bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unidentified drugs in traditional medications causing toxic epidermal necrolysis: a developing country experience
Authors: Das Kishore Kumar , Khondokar Sazzad , Rahman Ashrafur , Chakraborty Anjana 
Published: February 2014

AbstractBackgroundDrugs are by far the most common cause of toxic epidermal necrolysis (TEN), but unidentified drugs and chemicals present in herbal and traditional medications may also be responsible for this reaction, which manifests as widespread epidermal detachment of the skin and mucous membrane. In contexts in which a subject has used an herbal or traditional medication, it is very difficult to diagnose the condition, identify the offending agent, and prevent the disease from recurring.MethodsThis prospective study was conducted at a tertiary burn center between July 2004 and October 2012. All patients were referred to this unit by the local department of medicine at least one week after the eruption of vesicles. On arrival, all patients demonstrated a severe form of disease with features of sepsis and electrolyte imbalance (SCORTEN scores of ≥4). All non‐fatal cases were followed to observe long‐term sequelae and recurrences.ResultsAbout 34% of patients had developed the condition after ingesting traditional herbal medications and were unable to identify the responsible drug by name. Nineteen (66%) of the 29 patients referred to the unit with TEN died within the first week after being transferred. Nine patients achieved complete recovery, and one developed corneal haziness and alopecia. One patient experienced recurrence within three months but recovered.ConclusionsIlliteracy and financial vulnerability were major factors in driving patients towards the use of traditional medications, which were often prepared and preserved improperly. Mortality and other complications could be reduced by the prompt recognition of the condition, immediate withdrawal of the culprit drug, and quick referral to proper care.
Polytetrafluoroethylene expanded prosthesis as replacement of the inferior vena cava in renal cell carcinoma with caval thrombus
Authors: Benkirane Ahmed , Khodari Muhieddine , Yakoubi Rachid , Lambert Marc , Koussa Mohamad , Ghoneim Tarek , Haulon Stephan , Villers Arnauld , Lemaitre Laurent , Zini Laurent 
Published: February 2014

ObjectiveTo assess the outcomes of inferior vena cava replacement with polytetrafluoroethylene expanded prosthesis in patients with renal cell carcinoma and caval thrombosis.MethodsAll patients who underwent radical nephrectomy with inferior vena cava replacement by polytetrafluoroethylene expanded prosthesis for renal cancer associated with inferior vena cava thrombosis and a suspicion of inferior vena cava wall invasion from January 2000 to June 2011 were considered for this study. Demographic data, postoperative course, graft patency and survival data were evaluated.ResultsA total of 26 patients (median age 59.5 years, range 19.9–85.6 years) were included in the analysis. The median tumor diameter was 10 cm (range 5–14 cm). Histological invasion of the wall of the inferior vena cava was found in 16 (61.5%) cases. The median follow up was 28 months (range 1–136). A graft thrombosis occurred in five (19.2%) patients within the first year. Four of these patients died before the end of the second year. Patency of the inferior vena cava graft at 6 and 12 months was 88% and 79%, respectively. Overall survival probability at 3 years was 64%.ConclusionProsthetic replacement of the inferior vena cava can be carried out when invasion of the wall of the inferior vena cava is suspected. The postoperative complication rate in this subset of high‐risk patients undergoing radical nephrectomy seems acceptable, and the patency of the prostheses is good in most of the cases.
Scavenger receptor‐mediated endocytosis facilitates RNA interference in the desert locust, Schistocerca gregaria
Authors: Wynant N. , Santos D. , Van Wielendaele P. , Vanden Broeck J. 
Published: February 2014

AbstractRNA interference (RNAi) has become a widely used loss‐of‐function tool in eukaryotes; however, the delivery of double‐stranded (ds)RNA) to the target cells remains a major challenge when exploiting the RNAi‐technology. In insects, the efficiency of RNAi is highly species‐dependent. Yet, the mechanism of cell entry in insects has only been characterized in a cell line of the fruit fly, Drosophila melanogaster, a species that is well known to be poorly amenable to environmental RNAi. In the present paper, we demonstrate that silencing vacuolar H‐ATPase 16 (vha16) and clathrin heavy chain (clath), two components of the Clathrin‐dependent endocytosis pathway, together with pharmacological inhibition of scavenger receptors with polyinosine and dextran sulphate, can significantly attenuate the highly robust RNAi response in the desert locust, Schistocerca gregaria.
Inpatient antibiotic consumption in a regional secondary hospital in New Zealand
Authors: Hopkins C. J. 
Published: February 2014

AbstractBackgroundReporting of antibiotic consumption in hospitals is a crucial component of antibiotic stewardship, but data from Australasian secondary hospitals are scarce. The hypothesis of this audit is that antibiotic consumption in secondary hospitals would be lower than in tertiary centres.AimsThe study aims to present the first published audit of antibiotic consumption from a secondary hospital in New Zealand compared with two tertiary centres.MethodsHospital population‐level data were retrospectively accessed to identify all systemic antibiotics dispensed to adult inpatients at Taranaki District Health Board during 2011. Consumption was calculated in defined daily doses per 100 inpatient‐days and per 100 admissions, stratified by drug class. Comparison was against published data from two tertiary centres.ResultsTotal consumption was lower, but that of high‐risk antibiotic classes was higher than both tertiary centres. The relative consumption of lincosamides was 4.0 and 2.6 times higher than the two tertiary centres, with an associated 14% incidence of Clostridium difficile associated diarrhoea within 3 months.ConclusionOur secondary hospital appears to consume the wrong types of antibiotic rather than too much. Data from all Australasian hospitals, stratified by clinical service area and hospital level, are required for clinically relevant benchmarking.
Modification of the National Inpatient Medication Chart improves venous thromboembolism prophylaxis rates in high‐risk medical patients
Authors: Yates M. , Reddy M. , Machumpurath B. , Phelps G. , Hampson S.‐A. 
Published: February 2014

AbstractBackgroundVenous thromboembolism (VTE) is a significant contributor to morbidity and mortality in Australia. While there is well‐established evidence for the use of VTE prophylaxis in hospital inpatients, adherence to such guidelines is poor.AimThe aim of the present study is to assess the impact of education and system change on improving rates of VTE prophylaxis in hospital inpatients.MethodsWe performed four consecutive audits of inpatient medical records of a regional hospital service over 2 years. The audits aimed to test the impact of serial interventions at increasing the appropriate use of VTE prophylaxis (based on risk assessment). The interventions were (i) staff education and (ii) a process change that mandated a prophylaxis decision by modifying the National Inpatient Medication Chart with ‘VTE avoidance’ preprinted in the first medication box.ResultsOur results from the baseline study showed that of the 236 medical inpatients reviewed, 80% were at high risk of VTE. Of this high‐risk cohort, 34.9% (confidence interval (CI) 28–42%) had appropriate prophylaxis decisions. Post the education intervention, 43.2% (CI 37–49%) of the high‐risk cohort received appropriate VTE prophylaxis, an improvement of 8.3% (CI −1% to 18%) from baseline. With the subsequent introduction of a process change, 82.1% (CI 66–92%) of the high‐risk cohort received appropriate prophylaxis, an improvement of 47.2% and 38.8% (CI 24–54%) when compared with baseline and education respectively. Retention rates at 11 months postsystem change were 73% (CI 55–86%).ConclusionsThis study therefore concluded that while education has an impact on rates of appropriate VTE prophylaxis, it is system change that has the most marked and sustained effect.
Two‐faced haemophagocytic lymphohistiocytosis: comparative review of two cases of adult haemophagocytic lymphohistiocytosis
Authors: Mayson E. , Saverimuttu J. , Warburton P. 
Published: February 2014

AbstractHaemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal disease of children and adults. Cytokine dysfunction, uncontrolled accumulation of activated T‐cells and histiocytes, and the inability to terminate the immune response lead to the clinical manifestations of extreme inflammation and end‐organ damage. HLH is notoriously underreported because of its ability to mimic many other common diseases. Here, we outline two cases of HLH, one primary and the other secondary, to highlight some of the differences and to discuss therapeutic principles and emerging concepts.
Procalcitonin, a valuable biomarker assisting clinical decision‐making in the management of community‐acquired pneumonia
Authors: Lindstrom S. T. , Wong E. K. C. 
Published: February 2014

AbstractBackground and AimCommunity‐acquired pneumonia (CAP) is a leading cause of mortality, morbidity and hospital admission, which places strain on our healthcare system. Procalcitonin (PCT) is a biomarker of bacterial infection which may help gauge the severity and prognosis of patients with CAP. In addition to clinical predictors, PCT may assist in decisions pertaining to timing of discharge from hospital and the discontinuation of antibiotics. This study aimed to determine the predictive role of PCT measurement in reducing hospital admissions, length of stay (LOS) and antibiotic (AB) usage in patients with CAP.MethodsA prospective, single‐blinded, externally controlled study of consenting adult patients admitted with CAP. PCT levels were obtained on day 1 and day 3 (when indicated). Investigator‐evaluated clinical parameters, together with results of PCT levels, determined the timing of oral AB switch and discharge from hospital. This process was compared against standard practice, but was not actually implemented, for the purpose of this study.ResultsSixty patients were included in the study. The mean age was 66.5 ± 21.2 years (56.3% male). The average Pneumonia Severity Index was 93 ± 39 (class IV) and the median CURB‐65 was 2. The mean LOS for the standard practice cohort was 5.3 ± 4.6 days versus calculated LOS using the PCT guidance pathway of 3.7 ± 2.8 days. (P = 0.00006).ConclusionsOur study supports the hypothesis that by incorporation of PCT levels, hospital admission and LOS in patients with CAP can be reduced. A randomised prospective clinical trial is planned in an attempt to help confirm these findings.
Suboptimal management of unfractionated heparin compared with low‐molecular‐weight heparin in the management of pulmonary embolism
Authors: Khor Y. H. , Smith R. , McDonald C. F. 
Published: February 2014

AbstractBackgroundBoth low‐molecular‐weight heparin (LMWH) and unfractionated heparin (UFH) have been shown to be equivalent in efficacy and safety profiles for the management of pulmonary embolism (PE).AimsTo assess the real world management of anticoagulation in PE in a tertiary hospital setting.MethodsAn audit of patients with a new diagnosis of PE from March 2011 to March 2012. Data collected included patient demographics, anticoagulant, complication, mortality, time to first administration, frequency of monitoring and dose adjustment for UFH, time to therapeutic range for UFH (based on activated partial thromboplastin time) and length of hospital stay.ResultsOf the 211 patients who were included, 139 were admitted through the Emergency Department, and 45 were managed with UFH. There was no significant difference in time to initial dose between those treated with LMWH and UFH (192 vs 98 min, P = 0.16). For UFH, average time to therapeutic range was 594 min (range 87–2257 min). During the course of UFH therapy, only 22% of activated partial thromboplastin time was within therapeutic range, while 44% was above and 33% was below therapeutic range. Average number of UFH dose adjustment was 5. Increasing weight and higher baseline fibrinogen levels significantly delayed time to therapeutic range for patients on UFH (P = 0.02 and 0.04 respectively). Up to 18 months following PE, overall mortality rate was 28%, with no significant difference between LMWH and UFH (28% vs 29%).ConclusionPE was predominantly managed with LMWH. UFH was suboptimally managed when used, although there was no impact on mortality rate.
Care of the dying cancer patient in the emergency department: findings from a National survey of Australian emergency department clinicians
Authors: Marck C. H. , Weil J. , Lane H. , Weiland T. J. , Philip J. , Boughey M. , Jelinek G. A. 
Published: February 2014

AbstractBackgroundPatients with cancer are presenting to emergency departments (ED) for end‐of‐life care with increasing frequency. Little is known about this experience for patients and ED clinicians in Australia.AimsTo assess the barriers and enablers regarding end‐of‐life care for cancer patients as perceived by Australian ED clinicians.MethodsThere were 4501 Australian ED clinicians invited through their professional colleges to complete an online survey, using multiple‐choice and free‐text responses.ResultsA total of 681 ED clinicians responded, most (84.2%) felt comfortable providing care to the dying and found it to be rewarding (70.9%). Although 83.8% found caring for the dying a reasonable demand on their role as clinician, 83.8% also agreed that the ED is not the right place to die. Respondents demonstrated a wide range of views regarding caring for this patient group in ED through free‐text responses. In addition, 64.5% reported that futile treatment is frequently provided in the ED; the main reasons reported were that limitations of care were not clearly documented, or discussed with the patient or their family. Almost all (94.6%) agreed that advance care plans assist in caring for dying patients in the ED.ConclusionsOur findings provide important new insights into a growing area of care for ED. Barriers and enablers to optimal care of the dying patient in ED were identified, and especially the reported high occurrence of futile care, likely a result of these barriers, is detrimental to both optimal patient care and allocation of valuable healthcare resources.
Effect of Cobalt Doping on the Structural, Microstructure and Microwave Dielectric Properties of MgTiO3 Ceramics Prepared by Semi Alkoxide Precursor Method
Authors: Santhosh Kumar Thatikonda , Gogoi Pallabi , Perumal Alagarsamy , Sharma Pramod , Pamu Dobbidi 
Published: February 2014

We report a systematic investigation on crystal structure, microstructure, and microwave dielectric properties of (Mg1−xCox)TiO3 (x = 0–0.07) ceramics prepared by semialkoxide precursor method. All the as‐made samples exhibit an ilmenite structure with an incredible reduction in sintering temperature from 1350°C to 1200°C. Lattice parameter increases with increasing Co content due to the larger ionic radius of Co2+ as compared to Mg2+. The relative density, dielectric constant, and Q × f0 values increase with increasing Co up to 0.05 and decreases for x > 0.05. This is attributed to local lattice distortion, maximum relative density, and uniform grain growth. Q × f0 values were enhanced from 126 THz for x = 0 to a maximum value 170 THz for x = 0.05. A best combination of microwave dielectric properties (εr ~ 17.03, Q × f0 ~ 170 THz @ 9.4 GHz and τf of −40 ppm/°C) was obtained for (Mg0.95Co0.05)TiO3 ceramic sintered at 1200°C for 3 h. The observed results reveal (Mg0.95Co0.05)TiO3 ceramic as one of the promising dielectric materials for low‐loss and millimeter‐microwave applications.
Molecular dating of Winteraceae reveals a complex biogeographical history involving both ancient Gondwanan vicariance and long‐distance dispersal
Authors: Thomas Nanette , Bruhl Jeremy J. , Ford Andrew , Weston Peter H. 
Published: February 2014

AbstractAimOur aim was to implement a molecular dating analysis and assess divergence times among taxa of Winteraceae. This enabled us to test hypotheses of vicariance versus long‐distance dispersal to explain intercontinental disjunctions in the family.LocationMadagascar, Australia (including Lord Howe Island), New Zealand, New Caledonia and South America.MethodsWe sampled all Australian species and subspecies of Winteraceae. We also included the monotypic Takhtajania perrieri and at least two species of each genus from New Zealand, New Caledonia and South America. Three sets of sequences were combined into one data matrix, including two internal transcribed spacer (ITS) data sets and a trnL–F data set. Both ITS data sets included all genera of Winteraceae, and the paralogous genes identified in Zygogynum s.l. in a previous study were sequenced and aligned in separate ITS data sets. A Bayesian molecular phylogenetic tree of extant Winteraceae was used as a backbone constraint in paup* to establish the placement of fossils. Bayesian analyses were performed using beast, implementing fossil priors to fit lognormal distributions, to test a maximum‐parsimony phylogeny and assess divergence times.ResultsInterspecific relationships generally agreed with previous analyses. In particular, Bubbia comptonii was found to be sister to the rest of the Bubbia/Zygogynum clade, but our analysis has uniquely found sister clades within this group: one from New Caledonia, and one from Australia including Lord Howe Island. The phylogeny yields an age of 91.2 Ma with a 95% confidence interval of 118–67 Ma for crown‐group Winteraceae.Main conclusionsThe estimated age of Takhtajania is consistent with its origin in Madagascar as a result of Gondwanan vicariance – the only angiosperm for which this has been demonstrated with confidence. Differentiation of the rest of this ancient clade is a complicated story of vicariance as a result of the rifting, submergence and exhumation of continents and of long‐distance dispersal and extinctions.
Minimum wood density of Juniperus thurifera is a robust proxy of spring water availability in a continental Mediterranean climate
Authors: Camarero Jesús Julio , Rozas Vicente , Olano José Miguel 
Published: February 2014

AbstractAimThe Mediterranean Basin is considered to be a climate‐change hotspot, for which rising temperatures and associated aridification have been forecast. Such trends could affect the performance and growth of conifers in these drought‐prone areas. We evaluated whether radial growth and wood density can act as proxy measures of precipitation and drought in a Mediterranean conifer.LocationIberian Juniperus thurifera forests in northern and eastern Spain.MethodsWe sampled 10 stands encompassing J. thurifera's distributional area. We related four annually resolved tree‐ring variables (earlywood and latewood width, and maximum and minimum wood density) to climatic factors (temperature, precipitation and drought index) for the period 1951–2000. We then analysed the spatial and temporal patterns of those associations.ResultsOf all the four tree‐ring variables analysed, minimum wood density presented the strongest response to climate. Higher values of minimum wood density were related to drier spring conditions, particularly in the most xeric sites, confirming that a drought‐induced reduction in the radial expansion of tracheids increases earlywood density.Main conclusionsMinimum wood density is a biogeographically meaningful proxy of spring water availability for the Mediterranean conifer J. thurifera.
Suborbital climatic variability and centres of biological diversity in the Cape region of southern Africa
Authors: Huntley Brian , Midgley Guy F. , Barnard Phoebe , Valdes Paul J. 
Published: February 2014

AbstractAimTo explore the magnitude and spatial patterns of last glacial stage orbitally forced climatic changes and suborbital climatic fluctuations in southern Africa, and to evaluate their potential roles in determining present biodiversity patterns.LocationAfrica south of 15° S.MethodsPalaeoclimate scenarios for southern Africa were derived for 17 time slices using outputs from HadCM3 atmosphere–ocean general circulation model experiments, including five designed to mimic Heinrich events. Species distribution models for birds of Karoo (45) or Fynbos (31) were used to simulate species' potential past distributions. Species‐richness patterns were assessed for each time slice, and minimum species richness for regional endemics of each biome determined for each grid cell. Areas of greatest ‘stability’ for endemics of each biome were identified using grid cells with greatest minimum richness.ResultsSimulated suborbital climatic fluctuations were of greater magnitude than orbitally forced changes and had anomalies of opposite sign in many areas. The principal local drivers of suborbital fluctuations were marked contrasts in South Atlantic circulation and temperature between experiments mimicking Heinrich events and those with only slow forcings. These contrasts in ocean circulation and temperature were consistent with marine sediment core evidence of changes in the South Atlantic coincident with Heinrich events in the North Atlantic. Whereas orbitally forced last glacial climates generally resulted in range expansions and increased species richness in many grid cells compared with the present, the contrasting conditions of Heinrich events resulted in much reduced ranges and species richness, especially for Karoo species. Very few grid cells remained suitable for larger numbers of endemic species of either biome under all palaeoclimate scenarios examined, but this minority of ‘stable’ grid cells correspond to present diversity centres.Main conclusionsSuborbital climatic fluctuations during the last glacial stage were probably of considerable magnitude in southern Africa. This may account for apparent inconsistencies between regional palaeoclimate records, as well as being key to determining present biodiversity patterns.
Diagnosis in Young Children: How a Father's Perceptions of Mental Health Change
Authors: Morris Marian 
Published: February 2014

PurposeThis case study's purpose was to understand how diagnosing mental illness in a child affects a parent's perception of mental health, using Denzin's interpretive interactionism.SourcesTwo interviews from a case study were analyzed.ConclusionsEmergent themes were alienation from peers, ambivalence, shifting orientation to mental illness, school system stigmatization and conflict with mental health care, and discovery of mental healthcare specialists and new peers. Perceptions were influenced by peers, education, and mental healthcare systems, and by the disease model paradigm of mental illness. Future research should explore the effect of the diagnostic process on parents of very young children, and expand on consequences of undergoing current diagnostic and treatment practices.