bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Emergency Department Crowding on Length of Stay and Medication Treatment Times in Discharged Patients With Acute Asthma
Authors: Pines Jesse M. , Prabhu Anjeli , Hilton Joshua A. , Hollander Judd E. , Datner Elizabeth M. 
Published: July 2010

ACADEMIC EMERGENCY MEDICINE 2010; 17:834–839 © 2010 by the Society for Academic Emergency MedicineAbstractObjectives:  This study sought to determine if emergency department (ED) crowding was associated with longer ED length of stay (LOS) and time to ordering medications (nebulizers and steroids) in patients treated and discharged with acute asthma and to study how delays in ordering may affect the relationship between ED crowding and ED LOS.Methods:  A retrospective cohort study was performed in adult ED patients aged 18 years and older with a primary International Classification of Diseases, 9th Revision (ICD‐9), diagnosis of asthma who were treated and discharged from two EDs from January 1, 2007, to January 1, 2009. Four validated measures of ED crowding (ED occupancy, waiting patients, admitted patients, and patient‐hours) were assigned at the time of triage. The associations between the level of ED crowding and overall LOS and time to treatment orders were tested by analyzing trends across crowding quartiles, testing differences between the highest and lowest quartiles using Hodges‐Lehmann distances, and using relative risk (RR) regression for multivariable analysis.Results:  A total of 1,716 patients were discharged with asthma over the study period (932 at the academic site and 734 at the community site). LOS was longer at the academic site than the community site for asthma patients by 90 minutes (95% confidence interval [CI] = 79 to 101 minutes). All four measures of ED crowding were associated with longer LOS and time to treatment order at both sites (p < 0.001). At the highest level of ED occupancy, patients spent 75 minutes (95% CI = 58 to 93 minutes) longer in the ED compared to the lowest quartile of ED occupancy. In addition, comparing the highest and lowest quartiles of ED occupancy, time to nebulizer order was 6 minutes longer (95% CI = 1 to 13 minutes), and time to steroid order was 16 minutes longer (95% CI = 0 to 38 minutes). In the multivariable analysis, the association between ED crowding and LOS remained significant. Delays in nebulizer and steroid orders explained some, but not all, of the relationship between ED crowding and ED LOS.Conclusions:  Emergency department crowding is associated with longer ED LOS (by more than 1 hour) in patients who ultimately get discharged with asthma flares. Some but not all of longer LOS during crowded times is explained by delays in ordering asthma medications.
Efficiency and Economic Benefits of a Payer‐based Electronic Health Record in an Emergency Department
Authors: Daniel Gregory W. , Ewen Edward , Willey Vincent J. , Reese, IV Charles L. , Shirazi Farshad , Malone Daniel C. 
Published: July 2010

ACADEMIC EMERGENCY MEDICINE 2010; 17:824–833 © 2010 by the Society for Academic Emergency MedicineAbstractObjectives:  The objective was to evaluate the use of a payer‐based electronic health record (P‐EHR), which is a clinical summary of a patient’s medical and pharmacy claims history, in an emergency department (ED) on length of stay (LOS) and plan payments.Methods:  A large urban ED partnered with the dominant health plan in the region and implemented P‐EHR technology in September 2005 for widespread use for health plan members presenting to the ED. A retrospective observational study design was used to evaluate this previously implemented P‐EHR. Health plan and electronic hospital data were used to identify 2,288 ED encounters. Encounters with P‐EHR use (n = 779) were identified between September 1, 2005, and February 17, 2006; encounters from the same health plan (n = 1,509) between November 1, 2004, and March 31, 2005, were compared. Outcomes were ED LOS and plan payment for the ED encounter. Analyses evaluated the effect of using the P‐EHR in the ED setting on study outcomes using multivariate regressions and the nonparametric bootstrap.Results:  After covariate adjustment, among visits resulting in discharge (ED‐only), P‐EHR visits were 19 minutes shorter (95% confidence interval [CI] = 5 to 33 minutes) than non‐P‐EHR visits. Among visits resulting in hospitalization, the P‐EHR was associated with an average 77‐minute shorter ED LOS (95% CI = 28 to 126 minutes), compared to non–P‐EHR visits. The P‐EHR was associated with an average of $1,560 (95% CI = $43 to $2,910) lower total plan expenditures for hospitalized visits. No significant difference in total payments was observed among discharged visits.Conclusions:  In the study ED, the P‐EHR was associated with a significant reduction in ED LOS overall and was associated with lower plan payments for visits that resulted in hospitalization.
LD50 ‐ its value for the pharmaceutical industry in safety evaluation of drugs.
Authors: Malmfors T. , Teiling A. 
Published: July 2010

Abstract Does the pharmaceutical industry perform LD50‐determinations in animals just because it is required by the authorities or are there any scientific benefits from counting dead animals and calculating and index of lethal toxicity? This is an important question when discussing LD50 and possible alternatives. We will try to answer this question by presenting data and some views collected during almost ten years at a Swedish pharmaceutical company.We will describe how we have made use of the LD50‐values in the safety evaluation process. We will compare LD50‐values with the dose levels used in longterm toxicity both after single or repeated administration and with therapeutical dose levels in man for different classes of drugs.These data will enable us to demonstrate the value of the LD50‐determinations. As we are of the opinion that the LD50‐value itself has a limited value for the total safety evaluation of drugs we will look into the possibility of replacing the LD50‐determination with something else as an indication of lethal toxicity.In order to minimize the number of animals used and the number of animals dying because of dosing in studies on lethal toxicity we will try to support a proposal to use the maximal nonlethal dose (MNLD) as an indication of lethal toxicity in small animals.
Hemodynamic Effects of Calcium Channel Blockers in Essential Hypertension
Authors: Hulthén Lennart 
Published: July 2010

Abstract: Calcium channel blockers decrease blood pressure in essential hypertension due to a marked reduction of systemic vascular resistance (arteriolar tone). They also dilate conducting arteries but have no venodilatory effect in antihypertensive doses. With the dihydropyridines (e.g. nifedipine) and diltiazem there is a transient increase in heart rate and cardiac output but this is not observed with verapamil.The vasodilatory responsiveness in the resistance vessels to calcium channel blockers is selectively enhanced in patients with established essential hypertension but not in the early borderline phase of hypertension. During treatment with chlorthalidone, atenolol, acebutolol or nitrendipine for four to six weeks the reduction of blood pressure is accompanied by a selective decrease in the vasodilatory responsiveness to calcium channel blockers.
Medicinal leeches for the treatment of venous congestion and hematoma after plastic reconstructive surgery
Authors: Riede Friederike , Koenen Wolfgang , Goerdt Sergij , Ehmke Heimo , Faulhaber Jörg 
Published: July 2010

Summary Background: Leeches were used for medical purposes as long as 2 000 years ago in ancient Egypt. In recent years the use of medicinal leeches became rather popular again, e. g. to improve blood circulation in ischemic tissue after reconstructive plastic surgery. Patients and Methods: In a single center, retrospective study 23 consecutive cases were analyzed in which medicinal leeches had been used therapeutically after plastic reconstructive surgery. All cases were categorized regarding the indication for leech therapy, the onset, the duration, the number of leeches and the number of sessions. Results: Among the group of patients there were 7 female and 16 male patients with a mean age of 73 ± 14 years (48–94 years) altogether. The main indications were venous congestion (12/23; 52 %) and hematoma (9/23; 39 %). Two cases were diagnosed with a necrosis of the tip of the flap and therefore received leech therapy (2/23; 9 %). The average number of leeches was 2.6 leeches/session, the number of sessions was 1.7 ± 0.8. 20/23 patients (87 %) showed a restitutio ad integrum after leech therapy, in 3/23 patients (13 %) a necrosis of the tip of the flap could not be prevented. A clinical improvement was noticed after an average of 1.1 ± 0.3 days. Conclusions: The early application of medicinal leeches can improve local hemodynamic conditions. Leech therapy is a simple and effective method; the cost efficiency of the treatment is high.
Simulation of Combined Best Management Practices and Low Impact Development for Sustainable Stormwater Management1
Authors: Damodaram Chandana , Giacomoni Marcio H. , Prakash Khedun C. , Holmes Hillary , Ryan Andrea , Saour William , Zechman Emily M. 
Published: July 2010

Damodaram, Chandana, Marcio H. Giacomoni, C. Prakash Khedun, Hillary Holmes, Andrea Ryan, William Saour, and Emily M. Zechman, 2010. Simulation of Combined Best Management Practices and Low Impact Development for Sustainable Stormwater Management. Journal of the American Water Resources Association (JAWRA) 1‐12. DOI: 10.1111/j.1752‐1688.2010.00462.xAbstract:  Urbanization causes increased stormwater runoff volumes, leading to erosion, flooding, and the degradation of instream ecosystem health. Although Best Management Practices (BMPs) are used widely as a means for controlling flood runoff events, Low Impact Development (LID) options have been proposed as an alternative approach to better mimic the natural flow regime by using decentralized designs to control stormwater runoff at the source, rather than at a centralized location in the watershed. For highly urbanized areas, LID practices such as rainwater harvesting, green roofs, and permeable pavements can be used to retrofit existing infrastructure and reduce runoff volumes and peak flows. This paper describes a modeling approach to incorporate these LID practices in an existing hydrologic model to estimate the effects of LID choices on streamflow. The modeling approach has been applied to a watershed located on the campus of Texas A&M University in College Station, Texas, to predict the stormwater reductions resulting from retrofitting existing infrastructure with LID technologies. Results demonstrate that use of these LID practices yield significant stormwater control for small events and less control for flood events. A combined BMP‐LID approach is tested for runoff control for both flood and frequent rainfall events.
Musée national de Mongolie, Oulan Bator
Authors: Burnee Julziitiin 
Published: July 2010

Les présentations de ce grand musée s'organisent autow de trois composantes majeures: l'histoire humaine, l'histoire naturelle, l'ethnographie. Ce qu'elles perdent en expression de l'histoire globale, elZes le regagnent, en un sens, à la favew des soins, minutieux et rasnés, apportés aux trois parties respectivement.Avec le palais et les deux monastãres qui lui sont rattachés:a ane centrale de décentralisation B.
Musée d'histoire d'Amsterdam
Authors: Snoep Derk P. 
Published: July 2010

Une chose est surprenante, entre toutes, dans la genèse de cet enfant batave: le modèle d'histoire globale en émerge dès 1938, issu de la pensée de grands noms de la muséologie nationale et internationale, feu David Röell et les bien vivants Arthur van Schendel et Willem Sandberg.La périodisation en est explicite, du site naturel préalable à la prospective d'Amsterdam. Les moyens d'expression sont d'une variété égale à celle du Musée d'histoire allemande. On y met en cause, en la nuançant, l'omniprésence de l'art. Le texte pédagogique y règne d'un bout à l'autre, hiérarchisé.La confrontation est suggestive, à ce point du sommaire, entre partis respectifs des musées d'histoire de Londres, de Metz, d'Amsterdam, en matière d'architecture. Londres bâtit du neuf au pied d'une tour de bureaux, sur site romain dégagé en surface. Metz se loge en des monuments historiques du moyen âge et des temps modernes, sur site romain dégagé en profondeur. Amsterdam, lui, occupe, en plein cœur de la ville, un édifice baroque, percé lui‐même, à l'initiative du musée, d'une rue piétonne.
Avoidance Powers and Incentives to File for Bankruptcy*
Authors: Kim Jeong‐Yoo , Joo Sang Lyong 
Published: July 2010

AbstractIn this paper, we examine the incentives for a failing debtor and creditors to file for bankruptcy either under Chapter 7 or Chapter 11, and discuss whether avoidance powers can provide proper incentives to file. We show that if the future profitability of a failing firm is known, avoidance powers can eliminate an inefficient delay in bankruptcy filing. However, if profitability is uncertain, in particular, if a creditor is pessimistic, what might result is an inefficient rush to file under Chapter 7. We also demonstrate that the conditional avoidance powers can give creditors a stronger incentive to gather information pertinent to future profitability, thereby enhancing efficiency.
Impact of the Change in Tick Size on Transaction Costs and Liquidity: An Empirical Investigation of the Taiwan Stock Exchange*
Authors: Kuo Su‐Wen , Huang Chin‐Sheng , Chen Chia‐Cheng 
Published: July 2010

AbstractThe minimum price variation on the Taiwan Stock Exchange reduced for most price categories on March 1, 2005. The present paper simultaneously examines the institutional and endogenous impacts of tick size changes on transaction costs, market liquidity, and trading activity. The empirical evidence suggests that following a reduction in tick size, uniform declines are discernible in transaction costs and market liquidity. In particular, those stocks with a larger relative tick size reduction, higher trading volume, and higher order handling cost components have greater reductions in spread and market depth. Moreover, endogenous tick size reductions have an adverse effect on the trading activity for low‐price stocks, due to the relative disadvantage in explicit transaction costs. Finally, the present study observes a general diminution in trade size resulting from a reduction in tick size in the Taiwan Stock Exchange. This study attributes plausible rationales to the fact that after tick size reductions, informed traders employ a smaller trade size to hide private information, or front‐runners place a smaller trade size to avoid market turbulence.
An analytical model of the effects of pulse pileup on the energy spectrum recorded by energy resolved photon counting x‐ray detectors
Authors: Taguchi Katsuyuki , Frey Eric C. , Wang Xiaolan , Iwanczyk Jan S. , Barber William C. 
Published: July 2010

Purpose:Recently, novel CdTe photon counting x‐ray detectors (PCXDs) with energy discrimination capabilities have been developed. When such detectors are operated under a high x‐ray flux, however, coincident pulses distort the recorded energy spectrum. These distortions are called pulse pileup effects. It is essential to compensate for these effects on the recorded energy spectrum in order to take full advantage of spectral information PCXDs provide. Such compensation can be achieved by incorporating a pileup model into the image reconstruction process for computed tomography, that is, as a part of the forward imaging process, and iteratively estimating either the imaged object or the line integrals using, e.g., a maximum likelihood approach. The aim of this study was to develop a new analytical pulse pileup model for both peak and tail pileup effects for nonparalyzable detectors.Methods:The model takes into account the following factors: The bipolar shape of the pulse, the distribution function of time intervals between random events, and the input probability density function of photon energies. The authors used Monte Carlo simulations to evaluate the model.Results:The recorded spectra estimated by the model were in an excellent agreement with those obtained by Monte Carlo simulations for various levels of pulse pileup effects. The coefficients of variation (i.e., the root mean square difference divided by the mean of measurements) were 5.3%–10.0% for deadtime losses of 1%–50% with a polychromatic incident x‐ray spectrum.Conclusions:The proposed pulse pileup model can predict recorded spectrum with relatively good accuracy.
Quantification of arterial plaque and lumen density with MDCT
Authors: Paul Narinder S. , Blobel Joerg , Kashani Hany , Rice Murray , Ursani Ali 
Published: July 2010

Purpose:This study aimed to derive a mathematical correction function in order to normalize the CT number measurements for small volume arterial plaque and small vessel mimicking objects, imaged with multidetector CT (MDCT).Methods:A commercially available calcium plaque phantom (QRM GmbH, Moehrendorf, Germany) and a custom built cardiovascular phantom were scanned with 320 and 64 MDCT scanners. The calcium hydroxyapatite plaque phantom contained objects 0.5–5.0 mm in diameter with known CT attenuation nominal values ranging 50–800 HU. The cardiovascular phantom contained vessel mimicking objects 1.0–5.0 mm in diameter with different contrast media. Both phantoms were scanned using clinical protocols for CT angiography and images were reconstructed with different filter kernels. The measured CT number (HU) and diameter of each object were analyzed on three clinical postprocessing workstations. From the resultant data, a mathematical formula was derived based on absorption function to demonstrate the relation between measured CT numbers and object diameters.Results:The percentage reduction in measured CT number (HU) for the group of selected filter kernels, apparent during CT angiography, is dependent only on the object size (plaque or vessel diameter). The derived formula of the form showed reduction in CT number for objects between 0.5 and 5 mm in diameter, with asymptote reaching background noise for small objects with diameters nearing the CT in‐plane resolution (0.35 mm). No reduction was observed for the objects with diameters equal or larger than 5 mm.Conclusions:A clear mathematical relationship exists between object diameter and reduction in measured CT number in HU. This function is independent of exposure parameters and inherent attenuation properties of the objects studied. Future developments include the incorporation of this mathematical model function into quantification software in order to automatically generate a true assessment of measured CT number (HU) corresponding to plaque physical density . This is a significant development for the accurate, noninvasive classification of noncalcified arterial plaque.
Local plate/rod descriptors of 3D trabecular bone micro‐CT images from medial axis topologic analysis
Authors: Peyrin Françoise , Attali Dominique , Chappard Christine , Benhamou Claude Laurent 
Published: July 2010

Purpose:Trabecular bone microarchitecture is made of a complex network of plate and rod structures evolving with age and disease. The purpose of this article is to propose a new 3D local analysis method for the quantitative assessment of parameters related to the geometry of trabecular bone microarchitecture.Methods:The method is based on the topologic classification of the medial axis of the 3D image into branches, rods, and plates. Thanks to the reversibility of the medial axis, the classification is next extended to the whole 3D image. Finally, the percentages of rods and plates as well as their mean thicknesses are calculated. The method was applied both to simulated test images and 3D micro‐CT images of human trabecular bone.Results:The classification of simulated phantoms made of plates and rods shows that the maximum error in the quantitative percentages of plate and rods is less than 6% and smaller than with the structure model index (SMI). Micro‐CT images of human femoral bone taken in osteoporosis and early or advanced osteoarthritis were analyzed. Despite the large physiological variability, the present method avoids the underestimation of rods observed with other local methods. The relative percentages of rods and plates were not significantly different between osteoarthritis and osteoporotic groups, whereas their absolute percentages were in relation to an increase of rod and plate thicknesses in advanced osteoarthritis with also higher relative and absolute number of nodes.Conclusions:The proposed method is model‐independent, robust to surface irregularities, and enables geometrical characterization of not only skeletal structures but entire 3D images. Its application provided more accurate results than the standard SMI on simple simulated phantoms, but the discrepancy observed on the advanced osteoarthritis group raises questions that will require further investigations. The systematic use of such a local method in the characterization of trabecular bone samples could provide new insight in bone microarchitecture changes related to bone diseases or to those induced by drugs or therapy.
Fast, low‐dose patient localization on TomoTherapy via topogram registration
Authors: Moore Kevin L. , Palaniswaamy Geethpriya , White Benjamin , Goddu S. Murty , Low Daniel A. 
Published: July 2010

Purpose: To investigate a protocol which efficiently localizes TomoTherapy patients with a scout imaging (topogram) mode that can be used with or instead of 3D megavoltage computed tomography (MVCT) imaging.Methods: The process presented here is twofold: (a) The acquisition of the topogram using the TomoTherapy MV imaging system and (b) the generation of a digitally reconstructed topogram (DRT) derived from a standard kV CT simulation data set. The unique geometric characteristics of the current TomoTherapy imaging system were explored both theoretically and by acquiring topograms of anthropomorphic phantoms and comparing these images to DRT images. The performance of the MV topogram imaging system in terms of image quality, dose incurred to the patient, and acquisition time was investigated using ionization chamber and radiographic film measurements.Results: The time required to acquire a clinically usable topogram, limited by the maximum couch speed of , was 12.5 s for a 50 cm long field. The patient dose was less than 1% of that delivered by a helical MVCT scan. Further refinements within the current TomoTherapy system, most notably decreasing the imaging beam repetition rate during MV topogram acquisition, would further reduce the topogram dose to less than per scan without compromising image quality.Conclusions: Topogram localization on TomoTherapy is a fast and low‐dose alternative to 3D MVCT localization. A protocol designed that exclusively utilized MV topograms would result in a 30‐fold reduction in imaging time and a 100‐fold reduction in dose from localization scans using the current TomoTherapy workflow.