bluuebunny/crossref_metadata_2025_split huggingface dataset:
Idiographically Determined Versus Standard Absorption Periods in Alcohol Administration Studies
Authors: Schacht Rebecca L. , Stoner Susan A. , George William H. , Norris Jeanette 
Published: March 2010

Background:  Effects of alcohol vary depending on blood alcohol level and limb. Some researchers use standard absorption periods (SAPs) to determine when postdrinking experimental protocols should begin. Others use an idiographically determined absorption period (IDAP) based on criterion breath alcohol concentration (BrAC). We investigated and compared the characteristics of each method.Methods:  Sixty‐eight social drinkers (47% women) consumed a bolus dose of alcohol intended to raise BrAC to 0.08%. BrACs were recorded every 3 minutes until beginning to descend. Minutes to reach criterion BrAC (0.06%) and between‐subjects postdrinking BrAC variability were analyzed.Results:  Mean time to reach 0.06% BrAC was 22.9 ± 14.6 minutes. Standard deviations in BrAC were 4 times greater using SAPs compared to IDAPs. Ten percent of participants’ BrAC readings were on the descending limb 30 minutes postdrinking, and 25% were descending at 45 minutes postdrinking.Conclusions:  IDAPs result in less BrAC variability and may reduce experimental noise relative to SAPs. Experimental control in future alcohol administration studies may be enhanced by the use of IDAPs instead of SAPs.
Symbolic Versus Associative Learning
Authors: Hummel John E. 
Published: March 2010

AbstractRamscar and colleagues (2010, this volume) describe the “feature‐label‐order” (FLO) effect on category learning and characterize it as a constraint on symbolic learning. I argue that FLO is neither a constraint on symbolic learning in the sense of “learning elements of a symbol system” (instead, it is an effect on nonsymbolic, association learning) nor is it, more than any other constraint on category learning, a constraint on symbolic learning in the sense of “solving the symbol grounding problem.”
Automated External Defibrillators: Skill Maintenance Using Computer‐assisted Learning
Authors: Jerin John M. , Ansell Bruce A. , Larsen Mary Pat , Cummins Richard O. 
Published: March 2010

Abstract. Objective: To determine whether computer‐assisted learning (CAL) can maintain the automated external defibrillation (AED) skills of emergency medical technicians (EMTs). Methods: The authors conducted a 1‐year prospective comparison of an AED‐skill training software program, running on desktop computers, with traditional instructor‐led training. The subjects were experienced EMT‐Ds (EMT‐defibrillation), already trained in automated defibrillation (n= 105) employed as full‐time professional EMT‐D/firefighters. Two of the 3 groups (groups A and C) in the study were assigned to use the CAL program for 6 months. The third group (group B) remained on the normal, instructor‐led training regimen. Pre‐ and poststudy skill levels were measured using a skills performance test. Results: A secular trend of improved mean treatment scores was observed across all 3 groups [mean rise of 0.49 point (p = 0.01), repeated‐measures analysis of variance]. There were no differences between training groups in the increase in performance scores (p = 0.3). The 1‐time cost of supplying the CAL program to the 105 EMT‐Ds was $1,575, significantly less than the $3,240‐per‐year cost associated with instructor‐led training. Conclusions: The authors observed satisfactory AED skill maintenance for experienced EMT‐Ds using CAL to replace 2 of 4 quarterly instructor‐led skills reviews. CAL has cost and convenience advantages over instructor‐based skill maintenance and is an acceptable alternative.
Refusal of Out‐of‐hospital Medical Care: Effect of Medical‐control Physician Assertiveness on Transport Rate
Authors: Burstein Jonathan L. , Hollander Judd E. , Delagi Robert , Gold Matthew , Henry Mark C. , Alicandro Jeanne M. 
Published: March 2010

ABSTRACT Objective: Previous studies have shown that contacting an on‐line medical‐control physician increases the transport rate of patients who attempt to refuse medical assistance. The authors studied the physician‐patient interaction to determine the type of interaction that was more likely to result in patient transport. Methods: A prospective, observational study of patient‐initiated refusals of medical assistance (RMAs) was performed in a suburban volunteer emergency medical services (EMS) system, with 12 receiving hospitals county‐wide. Medical‐control contact was required for all patient‐initiated RMAs. Consecutive patients who attempted out‐of‐hospital RMA over a 3‐month period were monitored. Structured data instruments were completed by the medical‐control operator and medical‐control physician for all patients who attempted RMA. Data collected included patient demographics and contact information, scene characteristics, history and physical examination data, length of time of interaction, and the physician's assessment of the need for transport and the patient's capacity to refuse transport. The operator and physician independently graded the physician's assertiveness in talking to the patient on a continuous 10‐point scale. Results: There were 130 patients who attempted RMA; 69 (53%) refused transport even after discussion with the medical‐control physician, while 61 (47%) were transported to a hospital. The patients who were transported did not differ from those not transported with respect to age, chief complaint, vital signs, or presence of police on scene. Using the operators' independent assessments, the physicians were more assertive when they graded the patient as being more ill (needs transport, 8.8; may need transport, 7.7; doesn't need transport, 4.1; p < 0.01). When the physicians were more assertive, the patients were more likely to agree to transport (assertiveness >8, 81% transport; assertiveness <8, 19% transport; p < 0.01). Conclusions: Contact with a medical‐control physician appears to markedly improve the transport rate for patients who initially attempt to refuse out‐of‐hospital medical care. This is especially so when physicians are more assertive in recommending transport.
Effects of Hyperbaric Oxygen on Neurologic Outcome for Cerebral Ischemia in Rats
Authors: Roos Joel A. , Jackson‐Friedman Cathy , Lyden Patrick 
Published: March 2010

ABSTRACTObjective:To evaluate the effect of hyperbaric oxygen (HBO) therapy on neurologic outcome (assessed by the quantal bioassay approach) following acute focal cerebral ischemia in rats.Methods:Two separate experimental trials were conducted. Trial 1, a nonblinded experiment, used 38 rats. Trial 2, a blinded experiment, used 59 rats. Focal cerebral ischemia was induced with a surgically placed intraluminal occlusion of the left middle cerebral artery; subsequent removal allowed reperfusion. Arterial occlusion times were varied from 5 to 90 minutes in trial 1, and from 3 to 45 minutes in trial 2. The control groups were maintained at ambient pressure for the duration of each trial. The trial 1 treatment group received a single 30‐minute HBO treatment at 2.0 atmospheres absolute (ATA) on the initial day of ischemia. The trial 2 treatment group received 30‐minute HBO treatments at 2.0 ATA daily for 4 consecutive days. The animals underwent daily 5‐point neurologic examinations. A computerized quantal bioassay was used to determine the ET50—the occlusion time required to cause a neurologic abnormality in half of the animals. The control and treatment ET50values were compared in each trial using a 2‐tailed t‐test. An increased ET50for the treatment vs the control group implied a beneficial effect of HBO; a decrease, the opposite. The study had a power of 80% to detect a difference of 11.4 minutes in the ET50for a 2‐sided α= 0.05.Results:For trial 1: the HBO ET50was 18.1 ± 21.9 minutes and the control ET50was 22.8 ± 25.0 minutes (p > 0.2). For trial 2: the HBO ET50was 9.49 ± 17.4 minutes and the control ET50was 14.9 ± 14.2 minutes (p < 0.2).Conclusion:HBO therapy showed no apparent benefit in a rat model as a treatment modality for acute cerebral ischemia with reperfusion.
Noninvasive Cerebral Cooling in a Swine Model of Cardiac Arrest
Authors: Tadler Scott C. , Callaway Clifton W. , Menegazzi James J. 
Published: March 2010

ABSTRACT Objective: Mild cerebral hypothermia improves neurologic outcome in animals resuscitated from cardiac arrest. This study examined whether one practical external cooling method, i.e., local application of ice to the heads and necks of swine, during resuscitation induces cerebral cooling. Methods: Local external cerebral cooling was examined in a prospective laboratory investigation using 24 female swine in a model of cardiac arrest. The swine were randomized into hypothermia and normothermia groups. Intracerebral temperature was measured in the parietal cortex. Eight minutes after induction of ventricular fibrillation, chest compressions and mechanical ventilation were initiated. The hypothermia group was treated with 1,500 mL of ice in plastic bags applied to the head and neck, while the normothermia group received no extra interventions. Data were analyzed using repeated‐measures ANOVA. Results: In the normothermia group, there was no significant change in nasopharyngeal (‐0.8 ± 0.6°C), intracerebral (‐0.6 ± 0.8°C), or esophageal (‐0.2 ± 0.6°C) temperatures during 20 minutes of resuscitation. However, in the hypothermia group, application of ice during resuscitation significantly reduced nasopharyngeal (‐2.9 ± 1.4°C), intracerebral (‐2.1 ± 0.6°C), and esophageal (‐1.4 ± 0.8°C) temperatures. Conclusions: External application of ice packs during resuscitation effectively reduced intracerebral temperatures in swine by an amount that improved neurologic outcomes in previous large animal studies. These data suggest that clinically significant cerebral cooling could be accomplished with a noninvasive, inexpensive, and universally available intervention. Further studies are required to assess the clinical feasibility and therapeutic efficacy of this intervention.
Causes and Patterns of Injury from Ladder Falls
Authors: Partridge Robert A. , Virk Alamjit S. , Antosia Robert E. 
Published: March 2010

ABSTRACT Objectives: To review all ladder fall injuries seen in a community ED and to identify patterns of injury, factors that contribute to falls, and what pre‐event and event factors could have reduced the likelihood of a fall or a resulting injury. Methods: This was a retrospective, observational study involving patients who presented to a community hospital ED from January 1993 through December 1995 with injuries from a ladder fall. The medical records of all patients were reviewed. Patients then underwent a structured telephone interview to provide additional information about the circumstances of the fall. Results: There were 59 patients who sustained injuries relating to ladder falls. All were adults, aged >18 years (mean 42.9 ± 16.2 years), were predominantly male (93%), and had fallen a distance of 1–15 feet (mean 7.2 ± 3.6 feet). Thirteen percent were admitted to the hospital, and there was 1 death. Fractures were observed in 21 patients (36%) and usually involved an extremity (77%). There was no relationship between the distance fallen and the occurrence of fracture. Other primary injuries included sprain (27%), contusion (24%), laceration (10%), abrasion (3%), and subdural hematoma (2%). Of the 59 patients, 42 (71%) were contacted directly. Most falls (79%) resulted from excessive reaching or incorrect ladder placement. Fifty percent of the described falls were occupationally related. Conclusions: Falls from ladders, both in the occupational and nonoccupational settings, often result in significant injury. Simple safety measures may have prevented the majority of falls in this study. Public health efforts should emphasize education on safe ladder practices and techniques to reduce the possibility of injury in the event of a fall.
Rapid Response to Stroke Symptoms: The Delay in Accessing Stroke Healthcare (DASH) Study
Authors: Rosamond Wayne D. , Gorton Rebecca A. , Hinn Albert R. , Hohenhaus Susan M. , Morris Dexter L. 
Published: March 2010

ABSTRACT Objective: To assess the determinants of prehospital delay for patients with presumed acute cerebral ischemia (ACI) in order to provide the background necessary to develop interventions to shorten such delays. Methods: A prospective registry of patients presenting to the ED with signs and symptoms of stroke was established at a university hospital from July 1995 to March 1996. Trained nurses performed a structured ED interview, which assessed prehospital delay and potential confounders. Results: The median delay (interquartile range) from symptom onset to ED arrival for all patients seeking care for stroke‐like symptoms (n= 152) was 3.0 hours (1.5–7.8 hr). The median delay from symptom onset to ED arrival was less in cases where a witness first recognized that there was a serious problem than it was when the patient first identified the problem. A heightened sense of urgency by the patient about his or her symptoms, and use of 911/emergency medical services (EMS) transport were also associated with rapid arrival in the ED within 3 hours of symptom onset. After adjusting for all predictor variables in a multivariable logistic regression model, only recognition of symptoms by a witness and calling 911/EMS transport remained statistically significant. Conclusions: These data suggest that future efforts to intervene on prolonged prehospital delay for patients with ACI should include strategies for the community as a whole as well as persons at risk for stroke and should reinforce the use of 911 and EMS transport.
Domestic Violence Awareness and Prevalence in a First‐year Medical School Class*
Authors: Ernst Amy A. , Houry Debra , Nick Todd G. , Weiss Steven J. 
Published: March 2010

ABSTRACT Objective: To determine knowledge about domestic violence (DV), the effectiveness of formal instruction about DV, and the prevalence of DV in a first‐year medical school class. Methods: A general‐knowledge survey of DV was given before and approximately 1 month after 3 hours of instruction provided by emergency medicine and internal medicine faculty. A previously validated scale, the Index of Spouse Abuse (ISA), was offered to determine baseline levels of DV within the group. Differences in first‐year medical student knowledge of facts about DV and differences in responses by men vs women were determined before and after the instruction. Results: In the pre‐instruction series, 144 of 148 (97%) participated. After the instruction, 141 of the same 148 students participated (95%). The prevalence of DV against women was correctly identified by 45% of the students as “15–30%” prior to instruction, and 65% after instruction. The prevalence of DV against males was correctly identified as “0–15%” by 48% of the students prior to instruction, and 70% after instruction. Before instruction, 29% of the students knew that “DV rates are equal in different socioeconomic groups,” vs 72% after instruction. Similarly, prior to instruction 58% of the students knew that the victim is not responsible for the abuse, and 84% knew this after instruction. Before instruction 14 (10%) of the students believed they were victims of DV in the past, representing 7% of the men and 13% of the women. Before instruction neither group believed they were present victims of DV. However, according to ISA scoring, 6% of the women were positive for violence in the past, and approximately 5% were positive for present violence. No men were positive for ISA‐determined past or present violence. Conclusion: Improvement in awareness was demonstrated after 3 hours of instruction in a first‐year medical school class. There was DV among female medical students in this first‐year class and self‐reporting was not reliable. These results support instruction on DV for medical students.
Carbon Monoxide Poisoning from Spray Paint Inhalation
Authors: Nager Eric C. , O'Connor Robert E. 
Published: March 2010

SummaryThis case report emphasizes the varied manifestation of CO poisoning and its genesis from methylene chloride. Because DCM is now an ingredient in many popular spray paints, the ingredients should be checked routinely in toxic exposures. Manufacturer's suggestions concerning the use these products in ventilated areas to avoid harmful effects do not always protect the consumer, and the public should be well informed regarding this issue.
Prospective, Randomized, Controlled Trial of Tissue Adhesive (2‐Octylcyanoacrylate) vs Standard Wound Closure Techniques for Laceration Repair
Authors: Singer Adam J. , Hollander Judd E. , Valentine Sharon M. , Turque Theo W. , McCuskey Charles F. , Quinn James V. ,   for the Stony Brook Octylcyanoacrylate Study Group
Published: March 2010

ABSTRACT Objective: To compare a new tissue adhesive, 2‐octylcyanoacrylate, with standard wound closure techniques for the repair of traumatic lacerations. Methods: A prospective, randomized, controlled clinical trial enrolled consecutive patients >1 year of age with non‐bite, non‐crush‐induced lacerations who presented <6 hours after injury. Structured closed‐question data sheets were completed at the time of laceration repair and suture removal. Patients were randomly assigned to treatment with either 2‐octylcyanoacrylate or standard wound closure. Infection was determined at the time of suture removal. Long‐term cosmetic appearance (>3 months) was assessed by physicians using a previously validated categorical cosmetic scale and by patients using a 100‐mm visual analog scale. Results: There were 63 patients randomized to the octylcyanoacrylate group and 61 patients treated with standard wound closure techniques. The 2 treatment groups were similar with respect to age, gender, race, medical history, and wound characteristics. At the 5‐to‐10‐day follow‐up, only 1 wound was infected and only 2 wounds required reclosure due to dehiscence. These 3 patients received treatment with octylcyanoacrylate. At long‐term follow‐up, the cosmetic appearances were similar according to the patients (octylcyanoacrylate, 83.8 ± 19.4 mm vs standard techniques, 82.5 ± 17.6 mm; p = 0.72) and the physicians (optimal cosmetic appearance, 77% vs 80%; p = 0.67). Conclusions: Wounds treated with octylcyanoacrylate and standard wound closure techniques have similar cosmetic appearances 3 months later.
Intubation Difficulty in Poisoned Patients: Association with Initial Glasgow Coma Scale Score
Authors: Adnet Frédéric , Borron Stephen W. , Finot Marie‐Agnès , Lapandry Claude , Baud Frédéric J. 
Published: March 2010

ABSTRACT Objective: To determine whether the initial Glasgow Coma Scale (GCS) score is predictive of intubation difficulty in out‐of‐hospital airway management of poisoned patients. Methods: A prospective, observational study was performed in a toxicological intensive care unit of a university hospital and in a physician‐based out‐of‐hospital care system. Subjects included consecutive poisoned patients intubated during their airway management by out‐of‐hospital medical teams before hospitalization. The intubating operator (emergency physician or nurse anesthetist) completed a 1‐page checklist concerning the clinical parameters and circumstances (nature of sedation and difficulty) of endotracheal intubation upon hospital arrival. Results: Forms were completed for all 394 consecutive out‐of‐hospital intubations. The patients ranged from 15 to 95 years of age (median age 38 years). Most (96%) of the intubations were via the oral route. Intubation difficulty was related to GCS values. Intubation difficulty was seen more often in patients with 7≤ GCS ≤9 (36%) than in patients with GCS <7 (15%) or >9 (10%). Not surprisingly, perceived intubation difficulty was least for those patients undergoing rapid‐sequence intubation rather than administration of sedation alone. Conclusion: Maximum difficulty of intubation is encountered in poisoned patients with 7≤ GCS ≤9. Intubation of such patients appears to be facilitated by appropriate sedation and/or neuromuscular blockade.
Strategies for Improving Information Management in Emergency Medicine to Meet Clinical, Research, and Administrative Needs
Authors: Cordell William H. , Overhage J. Marc , Waeckerle Joseph F. ,   for the Information Management Work Group
Published: March 2010

ABSTRACTThe ED of the future will require the effective integration of information technologies into clinical care. This article proposes strategies for improving information management in emergency medicine to facilitate patient care, public health surveillance, clinical research, medical education, and health care management.
Supporting Emergency Medicine Research: Developing the Infrastructure
Authors: Biros Michelle H. , Barsan William G. , Lewis Roger J. , Sanders Arthur B. 
Published: March 2010

ABSTRACTThe long‐term goals of developing research within the specialty of emergency medicine (EM) include the following: 1) to continue to improve the quality and quantity of EM research in order to ultimately improve emergency patient care; 2) to maximize the research potential of emergency health care professionals in order to develop new emergency research talent and enthusiasm; and 3) to establish the academic research credentials of the specialty of EM in order to become competitive for federal research funding, and further improve emergency patient care. This article addresses the process by which the infrastructure for EM research can be developed at academic medical centers and provides recommendations. The roles of the academic chair, research director, senior researcher, and departmental faculty are discussed.
Out‐of‐hospital Spinal Immobilization: Its Effect on Neurologic Injury
Authors: Hauswald Mark , Ong Grade , Tandberg Dan , Omar Zaliha 
Published: March 2010

ABSTRACT Objective: To examine the effect of emergency immobilization on neurologic outcome of patients who have blunt traumatic spinal injuries. Methods: A 5‐year retrospective chart review was carried out at 2 university hospitals. All patients with acute blunt traumatic spinal or spinal cord injuries transported directly from the injury site to the hospital were entered. None of the 120 patients seen at the University of Malaya had spinal immobilization during transport, whereas all 334 patients seen at the University of New Mexico did. The 2 hospitals were comparable in physician training and clinical resources. Neurologic injuries were assigned to 2 categories, disabling or not disabling, by 2 physicians acting independently and blinded to the hospital of origin. Data were analyzed using multivariate logistic regression, with hospital location, patient age, gender, anatomic level of injury, and injury mechanism serving as explanatory variables. Results: There was less neurologic disability in the unimmobilized Malaysian patients (OR 2.03; 95% CI 1.03–3.99; p = 0.04). This corresponds to a <2% chance that immobilization has any beneficial effect. Results were similar when the analysis was limited to patients with cervical injuries (OR 1.52; 95% CI 0.64–3.62; p = 0.34). Conclusion: Out‐of‐hospital immobilization has little or no effect on neurologic outcome in patients with blunt spinal injuries.