bluuebunny/crossref_metadata_2025_split huggingface dataset:
Soft Tissue Infections and Emergency Department Disposition: Predicting the Need for Inpatient Admission
Authors: Sabbaj Alfredo , Jensen Brett , Browning Mary Ann , Ma O. John , Newgard Craig D. 
Published: December 2009

AbstractObjectives:  Little empiric evidence exists to guide emergency department (ED) disposition of patients presenting with soft tissue infections. This study’s objective was to generate a clinical decision rule to predict the need for greater than 24‐hour hospital admission for patients presenting to the ED with soft tissue infection.Methods:  This was a retrospective cohort study of consecutive patients presenting to a tertiary care hospital ED with diagnosis of nonfacial soft tissue infection. Standardized chart review was used to collect 29 clinical variables. The primary outcome was >24‐hour hospital admission (either general admission or ED observation unit), regardless of initial disposition. Patients initially discharged home and later admitted for more than 24 hours were included in the outcome. Data were analyzed using classification and regression tree (CART) analysis and multivariable logistic regression.Results:  A total of 846 patients presented to the ED with nonfacial soft tissue infection. After merging duplicate records, 674 patients remained, of which 81 (12%) required longer than 24‐hour admission. Using CART, the strongest predictors of >24‐hour admission were patient temperature at ED presentation and mechanism of infection. In the multivariable logistic regression model, initial patient temperature (odds ratio [OR] for each degree over 37°C = 2.91, 95% confidence interval [CI] = 1.65 to 5.12) and history of fever (OR = 3.02, 95% CI = 1.41 to 6.43) remained the strongest predictors of hospital admission. Despite these findings, there was no combination of factors that reliably identified more than 90% of target patients.Conclusions:  Although we were unable to generate a high‐sensitivity decision rule to identify ED patients with soft tissue infection requiring >24‐hour admission, the presence of a fever (either by initial ED vital signs or by history) was the strongest predictor of need for >24‐hour hospital stay. These findings may help guide disposition of patients presenting to the ED with nonfacial soft tissue infections.
Kaizen: A Method of Process Improvement in the Emergency Department
Authors: Jacobson Gregory H. , McCoin Nicole Streiff , Lescallette Richard , Russ Stephan , Slovis Corey M. 
Published: December 2009

AbstractIntroduction:  Recent position statements from health care organizations have placed a strong emphasis on continuous quality improvement (CQI). CQI finds many of its roots in kaizen, which emphasizes small, low‐cost, low‐risk improvements. Based on the successful Kaizen Programs at organizations such as Toyota, the authors thought the emergency department (ED) would be an ideal environment to benefit from such a program.Objectives:  The authors sought to create a CQI program using a suggestion‐based model that did not require a large time commitment, was easy to implement, and had the potential to empower all physicians in the department. It would not take the place of other improvement efforts, but instead augment them. The hypothesis was that such a program would foster sustainable engagement of emergency physicians in system improvement efforts and lead to a continuous stream of low‐cost implementable system improvement interventions.Methods:  A CQI program was created for the physician staff of the Department of Emergency Medicine at Vanderbilt University Medical Center, focusing on a suggestion‐based model using kaizen philosophy. Lectures teaching kaizen philosophy were presented. Over the past 4 years, a methodology was developed utilizing a Web‐based application, the Kaizen Tracker, which aids in the submission and implementation of suggestions that are called kaizen initiatives (KIs). The characteristics of the KIs submitted, details regarding resident and faculty participation, and the effectiveness of the Kaizen Tracker were retrospectively reviewed.Results:  There were 169, 105, and 101 KIs placed in the postimplementation calendar years 2006, 2007, and 2008, respectively. Seventy‐six percent of KIs submitted thus far have identified a “process problem.” Fifty‐three percent of KIs submitted have led to operational changes within the ED. Ninety‐three percent of the resident physicians entered at least one KI, and 73% of these residents submitted more than one KI. Sixty‐nine percent of the attendings entered at least one KI, and 89% of these attendings submitted more than one KI.Conclusions:  Over the past 4 years, the Kaizen Program at Vanderbilt has been widely and frequently used within the ED. It has resulted in over 400 changes in our adult ED system and has met the challenge of using CQI to drive ED improvements. There are limitations to this study, including the fact that its impact on patient outcomes remains unknown. However, this Kaizen Program may be an excellent tool for other departments to assist with quality improvement and should be studied with a multicenter prospective approach.
Use of the Visual Analog Scale to Rate and Monitor Severity of Nausea in the Emergency Department
Authors: Meek Robert , Kelly Anne‐Maree , Hu Xue Feng 
Published: December 2009

AbstractObjectives:  The objective was to describe the association between verbal descriptors of nausea severity and visual analog scale (VAS) ratings in an undifferentiated emergency department (ED) population and to calculate the minimum clinically significant difference (MCSD) in VAS rating of nausea severity in this population.Methods:  A prospective observational study was conducted at three EDs on a convenience sample of stable, consenting adult patients presenting with nausea as part of their symptom complex. Data included demographics, adjectival description of nausea severity (none, mild, moderate, or severe), and VAS rating (standard 100‐mm line) at enrollment, 30 minutes, and 60 minutes. At 30 and 60 minutes they were also asked to describe any change in nausea severity from the previous rating (“a lot less,”“a little less,”“the same,”“a little more,”“a lot more”). The MCSD was defined as the average VAS change when a patient reported “a little less” or “a little more” nausea.Results:  A total of 247 patients provided 693 matched adjectival ratings and VAS scores. Median age was 45 years, and 100 (40%) were male. The median VAS measures for none, mild, moderate, and severe nausea were 2, 23, 53, and 83 mm, respectively. VAS distributions in the verbal categories were statistically different from each other (Spearman rank correlation coefficient = 0.90; p < 0.0001). The MCSD was 22 mm (95% CI = 20 to 24 mm).Conclusions:  There is very good correlation between verbal descriptors of nausea and VAS ratings. The MCSD for VAS nausea ratings in an ED population is 22 mm.
Using a Discrete‐event Simulation to Balance Ambulance Availability and Demand in Static Deployment Systems
Authors: Wu Ching‐Han , Hwang Kevin P. 
Published: December 2009

AbstractObjectives:  To improve ambulance response time, matching ambulance availability with the emergency demand is crucial. To maintain the standard of 90% of response times within 9 minutes, the authors introduce a discrete‐event simulation method to estimate the threshold for expanding the ambulance fleet when demand increases and to find the optimal dispatching strategies when provisional events create temporary decreases in ambulance availability.Methods:  The simulation model was developed with information from the literature. Although the development was theoretical, the model was validated on the emergency medical services (EMS) system of Tainan City. The data are divided: one part is for model development, and the other for validation. For increasing demand, the effect was modeled on response time when call arrival rates increased. For temporary availability decreases, the authors simulated all possible alternatives of ambulance deployment in accordance with the number of out‐of‐routine‐duty ambulances and the durations of three types of mass gatherings: marathon races (06:00–10:00 hr), rock concerts (18:00–22:00 hr), and New Year’s Eve parties (20:00–01:00 hr).Results:  Statistical analysis confirmed that the model reasonably represented the actual Tainan EMS system. The response‐time standard could not be reached when the incremental ratio of call arrivals exceeded 56%, which is the threshold for the Tainan EMS system to expand its ambulance fleet. When provisional events created temporary availability decreases, the Tainan EMS system could spare at most two ambulances from the standard configuration, except between 20:00 and 01:00, when it could spare three. The model also demonstrated that the current Tainan EMS has two excess ambulances that could be dropped. The authors suggest dispatching strategies to minimize the response times in routine daily emergencies.Conclusions:  Strategies of capacity management based on this model improved response times. The more ambulances that are out of routine duty, the better the performance of the optimal strategies that are based on this model.
Variation in the Type, Rate, and Selection of Patients for Out‐of‐hospital Airway Procedures Among Injured Children and Adults
Authors: Newgard Craig D. , Koprowicz Kent , Wang Henry , Monnig Aaron , Kerby Jeffrey D. , Sears Gena K. , Davis Daniel P. , Bulger Eileen , Stephens Shannon W. , Daya Mohamud R. ,   the ROC Investigators
Published: December 2009

AbstractObjectives:  The objective was to compare the type, rate, and selection of injured patients for out‐of‐hospital airway procedures among emergency medical services (EMS) agencies in 10 sites across North America.Methods:  The authors analyzed a consecutive patient, prospective cohort registry of injured adults and children with an out‐of‐hospital advanced airway attempt, collected from December 1, 2005, through February 28, 2007, by 181 EMS agencies in 10 sites across the United States and Canada. Advanced airway procedures were defined as orotracheal intubation, nasotracheal intubation, supraglottic airway, or cricothyrotomy. Airway procedure rates were calculated based on age‐specific population values for the 10 sites and the number of injured patients with field physiologic abnormality (systolic blood pressure of ≤90 mm Hg, respiratory rate of <10 or >29 breaths/min, Glasgow Coma Scale [GCS] score of ≤12). Descriptive measures were used to compare patients between sites.Results:  A total 1,738 patients had at least one advanced airway attempt and were included in the analysis. There was wide variation between sites in the types of airway procedures performed, including orotracheal intubation (63% to 99%), supraglottic airways (0 to 27%), nasotracheal intubation (0 to 21%), and cricothyrotomy (0 to 2%). Use of rapid sequence intubation (RSI) varied from 0% to 65%. The population‐adjusted rates of field airway intervention (by site) ranged from 1.2 to 22.8 per 100,000 adults and 0.2 to 4.0 per 100,000 children. Among trauma patients with physiologic abnormality, some sites performed airway procedures in almost 50% of patients, while other sites used these procedures in fewer than 10%. There was also large variation in demographic characteristics, physiologic measures, mechanism of injury, mode of transport, field cardiopulmonary resuscitation, and unadjusted mortality among airway patients.Conclusions:  Among 10 sites across North America, there was wide variation in the types of out‐of‐hospital airway procedures performed, population‐based rates of airway intervention, and the selection of injured patients for such procedures.
Variation in fish assemblages across dry‐season pools in a Mediterranean stream: effects of pool morphology, physicochemical factors and spatial context
Authors: Pires D. F. , Pires A. M. , Collares‐Pereira M. J. , Magalhães M. F. 
Published: December 2009

Pires DF, Pires AM, Collares‐Pereira MJ, Magalhães MF. Variation in fish assemblages across dry‐season pools in a Mediterranean stream: effects of pool morphology, physicochemical factors and spatial context. Ecology of Freshwater Fish 2010: 19: 74–86. © 2009 John Wiley & Sons A/SAbstract –  Knowledge of patterns of refuge use by fish is critical for maintaining biodiversity in drought‐prone streams. In this study, the fish assemblages of 21 dry‐season pools in a Mediterranean stream were characterised and related to three sets of factors reflecting pool morphology, physicochemistry and spatial context. Fish were associated with the three sets of variables, with variation partitioning indicating that overall species richness and abundance were primarily related to pool morphology but relative species abundances were mainly associated with physicochemical contexts. In general, species richness was the highest but overall fish abundance was the lowest in large pools. Pools well shaded by riparian canopy held the highest richness and abundance of native fish, but relative species abundances and assembly structure varied among pools contingent on canopy cover, substrate composition and spatial location. These results suggested that conservation of fish diversity in Mediterranean streams requires networks of pools with diverse sizes and physicochemical contexts.
The effect of visiting zoos on human health and quality of life
Authors: SAKAGAMI Taketo , OHTA Mitsuaki 
Published: December 2009

ABSTRACTThe increased mental stress of daily life and aging of the population are serious matters in Japan. There are many studies regarding the effects of human‐animal interactions on mental and physical human health, whereas there are few studies examining the effects of visiting zoos. To determine the effect of visiting zoos on human health and quality of life, two different zoos were visited by 70 participants in Experiment 1 and 163 participants in Experiment 2. In this study we administered the WHO QOL‐26 questionnaire in Japanese to assess the psychological scales of participants, and blood pressures and pulse rates were measured to assess their physical scales. We also used pedometers to count the number of steps taken during zoo visits. Both zoo visits decreased blood pressure and participants demonstrated more than 6000 steps during each visit. The quality of life sub‐scale scores were improved after zoo visits.
Morphometric analysis and clinical application of the working dimensions of cricothyroid membrane in south Indian adults: With special relevance to surgical cricothyroidotomy
Authors: Prithishkumar Ivan J , David Suresh S 
Published: December 2009

AbstractObjective:  To measure the working dimensions of the cricothyroid membrane in the adult south Indian population and to establish the association between the working dimensions and the appropriate endotracheal tube size for the purpose of cricothyroidotomy.Methods:  Cross‐sectional evaluation of 50 fresh adult autopsy cases (35 men, 15 women) in a medical university teaching hospital in South India.Results:  Age ranged from 17.0 to 83.0 years. Working dimensions of the membrane in neutral position of neck, in men: width = 8.41 ± 2.11 mm, height = 6.57 ± 1.87 mm; in women: width = 6.30 ± 1.29 mm, height = 5.80 ± 1.56 mm. Depth of the subglottic larynx at the level of cricoid cartilage: men = 20.73 ± 1.97 mm, women = 15.62 ± 1.71 mm. Distance of the lower border of cricothyroid membrane from suprasternal notch in neutral position of neck, in men = 5.18 ± 1.76 cm, women = 4.72 ± 1.55 cm; in passively extended neck, men = 7.86 ± 1.25 cm, women = 8.05 ± 1.28 cm. Regression equations have been derived to determine endotracheal tube size for cricothyroidotomy, based on distance between sternal notch and chin, and height of the individual (P < 0.05).Conclusions:  Working dimensions are smaller in the Indian group compared with western publications. Endotracheal tubes ranging from size 3.0 to 6.0 might be used for cricothyroidotomy in the adult south Indian population.
Original Research—Outcomes Assessment: Development and Validation of a 6-Item Version of the Female Sexual Function Index (FSFI) as a Diagnostic Tool for Female Sexual Dysfunction
Authors: Isidori Andrea M. , Pozza Carlotta , Esposito Katherine , Giugliano Dario , Morano Susanna , Vignozzi Linda , Corona Giovanni , Lenzi Andrea , Jannini Emmanuele A. 
Published: December 2009

ABSTRACT

Introduction
A limiting step in the evaluation of female sexual dysfunction (FSD) is the availability of a rapid screening procedure. Often, practitioners avoid investigating sexual symptoms due to concerns of insufficient time or lack of proper tools to address FSD.

Aim
The purpose of this study was to prepare and validate an abridged form of the most popular psychometric diagnostic test (Female Sexual Function Index, FSFI-19) to provide a fast screener of FSD for easy use in outpatient visits, epidemiological studies, and assessment of treatment response.

Methods
We interviewed and administered the FSFI-19 to 200 women attending outpatient clinics for sexual and reproductive medicine. Forty women were excluded because they had no sexual activity or failed to attend the retest visit. Patients were evaluated on two subsequent visits to validate the abridged form of the questionnaire. Overall, 105 were found to suffer from a FSD.

Main Outcome Measure
We assessed, individually, the sensibility and sensitivity of all questions of the full-length FSFI. We then estimated the performance of each item with respect to the specific sexual domain they address. By selecting the best combination of performing items in each domain, we built an abridged, 6-item form of the FSFI.

Results
The Receiver Operating Characteristic curves of the FSFI-6 showed that women who scored ≤19 were classified as having FSD. Using the cut-off of 19, the sensitivity and specificity of the test were, 0.93 and 0.94, respectively. Reliability, internal consistency, and stability on retest were also good.

Conclusions
The abridged FSFI-6 is a valuable tool for screening women that are likely to suffer from FSD. In six simple questions, taking no more than 3 minutes, a score of less than 19 indicates the need for further investigations, including the full-length FSFI-19 and a dedicated interview. In conclusion, this is a novel tool that can help any doctor to disclose FSD rapidly and efficiently.
INFLUENCE OF PARTIAL REPLACEMENT OF OLIVE OIL ON FRYING PERFORMANCE OF PALM OLEIN
Authors: NAGHSHINEH M. , ARIFFIN A.A. , GHAZALI H.M. , MIRHOSSEINI H. , MOHAMMAD A.S. , KUNTOM A. 
Published: November 2009

ABSTRACT The influence of partial replacement of palm olein (POo) with olive oil (Oo), (25 and 50%, w/w) was investigated during five consecutive days of frying. The results indicated that frying performance of POo was significantly (P < 0.05) influenced by partial replacement with olive oil. The highest change in peroxide value (PV), anisidine value (AV), totox value (TV), total polar compound (TPC), viscosity and melting point was shown by the control sample; whereas the replacement of 50% (w/w) palm olein with 50% (w/w) olive oil exhibited the least changes in PV, AV, TV, TPC, viscosity and melting point during the frying process. This study suggests that the partial replacement of palm olein containing a high proportion of saturated fatty acids (i.e., palmitic acid) with olive oil containing a high content of monounsaturated fatty acid (i.e., oleic acid) can provide oil blends with higher chemical stability against oxidation. On the other hand, the prepared oil blend remained liquid at ambient temperature, thereby enhancing the physical stability induced by partial replacement with olive oil.PRACTICAL APPLICATIONSPartial replacement of palm olein with olive oil containing high oleic acid can improve the oxidative stability of palm olein during the frying process compared with regular palm olein. Therefore, the proposed oil blend can be suggested as a suitable replacement for pure palm olein for frying and cooking purposes by providing a higher oxidative stability besides the beneficial effects of olive oil on human health.
MONITORING OF VIRGIN COCONUT OIL (VCO) ADULTERATION WITH PALM OIL USING FOURIER TRANSFORM INFRARED SPECTROSCOPY
Authors: ROHMAN A. , CHE MAN Y.B. 
Published: November 2009

ABSTRACT Virgin coconut oil (VCO) may be adulterated with cheaper oils, such as palm oil (PO). Thus, the detection and quantification of VCO adulteration with PO was monitored using Fourier transform infrared (FTIR) spectroscopy, combined with chemometrics of partial least square (PLS) and discriminant analysis at frequency regions of 3,010–3,000, 1,660–1,650 and 1,120–1,105/cm. Attenuated total reflectance (ATR) measurements were made on pure VCO and that adulterated with varying concentrations of PO (0.5–50% w/w in VCO). PLS calibration exhibited a good relationship between actual and FTIR‐predicted values with coefficient of determination (R2) of 0.999 and standard error of calibration of 0.533. The cross validation was performed by removing one standard at a time, and the final R2 value of 0.996 and standard error of prediction of 0.953 were obtained. The discriminant analysis using seven principal components was able to classify pure VCO and that adulterated with PO.PRACTICAL APPLICATIONSThe adulteration of virgin coconut oil (VCO) with cheaper oils is a serious matter, not only for food suppliers but also for consumers. Therefore, an analytical technique offering fast and reliable detection of such adulteration must be developed. Fourier transform infrared spectroscopy combined with chemometrics of partial least square for quantitative analysis of adulterant, and discriminant analysis for classification between VCO and that adulterated with palm oil, can be employed for detection of palm oil as an adulterant in VCO for quality assurance purposes.
Oral magnesium supplementation in adults with coronary heart disease or coronary heart disease risk
Authors: Mathers Tavia W. , Beckstrand Renea L. 
Published: December 2009

AbstractPurpose: To review randomized control clinical trial (RCT) literature and prospective studies for the safety and efficacy of magnesium supplements in patients with coronary heart disease (CHD) or with CHD risk.Data sources: Databases were searched using the keywords: magnesium, heart disease, endothelium, prevention, treatment, therapy, level, and supplement.Conclusions: There were no reports of adverse effects from magnesium supplementation in any of the studies. Subjects reporting lower dietary magnesium intake had significantly lower serum magnesium concentrations than those reporting higher dietary magnesium intake and, in some cases, had a significantly higher frequency of supraventricular beats. There was a modest relationship between dietary magnesium intake and a reduced risk of CHD in male subjects; however, there was no noted decrease in the development of CHD disease in women who had high magnesium intake.Implications for practice: Magnesium is vital for many functions in the body and magnesium supplementation is safe. There is a possible association between a modestly lower risk of CHD in men and increased magnesium intake; therefore, it is reasonable to encourage diets high in magnesium as a potential means to lower the risk of CHD.