bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Department Management of Childhood Pneumonia in the United States Prior to Publication of National Guidelines
Authors: Neuman Mark I. , Shah Samir S. , Shapiro Daniel J. , Hersh Adam L. 
Published: March 2013

AbstractBackgroundRecent publication of national guidelines by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA) provide recommendations around diagnostic testing and antibiotic treatment for children with community‐acquired pneumonia (CAP). These guidelines emphasize limited use of chest radiograph (CXR) and complete blood count (CBC) and routinely performing viral testing and use of narrow‐spectrum antibiotics.ObjectivesThe objective was to estimate the rate of emergency department (ED) visits for pediatric CAP in the United States and to describe management of patients prior to publication of consensus national guidelines.MethodsData were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for ED visits from 2001 through 2009 for children with CAP.ResultsDuring the study period there were an estimated 375,000 ED visits for CAP annually; 85% occurred within a general, rather than pediatric, ED. Overall, 20% of children with CAP were hospitalized. Among children discharged from EDs with CAP, CBC was performed during 30% of visits, CXR during 83%, and viral testing in only 13%. Twelve percent of children discharged from EDs with CAP had blood cultures obtained. No major differences were observed in the rates of laboratory testing or antibiotic administration between children treated in general versus pediatric EDs. During the study period, only 21% of children discharged from EDs with CAP received amoxicillin, the guideline‐recommended antibiotic.ConclusionsMost ED visits for CAP in the United States occur in general EDs. To encourage care that is consistent with national guidelines, efforts should be made to reduce the performance of certain diagnostic testing, such as CBC and CXR, among children discharged from EDs with CAP. Additionally, the use of narrow‐spectrum antibiotics should be encouraged.
A Novel Approach to Incorporating Evidence‐based Medicine Into an Emergency Medicine Clerkship
Authors: Snashall Jonathan , Fair Malika , Scott James 
Published: March 2013

AbstractObjectivesDespite the growing emphasis of evidence‐based medicine (EBM) in the medical school curriculum, and the recognition of EBM's role in the practice of emergency medicine (EM), there are no current guidelines on how to teach EBM to fourth‐year medical students during their EM rotations. The goal was to create a unique EM clerkship curriculum that teaches students to incorporate EBM into their clinical decision‐making and complies with the core curriculum recommendations of the Clerkship Directors in Emergency Medicine (CDEM).Project DescriptionPrior to a scheduled, case‐based small group discussion, students are provided with a clinically relevant question to investigate. Case discussions are led by EM faculty with each case highlighting a core EM topic developed by CDEM. During the case discussion, the assigned clinical question is addressed and a plan of care is presented based on the tenets of EBM. Faculty members function as moderators for these discussions and provide individual feedback regarding search strategies, appraisal of the literature findings, and applicability to the patient population. This multifaceted approach to EBM through the incorporation of individual student literature searches, clinical vignettes, small group discussion with consensus building, and faculty moderation with timely feedback is an innovative educational technique. Future educational research must explore the efficacy of this curriculum and whether or not the model produces greater long‐term understanding of EBM by students and if similar curricula can be executed at other institutions.ConclusionsThe authors have developed a novel fourth‐year EM clerkship curriculum that integrates EBM through the use of a highly interactive, faculty‐led, small group‐learning environment that encourages students to develop the necessary skills to integrate EBM into their clinical practice.
Assessing the Validity Evidence of an Objective Structured Assessment Tool of Technical Skills for Neonatal Lumbar Punctures
Authors: Iyer Maya S. , Santen Sally A. , Nypaver Michele , Warrier Kavita , Bradin Stuart , Chapman Rachel , McAllister Jennifer , Vredeveld Jennifer , House Joseph B. 
Published: March 2013

AbstractBackgroundThe lumbar puncture (LP) is a procedural competency deemed necessary by the Accreditation Council for Graduate Medical Education and the Emergency Medicine and Pediatric Residency Review Committees. The emergency department (ED) is a primary site for residents to be evaluated performing neonatal LPs. Current evaluation methods lack validity evidence as assessment tools.ObjectivesThis was a pilot study to develop an objective structured assessment of technical skills for neonatal LP (OSATS‐LP) and to document validity evidence for the instrument in regard to five sources of test validity: content, response process, relation to other variables, inter‐rater reliability, and consequences of testing.MethodsPediatric residents were videotaped in the fall of 2011 for comparison of faculty evaluation of resident performance during a neonatal LP using a video‐delayed format. Residents completed a demographic experience survey evaluating relations to other variables. Content and response process validity was obtained through expert panel meetings and resulted in the following seven domains of performance for the OSATS‐LP: preparation, positioning, analgesia, needle insertion, cerebrospinal fluid (CSF) collection, management of laboratory studies, and sterility. t‐tests assessed significance between level of training, previous intensive care unit experience, and residents' self‐assessed confidence in comparison with their total performance score. The inter‐rater agreement of the OSATS‐LP was obtained using the Fleiss' kappa for each domain.ResultsSixteen pediatric residents completed the simulation with six raters evaluating each resident (96 ratings). The domains of sterility and CSF collection had moderate statistical reliability (κ = 0.41 and 0.51, respectively). The domains of preparation, analgesia, and management of laboratories had substantial reliability (κ = 0.60, 0.62, and 0.62, respectively). The domains of positioning and needle insertion were less reliable (κ = 0.16 and 0.16, respectively). Individuals who had completed one or more rotations in the neonatal intensive care unit (NICU) had a higher total score (12.5 vs. 16.9; p < 0.01). The residents' own perception of ability to perform an LP unsupervised did not result in a higher total score.ConclusionsThe OSATS‐LP has reasonable evidence in four of the five sources for test validity. This study serves as a launching point for using this tool in clinical environments such as the ED and, therefore, has the potential to provide real‐time formative and summative feedback to improve resident skills and ultimately lead to improvements in patient care.
Interpreting Red Blood Cells in Lumbar Puncture: Distinguishing True Subarachnoid Hemorrhage From Traumatic Tap
Authors: Czuczman Amanda D. , Thomas Lisa E. , Boulanger Alyson B. , Peak David A. , Senecal Emily L. , Brown David F. , Marill Keith A. 
Published: March 2013

AbstractObjectivesThe study purpose was to determine the optimal use of lumbar puncture (LP) red blood cell (RBC) counts to identify subarachnoid hemorrhage (SAH) when some blood remains in the final tube.MethodsA case series was performed at a tertiary emergency department (ED). Records of 4,496 consecutive adult patients billed for LPs between 2001 and 2009 were reviewed. Inclusion criteria were headache (HA), final tube RBCs ≥ 5, and neurovascular imaging within 2 weeks of the visit. Demographics, relevant history and physical examination components, LP results, and neuroimaging findings were recorded for 280 patients. True‐positive (TP) and true‐negative (TN) SAH were strictly defined. Primary outcomes were the areas under the receiver operating characteristic curves (AUC) for final tube RBC count, differential RBC count between the final and initial tubes, and absolute differential RBC count between the final and initial tubes divided by the mean RBC count of the two tubes (also called the percent change in RBC count).ResultsThere were 26 TP and 196 TN results; 58 patients were neither. The TP group consisted of 19 patients with visible or possible SAH on imaging (17 on noncontrast head computed tomography [CT; 12 definite and five possible] and two on magnetic resonance imaging), six with xanthochromia and a vascular lesion (aneurysm or arteriovenous malformation [AVM] > 2 mm), and one with xanthochromia and polymerase chain reaction (PCR)‐positive meningitis. As a test for SAH, final tube RBC AUC was 0.85 (95% confidence interval [CI] = 0.80 to 0.91). Interval likelihood ratios (LRs) for final tube RBC count were LR 0 (95% CI = 0 to 0.3) for RBCs < 100, LR 1.6 (95% CI = 1.1 to 2.3) for 100 < RBCs < 10,000, and LR 6.3 (95% CI = 4.8 to 23.4) for RBCs > 10,000. Differential RBC count was not associated with SAH, with AUC 0.45 (95% CI = 0.31 to 0.60). However, the percent change in RBC count between the final and initial tubes had an AUC 0.84 (95% CI = 0.78 to 0.90), and the optimal test threshold for SAH was 0.63, with positive LR 3.6 (95% CI = 2.7 to 4.7) and negative LR 0.10 (95% CI = 0.03 to 0.4) for percent change <63% and >63%, respectively. This test added additional independent information to the final tube RBC count based on improved logistic regression model fit and discriminatory ability as measured by the LR test and c statistic, respectively.ConclusionsFinal LP tube RBC count and the percent change in RBC count, but not the simple differential count between the final and initial tubes, were associated with SAH. In this sample, there were no patients with SAH who had RBCs < 100 in the final tube, and RBCs > 10,000 increased the odds of SAH by a factor of 6.
Correction: Unscheduled Return Visits to the Emergency Department: Consequences for Triage
Authors: Sauvin Gabrielle , Freund Yonathan , Saïdi Khaled , Riou Bruno , Hausfater Pierre 
Published: March 2013

AbstractObjectivesThe objective was to conduct a survey of unscheduled revisits (URs) to the emergency department (ED) within 8 days of a prior visit, to test the hypothesis that patients making these URs are disproportionately likely to suffer short‐term mortality or manifest a need for any admission to the hospital (adverse events [AEs]) at the time of the UR, compared to patients triaged at the same level who did not have an unscheduled ED revisit within 8 days.MethodsThis was a 1‐year retrospective study of patients with an UR to the ED of an urban, 1,600‐bed tertiary care center and teaching hospital. The criteria for inclusion as an UR were: 1) making an emergency visit to our adult ED during 2008, without being admitted to our hospital nor being transferred to another hospital; and 2) subsequently making an UR to the same ED within 8 days following the first one. Patients who were contacted by members of our staff and specifically asked to make return visits to our ED (such as those who returned for wound care follow‐up visits), and those who made more than five visits to our ED during 2008, were excluded. AEs were defined as death or hospitalization within 8 days of the second visit.ResultsDuring 2008, there were 946 patients with URs (2% of patients treated and released after the first ED visit), and 931 were analyzed (n = 15 missing values). Associated with the second visit, an AE was noted for 276 (30%) patients. Eight variables were significantly associated with AE: age ≥ 65 years, previously diagnosed cancer, previously diagnosed cardiac disease, previously diagnosed psychiatric disease, presence of a relative at the time of the UR, arrival with a letter from a general practitioner at the time of the UR, a higher level of severity assigned at triage for the UR than for the first ED visit, and having had blood sample analysis performed during the first visit. The median triage score for the UR was not significantly different from that group's median triage score for the first ED visit, whereas the proportion of admissions to the hospital (29%) or to the intensive care unit (ICU; 2%) was greater overall in the UR group than in the patients making their first ED visit.ConclusionsThe authors observed that 2% of patients had an UR. This UR population was at greater risk of AE at the time of their URs compared to their initial visits, but the median triage nurse score was not significantly different between the first visit and the UR. This suggests that the triage score should be systematically upgraded for UR patients.
Aberrant deleted in liver cancer‐1 expression is associated with tumor metastasis and poor prognosis in urothelial carcinoma
Authors: Chen Wan‐Tzu , Yang Ching‐Hsiu , Wu Chun‐Chieh , Huang Ya‐Chun , Chai Chee‐Yin 
Published: March 2013

This study explored the potential role of deleted in liver cancer‐1 (DLC‐1) as a prognostic indicator of cancer metastasis and survival in urothelial carcinoma (UC). Tissue microarrays were constructed from paraffin‐embedded specimens from 88 UC patients, and immunohistochemical staining was performed to investigate the association of DLC‐1 with clinicopathologic characteristics and clinical outcome. The DLC‐1 expression showed a significant positive correlation with tumor location (p = 0.041) and a significant negative correlation with advanced histological grade (p = 0.013). In tumors with low DLC‐1 expression, Bcl‐2 positivity was observed in 24.4% of cases. The DLC‐1 expression had significant negative associations with Bcl‐2 expression (p = 0.032) and with highly metastatic UC (p = 0.032). Kaplan–Meier analysis showed that DLC‐1 protein expression was negatively associated with both overall survival (OS) (p = 0.035) and with distant metastasis‐free survival (DMFS) (p = 0.041), but not with disease‐free survival. Multivariate analyses indicated that tumor size was the significant independent predictors of OS (p = 0.048); however, only DLC‐1 expression was a significant independent predictor of DMFS (p = 0.019). In conclusion, reduced DLC‐1 protein expression may be an important factor in tumor progression and a useful prognostic molecular marker in UC.
Dynamics of antibody response and viraemia following natural infection of porcine circovirus 2 (PCV‐2) in a conventional pig herd
Authors: Csank Tomáš , Pistl Juraj , Polláková Jana , Bhide Katarína , Herich Robert , Levkut Mikuláš 
Published: March 2013

Porcine circovirus 2 (PCV‐2) is a primary agent of post‐weaning multi‐systemic wasting syndrome (PMWS), ubiquitous in pig herds. The course of viraemia and seroconversion in naturally infected pigs were investigated in piglets from the 2nd week of their life. Piglets were divided into seropositive (Ab+) and seronegative (Ab−) groups. Subsequently, after vaccination against PCV‐2 (Ingelvac® CIRCOFLEX™, Böehringer Ingelheim), they were further divided into non‐vaccinated seronegative (NVAC/Ab−) and seropositive (NVAC/Ab+), and vaccinated seronegative (VAC/Ab−) and seropositive (VAC/Ab+). PCV‐2 colostral antibodies failed to prevent development of natural PCV‐2 infection in conventional piglets; however, this occurred at a higher age in comparison with seronegative pigs. Neither colostral nor post‐infection antibodies prevented development of viraemia, which persisted up to the end of the study (the 19th week), but without clinical signs of PMWS. Vaccination failed to prevent development of natural PCV‐2 infection, but viraemia was limited to between the 8th and 10th week. The presence of colostral anti‐PCV‐2 antibodies did not show any untoward effect to vaccination; on the contrary, VAC/Ab+ animals showed the lowest titre of viraemia.
Angiotensin II causes imbalance between pro‐ and anti‐inflammatory cytokines by modulating GSK‐3β in neuronal culture
Authors: Agarwal Deepmala , Dange Rahul B , Raizada Mohan K , Francis Joseph 
Published: March 2013

Background and PurposeEmerging evidence indicates that the balance between pro‐inflammatory cytokines (PICs) and anti‐inflammatory cytokines (AICs) within the brain is an important determinant in the outcome of hypertension. However, the mechanism by which this dysregulation occurs is not known. We aimed to investigate whether AngII induces imbalance between PIC and AIC by modulating downstream transcription factors, NFκB and cyclic AMP response element‐binding protein (CREB), and whether AngII‐induced effects are mediated by glycogen synthase kinase‐3β (GSK‐3β).Experimental ApproachCATH.a neurons were exposed to AngII (10 nM–1 μM) over a preset time course. In another set of experiments, GSK‐3β was knock down by using lentivirus containing short hairpin RNA targeting GSK‐3β (L‐sh‐GSK3β) before AngII exposure. Cell extracts were subjected to RT‐PCR, immunoblot and immunoprecipitation.Key ResultsAngII caused time‐dependent increase in PICs (TNF‐α and IL‐1β) and reduction in AIC (IL‐10). AngII exposure caused reduced phosphorylated CREB(Ser‐133) and increased p‐NFκB(Ser‐276) levels, leading to reduced CREB‐CBP and increased NFκB‐CBP binding. These results were accompanied by increased activation of GSK‐3β, as indicated by increased p‐GSK3(Tyr‐216) to p‐GSK3(Ser‐9) ratio. In a subsequent study, pretreatment with L‐sh‐GSK3β attenuated AngII‐induced alterations in PICs and IL‐10 by augmenting CREB‐CBP and attenuating NFκB‐CBP binding.Conclusions and ImplicationsCollectively, these findings are the first to provide direct evidence that AngII‐induced dysregulation in cytokines is mediated by GSK‐3β‐mediated alterations in downstream transcription factors in neuronal cells. Our data also reveal that AngII‐induced effects could be alleviated by GSK‐3β inhibition, suggesting GSK‐3β as an important therapeutic target for hypertension that is characterized by increased PICs and NFκB activation.
MDMA‘ecstasy’ increases cerebral cortical perfusion determined by bolus‐tracking arterial spin labelling (btASL)MRI
Authors: Rouine J , Gobbo O L , Campbell M , Gigliucci V , Ogden I , McHugh Smith K , Duffy P , Behan B , Byrne D , Kelly M E , Blau C W , Kerskens C M , Harkin A 
Published: March 2013

Background and PurposeThe purpose of this study was to assess cerebral perfusion changes following systemic administration of the recreational drug 3,4‐methylendioxymethamphetamine (MDMA‘ecstasy’) to rats.Experimental ApproachCerebral perfusion was quantified using bolus‐tracking arterial spin labelling (btASL)MRI. Rats receivedMDMA(20 mg·kg−1; i.p.) and were assessed 1, 3 or 24 h later. Rats receivedMDMA(5 or 20 mg·kg−1; i.p.) and were assessed 3 h later. In addition, rats receivedMDMA(5 or 10 mg·kg−1; i.p.) or saline four times daily over 2 consecutive days and were assessed 8 weeks later. Perfusion‐weighted images were generated in a 7 tesla (7T)MRIscanner and experimental data was fitted to a quantitative model of cerebral perfusion to generate mean transit time (MTT), capillary transit time (CTT) and signal amplitude.Key ResultsMDMAreducesMTTandCTTand increases amplitude in somatosensory and motor cortex 1 and 3 h following administration, indicative of an increase in perfusion. Prior exposure toMDMAprovoked a long‐term reduction in cortical 5‐HTconcentration, but did not produce a sustained effect on cerebral cortical perfusion. The response to acuteMDMAchallenge (20 mg·kg−1; i.p.) was attenuated in these animals indicating adaptation in response to priorMDMAexposure.Conclusions and ImplicationsMDMAprovokes changes in cortical perfusion, which are quantifiable bybtASL MRI, a neuroimaging tool with translational potential. Future studies are directed towards elucidation of the mechanisms involved and correlating changes in cerebrovascular function with potential behavioural deficits associated with drug use.
N‐arachidonoyl glycine suppresses Na+/Ca2+ exchanger‐mediated Ca2+ entry into endothelial cells and activates BKCa channels independently of GPCRs
Authors: Bondarenko Alexander I , Drachuk Konstantin , Panasiuk Olga , Sagach Vadim , Deak Andras T , Malli Roland , Graier Wolfgang F 
Published: March 2013

Background and PurposeN‐arachidonoyl glycine (NAGly) is a lipoamino acid with vasorelaxant properties. We aimed to explore the mechanisms of NAGly's action on unstimulated and agonist‐stimulated endothelial cells.Experimental ApproachThe effects of NAGly on endothelial electrical signalling were studied in combination with vascular reactivity.Key ResultsIn EA.hy926 cells, the sustained hyperpolarization to histamine was inhibited by the non‐selective Na+/Ca2+ exchanger (NCX) inhibitor bepridil and by an inhibitor of reversed mode NCX, KB‐R7943. In cells dialysed with Cs+‐based Na+‐containing solution, the outwardly rectifying current with typical characteristics of NCX was augmented following histamine exposure, further increased upon external Na+ withdrawal and inhibited by bepridil. NAGly (0.3–30 μM) suppressed NCX currents in a URB597‐ and guanosine 5′‐O‐(2‐thiodiphosphate) (GDPβS)‐insensitive manner, [Ca2+]i elevation evoked by Na+ removal and the hyperpolarization to histamine. In rat aorta, NAGly opposed the endothelial hyperpolarization and relaxation response to ACh. In unstimulated EA.hy926 cells, NAGly potentiated the whole‐cell current attributable to large‐conductance Ca2+‐activated K+ (BKCa) channels in a GDPβS‐insensitive, paxilline‐sensitive manner and produced a sustained hyperpolarization. In cell‐free inside‐out patches, NAGly stimulated single BKCa channel activity.Conclusion and ImplicationsOur data showed that NCX is a Ca2+ entry pathway in endothelial cells and that NAGly is a potent G‐protein‐independent modulator of endothelial electrical signalling and has a dual effect on endothelial electrical responses. In agonist pre‐stimulated cells, NAGly opposes hyperpolarization and relaxation via inhibition of NCX‐mediated Ca2+ entry, while in unstimulated cells, it promotes hyperpolarization via receptor‐independent activation of BKCa channels.