bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can Ultrasound Accurately Assess Ischiofemoral Space Dimensions? A Validation Study
Authors: Finnoff Jonathan T. , Johnson Adam C. , Hollman John H. 
Published: July 2016

AbstractBackgroundIschiofemoral impingement is a potential cause of hip and buttock pain. It is evaluated commonly with magnetic resonance imaging (MRI). To our knowledge, no study previously has evaluated the ability of ultrasound to measure the ischiofemoral space (IFS) dimensions reliably.ObjectiveTo determine whether ultrasound could accurately measure the IFS dimensions when compared with the gold standard imaging modality of MRI.DesignA methods comparison study.SettingSports medicine center within a tertiary‐care institution.ParticipantsA total of 5 male and 5 female asymptomatic adult subjects (age mean = 29.2 years, range = 23‐35 years; body mass index mean = 23.5, range = 19.5‐26.6) were recruited to participate in the study.MethodsSubjects were secured in a prone position on a MRI table with their hips in a neutral position. Their IFS dimensions were then acquired in a randomized order using diagnostic ultrasound and MRI.Main Outcome MeasurementsThe main outcome measurements were the IFS dimensions acquired with ultrasound and MRI.ResultsThe mean IFS dimensions measured with ultrasound was 29.5 mm (standard deviation [SD] 4.99 mm, standard error mean 1.12 mm), whereas those obtained with MRI were 28.25 mm (SD 5.91 mm, standard error mean 1.32 mm). The mean difference between the ultrasound and MRI measurements was 1.25 mm, which was not statistically significant (SD 3.71 mm, standard error mean 3.71 mm, 95% confidence interval −0.49 mm to 2.98 mm, t19 = 1.506, P = .15). The Bland‐Altman analysis indicated that the 95% limits of agreement between the 2 measurement was −6.0 to 8.5 mm, indicating that there was no systematic bias between the ultrasound and MRI measurements.ConclusionsOur findings suggest that the IFS measurements obtained with ultrasound are very similar to those obtained with MRI. Therefore, when evaluating individuals with suspected ischiofemoral impingement, one could consider using ultrasound to measure their IFS dimensions.Level of EvidenceIII
Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management
Authors: Sturesson Lars , Falk Ann-Charlotte , Castrén Maaret , Niemi-Murola Leila , Lindström Veronica 
Published: July 2016

Abstract

Background
Pain is one of the most common symptoms treated in emergency department (ED). Pain may cause suffering and disability for the patient. Inadequate pain management may be associated with increased risk of complications such as sleep disturbance, delirium and depression. Previous studies conclude that pain management in ED is insufficient and inadequate. Yet, little is known about patients’ own experience regarding pain management in ED.

Objective
The aim of this study was to explore the satisfaction of pain management in patients having acute musculoskeletal injuries before and after implementation of mandatory documentation regarding pain assessment in the ED.

Method
An observational pre-post intervention study design was used. The study was conducted on patients having acute musculoskeletal injuries such as soft tissue injury, back pain or wrist/arm/leg/foot fractures in a 24-h adult (>15 years) ED at a public urban teaching hospital in Stockholm, Sweden. Data was collected by an interview based on a questionnaire.

Results
A total of 160 patients answered the questionnaire. In the pre- (n = 80) and post-intervention (n = 80) groups, 91/95% experienced pain in the ED. A significant difference (p < 0.003) was found during the post-intervention period, with more patients receiving analgesics compared to the pre-intervention group. A significant decline (p < 0.03) in patients’ own reported pain intensity at discharge was found between the groups. Patients’ reported satisfaction on pain management in the ED increased in the post-intervention group, but the difference was not statistically significantly.

Conclusion
Patients’ satisfaction with pain management increased, but not statistically significantly. However, both percentages of patients receiving analgesic drugs increased and pain intensity decrease at discharge were statistically significant after the intervention that made nurses obliged to register pain.

Implication
According to the findings of this study, mandatory pain documentation facilitates pain management in the ED, but there is still room for improvement. Additional actions are needed to improve patients’ satisfaction on pain management in the ED. Mandatory pain documentation in combination with person-centred care could be a way of improving patients’ satisfaction on pain management. Effective pain management is an important quality measure, and should be focused on in acute care in the ED. By routinely asking patients to report the pain intensity at discharge, the ED personnel can have direct feedback about the factual pain management. RNs may also be encouraged to use intravenous analgesics in higher extent when the patients have very severe pain.
Identification of the chitinase genes from the diamondback moth,Plutella xylostella
Authors: Liao Z.H. , Kuo T.C. , Kao C.H. , Chou T.M. , Kao Y.H. , Huang R.N. 
Published: July 2016

AbstractChitinases have an indispensable function in chitin metabolism and are well characterized in numerous insect species. Although the diamondback moth (DBM)Plutella xylostella, which has a high reproductive potential, short generation time, and characteristic adaptation to adverse environments, has become one of the most serious pests of cruciferous plants worldwide, the information on the chitinases of the moth is presently limited. In the present study, using degenerated polymerase chain reaction (PCR) and rapid amplification of cDNA ends-PCR strategies, four chitinase genes ofP. xylostellawere cloned, and an exhaustive search was conducted for chitinase-like sequences from theP. xylostellagenome and transcriptomic database. Based on the domain analysis of the deduced amino acid sequences and the phylogenetic analysis of the catalytic domain sequences, we identified 15 chitinase genes fromP. xylostella. Two of the gut-specific chitinases did not cluster with any of the known phylogenetic groups of chitinases and might be in a new group of the chitinase family. Moreover, in our study, group VIII chitinase was not identified. The structures, classifications and expression patterns of the chitinases ofP. xylostellawere further delineated, and with this information, further investigations on the functions of chitinase genes in DBM could be facilitated.
COLLABORATORS, COLLABORATION, AND THE PROBLEMS OF EMPIRE IN NAPOLEONIC ITALY, THE OPPIZZONI AFFAIR, 1805–1807
Authors: CAIANI AMBROGIO A. 
Published: July 2016

ABSTRACTThe recent bicentennial commemorations of the Napoleonic empire have witnessed a proliferation of new studies. Scholars now possess much more sophisticated conceptual tools than in past decades with which to gauge the problems faced by French imperial administrators throughout Europe. Well-trodden concepts, like centre/periphery or collaboration/resistance, have been reinvigorated by more sophisticated understandings of how rulers and ruled interacted in the early nineteenth century. This article argues that, while much progress has been made in understanding problems of ‘resistance’, there is more to be said about the other side of the same coin, namely: ‘collaboration’. Using the micro/local history of a scandal in Napoleonic Bologna, this article wishes to reaffirm that collaboration was an active agent that shaped, and often shook, the French imperial project. The biggest problem remained that, despite ‘good intentions’, collaborators sometimes simply did not collaborate with each other. After all, imperial clients were determined to benefit from the experience of empire. The centre was often submerged by local petty squabbles. This article will use a specific micro-history in Bologna to highlight the extent to which Napoleonic empire builders had to thread a fine line between the impracticalities of direct control and the dangers of ‘going native’.
Irreducible characters of even degree and normal Sylow 2-subgroups
Authors: HUNG NGUYEN NGOC , TIEP PHAM HUU 
Published: July 2016

AbstractThe classical Itô-Michler theorem on character degrees of finite groups asserts that if the degree of every complex irreducible character of a finite group G is coprime to a given prime p, then G has a normal Sylow p-subgroup. We propose a new direction to generalize this theorem by introducing an invariant concerning character degrees. We show that if the average degree of linear and even-degree irreducible characters of G is less than 4/3 then G has a normal Sylow 2-subgroup, as well as corresponding analogues for real-valued characters and strongly real characters. These results improve on several earlier results concerning the Itô-Michler theorem.
Distinct Distances on Algebraic Curves in the Plane
Authors: PACH JÁNOS , DE ZEEUW FRANK 
Published: July 2016

LetSbe a set ofnpoints in${\mathbb R}^{2}$contained in an algebraic curveCof degreed. We prove that the number of distinct distances determined bySis at leastcdn4/3, unlessCcontains a line or a circle.We also prove the lower boundcd′ min{m2/3n2/3,m2,n2} for the number of distinct distances betweenmpoints on one irreducible plane algebraic curve andnpoints on another, unless the two curves are parallel lines, orthogonal lines, or concentric circles. This generalizes a result on distances between lines of Sharir, Sheffer and Solymosi in [19].
Standard Operating Procedures: A Safety Net for Pre-Analysis Plans
Authors: Lin Winston , Green Donald P. 
Published: July 2016

ABSTRACTAcross the social sciences, growing concerns about research transparency have led to calls for pre-analysis plans (PAPs) that specify in advance how researchers intend to analyze the data they are about to gather. PAPs promote transparency and credibility by helping readers distinguish between exploratory and confirmatory analyses. However, PAPs are time-consuming to write and may fail to anticipate contingencies that arise in the course of data collection. This article proposes the use of “standard operating procedures” (SOPs)—default practices to guide decisions when issues arise that were not anticipated in the PAP. We offer an example of an SOP that can be adapted by other researchers seeking a safety net to support their PAPs.
Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation
Authors: Kircher Janeva , Drendel Amy L. , Newton Amanda S. , Dulai Sukhdeep , Vandermeer Ben , Samina Ali  
Published: July 2016

ABSTRACTObjective:Musculoskeletal (MSK) injuries are a common, painful pediatric presentation to the emergency department (ED). The primary objective of this study was to describe current analgesic administration practices for the outpatient management of children’s MSK pain, both in the ED and postdischarge.Methods:We reviewed the medical records of consecutive pediatric patients evaluated in either a pediatric or a general ED (Edmonton, Alberta) during four evenly distributed calendar months, with a diagnosis of fracture, dislocation, strain, or sprain of a limb. Abstracted data included demographics, administered analgesics, pain scores, discharge medication advice, and timing of clinical care.Results:A total of 543 medical records were reviewed (n 5 468 pediatric ED, n 5 75 general ED). Nineteen percent had documented prehospital analgesics, 34% had documented in-ED analgesics, 13% reported procedural sedation, and 24% documented discharge analgesia advice. Of those children receiving analgesics in the ED, 59% (126 of 214) received ibuprofen. Pain scores were recorded for 6% of patients. At discharge, ibuprofen was recommended to 47% and codeine-containing compounds to 21% of children. The average time from triage to first analgesic in the ED was 121 6 84 minutes.Conclusions:Documentation of the assessment and management of children’s pain in the ED is poor, and pain management appears to be suboptimal. When provided, ibuprofen is the most common analgesic used for children with MSK pain. Pediatric patients with MSK pain do not receive timely medication, and interventions must be developed to improve the ‘‘door to analgesia’’ time for children in pain.
Radiation doses to emergency department patients undergoing computed tomography
Authors: Worrall James C. , Jama Sadia , Stiell Ian G. 
Published: July 2016

Abstract

Objectives:
Computed tomography (CT) use is increasing in the emergency department (ED). Many physicians are concerned about exposing patients to radiation from CT scanning, but estimates of radiation doses vary. This study’s objective was to determine the radiation doses from CT scanning for common indications in a Canadian ED using modern multidetector CT scanners.

Methods:
We conducted a health records review of consecutive adult patients seen at two busy tertiary care EDs over a 2-month period who underwent CT scanning ordered by emergency physicians. Cases were identified by searching an imaging database. Data collected included patient age and sex, study indication, scanner model, body area, and reported dose-length product. Effective dose per scan was calculated from reported dose-length product. Data were collected on a standardized form, entered into an electronic database, and analyzed with descriptive statistics and 95% CIs. Results: During the study period, emergency physicians assessed 19,880 patients. Overall, 2,720 (13.7%) underwent CT scanning, and of these, 144 (5.3%) patients had more than one scan. Patients had a mean age of 59.0 years, and 45.3% were men. Mean doses for the most common indications were as follows: simple head, 2.9 mSv; cervical spine, 5.7 mSv; complex head, 9.3 mSv; CT pulmonary angiogram, 11.2 mSv; abdomen (nontraumatic abdominal pain), 15.4 mSv; and abdomen (renal colic), 9.8 mSv.

Conclusions:
Approximately one in seven ED patients had a CT scan. Emergency physicians should be aware of typical radiation doses for the studies they order and how the dose varies by protocol and indication.
Lumbar Puncture First? An old test and a new approach to lone acute sudden headaches
Authors: Schull Michael J. 
Published: July 2016

RÉSUMÉ:
On évoque souvent le diagnostic de l’hémorragie sous-arachnoïdienne chez les patients qui se présentent à l’urgence pour un mal de tête violent et soudain, mais dont l’examen physique est normal. La norme de soins de nos jours consiste à soumettre ces patients à une tomodensitométrie (TDM) sans substance de contraste suivie d’une ponction lombaire pour les TDM négatives. Cependant, comme la plupart des céphalées évaluées sont bénignes, la plupart des résultats de la TDM et de la ponction lombaire sont normaux.
Le présent article a pour but d’analyser l’impact d’un protocole diagnostique de rechange, où la ponction lombaire serait la première (et dans la plupart des cas, la seule) épreuve diagnostique effectuée chez les patients chez qui l’on soupçonne une hémorragie sous-arachnoïdienne et qui présentent ce symptôme isolé de mal de tête violent. Selon une hypothèse raisonnable, pour chaque 100 patients évalués, le protocole de «ponction lombaire en premier» nécessiterait 81 TDM de moins et seulement 9 ponctions lombaires additionnelles, comparativement à la stratégie diagnostique traditionnelle. Ces avantages demeurent stables même en variant les hypothèses à l’intérieur des limites cliniquement plausibles.
Nous croyons que ce protocole pourrait entraîner une utilisation beaucoup plus efficace des ressources en limitant le taux de morbidité additionnel, tout en offrant une précision diagnostique équivalente pour l’hémorragie sous-arachnoïdienne chez le patient à l’urgence qui répond au critère de mal de tête isolé violent et soudain.
Confined-space accidents on the farm: the manure pit and the silo
Authors: Shepherd Lisa G. 
Published: July 2016

ABSTRACT:Manure pits and silos are potentially dangerous, gas-containing confined spaces on the farm that may generate hazardous levels of hydrogen sulphide and nitrogen dioxide respectively. Although these inhalation injuries are uncommon, emergency physicians who work within transport distance of rural areas should be aware of the toxic agents involved and their acute management. This article reviews the toxicology, clinical manifestations and treatment of acute, farm-related hydrogen sulphide and nitrogen dioxide exposures.
Malignant superior vena cava syndrome presenting after trauma
Authors: Price Laura A. , Gilkinson Trevor L. 
Published: July 2016

SUMMARY:
A 41-year-old man was brought to the ED after a motor vehicle crash. On presentation, he demonstrated symptoms compatible with superior vena cava (SVC) syndrome, including extreme dyspnea, face and neck cyanosis and facial swelling. A chest tube was inserted and drained large amounts of sanguineous fluid. An exploratory thoracotomy revealed an extensive tumour encasing the SVC and the hilum. Biopsy confirmed the diagnosis of T-cell lymphoma.
The most common cause of SVC syndrome is malignant disease, with bronchogenic carcinoma and lymphoma being most frequent. Review of the literature uncovered only a few anecdotal reports of traumatic SVC syndrome. There are no previous reported cases of malignant SVC syndrome presenting in association with trauma.
Meditating on what we do
Authors: Zeit Harry 
Published: July 2016

You’ll start in the ER!” the Chief of Staff informs his prize new surgical fellow, Robert Yeats, played by Hollywood heartthrob Eric Stoltz. This is TV land, Chicago Hope to be exact, and a great set-up for a hard-hitting personality clash.
“I don’t want him,” the ER director and trauma surgeon, Dr. Keith Wilks, complains ineffectually. “I’m ‘way too busy today.”
An emergency medical services controversy in Nova Scotia: What is expanded-scope EMS?
Authors: Petrie David 
Published: July 2016

RÉSUMÉ:
Les services médicaux d’urgence d’application élargie (SMU) est un sujet d’actualité qui demeure une énigme pour plusieurs. Une vue d’ensemble des SMU d’application élargie prendrait en considération quatre variations.
La première, les SMU aigus, non planifiés (d’application élargie) inclurait des protocoles de «traitement et de congé» pour des problèmes comme l’hypoglycémie, les traumatismes mineurs et les blessures. Cette variation intégrerait également le concept de SMU à «choix multiples», où les préposés aux SMU évalueraient l’état du patient et auraient le choix de le transporter vers un département d’urgence, vers une clinique ou un autre établissement de soins, ou de le traiter et de lui donner son congé. Dans un tel système, le protocole offrirait la flexibilité aux répartiteurs médicaux d’orienter les appels vers une ligne Info-Santé ou d’organiser un transport non ambulancier. Ce type de SMU pourrait aussi permettre l’application des fonctions traditionnelles des SMU dans de nouveaux environnements, comme par exemple donner aux préposés aux services médicaux d’urgence la responsabilité d’équipes d’arrêt cardiaque dans les hôpitaux..
Les SMU non aigus, planifiés (d’application élargie) incluraient des initiatives dirigées par les SMU qui établiraient un pont entre la médecine d’urgence et la santé publique. Celles-ci comprendraient, par exemple, des programmes communautaires de vaccination, des programmes d’évaluation de l’état de santé à domicile, des soins prénatals et des visites de suivi pour la vérification de plaies, l’administration intraveineuse d’antibiotiques ou de médicaments après une visite à l’urgence, et des programmes d’observance de traitement.

Le «service» d’application élargie fait référence aux initiatives de prévention et d’éducation dirigées par les SMU, comme la prévention des blessures (p. ex. le port du casque de bicyclette, les programmes de contrôle de l’alcool au volant) et l’éducation des citoyens (p. ex. la RCR et l’abandon de la cigarette).
Les SMU cliniques, hospitaliers ou en région éloignée (d’application élargie) intégreraient une nouvelle classe de préposés aux SMU ou dispensateurs de soins intermédiaires qui travailleraient avec les médecins, possiblement par le biais de la télémédecine. Ces préposés s’acquitteraient principalement de tâches spécifiques, comme poser des plâtres, faire des points de suture et extraire des corps étrangers oculaires. Avec une certaine formation post-secondaire, ils pourraient avoir la possibilité de poser des diagnostics et de prescrire des médicaments, un peu comme un «assistant médecin».
Préparez-vous! Les SMU d’application élargie s’en viennent.
The NARC (Nonsteroidal Anti-inflammatory in Renal Colic) Trial. Single-dose intravenous ketorolac versus titrated intravenous meperidine in acute renal colic: a randomized clinical trial
Authors: Wood Victor M. , Christenson James M. , Innes Grant D. , Lesperance Mary , McKnight R. Douglas 
Published: July 2016

ABSTRACTObjectives:Intravenous (IV) opioid titration is an accepted method of relieving acute renal colic. Studies have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) are also effective in this setting. Our objective was to compare single-dose ketorolac and titrated meperidine, both administered intravenously, with respect to speed and degree of analgesia, adverse effects and functional status. Our primary hypothesis was that these agents provide equivalent analgesia within 60 minutes. Our secondary hypotheses were that ketorolac-treated patients would experience fewer adverse effects and would be better able to resume usual activity.Methods:This was a multicentre, double-blind randomized equivalence trial in a convenience sample of patients age 18–65 with moderate or severe renal colic, documented by intravenous pyelogram, ultrasound or stone passage. Meperidine-treated patients received 50 mg IV meperidine at 0 minutes, then 25–50 mg every 15 minutes as needed for ongoing pain. Ketorolac-treated patients received 30 mg IV ketorolac at 0 minutes and placebo injections every 15 minutes as needed. Pain levels and adverse effects were assessed every 15 minutes, and functional status was evaluated at 60 minutes. Our primary outcome was the proportion of patients with mild or no pain at 60 minutes.Results:Overall, 49 of 77 meperidine-treated patients (64%; 95% confidence interval [CI], 53%–75%) and 47 of 65 ketorolac-treated patients (72%; 95% CI, 61%–83%) achieved successful pain relief at 60 minutes (pvalue for equivalence = 0.002). Ten percent of meperidine-treated patients and 44% of ketorolac-treated patients were able to resume usual activity at 60 minutes (p= 0.001).Conclusions:In the doses studied, single-dose IV ketorolac is as effective as titrated IV meperidine for the relief of acute renal colic and causes less functional impairment.