bluuebunny/crossref_metadata_2025_split huggingface dataset:
Avulsion fracture of the lesser trochanter: an unusual cause of hip pain in an adolescent
Authors: Vazquez Eugenio , Kim Tommy Y. , Young Timothy P. 
Published: July 2016

ABSTRACTSports injuries involving the hip and groin are common. Special consideration must be given to musculoskeletal injuries in children and adolescents as their immature skeletons have growth plates that are relatively weaker than the tendons and ossified bone to which they connect. We present a case of an adolescent athlete with acute-onset groin pain who was found to have an avulsion fracture of the lesser trochanter.
Variability in the emergency department use of discretionary radiographs in children with common respiratory conditions: the mixed effect of access to pediatrician care
Authors: Guttmann Astrid , Weinstein Michael , Austin Peter C. , Bhamani Azim , Anderson Geoffrey 
Published: July 2016

ABSTRACTObjectives:The objective of this study was to investigate whether different staffing models are associated with variation in radiograph use for children seen for bronchiolitis, croup, and asthma and discharged home from emergency departments (EDs) in Ontario.Methods:We surveyed all Ontario EDs regarding physician staffing models and use of clinical protocols. We used a population-based ED database to determine radiograph rates and patient characteristics. Regression techniques that controlled for patient factors and clustering within EDs were applied.Results:From April 2004 to March 2006, 5,186, 10,408, and 35,150 children were discharged home from an ED with bronchiolitis, croup, and asthma, respectively. Radiograph rates were 42.7% for bronchiolitis, 10.1% for croup, and 25.9% for asthma. Over 50% of children were treated in EDs with nonpediatric front-line care but with consultant pediatricians available. Compared to children in these settings, those seen in EDs with front-line pediatric staff were less likely to have radiographs for all three conditions (adjusted odds ratios [ORs] 0.47 [95% CI 0.24–0.95], 0.47 [95% CI 0.27–0.82], 0.13 [95% CI 0.02–0.66] for bronchiolitis, croup, and asthma, respectively). Children in community hospitals with pediatricians were significantly more likely to have a radiograph if seen by a consultant pediatrician (OR 1.40, 95% CI 1.20–1.63 [bronchiolitis]; OR 2.76, 95% CI 2.16–3.53 [croup]; and OR 1.97, 95% CI 1.64–2.36 [asthma]). We found no association between clinical protocol use and radiograph rates.Conclusions:High rates of discretionary radiograph use exist for common respiratory problems of children seen across ED settings. Quality improvement efforts should be focused in this area, and radiograph use in EDs staffed by front-line pediatrics-trained staff could serve as an initial benchmark target for other institutions.
Impaired driving charges in injured impaired drivers requiring treatment in an emergency department
Authors: Fieldus Warren , Cain Ed 
Published: July 2016

ABSTRACTObjective:To determine the percentage of injured impaired drivers brought to the only trauma centre in Nova Scotia who were charged with impaired driving.Methods:This retrospective observational study identified alcohol impaired drivers involved in a motor vehicle crash (MVC) brought to the emergency department (ED). Patients were selected based on blood alcohol concentrations (BACs) found to be above the legal limit. Medical records were examined to determine if the patient was the driver in an MVC. Patient records were then cross-referenced with a police database to determine the percentage of injured impaired drivers who were charged with impaired driving.Results:Between April 1, 2006, and April 1, 2008, 1,102 patients brought to the QEII Health Sciences Centre (QEII HSC) ED were found to have BACs over the legal limit. Of these patients, only 57 (5.2%) were found to have been the driver in an MVC. The majority of patients were male (49; 86%), with an average age of 32 years. Most injuries (51; 89.5%) were the result of a single-vehicle crash. The mean Glasgow Coma Scale score was 12.6, and the mean Injury Severity Score was 14.4. Cross-referencing with police records showed that only 22.8% (13 of 57) of injured drivers were charged with impaired driving. Those drivers not charged with impaired driving had a significantly lower median BAC and median age.Conclusion:During the study, the majority of alcoholimpaired drivers injured in an MVC who were brought to the QEII HSC ED for assessment of their injuries were not charged with impaired driving.
Predictors of admission to hospital of patients triaged as nonurgent using the Canadian Triage and Acuity Scale
Authors: Lin Daren , Worster Andrew 
Published: July 2016

ABSTRACTObjectives:To identify factors known prior to triage that might have predicted hospital admission for patients triaged by the Canadian Triage Acuity Scale (CTAS) as level 5 (CTAS 5, nonurgent) and to determine whether inappropriate triage occurred in the admitted CTAS 5 patients.Methods:We reviewed the triage records of patients triaged as CTAS 5 at the emergency departments (EDs) of three tertiary care hospitals between April 2002 and September 2009. Two triage nurses unaware of the study objective independently assigned the CTAS level in 20% of randomly selected CTAS 5 patients who were admitted. We used the kappa statistic (κ) to measure the agreement among the raters in CTAS level between the assessment of the research nurses and the original triage assessment and regression analysis to identify independent predictors of admission to hospital.Results:Of the 37,416 CTAS 5 patients included in this study, 587 (1.6%) were admitted. Agreement on CTAS assignment in CTAS 5 patients who were admitted was κ −0.9, (95% confidence interval [CI] 20.96 to 20.84). Age over 65 (odds ratio [OR] 5.46, 95% CI 4.57 to 6.53) and arrival by ambulance (OR 7.42, 95% CI 6.15 to 8.96) predicted hospital admission in CTAS 5 patients.Conclusions:Most of the CTAS 5 patients who were subsequently admitted to hospital may have qualified for a higher triage category. Two potential modifiers, age over 65 and arrival by ambulance, may have improved the prediction of admission in CTAS 5 patients. However, the consistent application of existing CTAS criteria may also be important to prevent incorrect triage.
Unnecessary shock from an implantable cardioverter-defibrillator following transcutaneous pacing
Authors: Somani Riyaz , DeJong Peggy , Michael Kevin , Baranchuk Adrian 
Published: July 2016

ABSTRACT
As the population ages and cardiovascular disease becomes more prevalent, an increasing number of patients are receiving implantable cardioverter-defibrillators (ICDs). When these patients present to the emergency department, it is imperative that physicians are not only aware of the possible underlying medical issues that may have precipitated their admission but should also have a good understanding of the potential interactions that any medical intervention may have on the patient’s device. We discuss a case in which a patient known to have an ICD in situ was transcutaneously paced for the management of bradycardia, leading to an unnecessary shock.
Detection and correction of prescription errors by an emergency department pharmacy service
Authors: Stasiak Philip , Afilalo Marc , Castelino Tanya , Xue Xiaoqing , Colacone Antoinette , Soucy Nathalie , Dankoff Jerrald 
Published: July 2016

ABSTRACTObjectives:Emergency departments (EDs) are recognized as a high-risk setting for prescription errors. Pharmacist involvement may be important in reviewing prescriptions to identify and correct errors. The objectives of this study were to describe the frequency and type of prescription errors detected by pharmacists in EDs, determine the proportion of errors that could be corrected, and identify factors associated with prescription errors.Methods:This prospective observational study was conducted in a tertiary care teaching ED on 25 consecutive weekdays. Pharmacists reviewed all documented prescriptions and flagged and corrected errors for patients in the ED. We collected information on patient demographics, details on prescription errors, and the pharmacists’ recommendations.Results:A total of 3,136 ED prescriptions were reviewed. The proportion of prescriptions in which a pharmacist identified an error was 3.2% (99 of 3,136; 95% confidence interval [CI] 2.5–3.8). The types of identified errors were wrong dose (28 of 99, 28.3%), incomplete prescription (27 of 99, 27.3%), wrong frequency (15 of 99, 15.2%), wrong drug (11 of 99, 11.1%), wrong route (1 of 99, 1.0%), and other (17 of 99, 17.2%). The pharmacy service intervened and corrected 78 (78 of 99, 78.8%) errors. Factors associated with prescription errors were patient age over 65 (odds ratio [OR] 2.34; 95% CI 1.32–4.13), prescriptions with more than one medication (OR 5.03; 95% CI 2.54–9.96), and those written by emergency medicine residents compared to attending emergency physicians (OR 2.21, 95% CI 1.18–4.14).Conclusions:Pharmacists in a tertiary ED are able to correct the majority of prescriptions in which they find errors. Errors are more likely to be identified in prescriptions written for older patients, those containing multiple medication orders, and those prescribed by emergency residents.
The reverse classroom: lectures on your own and homework with faculty
Authors: Sherbino Jonathan , Chan Teresa , Schiff Karen 
Published: July 2016

ABSTRACT
With the arrival of a technologically proficient generation of learners (often described with the moniker “digital natives”) into Canadian medical schools and residency programs, there is an increasing trend toward harnessing technology to enhance education and increase teaching efficiency. We present an instructionalmethod that allows medical educators to “reverse” the traditional classroom paradigm. Imagine that prior to an academic half-day session, learners watch an e-lecture on their own time; then during class, they do “homework” with tailored consultations from a content expert. The reverse classroom uses simple, readily accessible technology to allow faculty members to engage learners in high-order learning such as information analysis and synthesis. With this instructional method, the inefficient, repetitious delivery of recurring core lectures is no longer required. The reverse classroom is an effective instructional method. Using this technique, learners engage in high-order learning and interaction with teachers, and teachers are able to optimally share their expertise.
Validity of ultrasonography to diagnosing pneumothorax: a critical appraisal of two meta-analyses
Authors: Azad Aftab , Juma Saad Al , Bhatti Junaid A. , Dankoff Jerrald 
Published: July 2016

Clinical questionCan ultrasonography be used in lieu of chest radiography to diagnose pneumothorax?Articles chosen1. Ding W, Shen Y, Yang J, et al. Diagnosis of pneumothorax by radiography and ultrasonography: a metaanalysis. Chest 2011;140:859-66. [Epub 2011 May 5]2. Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest 2012; 141:703-8.
Implementing peer review at an emergency medicine blog: bridging the gap between educators and clinical experts
Authors: Thoma Brent , Chan Teresa , Desouza Natalie , Lin Michelle 
Published: July 2016

AbstractEmergency physicians are leaders in the ‘‘free open-access meducation’’ (FOAM) movement. The mandate of FOAM is to create open-access education and knowledge translation resources for trainees and practicing physicians (e.g., blogs, podcasts, and vodcasts). Critics of FOAM have suggested that because such resources can be easily published online without quality control mechanisms, unreviewed FOAM resources may be erroneous or biased. We present a new initiative to incorporate open, expert, peer review into an established academic medical blog. Experts provided either pre- or postpublication reviews that were visible to blog readers. This article outlines the details of this initiative and discusses the potentially transformative impact of this educational innovation.
What are emergency-sensitive conditions? A survey of Canadian emergency physicians and nurses
Authors: Berthelot Simon , Lang Eddy S. , Quan Hude , Stelfox Henry T. 
Published: July 2016

AbstractObjective: In a previous study, we assembled a multidisciplinary Canadian panel and identified 37 International Classification of Diseases-10-Canada Diagnosis Groups (DGs) for which emergency department (ED) management may potentially reduce mortality (emergency-sensitive conditions). Before using these 37 DGs to calculate a hospital standardized mortality ratio (HSMR) specific to emergency care, we aimed to test their face validity with ED care providers.Methods: We conducted a self-administered web survey among Canadian emergency physicians and nurses between November 22 and December 31, 2012. All members (N=2,507) of the Canadian Association of Emergency Physicians and the National Emergency Nurses Association were surveyed. They were asked to agree or disagree (binary response) with the panel classification for each of the 37 DG emergency-sensitive conditions identified and provide free text responses to identify missing entities.Results: A total of 719 ED providers (719 of 2,507, 29%) completed the survey, of whom 470 were physicians (470 of 1,407, 33%) and 232 were nurses (232 of 1,100, 21%). Information on professional status was not provided for 17 respondents. Of 37 DGs, 32 (e.g., A41 sepsis) were rated by more than 80% of respondents to be emergency-sensitive conditions. The remaining five DGs (e.g., E11 type 2 diabetes mellitus) were rated by 68.5 to 79.7% of the respondents to be emergency-sensitive conditions. Respondents suggested an additional 31 emergency-sensitive diagnoses.Conclusion: We identified 37 emergency-sensitive DGs that had high face validity with emergency physicians and nurses, which will enable the calculation of an ED-HSMR.
Biomechanical comparison of 3.0 mm headless compression screw and 3.5 mm cortical bone screw in a canine humeral condylar fracture model
Authors: Jankovits Daniel , Huber Michael , Strom Adam , Garcia Tanya , Stover Susan , Gonsalves Mishka 
Published: July 2016

SummaryObjective: To compare the biomechanical properties of simulated humeral condylar fractures reduced with one of two screw fixation methods: 3.0 mm headless compression screw (HCS) or 3.5 mm cortical bone screw (CBS) placed in lag fashion.Methods: Bilateral humeri were collected from nine canine cadavers. Standardized osteotomies were stabilized with 3.0 mm HCS in one limb and 3.5 mm CBS in the contralateral limb. Condylar fragments were loaded to walk, trot, and failure loads while measuring construct properties and condylar fragment motion.Results: The 3.5 mm CBS-stabilized constructs were 36% stiffer than 3.0 mm HCS-stabilized constructs, but differences were not apparent in quality of fracture reduction nor in yield loads, which exceeded expected physiological loads during rehabilitation. Small residual fragment displacements were not different between CBS and HCS screws. Small fragment rotation was not significantly different between screws, but was weakly correlated with moment arm length (R2 = 0.25).Clinical significance: A CBS screw placed in lag fashion provides stiffer fixation than an HCS screw, although both screws provide similar anatomical reduction and yield strength to condylar fracture fixation in adult canine humeri.
DIFFERENCES IN THE STRUCTURAL PROPERTIES AND STAR FORMATION RATES OF FIELD AND CLUSTER GALAXIES AT Z ∼ 1
Authors: Allen Rebecca J. , Kacprzak Glenn G. , Glazebrook Karl , Tran Kim-Vy H. , Spitler Lee R. , Straatman Caroline M. S. , Cowley Michael , Nanayakkara Themiya 
Published: July 2016

ABSTRACT
We investigate the dependence of galaxy sizes and star formation rates (SFRs) on their environment using a mass-limited sample of quiescent and star-forming galaxies with log(M
*/

) ≥ 9.5 at

selected from the NEWFIRM medium-band Survey (NMBS). Using the Galaxy Environment Evolution Collaboration 2 spectroscopic cluster catalog and the accurate photometric redshifts from the NMBS, we select quiescent and star-forming cluster (

km s−1) galaxies within two virial radius, R
vir, intervals of 2 > R
vir > 0.5 and R
vir < 0.5. Galaxies residing outside of the 2 R
vir of both the cluster centers and the additional candidate over-densities are defined as our field sample. Galaxy structural parameters are measured from the COSMOS legacy Hubble Space Telescope/ACS F814W image. The sizes and Sérsic indices of quiescent field and cluster galaxies have the same distribution regardless of R
vir. However, cluster star-forming galaxies within 0.5 R
vir have lower mass-normalized average sizes by

, and a higher fraction of Sérsic indices with

, than field star-forming galaxies. The average SFRs of star-forming cluster galaxies show a trend of decreasing SFR with clustocentric radius. The mass-normalized average SFR of cluster star-forming galaxies is a factor of

(

) lower than that of star-forming galaxies in the field. While we find no significant dependence on environment for quiescent galaxies, the properties of star-forming galaxies are affected, which could be the result of environment acting on their gas content.
c-Src Suppresses Dendritic Cell Antitumor Activity via T Cell Ig and Mucin Protein-3 Receptor
Authors: Gujar Ravindra , Maurya Neeraj , Yadav Vinod , Gupta Mamta , Arora Saurabh , Khatri Neeraj , Sen Pradip 
Published: July 2016

Abstract
The enhanced expression of T cell Ig and mucin protein-3 (TIM-3) on tumor-associated dendritic cells (DCs) attenuates antitumor effects of DNA vaccines. To identify a potential target (or targets) for reducing TIM-3 expression on tumor-associated DCs, we explored the molecular mechanisms regulating TIM-3 expression. In this study, we have identified a novel signaling pathway (c-Src→Bruton’s tyrosine kinase→transcription factors Ets1, Ets2, USF1, and USF2) necessary for TIM-3 upregulation on DCs. Both IL-10 and TGF-β, which are produced in the tumor microenvironment, upregulated TIM-3 expression on DCs via this pathway. Suppressed expression of c-Src or downstream Bruton’s tyrosine kinase, Ets1, Ets2, USF1, or USF2 blocked IL-10– and TGF-β–induced TIM-3 upregulation on DCs. Notably, in vivo knockdown of c-Src in mice reduced TIM-3 expression on tumor-associated DCs. Furthermore, adoptive transfer of c-Src–silenced DCs in mouse tumors enhanced the in vivo antitumor effects of immunostimulatory CpG DNA; however, TIM-3 overexpression in c-Src–silenced DCs blocked this effect. Collectively, our data reveal the molecular mechanism regulating TIM-3 expression in DCs and identify c-Src as a target for improving the efficacy of nucleic acid–mediated anticancer therapy.
In Vivo Expansion of Endogenous Regulatory T Cell Populations Induces Long-Term Suppression of Contact Hypersensitivity
Authors: El Beidaq Asmaa , Link Christopher W. M. , Hofmann Katharina , Frehse Britta , Hartmann Karin , Bieber Katja , Martin Stefan F. , Ludwig Ralf J. , Manz Rudolf A. 
Published: July 2016

Abstract
Contact hypersensitivity (CHS) of murine skin serves as a model of allergic contact dermatitis. Hapten-specific CD8 T cells and neutrophils represent the major effector cells driving this inflammatory reaction whereas Foxp3+ regulatory T cells (Tregs) control the severity of inflammation. However, whether in vivo expansion of endogenous Tregs can downregulate CHS-mediated inflammation remains to be elucidated. In this study, we addressed this issue by using injection of an IL-2/anti–IL-2 mAb JES6-1 complex (IL-2/JES6-1) as a means of Treg induction in 2,4,6-trinitrochlorobenzene–induced CHS. IL-2/JES6-1 injection before or after hapten sensitization led to a considerable reduction of skin inflammation, even when rechallenged up to 3 wk after the last treatment. Conversely, Treg depletion re-established the CHS response in IL-2/JES6-1–treated mice. IL-2/JES6-1 injection resulted in increased frequencies of natural and peripheral Tregs in spleen and draining lymph nodes (LNs), elevated IL-10 and TGF-β production by CD4 T cells, reduced CD86 expression by dendritic cells, and led to lower numbers of hapten-specific IFN-γ–producing CD8 T effector cells in LNs. Neutrophil and CD8 T cell infiltration was reduced in inflamed ear tissue, whereas CTLA-4+Foxp3+ Treg frequencies were augmented. Adoptive transfer of LN cells of sensitized mice into recipients treated with IL-2/JES6-1 showed impaired CHS. Our results show that in vivo Treg expansion results in a prolonged CHS suppression, a sustained reduction of hapten-specific CD8 T cells, and a decrease in effector cell influx in inflamed tissue.
RECFMM: Recursive Parallelization of the Adaptive Fast Multipole Method for Coulomb and Screened Coulomb Interactions
Authors: Zhang Bo , Huang Jingfang , Pitsianis Nikos P. , Sun Xiaobai 
Published: July 2016

AbstractWe present RECFMM, a program representation and implementation of a recursive scheme for parallelizing the adaptive fast multipole method (FMM) on shared-memory computers. It achieves remarkable high performance while maintaining mathematical clarity and flexibility. The parallelization scheme signifies the recursion feature that is intrinsic to the FMM but was not well exploited. The program modules of RECFMM constitute a map between numerical computation components and advanced architecture mechanisms. The mathematical structure is preserved and exploited, not obscured nor compromised, by parallel rendition of the recursion scheme. Modern software system—CILK in particular, which provides graph-theoretic optimal scheduling in adaptation to the dynamics in parallel execution—is employed. RECFMM supports multiple algorithm variants that mark the major advances with low-frequency interaction kernels, and includes the asymmetrical version where the source particle ensemble is not necessarily the same as the target particle ensemble. We demonstrate parallel performance with Coulomb and screened Coulomb interactions.
Mini-implants for Orthodontic Anchorage: Surface Analysis after Redrilling and Sterilization – An in vitro Study
Authors: Gross JM , Nascimento GG , Araújo VC , Bönecker MJS , Furuse C 
Published: July 2016

ABSTRACT

Objective
This study aimed to investigate, in vitro, possible alterations on mini-implants surface after retrieval and if the cleaning process and sterilization can predispose damages.

Materials and methods
Two commercial mini-implants were tested for deformations after drilling and removing in artificial bone four times. Samples were analyzed by scanning electron microscopy, and surface alterations verified through thread and pitches deformation. To alterations caused by insertion/removal and the cleaning process and sterilization were verified in different procedures: Insertions and sterilization, only insertions, and only sterilization. Photomicrographs were analyzed in order to compare the surface characteristics. Head deformation was verified qualitatively. For a quantitative analysis, distances between threads were measured across the active part of the mini-implants.

Results
No deformation was observed in both groups. The cleaning and sterilization processes did not provoke alteration in both groups. Nevertheless, the presence of synthetic bone was noted in some samples. The mean distances between implant threads were similar after all steps in all regions in both groups.

Conclusion
The results suggest that the tested mini-implants can be retrieved without damage of its surface after four cycles of insertion, removal, and sterilization.

Clinical significance
Mini-implants can be retrieved without damage to its surface after four cycles of insertion, removal, and sterilization in the same patient without representing a biological concern.

How to cite this article
Gross JM, Nascimento GG, Araújo VC, Bönecker MJS, Furuse C. Mini-implants for Orthodontic Anchorage: Surface Analysis after Redrilling and Sterilization – An in vitro Study. J Contemp Dent Pract 2016;17(4):300-305.