bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous infusion of ropivacaïne: an optimal postoperative analgesia regimen for iliac crest bone graft in children
Authors: OUAKI JULIE , DADURE CHRISTOPHE , BRINGUIER SOPHIE , RAUX OLIVIER , ROCHETTE ALAIN , CAPTIER GUILLAUME , CAPDEVILA XAVIER 
Published: August 2009

SummaryBackground:  Postoperative analgesia of iliac crest (IC) donor site can be performed by on site infiltrations of local anesthetics (LA) or morphine. Single injections or continuous infusions of LA proved their efficacy in adults, but was not reported in children. We prospectively evaluated the interest of a continuous infusion of 0.2% ropivacaïne at the IC donor site in terms of postoperative pain relief and rescue analgesics consumption.Methods:  Sixteen consecutive patients, aged from 4 to 16 years scheduled for maxillar alveolar graft with IC bone, were included. After IC bone graft surgery under general anesthesia, they received a 0.2–0.4 ml·kg−1 bolus of 0.2% ropivacaïne through the IC catheter; then a continuous infusion of 0.2% ropivacaïne at 0.125 ml·kg−1·h−1 was administrated for 48 h with disposable elastomeric pumps. Children systematically received paracetamol (15 mg·kg−1 four times a day) and niflumic acid (40 mg·kg−1 twice a day). Postoperative pain was evaluated using a Visual Analog Scale (>7 years old) or Children and Infants Postoperative Pain Score (between 4 and 7 years old) every 4 h until H48. Doses of rescue analgesics and adverse events (LA toxicity, catheter’s removal, nausea–vomiting) were also noted. Three months after surgery a blinded clinical research assistant reviewed all children and assessed functional recovery, neuropathic chronic pain symptoms or local complications.Results:  The median value of IC graft pain scores was 0 during whole studied period. Of the patients, 31.2% did not require any rescue analgesics and 43.8% needed only once. No adverse events related to LA and no removal of catheter were noted. One child had nausea in the 48‐h postoperative period, and one child had neuropathic pain symptoms at 3 months at the donor site.Conclusion:  Continuous infusion of 0.2% ropivacaïne through an IC catheter is an optimal and safe technique of regional postoperative analgesia after bone graft harvest in children.
A survey of pediatric caudal extradural anesthesia practice
Authors: MENZIES ROBERT , CONGREVE KATE , HERODES VEIKO , BERG SIMON , MASON DAVID G. 
Published: August 2009

SummaryBackground:  Caudal extradural blockade is one of the most commonly performed procedures in pediatric anesthesia. However, there is little information available on variations in clinical practice.Objectives:  To perform a survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland who undertake caudal anesthesia.Methods:  An ‘online’ World Wide Web questionnaire collected information on various aspects of clinical practice. The survey ran from April to June 2008.Results:  There were 366 questionnaires completed. The majority of respondents had >5 years of pediatric experience and performed up to ten caudal extradural procedures a month. The commonest device used was a cannula (69.7%) with 68.6% using a 22G device. There was a trend toward the use of a cannula in those anesthetists with <15 years experience, while those with >15 years experience tended to use a needle. Most anesthetists (91.5%) did not believe that there was a significant risk of implantation of dermoid tissue into the caudal extradural space. The majority used a combination of clinical methods to confirm correct placement. Only 27 respondents used ultrasound. The most popular local anesthetics were bupivacaine (43.4%) and levobupivacaine (41.7%). The most common additives were clonidine (42.3%) and ketamine (37.5%). The caudal catheter technique was used by 43.6%. Most anesthetists (74%) wear gloves for a single shot caudal injection.Conclusions:  This survey provides a snapshot of current practice and acts a useful reference for the development of enhanced techniques and new equipment in the future.
Ascomycetes associated with ectomycorrhizas: molecular diversity and ecology with particular reference to the Helotiales
Authors: Tedersoo Leho , Pärtel Kadri , Jairus Teele , Gates Genevieve , Põldmaa Kadri , Tamm Heidi 
Published: August 2009

SummaryMycorrhizosphere microbes enhance functioning of the plant–soil interface, but little is known of their ecology. This study aims to characterize the ascomycete communities associated with ectomycorrhizas in two Tasmanian wet sclerophyll forests. We hypothesize that both the phyto‐ and mycobiont, mantle type, soil microbiotope and geographical distance affect the diversity and occurrence of the associated ascomycetes. Using the culture‐independent rDNA sequence analysis, we demonstrate a high diversity of these fungi on different hosts and habitats. Plant host has the strongest effect on the occurrence of the dominant species and community composition of ectomycorrhiza‐associated fungi. Root endophytes, soil saprobes, myco‐, phyto‐ and entomopathogens contribute to the ectomycorrhiza‐associated ascomycete community. Taxonomically these Ascomycota mostly belong to the orders Helotiales, Hypocreales, Chaetothyriales and Sordariales. Members of Helotiales from both Tasmania and the Northern Hemisphere are phylogenetically closely related to root endophytes and ericoid mycorrhizal fungi, suggesting their strong ecological and evolutionary links. Ectomycorrhizal mycobionts from Australia and the Northern Hemisphere are taxonomically unrelated to each other and phylogenetically distant to other helotialean root‐associated fungi, indicating independent evolution. The ubiquity and diversity of the secondary root‐associated fungi should be considered in studies of mycorrhizal communities to avoid overestimating the richness of true symbionts.
Prospective evaluation of a colorectal cancer nurse follow‐up clinic
Authors: Jeyarajah S. , Adams K. J. , Higgins L. , Ryan S. , Leather A. J. M. , Papagrigoriadis S. 
Published: August 2009

AbstractAim  Colorectal Nurse Specialist (CNS) clinics for postoperative follow up of colorectal cancer aim to maintain clinical efficacy while reducing costs. We prospectively studied the efficacy and financial implications of such a clinic.Method  This was a prospective study of all patients attending CNS clinics over 3 years. A lower‐risk protocol for patients with Dukes A was used over 3 years and a higher‐risk protocol for patients with Dukes B, C or D was used over 5 years. Department of Health Pricing Charts were used to cost the follow‐up protocols, and adjustment was performed to calculate the cost of each quality adjusted life year (QALY) gained.Results  One hundred and ninety‐three patients entered into this nurse‐led follow‐up protocol implemented by the CNS clinic between 2005 and 2007. The Dukes stages and proportions of patients in each stage were as follows: stage A, 13%; stage B, 8%; stage C, 36.3%; and stage D, 9.3%. Ninety‐seven per cent underwent curative treatment and 2.6% had palliative treatment. Twenty‐one per cent of patients developed recurrent disease. Overall actuarial 5‐year survival was 80% and recurrences had a 30% 5‐year actuarial survival. The total cost per patient for 3 years of follow up was £1506 and £1179 for lower‐risk rectal and nonrectal cancers, respectively. The adjusted cost for each QALY gained for lower‐risk tumours was £1914. The total cost per patient with higher‐risk tumours was £1814 and £1487 for rectal and nonrectal tumours, respectively. The adjusted cost for each QALY gained was £2180 for higher‐risk tumours.Conclusions  This clinic demonstrated cost‐effective detection of recurrent disease. Computed tomography (CT) was the most sensitive alert test. As all recurrences were detected within 4 years, we suggest that this is the indicated time to follow up.
Stages of Organizational Transformation in Transition Economies: A Dynamic Capabilities Approach
Authors: Dixon Sarah E. A. , Meyer Klaus E. , Day Marc 
Published: August 2009

abstractHow do organizations previously dominated by the state develop dynamic capabilities that would support their growth in a competitive market economy? We develop a theoretical framework of organizational transformation that explains the processes by which organizations learn and develop dynamic capabilities in transition economies. Specifically, the framework theorizes about the importance of, and inter‐relationships between, leadership, organizational learning, dynamic capabilities, and performance over three stages of transformation. Propositions derived from this framework explain the pre‐conditions enabling organizational learning, the linkages between types of learning and functions of dynamic capabilities, and the feedback from dynamic capabilities to organizational learning that allows firms in transition economies to regain their footing and build long‐term competitive advantage. We focus on transition contexts, where these processes have been magnified and thus offer new insights into strategizing in radically altered environments.
The Multiple Effects of Business Planning on New Venture Performance
Authors: Burke Andrew , Fraser Stuart , Greene Francis J. 
Published: August 2009

abstractWe investigate the multiple effects of writing a business plan prior to start‐up on new venture performance. We argue that the impact of business plans depends on the purpose for and circumstances in which they are being used. We offer an empirical methodology which can account for these multiple effects while disentangling real impact effects from selection effects. We apply this to English data where we find that business plans promote employment growth. This is found to be due to the impact of the plan and not selection effects.
Global Financial Transmission of Monetary Policy Shocks*
Authors: Ehrmann Michael , Fratzscher Marcel 
Published: August 2009

AbstractThe paper analyses the transmission of US monetary policy shocks to global equity markets and the macroeconomic determinants of the underlying transmission process. We show that there is a substantial cross‐country heterogeneity in reactions across 50 equity markets worldwide, with returns falling on average around 2.7% in response to a 100 basis point tightening of US monetary policy, but ranging from a zero response in some to a reaction of 5% or more in other markets. As to the determinants of the strength of transmission to individual countries, we test the relevance of their macroeconomic policies and the role of real and financial integration. We find that in particular the degree of global integration of countries – and not a country's bilateral integration with the United States – is a key determinant for the transmission process.
When Battlefields become Marketplaces: Migrant Workers and the Role of Civil Society and NGO Activism in Thailand
Authors: Pangsapa Piya 
Published: August 2009

AbstractThe vast majority of migrant workers in Thailand are employed predominantly in low‐paying occupations commonly described as “3‐D jobs” (dangerous, dirty, and difficult). Currently, there are nearly two million documented and undocumented migrant workers, mostly from neighbouring Burma, Lao People’s Democratic Republic, and Cambodia, employed in various industries, including domestic service, throughout the country. While over half a million migrants are officially registered to work in the country, both documented and undocumented migrant workers remain unprotected primarily due to the lack of concrete measures to monitor, implement and enforce laws regarding working and living conditions. Regardless of where they are employed, migrant workers face common problems: low wages; harmful working conditions, poor living conditions; discrimination and harassment, the threat of arrest and deportation; and lack of access to basic resources such as medical care and legal assistance. Based on preliminary research conducted in the summer of 2005, this article looks at the situation of migrant factory and domestic workers in Thailand and explores the ways in which local activists, NGOs, community‐based organisations, and international bodies have been looking to assist and protect migrant workers. Successful migrant workers’ struggles and ongoing efforts of mobilization have been made possible with the help of these support groups, and raise the possibility that union and NGO activity have the potential to improve the situation of migrants in Thailand. This also raises the question of whether advocacy groups should be acting in lieu of the state rather than alongside the state, especially when it appears that they are fulfilling their civic duty as enforcer and monitor of migrant workers’ problems.
Adaptation of the Threshold IMT® with double spring load allows higher inspiratory pressure for muscle training
Authors: Fregonezi Guilherme A. F. , Azevedo Ingrid G. , Araujo Thaise L. , Dias Fernando A. L. , Resqueti Vanessa R. 
Published: August 2009

SummaryPurpose:  We aimed to evaluate the functionality of an adapted inspiratory muscle training device designed to allow pressures higher than 41 cmH2O that can be precisely controlled. The adaptation was made in a commercially available Threshold IMT® device, and the opening pressures and linearity of load were evaluated in an experimental setting.Methods:  The original IMT Threshold® device was modified by inserting a second spring load juxtaposed to the original spring and then the modified device was coupled to a system designed to assess the range of opening pressures. Linear regression was used to test the correlation between the visual pressure scale of the original device and the opening pressure load obtained from the adapted device.Results:  For the modified device, we found a range of load from 13·9 ± 0·7 to 85·6 ± 0·7 cmH2O. Linear regression analysis of our data found an excellent relation between the modified device’s opening pressure and the preset opening pressure marked on the visual scale in the original device, y = −1·275 + 2·08x, r2 = 0·99 and P = 0·0001.Conclusion:  The Threshold IMT® adaptation proposed here is simple, affordable, precise, safe and allows for a high degree of reproducibility. It also achieves pressures higher than 41 cmH2O that can be used when training inspiratory muscles.
Current Status of Academic Emergency Medicine within Academic Medicine in the United States
Authors: Gallagher E. John , Goldfrank Lewis R. , Anderson Gail V. , Barsan William G. , Levy Richard C. , Sanders Arthur B. , Strange Gary R. , Trott Alexander T. 
Published: August 2009

ABSTRACT Objective: To characterize the status of emergency medicine within U.S. academic medical centers. Methods: All accredited emergency medicine residency programs and all four‐year allopathic medical schools in the United States were identified. Institutions were defined as academic medical centers based upon NIH research grant funding. These institutions were ranked using five measures of academic stature: a survey of medical school deans, a survey of internal medicine residency directors, level of research funding, characteristics of the student body, and an unweighted composite variable reflecting overall academic stature. The relationship between institutional academic stature and an empiric scale of institutional affiliation with emergency medicine was assessed. Results: Sixty‐two institutions were designated academic medical centers. These medical schools captured 90% of all NIH grant monies awarded in fiscal year 1990. Twenty‐six of 87 emergency medicine residency programs (30%) were closely affiliated with one of these medical schools. Within academic medical centers, the presence of a residency or an academic department of emergency medicine was inversely associated with the medical school deans' ranking (p < 0.005), research rank (p < 0.001), and composite academic rank (p < 0.0001). Conclusion: The majority of emergency medicine residency programs (70%) are not closely affiliated with institutions receiving the bulk (90%) of NIH resources for research. Within the institutions receiving the majority of NIH funding, there is a quantitatively and statistically significant inverse association of institutional emergency medicine affiliation and institutional academic rank.
Substance Use and Alcohol Abuse in Emergency Medicine Training Programs, by Resident Report
Authors: McNamara Robert M. , Sanders Arthur B. , Ling Louis , Witzke Donald B. , Bangs Kathleen A. 
Published: August 2009

ABSTRACT Objective: To determine the prevalence of substance use and alcohol abuse among emergency medicine residents. Method: The study instrument was an anonymous, self‐report survey that assessed the use of 13 substances and included the CAGE questions for measuring alcohol abuse. The survey was administered to emergency medicine residents at the time of the American Board of Emergency Medicine's annual In‐Service Examination. Results: Alcohol was the substance most commonly used by emergency medicine residents for nonmedical reasons. Using the CAGE score, 4.9% of residents were classified as alcoholic and another 7.6% as suspect for alcoholism, rates similar to those for housestaff of all specialties as reported in earlier studies. Instruction related to physician impairment during training in their emergency medicine residency was reported by only 36% of the respondents. Conclusions: Emergency medicine residents report a low rate of illicit substance use and do not appear to misuse alcohol differently than other housestaff. Interpretation of these results must be tempered with the potential for underreporting that may occur with a voluntary self‐report survey of a sensitive nature.Acad. Emerg. Med. 1994; 1:47–53.
Retropharyngeal and Bowel Hematomas in an Anticoagulated Patient
Authors: Sinert Richard , Scalea Thomas 
Published: August 2009

ABSTRACTAs the indications for oral anticoagulation therapy increase, the number of patients being treated with anticoagulants and at risk for complications also will rise. Major bleeding episodes have been reported to occur in approximately 2–4% of patients being treated with oral anticoagulants. The case report of a patient with concurrent spontaneous retropharyngeal and small‐bowel hematomas from overanticoagulation with warfarin is presented. The authors review the subtle presentation of retropharyngeal hematomas, common medications that may enhance warfarin anticoagulation, and therapy of potentially life‐threatening hematomas. Airway management and possible surgical therapies to treat the complications of hematomas are discussed. Depending upon the indication for the initial anticoagulation, interim anticoagulation with heparin may be indicated.Acad. Emerg. Med. 1994; 1:67–72.
Can Money and Morality Mix in Medicine?
Authors: Caplan Arthur L. 
Published: August 2009

ABSTRACTThe escalation of health care costs in the United States has become a problem now that business and taxpayers are paying larger shares of these costs. Many believe that the only way to cope with rising costs is to institute explicit rationing of access to health care services. Proposals to ration based upon age, “sin” exclusions, physician gatekeeper incentives, patient ability to pay, and community values all have shortcomings. An alternative approach to controlling costs that emphasizes efficiency by cutting administrative and malpractice overhead costs and universally providing those medical services that have proven patient benefit is proposed. Physicians must take a more active role in the debate to ensure that patient needs are met and that expenditures are directed toward effective therapies.
The Emerging Era of Novel Tropical Forests
Authors: Lugo Ariel E. 
Published: August 2009

ABSTRACTIn 1966 Eugene P. Odum delivered a speech before the Ecological Society of America that transformed the way ecologists looked at succession. His comparison of mature and successional systems lead ecologists to place secondary forests in an inferior position relative to mature ones to the point that today, prominent tropical biologists argue for and against the conservation value of secondary forests. Nevertheless, we live in the era of secondary forests that is rapidly giving way to a new era of novel tropical forests. Research in Puerto Rico documents the emergence of novel forests, which are different in terms of species composition, dominance, and relative importance of species from forests that were present before the island was deforested. These novel forests emerged without assistance. They are a natural response to the new environmental conditions created by human activity. Natural processes have remixed or reassembled native and introduced plant and animal species into novel communities adapted to anthropogenic environmental conditions. Novel forests are expected to protect soils, cycle nutrients, support wildlife, store carbon, maintain watershed functions, and mitigate species extinctions. The dawn of the age of tropical novel forests is upon us and must not be ignored.
The Calculated Ionization Potential and Electron Affinity of Cationic Cyanine Dyes
Authors: Delgado Juan C. , Ishikawa Yasuyuki , Selsby Ronald G. 
Published: August 2009

AbstractThe ionization potential (IP) and electron affinity (EA) of the isolated single dye molecule and a hypothetical isolated J‐aggregated dimer are calculated as an energy difference between separately minimized ground and ionized states. Three quantum methods are employed: density functional theory (DFT) Gaussian03 B3LYP/6‐311G** (++G**); DFT using Dmol3; and a modification of CNDO/S, called CNDO/S‐Δζ, which is developed for rapid calculation of the IP and EA. Results indicate that for the monomer, 1,1′‐dimethyl‐2,2′carbocyanine chloride, the vertical IP and EA are 6.2 ± 0.1 and 1.90 ± 0.05 eV, respectively. This is consistent with the threshold IP and EA predicted by the Yianoulis and Nelson “Statistical Model” of spectral sensitization. For the isolated J‐aggregated dimer, whose configuration is consistent with being adsorbed on a dielectric substrate, the calculations predict a value of 5.2 ± 0.2 and 2.35 ± 0.05 eV for the IP and EA, respectively. Significant charge density is removed from the halide anion in the ionization process. The HOMO of the dye molecule is an MO associated with the halide anion. Calculation of theisolated entitiesis a necessary preliminary step in the study of the IP and EA of theadsorbeddye monomer and aggregate.