bluuebunny/crossref_metadata_2025_split huggingface dataset:
To Keep an Incessant Watch
Authors: Smith Kurt A. 
Published: May 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:545–548 © 2011 by the Society for Academic Emergency MedicineAbstractMedical residency is an educational enterprise directed toward producing clinicians who recognize and correctly manage disease. While formal graduate medical education provides didactics and bedside teaching to improve knowledge, individual learning efforts are essential to the educational experience. Keeping track of patient outcomes after disposition from the emergency department (ED) is a useful exercise in reviewing gaps in knowledge of the individual and deficiencies in systems‐based care. In reviewing the agreement between admission and discharge diagnoses of a single resident over 4 years of residency, significant improvement in diagnostic accuracy was observed. This method of self‐correction has potential to supplement formal residency education in emergency medicine.
Emergency Department Quality: An Analysis of Existing Pediatric Measures
Authors: Alessandrini Evaline , Varadarajan Kartik , Alpern Elizabeth R. , Gorelick Marc H. , Shaw Kathy , Ruddy Richard M. , Chamberlain James M. ,   for the Pediatric Emergency Care Applied Research Network
Published: May 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:519–526 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  The Institute of Medicine (IOM) has recommended the development of national standards for the measurement of emergency care performance. The authors undertook this study with the goals of enumerating and categorizing existing performance measures relevant to pediatric emergency care.Methods:  Potential performance measures were identified through a survey of 1) the peer‐reviewed literature, 2) websites of organizations and societies pertaining to quality improvement, and 3) emergency department (ED) directors. Performance measures were enumerated and categorized, using consensus methods, on three dimensions: 1) the IOM quality domains; 2) Donabedian’s structure/process/outcome framework; and 3) general, cross‐cutting, or disease‐specific measures.Results:  A total of 405 performance measures were found for potential use for pediatric emergency care. When categorized by IOM domain, nearly half of the measures were related to effectiveness, while only 6% of measures addressed patient‐centeredness. In the Donabedian dimension, 67% of measures were categorized as process measures, with 29% outcome and 4% structure measures. Finally, 31% of measures were general measures relevant to every ED visit. Although 225 measures (55%) were disease‐specific, the majority (56%) of these measures related to only five common conditions.Conclusions:  A wide range of performance measures relevant to pediatric emergency care are available. However, measures lack a systematic and comprehensive approach to evaluate the quality of care provided.
Is Coronary Computed Tomography Angiography a Resource Sparing Strategy in the Risk Stratification and Evaluation of Acute Chest Pain? Results of a Randomized Controlled Trial
Authors: Miller Adam H. , Pepe Paul E. , Peshock Ron , Bhore Rafia , Yancy Clyde C. , Xuan Lei , Miller Margarita M. , Huet Gisselle R. , Trimmer Clayton , Davis Rene , Chason Rebecca , Kashner Micheal T. 
Published: May 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:458–467 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  Annually, almost 6 million U.S. citizens are evaluated for acute chest pain syndromes (ACPSs), and billions of dollars in resources are utilized. A large part of the resource utilization results from precautionary hospitalizations that occur because care providers are unable to exclude the presence of coronary artery disease (CAD) as the underlying cause of ACPSs. The purpose of this study was to examine whether the addition of coronary computerized tomography angiography (CCTA) to the concurrent standard care (SC) during an index emergency department (ED) visit could lower resource utilization when evaluating for the presence of CAD.Methods:  Sixty participants were assigned randomly to SC or SC + CCTA groups. Participants were interviewed at the index ED visit and at 90 days. Data collected included demographics, perceptions of the value of accessing health care, and clinical outcomes. Resource utilization included services received from both the primary in‐network and the primary out‐of‐network providers. The prospectively defined primary endpoint was the total amount of resources utilized over a 90‐day follow‐up period when adding CCTA to the SC risk stratification in ACPSs.Results: The mean (± standard deviation [SD]) for total resources utilized at 90 days for in‐network plus out‐of‐network services was less for the participants in the SC + CCTA group ($10,134; SD ±$14,239) versus the SC‐only group ($16,579; SD ±$19,148; p = 0.144), as was the median for the SC + CCTA ($4,288) versus SC only ($12,148; p = 0.652; median difference = –$1,291; 95% confidence interval [CI] = –$12,219 to $1,100; p = 0.652). Among the 60 total study patients, only 19 had an established diagnosis of CAD at 90 days. However, 18 (95%) of these diagnosed participants were in the SC + CCTA group. In addition, there were fewer hospital readmissions in the SC + CCTA group (6 of 30 [20%] vs. 16 of 30 [53%]; difference in proportions = –33%; 95% CI = –56% to –10%; p = 0.007).Conclusions:  Adding CCTA to the current ED risk stratification of ACPSs resulted in no difference in the quantity of resources utilized, but an increased diagnosis of CAD, and significantly less recidivism and rehospitalization over a 90‐day follow‐up period.
Cost‐effectiveness of Point‐of‐care Biomarker Assessment for Suspected Myocardial Infarction: The Randomized Assessment of Treatment Using Panel Assay of Cardiac Markers (RATPAC) Trial
Authors: Fitzgerald Patrick , Goodacre Steve W. , Cross Elizabeth , Dixon Simon 
Published: May 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:488–495 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  Chest pain due to suspected myocardial infarction (MI) is responsible for many hospital admissions and consumes substantial health care resources. The Randomized Assessment of Treatment using Panel Assay of Cardiac markers (RATPAC) trial showed that diagnostic assessment using a point‐of‐care (POC) cardiac biomarker panel consisting of CK‐MB, myoglobin, and troponin increased the proportion of patients successfully discharged after emergency department (ED) assessment. In this economic analysis, the authors aimed to determine whether POC biomarker panel assessment reduced health care costs and was likely to be cost‐effective.Methods:  The RATPAC trial was a multicenter individual patient randomized controlled trial comparing diagnostic assessment using a POC biomarker panel (CK‐MB, myoglobin, and troponin, measured at baseline and 90 minutes) to standard care without the POC panel in patients attending six EDs with acute chest pain due to suspected MI (n = 2,243). Individual patient resource use data were collected from all participants up to 3 months after hospital attendance using self‐completed questionnaires at 1 and 3 months and case note review. ED staff and POC testing costs were estimated through a microcosting study of 246 participants. Resource use was valued using national unit costs. Health utility was measured using the EQ‐5D self‐completed questionnaire, mailed at 1 and 3 months. Quality‐adjusted life‐years (QALYs) were calculated by the trapezium rule using the EQ‐5D tariff values at all follow‐up points. Mean costs per patient were compared between the two treatment groups. Cost‐effectiveness was estimated in terms of probability of dominance and incremental cost per QALY.Results:  Point‐of‐care panel assessment was associated with higher ED costs, coronary care costs, and cardiac intervention costs, but lower general inpatient costs. Mean costs per patient were £1217.14 (standard deviation [SD] ± 3164.93), or $1,987.14 (SD ±$4,939.25), with POC versus £1005.91 (SD ±£1907.55), or $1,568.64 (SD ±$2,975.78), with standard care (p = 0.056). Mean QALYs were 0.158 (SD ± 0.052) versus 0.161 (SD ± 0.056; p = 0.250). The probability of standard care being dominant (i.e., cheaper and more effective) was 0.888, while the probability of the POC panel being dominant was 0.004. These probabilities were not markedly altered by sensitivity analysis varying the costs of the POC panel and excluding intensive care costs.Conclusions:  Point‐of‐care panel assessment does not reduce costs despite reducing admissions and may even increase costs. It is unlikely to be considered a cost‐effective use of health care resources.
Neutrophil defensins but not interleukin‐6 in vaginal fluid after preterm premature rupture of membranes predict fetal/neonatal inflammation and infant neurological impairment
Authors: LUCOVNIK MIHA , KORNHAUSER‐CERAR LILIJANA , PREMRU‐SRSEN TANJA , GMEINER‐STOPAR TANJA , DERGANC METKA 
Published: May 2011

Abstract Objective. To determine whether neutrophil defensins (HNP1–3) and interleukin‐6 (IL‐6) in vaginal fluid after preterm premature rupture of membranes predict fetal inflammatory response syndrome (FIRS), neurological impairment or chorioamnionitis. Design. Prospective study. Setting. Tertiary referral university hospital. Population. Forty‐two patients with preterm premature rupture of membranes at <32 weeks. Methods. Levels of HNP1–3 and IL‐6 were measured in vaginal fluid obtained by swabs. Mann–Whitney U‐test was used to compare HNP1–3 and IL‐6 levels in groups with vs. without FIRS, infant death or neurological impairment, and chorioamnionitis (p<0.05 significant). Logistic regression was used to control for potential confounders. Diagnostic accuracies of HNP1–3 and IL‐6 were determined by receiver operator characteristics analysis. Main Outcome Measures. Fetal inflammatory response syndrome was defined as neonatal inflammation within 72hours postpartum. Neurological impairment was defined as motor and/or tone abnormalities at one year of corrected age. Chorioamnionitis was diagnosed histologically. Results. Levels of HNP1–3, but not IL‐6, were higher in 12 cases of FIRS (p=0.019 and p=0.256, respectively). Levels of HNP1–3, but not IL‐6, were higher in 14 cases of infant death or neurological impairment (p=0.015 and p=0.100, respectively) and, when only survivors were analyzed, in nine cases of neurological impairment (p=0.030 and p=0.187, respectively). Levels of HNP1–3 and IL‐6 were higher in 29 cases of chorioamnionitis (p=0.005 and p=0.003, respectively). The differences remained significant after adjustment for gestational age. Levels of HNP1–3 predicted FIRS, infant death or neurological impairment and chorioamnionitis with an area under the curve of 0.75, 0.79 and 0.78, respectively. Conclusions. Elevated vaginal fluid HNP1–3 and IL‐6 levels are associated with histological chorioamnionitis. Elevated HNP1–3 can also identify FIRS and predict infant death or neurological impairment.
Likelihood ratios for the prediction of preterm delivery with biomarkers
Authors: HEE LENE 
Published: May 2011

AbstractObjective. To conduct a literature search for selected biomarkers on preterm delivery and estimate their likelihood ratios (LR). Design. Structured review. Population. Low and high‐risk populations and women with symptoms of preterm delivery. Methods. Publications were identified in PubMed. Main outcome measures. LR on selected biomarkers for preterm delivery. Results. In asymptomatic women with low risk of preterm delivery, the following biomarkers gave major shifts in probability (LR above 5): twins (LR+ 10), Ureaplasma urealyticum in amniotic fluid (LR+ of 10), cervical length <25mm (LR+ 6), salival estriol (LR+ 5) and various combined tests. In asymptomatic women with high risk of preterm delivery, short cervical length (LR+ 11, LR– 0.7), high serum tumor necrosis factor‐alpha (LR+ 10, LR– 0.6) gave major shifts in probability. In women with symptoms of preterm delivery, major shifts in probability can be obtained from the following amniotic fluid biomarkers: high matrix metalloproteinase‐8 (LR+ 23, LR– 0.6), Ureaplasma urealyticum (LR+ 19, LR– 0.8), high interleukin (IL)‐6 (LR+ 9, LR– 0.2), IL‐8 (LR+10, LR– 0.2) and tumor necrosis factor‐alpha (LR+ 8, LR– 0.4). In serum IL‐6 (LR+ 12, LR– 0.2), Cluster of Differentiation 163 (LR+9, LR‐0.8) and various combined tests. Vaginal fetal fibronectin (LR+ 3 and LR– 0.5) and short cervical length (LR+ 2, LR– 0.3) gave LRs of some importance (LR below 5). Conclusion. Several biomarkers have been identified for assessment of risk of preterm delivery. Their clinical relevance depends on the efficacy of the interventions which can be offered to these patients.
Factors involved in the feelings related to school avoidance among high school students in Nagano Prefecture, Japan
Authors: ARUGA Mieko , SUZUKI Eiko , TAGAYA Akira 
Published: May 2011

AbstractAim:  The present study aimed to identify the factors that are involved in the feelings related to school avoidance of high school students in order to develop a support method and a strategy for preventing school maladjustment.Method:  A total of 1756 students from three public high schools in Nagano Prefecture in Japan agreed to participate in the study. They were asked to complete the Feelings of School Avoidance (FSA) Scale, as well as information relating to their demographic details, living environment, lifestyle, and psychosocial factors.Results:  Valid responses were obtained from 1178 students. The mean scores of all three subscales of the FSA Scale increased with the students' grade. In the hierarchical multiple linear regression analysis, the students' age, family size, and social support were excluded from the predictors and the anthropophobic tendency and social skills were analyzed separately in order to avoid multicollinearity. When the anthropophobic tendency was included, the students' grade, anthropophobic tendency, self‐esteem, and support by school friends were significant predictors for all the FSA subscales. When the level of social skills was included instead of the anthropophobic tendency, the analysis yielded similar results, except that the students' social skills and unidentified complaints were selected instead of the anthropophobic tendency.Conclusion:  Among the high school students, the anthropophobic tendency contributed to their feelings related to school avoidance most strongly. These results suggest the necessity of understanding students' anthropophobic tendency in detail, developing effective support in order to promote their social skills and self‐esteem, and helping them to make friends, as well as improving their human relationships in order to prevent school maladjustment.
Favorable Female Sexual Function is Associated with Patient Satisfaction after Inflatable Penile Prosthesis Implantation
Authors: Moskovic Daniel J. , Gittens Paul , Avila Jr. Desiderio , Chandrashekar Aravind , Khera Mohit , Lipshultz Larry I. 
Published: May 2011

Abstract

Introduction
The interrelationship between male and female sexual function suggests that partner outcomes after inflatable penile prosthesis (IPP) implantation must be assessed.

Aim
We examined predictors of patient and partner satisfaction, and the relationship between patient satisfaction and female sexual function, after IPP implantation.

Methods
We designed a questionnaire (scored 1–5) assessing satisfaction with various domains related to the IPP (e.g., overall satisfaction and satisfaction related to: length, width, ease of use, and partner perception). Scores ≥3 were classified as satisfied. The Female Sexual Function Index (FSFI) was administered to the female partners of patients that underwent an IPP.

Main Outcome Measures
Independent samples Students' t-test was used to compare various FSFI domain scores in relation to male and female satisfaction. Analysis of variance test was used to assess linear regression correlation between various continuous variables.

Results
45 men and 32 partners with a mean follow-up of 2.2 years were contacted. Overall satisfaction for men and women was 3.60 and 3.62 (out of 5), respectively. Partner FSFI scores were higher, respectively, in men with higher implant satisfaction than those with lower implant satisfaction (25.09 ± 6.79 vs. 13.67 ± 12.70, P &lt; 0.001). Regression analysis suggests a direct correlation between FSFI scores and the degree of patient (r = 0.50, r2 = 0.23; P = 0.001) and partner (r = 0.70 r2 = 0.50; P &lt; 0.001) satisfaction with the IPP.

Conclusion
Patient satisfaction after IPP implantation implies favorable partner sexual function compared to that of unsatisfied patients. The correlation observed suggests that patients not satisfied with their IPP are likely to have female partners at high risk for female sexual dysfunction. Further interventions may be needed to improve patient and partner sexual function, particularly unsatisfied men and their female partners.
Associations of Unhealthy Lifestyle Factors with Sexual Inactivity and Sexual Dysfunctions in Denmark
Authors: Christensen Birgitte S. , Grønbæk Morten , Pedersen Bo V. , Graugaard Christian , Frisch Morten 
Published: May 2011

Abstract

Introduction
Studies have linked obesity, a sedentary lifestyle, and tobacco smoking to erectile dysfunction, but the evidence linking unhealthy lifestyle factors to other sexual dysfunctions or to sexual inactivity is conflicting.

Aim
To examine associations between unhealthy lifestyle factors and sexual inactivity with a partner and four specific sexual dysfunctions in each sex.

Methods
We used nationally representative survey data from 5,552 Danish men and women aged 16–97 years in 2005. Cross-sectional associations of lifestyle factors with sexual inactivity and sexual dysfunctions were estimated by logistic regression-derived, confounder-adjusted odds ratios (ORs).

Main Outcome Measures
We calculated ORs for sexual inactivity with a partner and for sexual dysfunction and sexual difficulties overall in both sexes, for erectile dysfunction, anorgasmia, premature ejaculation, and dyspareunia in men, and for lubrication insufficiency, anorgasmia, dyspareunia, and vaginismus in women.

Results
Obesity (body mass index [BMI]≥30 kg/m2) or a substantially increased waist circumference (men ≥102 cm; women ≥88 cm), physical inactivity, and, among women, tobacco smoking were each significantly associated with sexual inactivity in the last year. Among sexually active men, both underweight (BMI &lt;20 kg/m2) and obesity, a substantially increased waist circumference, physical inactivity in leisure time, high alcohol consumption (&gt;21 alcoholic beverages/week), tobacco smoking, and use of hard drugs were each significantly positively associated with one or more sexual dysfunctions (ORs between 1.71 and 22.0). Among sexually active women, the only significant positive association between an unhealthy lifestyle factor and sexual dysfunction was between hashish use and anorgasmia (OR 2.85).

Conclusion
In both sexes, several unhealthy lifestyle factors were associated with sexual inactivity with a partner in the last year. Additionally, among sexually active participants, men with unhealthy lifestyles were significantly more likely to experience sexual dysfunctions. Considering the importance of a good sex life, our findings may be useful in attempts to promote healthier lifestyles.
Identification of Functional Genetic Variations Underlying Drought Tolerance in Maize Using SNP Markers
Authors: Hao Zhuanfang , Li Xinhai , Xie Chuanxiao , Weng Jianfeng , Li Mingshun , Zhang Degui , Liang Xiaoling , Liu Lingling , Liu Sisi , Zhang Shihuang 
Published: May 2011

Abstract Single nucleotide polymorphism (SNP) is a common form of genetic variation and popularly exists in maize genome. An Illumina GoldenGate assay with 1 536 SNP markers was used to genotype maize inbred lines and identified the functional genetic variations underlying drought tolerance by association analysis. Across 80 lines, 1 006 polymorphic SNPs (65.5% of the total) in the assay with good call quality were used to estimate the pattern of genetic diversity, population structure, and familial relatedness. The analysis showed the best number of fixed subgroups was six, which was consistent with their original sources and results using only simple sequence repeat markers. Pairwise linkage disequilibrium (LD) and association mapping with phenotypic traits investigated under water‐stressed and well‐watered regimes showed rapid LD decline within 100–500 kb along the physical distance of each chromosome, and that 29 SNPs were associated with at least two phenotypic traits in one or more environments, which were related to drought‐tolerant or drought‐responsive genes. These drought‐tolerant SNPs could be converted into functional markers and then used for maize improvement by marker‐assisted selection.
Technologies involved in molecular blood group genotyping
Authors: Monteiro F. , Tavares G. , Ferreira M. , Amorim A. , Bastos P. , Rocha C. , Araújo F. , Cunha‐Ribeiro L. M. 
Published: May 2011

Background  Until the 1990s, blood screening, typing and diagnostics depended entirely on serological techniques. For over a century, agglutination has been the gold standard for red blood cell (RBC) antigen detection used in all blood services. However, haemagglutination has certain limitations, such as, the difficulty to phenotype recently and multi‐transfused patients or direct antiglobulin test (DAT)‐positive patients. The haemagglutination test provides only indirect indications of risk or severity of haemolytic disease of the new born. In part, to overcome these limitations, nucleic acid‐based technologies have been used in immunohematology reference laboratories.Methods  There are many molecular methods available for red cell genotyping: PCR, PCR‐RFLP, PCR‐SSP or PCR‐ASP, real time PCR, DNA sequencing and pirosequencing and methods with microarrays‐based systems.Other molecular techniques that are under development and may be available for red cell genotyping in the next decade include fluidic or open microarrays; matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry (MALDI‐TOF MS); and mini‐sequencing.Conclusions  Although serology may be superior for some blood group typing, genotyping assays offer a good alternative for problems encountered by serology. In many laboratories, blood group genotyping is already used at a low‐throughput level for diagnostics in cases of problematic serology. Especially in case of weak expression of antigens, the presence of rare antigens or auto‐antibodies or after multiple transfusions, genotyping is superior. The non‐invasive determination of the foetal RHD analysis in maternal plasma by real‐time PCR is well established and already offered as a clinical service in a number of countries.The recent availability of automated, high throughput, DNA‐array platforms, allows to introduce into the hospital and donor centres this DNA‐based typing methodology. The evolution of molecular methods combined with automation and high‐quality standards will make large‐scale screening a cost‐effective reality.