis.
Ductal Carcinoma In Situ: What Can We Learn from Clinical Trials?
Authors: Fortunato Lucio , Poccia Igor , de Paula Ugo , Santini Elena
Published: May 2012

Ductal Carcinoma in situ has been diagnosed more frequently in the last few years and now accounts for approximately one-fourth of all treated breast cancers. Traditionally, this disease has been treated with total mastectomy, but conservative surgery has become increasingly used in the absence of unfavourable clinical conditions, if a negative excision margin can be achieved. It is controversial whether subgroups of patients with favourable in situ tumors could be managed by conservative surgery alone, without radiation. As the disease is diagnosed more frequently in younger patients, these issues are very relevant, and much research has focused on this topic in the last two decades. We reviewed randomized trials regarding adjuvant radiation after breast-conservative surgery and compared data with available retrospective studies.
Horizontal Violence and the Quality and Safety of Patient Care: A Conceptual Model
Authors: Purpora Christina , Blegen Mary A.
Published: May 2012

For many years, nurses in international clinical and academic settings have voiced concern about horizontal violence among nurses and its consequences. However, no known framework exists to guide research on the topic to explain these consequences. This paper presents a conceptual model that was developed from four theories to illustrate how the quality and safety of patient care could be affected by horizontal violence. Research is needed to validate the new model and to gather empirical evidence of the consequences of horizontal violence on which to base recommendations for future research, education, and practice.
Toward a Blended Ontology: Applying Knowledge Systems to Compare Therapeutic and Toxicological Nanoscale Domains
Authors: Grulke Christopher M. , Goldsmith Michael-Rock , Vallero Daniel A.
Published: May 2012

Bionanomedicine and environmental research share need common terms and ontologies. This study applied knowledge systems, data mining, and bibliometrics used in nano-scale ADME research from 1991 to 2011. The prominence of nano-ADME in environmental research began to exceed the publication rate in medical research in 2006. That trend appears to continue as a result of the growing products in commerce using nanotechnology, that is, 5-fold growth in number of countries with nanomaterials research centers. Funding for this research virtually did not exist prior to 2002, whereas today both medical and environmental research is funded globally. Key nanoparticle research began with pharmacology and therapeutic drug-delivery and contrasting agents, but the advances have found utility in the environmental research community. As evidence ultrafine aerosols and aquatic colloids research increased 6-fold, indicating a new emphasis on environmental nanotoxicology. User-directed expert elicitation from the engineering and chemical/ADME domains can be combined with appropriate Boolean logic and queries to define the corpus of nanoparticle interest. The study combined pharmacological expertise and informatics to identify the corpus by building logical conclusions and observations. Publication records informatics can lead to an enhanced understanding the connectivity between fields, as well as overcoming the differences in ontology between the fields.
Phi-Functions for 2D Objects Formed by Line Segments and Circular Arcs
Authors: Chernov N. , Stoyan Yu. , Romanova T. , Pankratov A.
Published: May 2012

We study the cutting and packing (C&P) problems in two dimensions by using phi-functions. Our phi-functions describe the layout of given objects; they allow us to construct a mathematical model in which C&P problems become constrained optimization problems. Here we define (for the first time) a complete class of basic phi-functions which allow us to derive phi-functions forall2D objects that are formed by linear segments and circular arcs. Our phi-functions support translations and rotations of objects. In order to deal with restrictions on minimal or maximal distances between objects, we also propose adjusted phi-functions. Our phi-functions are expressed by simple linear and quadratic formulas without radicals. The use of radical-free phi-functions allows us to increase efficiency of optimization algorithms. We include several model examples.
Bifocal Spinal Cord Injury without Radiographic Abnormalities in a 5-Year Old Boy: A Case Report
Authors: Snoek K. G. , Jacobsohn M. , van As A. B.
Published: May 2012

We present the extremely unusual case of a 5-year-old boy with a bifocal (cervical as well as lumbar) spinal cord injury without radiographic abnormalities (SCIWORAs). The MRI showed cord oedema at the level of C2 and T10. We propose that during the motor vehicle crash severe propulsion of the head with a flexed lumbar region resulted in a traction injury to the lower thoracic and lumbar spine and maximum flexion caused SCIWORA in C2.
Physiologically Based Toxicokinetic Modelling as a Tool to Support Risk Assessment: Three Case Studies
Authors: Mielke Hans , Gundert-Remy Ursula
Published: May 2012

In this contribution we present three case studies of physiologically based toxicokinetic (PBTK) modelling in regulatory risk assessment. (1) Age-dependent lower enzyme expression in the newborn leads to bisphenol A (BPA) blood levels which are near the levels of the tolerated daily intake (TDI) at the oral exposure as calculated by EFSA. (2) Dermal exposure of BPA by receipts, car park tickets, and so forth, contribute to the exposure towards BPA. However, at the present levels of dermal exposure there is no risk for the adult. (3) Dermal exposure towards coumarin via cosmetic products leads to external exposures of two-fold the TDI. PBTK modeling helped to identify liver peak concentration as the metric for liver toxicity. After dermal exposure of twice the TDI, the liver peak concentration was lower than that present after oral exposure with the TDI dose. In the presented cases, PBTK modeling was useful to reach scientifically sound regulatory decisions.
Bipolar Affective Disorder and Migraine
Authors: Engmann Birk
Published: May 2012

This paper consists of a case history and an overview of the relationship, aetiology, and treatment of comorbid bipolar disorder migraine patients. A MEDLINE literature search was used. Terms for the search were bipolar disorder bipolar depression, mania, migraine, mood stabilizer. Bipolar disorder and migraine cooccur at a relatively high rate. Bipolar II patients seem to have a higher risk of comorbid migraine than bipolar I patients have. The literature on the common roots of migraine and bipolar disorder, including both genetic and neuropathological approaches, is broadly discussed. Moreover, bipolar disorder and migraine are often combined with a variety of other affective disorders, and, furthermore, behavioural factors also play a role in the origin and course of the diseases. Approach to treatment options is also difficult. Several papers point out possible remedies, for example, valproate, topiramate, which acts on both diseases, but no first-choice treatments have been agreed upon yet.
Infrastructure Sharing as an Opportunity to Promote Competition in Local Access Networks
Authors: Pereira João Paulo , Ferreira Pedro
Published: May 2012

Telecom infrastructures are facing unprecedented challenges, with increasing demands on network capacity. Today, network operators must determine how to expand the existing access network infrastructure into networks capable of satisfying the user’s requirements. Thus, in this context, providers need to identify the technological solutions that enable them to profitably serve customers and support future needs. However, the identification of the “best” solution is a difficult task. Although the cost of bandwidth in the active layer has reduced significantly (and continually) in recent years, the cost of the civil works—such as digging and trenching—represents a major barrier for operators to deploy NGA infrastructure. Duct is a critical part of the next-generation access networks, and its sharing would reduce or eliminate this capital cost and this barrier to entry. The aim of this paper is to provide a better understanding of the economics of broadband access networks technologies (wireline and wireless), their role in the deployment of several services in different regions, and the development of competition in the access networks.
A System of Mixed Equilibrium Problems, a General System of Variational Inequality Problems for Relaxed Cocoercive, and Fixed Point Problems for Nonexpansive Semigroup and Strictly Pseudocontractive Mappings
Authors: Kumam Poom , Katchang Phayap
Published: May 2012

We introduce an iterative algorithm for finding a common element of the set of solutions of a system of mixed equilibrium problems, the set of solutions of a general system of variational inequalities for Lipschitz continuous and relaxed cocoercive mappings, the set of common fixed points for nonexpansive semigroups, and the set of common fixed points for an infinite family of strictly pseudocontractive mappings in Hilbert spaces. Furthermore, we prove a strong convergence theorem of the iterative sequence generated by the proposed iterative algorithm under some suitable conditions which solves some optimization problems. Our results extend and improve the recent results of Chang et al. (2010) and many others.
An Extended Virtual Force-Based Approach to Distributed Self-Deployment in Mobile Sensor Networks
Authors: Li Jun , Zhang Baihai , Cui Lingguo , Chai Senchun
Published: May 2012

Virtual physics based approach is one of the major solutions for self-deployment in mobile sensor networks with stochastic distribution of nodes. To overcome the connectivity maintenance and nodes stacking problems in the traditional virtual force algorithm (VFA), an extended virtual force-based approach is investigated to achieve the ideal deployment. In low-[Formula: see text] VFA, the orientation force is proposed to guarantee the continuous connectivity. While in high-[Formula: see text] VFA, a judgment of distance force between node and its faraway nodes is considered for preventing node stacking from nonplanar connectivity. Simulation results show that self-deployment by the proposed extended virtual force approach can effectively reach the ideal deployment in the mobile sensor networks with different ratio of communication range to sensing range. Furthermore, it gets better performance in coverage rate, distance uniformity, and connectivity uniformity than prior VFA.