bluuebunny/crossref_metadata_2025_split huggingface dataset:
Demography of pediatric emergency care in Halifax, Canada
Authors: Taylor B.W. 
Published: July 2016

ABSTRACT

Objectives:
Demography affects emergency department (ED) utilization and influences the health care needs of patients, yet the demographics of the caregivers who accompany children to pediatric EDs are not well described. The objective of this study was to provide a demographic description of this population. The hypothesis was that single parent status, annual income less than $20 000, and education no greater than high school constitute a social triad that might reduce the ability to provide health care for a sick child.

Methods:
Over a 1-month period, a convenience survey of caregivers who brought children to a pediatric ED was conducted. Twelve hundred surveys were distributed to 1733 eligible subjects. Social and economic determinants were captured, including age, gender, visible minority status, income group, employment, single parent status and education level.

Results:
In total, 1018 (85%) of 1200 surveys were returned — a population response rate of 59%. Single parent status, income less than $20 000/yr, and education no greater than high school were found to be risk factors for altered delivery of health care. Overall, 40.9% of caregivers had at least one risk factor, including 43.2% of women, 63.4% of those under 30 years of age, 65.1% of those with visible minority status, and 71.6% of women who were from a visible minority. In addition, 41.7% of single parents had no more than a high school education, and 75.7% of single parent families had incomes of less than $40 000 per year.

Conclusions:
It was found that a high level of educational, social and financial disadvantage in our population. These factors may adversely affect parental capability to provide health care at home for their child. The extent of this problem in other regions is not well defined and should be a focus of future research. It is recommended that inquiry into parental income, education and single parent status be a routine part of the history in pediatric emergency populations.
Perinephric abscess secondary to a staghorn calculus presenting as a subcutaneous abscess
Authors: Tsukagoshi Dylan , Dinkovski Bozanka , Dasan Sunil , Jethwa Jalpesh 
Published: July 2016

ABSTRACTPerinephric abscesses often present with flank pain and signs of sepsis, and are known to discharge to the skin. We report a case of a young patient presenting with a 48-hour history of painful swelling in her right renal angle following a urinary tract infection and no overt signs or symptoms of sepsis. Plain abdominal films showed a perinephric abscess secondary to a staghorn calculus in the upper pole of the right kidney. On incision and drainage, 700 mL of pus was drained freely. The patient recovered well but required partial nephrectomy.Subcutaneous abscess as a result of intra-abdominal pathology is a recognized but rare complication. This case illustrates that subcutaneous abscesses may have underlying intra-abdominal pathology without overt signs of sepsis.
Primary amebic meningoencephalitis: a silent killer
Authors: Grate Isaac 
Published: July 2016

ABSTRACTOne week after swimming in a man-made lake, a 9-year-old boy presented to the emergency department with headache, vomiting and lethargy. He had neck pain upon flexion and was unable to stand or walk. Cerebrospinal fluid examination revealed trophozoite and diflagellate forms consistent withNaegleria fowleri, an ameba species known to cause primary amebic meningoencephalitis. Despite aggressive management with amphotericin B and rifampin, he died 2 days later. This case report describes the clinical presentation, diagnostic findings and management of this uncommon but lethal entity.
Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field
Authors: Le May Michel R. , Dionne Richard , Maloney Justin , Trickett John , Watpool Irene , Ruest Michel , Stiell Ian , Ryan Sheila , Davies Richard F. 
Published: July 2016

ABSTRACT

Objectives:
Most studies of pre-hospital management of ST-elevation myocardial infarction (STEMI) have involved physicians accompanying the ambulance crew, or electrocardiogram (ECG) transmission to a physician at the base hospital. We sought to determine if Advanced Care Paramedics (ACPs) could accurately identify STEMI on the pre-hospital ECG and contribute to strategies that shorten time to reperfusion.

Methods:
A STEMI tool was developed to: 1) measure the accuracy of the ACPs at diagnosing STEMI; and 2) determine the potential time saved if ACPs were to independently administer thrombolytic therapy. Using registry data, we subsequently estimated the time saved by initiating thrombolytic therapy in the field compared with in-hospital administration by a physician.

Results:
Between August 2003 and July 2004, a correct diagnosis of STEMI on the pre-hospital ECG was confirmed in 63 patients. The performance of the ACPs in identifying STEMI on the ECG resulted in a sensitivity of 95% (95% confidence interval [CI] 86%–99%), a specificity of 96% (95% CI 94%–98%), a positive predictive value (PPV) of 82% (95% CI 71%–90%), and a negative predictive value (NPV) of 99% (95% CI 97%–100%). ACP performance for appropriately using thrombolytic therapy resulted in a sensitivity of 92% (95% CI 78%–98%), a specificity of 97% (95% CI 94%–98%), a PPV of 73% (95% CI 59%–85%) and an NPV of 99% (95% CI 97%–100%). We estimated that the median time saved by ACP administration of thrombolytic therapy would have been 44 minutes.

Conclusions:
ACPs can be trained to accurately interpret the pre-hospital ECG for the diagnosis of STEMI. These results are important for the design of regional integrated programs aimed at reducing delays to reperfusion.
Myth: Intravenous amiodarone is safe in patients with atrial fibrillation and Wolff–Parkinson–White syndrome in the emergency department
Authors: Tijunelis Marius A. , Herbert Mel E. 
Published: July 2016

ABSTRACT
Wolff–Parkinson–White (WPW) syndrome with atrial fibrillation (AF) is a potentially life-threatening problem requiring rapid conversion to sinus rhythm. The most recent American Heart Association guidelines for the treatment of patients with WPW, published in conjunction with the 2000 Advanced Cardiac Life Support (ACLS) guidelines, suggests that intravenous amiodarone is a first-line therapy for AF–WPW; however the evidence suggests this is a potentially dangerous myth.
Emergency preparedness: what every health care worker needs to know
Authors: Christian Michael D. , Kollek Daniel , Schwartz Brian 
Published: July 2016

ABSTRACTCanada is moving forward quickly with plans to ensure that it is prepared to deal with emergencies. The National Framework for Health Emergency Management, released Nov. 26, 2004, recommends that a National Health Incident Management System (IMS) be developed. However, although most communities have successfully implemented IMS in the emergency services sector, many are still struggling with the integration of IMS into their health care systems. It is essential that all health care workers, regardless of profession or position, understand at least the basic concepts of emergency preparedness because of the wide variety of roles they may be asked to fulfill in an emergency situation. This article will review the basic concepts in emergency preparedness and management with a specific focus on IMS in health care.
Can urine cultures and reagent test strips be used to diagnose urinary tract infection in elderly emergency department patients without focal urinary symptoms?
Authors: Ducharme James , Neilson Shane , Ginn Jeffery L. 
Published: July 2016

ABSTRACT

Objective:
To compare the results of urine cultures and reagent strip testing in 2 groups of elderly emergency department (ED) patients: an asymptomatic group unlikely to have urinary tract infection (UTI), and a group who had vague symptoms and were considered at risk for UTI.

Methods:
We performed a prospective observational convenience study with 2 groups of 100 patients aged 65 or older. The asymptomatic group consisted of afebrile patients presenting to the ED with non-infectious complaints, while the symptomatic group included patients presenting with acute confusion, weakness or fever but no apparent urinary symptoms. We defined a positive urine culture as a single organism count greater than 100 000 CFU/mL in mid-stream specimens, or greater than 1000 CFU/mL in catheter specimens. We considered reagent strips positive if they demonstrated any reaction to the leukocyte-esterase assay, the nitrite assay or both.

Results:
Of the 33 positive cultures, 10 had negative reagent strips. Thirteen of the 14 positive nitrite tests were culture positive for a specificity of 92.8% and a sensitivity of 36.1%. Positive cultures did not infer a diagnosis of UTI. Of the 67 positive reagent strips, 41 (61.2%) were associated with negative cultures. Likelihood ratios (LRs) in both groups affirmed the inability of the reagent strips to help significantly in decision making, with positive and negative LR in the indeterminate range (control group: 2.8 and 0.31, symptomatic group: 2.7 and 0.46, respectively).

Conclusion:
In the elderly, reagent testing is an unreliable method of identifying patients with positive blood cultures. Moreover, positive urine culture rates are only slightly higher in patients with vague symptoms attributable to UTI than they are in (asymptomatic) patients treated for non-urologic problems, which suggests that many positive cultures in elderly patients with non-focal systemic symptoms are false-positive tests reflecting asymptomatic bacteriuria and not UTIs. Blood cultures, regarded by many as the criterion standard for UTI, do not have sufficient specificity to confirm the diagnosis of UTI in elderly patients with non-specific symptoms.
A rare case of leaking abdominal aneurysm presenting as isolated right testicular pain
Authors: Sufi P.A. 
Published: July 2016

ABSTRACT
An abdominal aortic aneurysm (AAA) is not usually considered in the differential diagnosis of isolated right testicular pain. We describe a patient who did present with isolated acute right testicular pain as the sentinel feature of a leaking AAA. In the patient group with right testicular pain, consideration of a leaking AAA should be added to the differential diagnosis. An adverse outcome can be avoided by timely diagnosis and intervention.
Scrofula as a presentation of tuberculosis and HIV
Authors: Barnett Katrina , Medzon Ron 
Published: July 2016

ABSTRACT
Scrofula, or tuberculous cervical lymphadenitis, though now rare, is more commonly seen in minorities, women and immunosuppressed patients, especially those with HIV. We discuss a patient who presented to the emergency department with an anterior neck abscess and was diagnosed with both advanced HIV and disseminated tuberculosis. A high level of suspicion is necessary to make this diagnosis, but given an increasing degree of global mobility, such patients may present anywhere. Medical management is effective, though difficult. Early diagnosis improves the patient's individual prognosis and may prevent further exposure and transmission to the population.
Integrating nurse practitioners into Canadian emergency departments: a qualitative study of barriers and recommendations
Authors: Thrasher Christine , Purc-Stephenson Rebecca J. 
Published: July 2016

ABSTRACTObjective:The objective of this study was to identify the facilitators and barriers associated with integrating nurse practitioners (NPs) into Canadian emergency departments (EDs) from the perspectives of NPs and ED staff.Methods:We conducted 24 semi-structured interviews with key multidisciplinary stakeholders in 6 Ontario EDs to gain a broad range of perspectives on implementation issues. Data were analyzed using a grounded-theory approach.Results:Qualitative analysis of the interview data revealed 3 major issues associated with NP implementation: organizational context, role clarity and NP recruitment. Organizational context refers to the environment an NP enters and involves issues related to the ED culture, physician reimbursement system and patient volume. Role clarity refers to understanding the NP's function in the ED. Recruitment issues are associated with attracting and retaining NPs to work in EDs. Examples of each issue using respondent's own words are provided.Conclusion:Our study identified 3 issues that illustrate the complex issues involved when implementing NPs in EDs. The findings may inform policy makers and health care professionals in the future development of the role of NPs in Canadian EDs.
A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department
Authors: Carter Alix J.E. , Chochinov Alecs H. 
Published: July 2016

ABSTRACTIntroduction:US emergency personnel cared for 106% more patients in 1990 than they did in 1980, and national emergency department census data show that 60%–80% of those patients presented with non-urgent or minor medical problems. The hiring of nurse practitioners (NPs) is one proposed solution to the ongoing overcrowding and physician shortage facing emergency departments (EDs).Methods:We conducted a systematic review of MEDLINE and Cinahl to find articles that discussed NPs in the ED setting, looking specifically at 4 key outcome measures: wait times, patient satisfaction, quality of care and cost effectiveness.Results:Although some questions remain, a review of the literature suggests that NPs can reduce wait times for the ED, lead to high patient satisfaction and provide a quality of care equal to that of a mid-grade resident. Cost, when compared with resident physicians, is higher; however, data comparing to the hiring additional medical professionals is lacking.Conclusion:The medical community should further explore the use of NPs, particularly in fast track areas for high volume departments. In rural areas, NPs could supplement overextended physicians and allow health centres to remain open when they might otherwise have to close. These strategies could improve access to care and patient satisfaction for selected urban and rural populations as well as make the best use of limited medical resources.
Efficacy, safety and patient satisfaction of propofol for procedural sedation and analgesia in the emergency department: a prospective study
Authors: Zed Peter J. , Abu-Laban Riyad B. , Chan Winnie W.Y. , Harrison David W. 
Published: July 2016

ABSTRACTObjective:We evaluated the efficacy, safety and patient satisfaction with the use of propofol for procedural sedation and analgesia in the emergency department (ED).Methods:All patients receiving propofol for procedural sedation and analgesia in the ED between December 1, 2003, and November 30, 2005, were prospectively assessed. Propofol was administered using a standardized protocol, which included an initial dose of 0.25–0.5 mg/kg followed by 10–20 mg/minute until sedated. Efficacy was evaluated using procedural success rate, recovery time and physician satisfaction. Adverse respiratory effects were defined as apnea for more than 30 seconds or an oxygen saturation of less than 90%. Hypotension was defined as systolic blood pressure &lt; 90 mm Hg or &gt; 20% decrease from baseline. Patient and physician satisfaction were determined using 5-point Likert scales.Results:Our study included 113 patients with a mean age of 50 (standard deviation [SD] 19) years; 62% were male. The most common procedures were orthopedic manipulation (44%), cardioversion (37%), and abscess incision and drainage (13%). The mean total propofol dose required was 1.6 (SD 0.9) mg/kg. Procedural success was achieved in 90% of cases and the mean patient recovery time was 7.6 (SD 3.4) minutes. No patient (0%, 95% confidence interval [CI] 0%–3%) experienced apnea; however, 1 patient (1%, 95% CI 0%–5%) experienced emesis, which resulted in an oxygen saturation &lt;90%. Nine patients (8%, 95% CI 4%–15%) experienced hypotension and 7 (6%, 95% CI 3%–12%) experienced pain on injection. All patients were very satisfied (92%, 95% CI 85%–96%) or satisfied (8%, 95% CI 4%–15%), and 94% (95% CI 88%–98%) reported no recollection of the procedure. The majority of physicians were very satisfied (85%, 95% CI 77%–91%) or satisfied (6%, 95% CI 3%–12%) with the sedation and the conditions achieved.Conclusion:When administered as part of a standardized protocol, propofol appears to be a safe and effective agent for performing procedural sedation and analgesia in the ED, and is associated with high patient and physician satisfaction.
Do fluoroquinolones commonly cause arthropathy in children?
Authors: Forsythe Clinton T. , Ernst Michael E. 
Published: July 2016

ABSTRACT

Objective:
The objective of this paper was to review the relation between fluoroquinolone (FQ) use and arthropathy in children.

Methods:
The biomedical literature from January 1980 to February 2007 was searched using PubMed. Key search terms included fluoroquinolones, arthropathy, tendinopathy and children. Literature was included if it was a clinical trial or meta-analysis examining the use of 1 or more FQs in a pediatric human population and if it had a primary outcome measure of reported incidence of arthropathy or tendinopathy. Articles were excluded if the primary outcome measure was efficacy of an FQ in a particular pediatric disease state, and evaluated safety was a secondary end point.

Results:
Data was reviewed from 4 large retrospective studies. Three of the 4 studies failed to find a significant link between musculoskeletal injury and FQ treatment. One study reported a correlation between use of pefloxacin and arthropathy, but the authors' conclusions supported the use of FQs in select pediatric cases.

Conclusion:
Arthropathy that occurs as a result of FQ use in children has not been adequately supported by published data from safety trials in human children. Concerns about arthropathy with FQs should not preclude their use by emergency physicians when appropriate and necessary in pediatric patients.
Airbag pneumonitis: a report and discussion of a new clinical entity
Authors: Caudle Jaelyn M. , Hawkes Robert , Howes Daniel W. , Brison Robert J. 
Published: July 2016

ABSTRACT
This report describes the occurrence of pneumonitis in a young male immediately after inhalation of aerosolized chemicals subsequent to motor vehicle airbag deployment. The clinical presentation was one of mild shortness of breath associated with bilateral alveolar infiltrates on chest radiology. Not previously described, this diagnosis should be considered in the differential of pulmonary infiltrates in motor vehicle crash patients.
An application of Markov chain Monte Carlo (MCMC) to continuous-time incurred but not yet reported (IBNYR) events
Authors: Brown Garfield O. , Buckley Winston S. 
Published: July 2016

AbstractWe develop a Bayesian model for continuous-time incurred but not yet reported (IBNYR) events under four types of secondary data, and show that unreported events, such as claims, have a Poisson distribution with a reduced arrival parameter if event arrivals are Poisson distributed. Using insurance claims as an example of an IBNYR event, we apply Markov chain Monte Carlo (MCMC) to the continuous-time IBNYR claims model of Jewell using Type I and Type IV data. We illustrate the relative stability of the MCMC method versus the Gammoid approximation of Jewell by showing that the MCMC estimates approach their prior parameters, while the Gammoid approximations grow without bound for Type IV data. Moreover, this holds for any distribution that the delay parameter is assumed to follow. Our framework also allows for the computation of posterior confidence intervals for the parameters.
iVirus: facilitating new insights in viral ecology with software and community data sets imbedded in a cyberinfrastructure
Authors: Bolduc Benjamin , Youens-Clark Ken , Roux Simon , Hurwitz Bonnie L , Sullivan Matthew B 
Published: July 2016

Abstract
Microbes affect nutrient and energy transformations throughout the world’s ecosystems, yet they do so under viral constraints. In complex communities, viral metagenome (virome) sequencing is transforming our ability to quantify viral diversity and impacts. Although some bottlenecks, for example, few reference genomes and nonquantitative viromics, have been overcome, the void of centralized data sets and specialized tools now prevents viromics from being broadly applied to answer fundamental ecological questions. Here we present iVirus, a community resource that leverages the CyVerse cyberinfrastructure to provide access to viromic tools and data sets. The iVirus Data Commons contains both raw and processed data from 1866 samples and 73 projects derived from global ocean expeditions, as well as existing and legacy public repositories. Through the CyVerse Discovery Environment, users can interrogate these data sets using existing analytical tools (software applications known as ‘Apps’) for assembly, open reading frame prediction and annotation, as well as several new Apps specifically developed for analyzing viromes. Because Apps are web based and powered by CyVerse supercomputing resources, they enable scalable analyses for a broad user base. Finally, a use-case scenario documents how to apply these advances toward new data. This growing iVirus resource should help researchers utilize viromics as yet another tool to elucidate viral roles in nature.
Determining solar effects in Neptune’s atmosphere
Authors: Aplin K. L. , Harrison R. G. 
Published: July 2016

AbstractLong-duration observations of Neptune’s brightness at two visible wavelengths provide a disk-averaged estimate of its atmospheric aerosol. Brightness variations were previously associated with the 11-year solar cycle, through solar-modulated mechanisms linked with either ultraviolet or galactic cosmic ray (GCR) effects on atmospheric particles. Here, we use a recently extended brightness data set (1972–2014), with physically realistic modelling to show, rather than alternatives, ultraviolet and GCR are likely to be modulating Neptune’s atmosphere in combination. The importance of GCR is further supported by the response of Neptune’s atmosphere to an intermittent 1.5- to 1.9-year periodicity, which occurred preferentially in GCR (not ultraviolet) during the mid-1980s. This periodicity was detected both at Earth, and in GCR measured by Voyager 2, then near Neptune. A similar coincident variability in Neptune’s brightness suggests nucleation onto GCR ions. Both GCR and ultraviolet mechanisms may occur more rapidly than the subsequent atmospheric particle transport.
Challenges in identifying cancer genes by analysis of exome sequencing data
Authors: Hofree Matan , Carter Hannah , Kreisberg Jason F. , Bandyopadhyay Sourav , Mischel Paul S. , Friend Stephen , Ideker Trey 
Published: July 2016

AbstractMassively parallel sequencing has permitted an unprecedented examination of the cancer exome, leading to predictions that all genes important to cancer will soon be identified by genetic analysis of tumours. To examine this potential, here we evaluate the ability of state-of-the-art sequence analysis methods to specifically recover known cancer genes. While some cancer genes are identified by analysis of recurrence, spatial clustering or predicted impact of somatic mutations, many remain undetected due to lack of power to discriminate driver mutations from the background mutational load (13–60% recall of cancer genes impacted by somatic single-nucleotide variants, depending on the method). Cancer genes not detected by mutation recurrence also tend to be missed by all types of exome analysis. Nonetheless, these genes are implicated by other experiments such as functional genetic screens and expression profiling. These challenges are only partially addressed by increasing sample size and will likely hold even as greater numbers of tumours are analysed.