bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variations in Ambulance Use in the United States: The Role of Health Insurance
Authors: Meisel Zachary F. , Pines Jesse M. , Polsky Daniel , Metlay Joshua P. , Neuman Mark D. , Branas Charles C. 
Published: October 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:1036–1044 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  The purpose of this study was to describe the associations between individual health insurance and ambulance utilization using a national sample of patients who receive emergency department (ED) care.Methods:  The data source was the National Hospital Ambulatory Medical Care Survey, years 2004 through 2006. Noninstitutionalized patients between ages 18 and 65 years were included. The primary dependent variable was ambulance use. Multivariable logistic regression methods were used to assess the associations between health insurance status and ambulance use and to adjust for confounders.Results:  A total of 61,013 ED visits were included, representing a national sample of approximately 70 million annual ED visits over 3 years. Ambulance transport was used in 11% of private insurance visits, 16% of Medicaid visits, and 13% of uninsured visits. In the adjusted model, visits by patients with Medicaid (adjusted odds ratio [aOR] = 1.60, 99% confidence interval (CI) = 1.37 to 1.86) and the uninsured (aOR = 1.43, 99% CI = 1.23 to 1.66) were more likely to arrive by ambulance than visits by patients with private insurance. Ambulance use among the uninsured was most pronounced in metropolitan areas.Conclusions:  Ambulance use varies by health insurance status. Medicaid coverage and lack of insurance are each independently associated with increased odds of ambulance use, suggesting a disproportionate role for emergency medical services (EMS) in the care of patients with limited financial resources.
Integrating Emergency Medicine Principles and Experience Throughout the Medical School Curriculum: Why and How
Authors: Tews Matthew C. , Hamilton Glenn C. 
Published: October 2011

Academic Emergency Medicine 2011; 18:1072–1080 © 2011 by the Society for Academic Emergency MedicineAbstractThe management of acutely ill and injured patients is an essential component of medical student education, yet the formal integration of emergency medicine (EM) into the medical school curriculum has progressed slowly since the inception of the specialty. Medical student interest and the number of resident positions in the National Resident Matching Program are higher than any time in the past, yet students often find access to EM faculty and clinical experience limited to a fourth‐year rotation. Incorporating EM into all years of the undergraduate medical student curriculum can offer unique educational experiences and enhance exposure to the necessary and recommended knowledge and skills students must attain prior to graduation. Academic emergency physicians (EPs) should advocate our specialty’s importance in their medical school curricula using a proactive approach and actively involve themselves in medical student education at all stages of training. The goals of this article are to describe several approaches for EM faculty to expand medical student exposure to the specialty and enhance student experiences in the core principles of EM throughout the undergraduate medical curriculum.
Evaluation of a Novel Wound Closure Device: A Multicenter Randomized Controlled Trial
Authors: Singer Adam J. , Chale Stuart , Giardano Phil , Hocker Michael , Cairns Charles , Hamilton Richard , Nadkarni Milan , Mills Angela M. , Hollander Judd E. 
Published: October 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:1060–1064 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  A novel wound closure device combining a mesh tape and octylcyanoacrylate (OCA) topical skin adhesive (TSA) was developed to facilitate wound closure and enhance the adhesive’s strength. The objective of this study was to determine whether the incidence of wound dehiscence after laceration repair with the new device was equivalent to that after use of a high‐viscosity OCA. We hypothesized that the rate of complete wound edge apposition would be equivalent for the two closure devices.Methods:  This was a multicenter, randomized clinical trial in nine academic and community emergency departments (EDs) and urgent care centers. Patients with simple traumatic lacerations were included. Lacerations were randomly closed with a high‐viscosity OCA or mesh tape–OCA combination. The rate of complete wound edge apposition at 14 days, rates of wound infection at 14 and 30 days, and the percentage of optimally appearing scars at 30 days after closure were assessed. Assuming a maximal clinically acceptable difference for equivalence of 8% in the rate of completely apposed wound edges, a sample of at least 138 patients in the tape–OCA group and at least 69 in the OCA‐only group would give 80% power and a one‐sided significance level of 5%.Results:  During the study period the investigators enrolled 216 subjects, of whom 143 were randomized to the tape–OCA combination and 73 to the OCA‐only group. Most wounds were located on the face and the upper extremities. Mean laceration length was similar in patients in both groups (tape–OCA 2.1 cm vs. OCA‐only 2.0 cm; difference 0.1 cm, 95% confidence interval [CI] = −0.45 to 0.58 cm). The rate of complete wound edge apposition at 14 days was higher in wounds treated with the tape–OCA combination than in wounds treated with OCA alone (86.0% vs. 78.1%). The upper bound of the one‐sided CI was 1.0% for the intention‐to‐treat population, which was less than the predetermined acceptable difference of less than 8%. There were no between‐group differences in rates of infection and optimally appearing scars.Conclusions:  When compared with OCA alone, the novel tape–OCA combination is equivalent with regard to complete wound edge apposition and cosmetic appearance.
Duplication of the extrahepatic bile duct
Authors: Gupta Vishal , Chandra Abhijit 
Published: October 2011

ABSTRACTDuplication of the extrahepatic bile duct is an extremely rare anomaly. There are five types of this anomaly, with type V being the least common variant. Only two cases of type V (one each of type Va and type Vb) have been reported. Here we report the second case of type Va duplication of the common bile duct presenting with choledocholithiasis. The patient underwent open choledocholithotomy and T‐tube choledochostomy after failed endoscopic stone clearance. Duplication of the bile duct was detected on T‐tube cholangiogram, which was confirmed by magnetic resonance cholangiopancreaticography (MRCP). No associated pancreaticobiliary maljunction was found on the imaging.
Prenatal diagnosis of osteogenesis imperfecta type II by three‐dimensional computed tomography: The current state of fetal computed tomography
Authors: Akizawa Yoshika , Nishimura Gen , Hasegawa Tomonobu , Takagi Masaki , Kawamichi Yayoi , Matsuda Yoshio , Matsui Hideo , Saito Kayoko 
Published: October 2011

ABSTRACTWe report a case of osteogenesis imperfecta (OI) (OMIM166210) type II, in which a prenatal diagnosis was made by three‐dimensional computed tomography (3D‐CT). Subsequent molecular analysis revealed a recurrent, heterozygous mutation in COL1A2. Fetal CT is a powerful tool for visualizing the fetal skeleton and can provide a definitive diagnosis of fetal skeletal dysplasias; however, whether or not its employment for prenatal diagnosis is warranted in terms of fetal radiation risks remains controversial, both medically and ethically. Based on our experience, we review the current state of fetal CT for the diagnosis of skeletal dysplasias, with a discussion of the relevant literature.
Crystal structure of the catalytic domain of UCHL5, a proteasome‐associated human deubiquitinating enzyme, reveals an unproductive form of the enzyme
Authors: Maiti Tushar K. , Permaul Michelle , Boudreaux David A. , Mahanic Christina , Mauney Sarah , Das Chittaranjan 
Published: October 2011

Ubiquitin carboxy‐terminal hydrolase L5 (UCHL5) is a proteasome‐associated deubiquitinating enzyme, which, along with RPN11 and USP14, is known to carry out deubiquitination on proteasome. As a member of the ubiquitin carboxy‐terminal hydrolase (UCH) family, UCHL5 is unusual because, unlike UCHL1 and UCHL3, it can process polyubiquitin chain. However, it does so only when it is bound to the proteasome; in its free form, it is capable of releasing only relatively small leaving groups from the C‐terminus of ubiquitin. Such a behavior might suggest at least two catalytically distinct forms of the enzyme, an apo form incapable of chain processing activity, and a proteasome‐induced activated form capable of cleaving polyubiquitin chain. Through the crystal structure analysis of two truncated constructs representing the catalytic domain (UCH domain) of this enzyme, we were able to visualize a state of this enzyme that we interpret as its inactive form, because the catalytic cysteine appears to be in an unproductive orientation. While this work was in progress, the structure of a different construct representing the UCH domain was reported; however, in that work the structure reported was that of an inactive mutant [catalytic Cys to Ala; Nishio K et al. (2009) Biochem Biophys Res Commun390, 855–860], which precluded the observation that we are reporting here. Additionally, our structures reveal conformationally dynamic parts of the enzyme that may play a role in the structural transition to the more active form.DatabaseProtein Data Bank codes: Coordinates and structure factors have been deposited in the PDB under the entries 3RII (UCHL5N228C88S) and 3RIS (UCHL5N240).
International Federation for Emergency Medicine Model Curriculum for Emergency Medicine Specialists
Authors: Hobgood Cherri , Anantharaman Venkataraman , Bandiera Glen , Cameron Peter , Halpern Pinchas , Holliman C James (Jim) , Jouriles Nicholas , Kilroy Darren , Mulligan Terrence , Singer Andrew ,   Core Curriculum and Education Committee for the International Federation for Emergency Medicine
Published: October 2011

AbstractTo meet a critical and growing need for emergency physicians and emergency medicine resources worldwide, physicians must be trained to deliver time‐sensitive interventions and lifesaving emergency care. Currently, there is no globally recognized, standard curriculum that defines the basic minimum standards for specialist trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine convened a committee of international physicians, health professionals and other experts in emergency medicine and international emergency medicine development to outline a curriculum for training of specialists in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed to provide a framework for educational programmes in emergency medicine. The focus is on the basic minimum emergency medicine educational content that any emergency medicine physician specialist should be prepared to deliver on completion of a training programme. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance physician education in basic emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems, but in particular for developing nations or for nations seeking to expand emergency medicine within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught. This variability will reflect the existing educational milieu, the resources available, and the goals of the institutions' educational leadership with regard to the training of emergency medicine specialists.
Bed Rest or Mobilization after rt-PA? A Case-Crossover Study of Factors Influencing Clinical Decision Making in Stroke Services
Authors: Ha Jason , Churilov Leonid , Linden Thomas , Bernhardt Julie 
Published: October 2011

Background Acute stroke management is a dynamic field. Treatment with recombinant tissue plasminogen activator is standard care in Australia, but there are no evidence-based practice guidelines about first out of bed activity (mobilization) after recombinant tissue plasminogen activator. Aims To identify factors influencing clinicians' decisions to delay or allow mobilization. Methods Case-crossover design. Using hypothetical case vignettes, we explored the factors that clinicians consider when deciding to first mobilize a patient after recombinant tissue plasminogen activator. Acute stroke physicians and nurses from Australian hospitals known to treat with recombinant tissue plasminogen activator participated. Information about hospital recombinant tissue plasminogen activator protocols and perceived benefits and harms of mobilization after recombinant tissue plasminogen activator were also captured. Results Fifty-four clinicians, 52% senior nurses, and 48% senior physicians from all states of Australia participated. Of the factors influencing decisions about mobilization after recombinant tissue plasminogen activator, neurological decline (0·29; confidence interval 0·12, 0·46; P = 0·001), neurological decline with symptomatic intracerebral hemorrhage (0·41; confidence interval 0·24, 0·59; P < 00001), infection of uncertain cause (0·32; confidence interval 0·14, 0·50; P = 0·001), severe chest infection (0·35; confidence interval 0·16, 0·53; P = 00004), severe stroke (0·29; confidence interval 0·12, 0·46; P = 0·001), drowsiness (0·47; confidence interval 0·29, 0·63; P < 00001), and confusion (0·31; confidence interval 0·15, 0·47; P = 00001) significantly influenced decisions. Falls risk was a common concern (85%). Conclusion Growing interest in development of clear protocols that guide first mobilization after recombinant tissue plasminogen activator prompted this study. We have identified factors that may influence decisions about when to allow patients to mobilize after recombinant tissue plasminogen activator. These, combined with emerging evidence of risks and benefits of early mobilization, should help protocol development in the future.
Internationalism and the Invention of the 1st of December Independence Day in Portugal
Authors: Rivero Ángel 
Published: October 2011

AbstractPortuguese national identity was consciously recreated during the 1860s, and a full programme of national identity socialisation was devised. At the core of this project was the proposal to celebrate the 1st of December as the ‘Restoration of Independence Day’. The goal of the National Association 1st of December 1640, which was founded in 1861, was to combat cosmopolitanism, internationalism, and Iberianism, and highlight to the outside world, in general, and to the Portuguese ‘traitors’ in particular, the determination of the Portuguese people to retain their independence. To fulfil this purpose, it was felt necessary to awaken the soul of the Portuguese people by remembering the sufferings of the nation under the yoke of Spain, which lasted from 1580 and 1640, and the national jubilation that accompanied the restoration of freedom. This article argues that, contrary to what is stated in the vast majority of nationalist literature, the original celebration of the 1st of December should not be seen as a response to the Spanish threat of annexation, but rather as a mechanism to prevent attacks against the royal house and the regime it stood for both at home and abroad.
Ethnic Migration in Central and Eastern Europe: Its Historical Background and Contemporary Flows
Authors: Jennissen Roel 
Published: October 2011

AbstractThis article aims to describe the historical background of international ethnic migration in Central and Eastern Europe. The rise and fall of the Habsburg Empire in Central Europe and the Ottoman Empire in Southeastern Europe has been the underlying cause of many ethnic migration flows in Central and Eastern Europe in the post‐communist era. Moreover, the German Ostkolonisation, border changes after the two World Wars, and interstate migration in the former Soviet Union caused a large pool of potential ethnic migrants. In addition to the description of this historical background, this article contains a description of important contemporary ethnic migration flows that originate from the aforementioned historical developments, and a discussion of future developments of ethnic migration in Central and Eastern Europe.
Incidence and prevalence of idiopathic inflammatory myopathies in South Australia: a 30‐year epidemiologic study of histology‐proven cases
Authors: TAN Ju Ann , ROBERTS‐THOMSON Peter J. , BLUMBERGS Peter , HAKENDORF Paul , COX Sally R. , LIMAYE Vidya 
Published: October 2011

AbstractAim:  To describe the epidemiology of biopsy‐proven idiopathic inflammatory myopathies (IIM) in South Australia (SA).Methods:  Cases of IIM were ascertained by review of all muscle biopsy reports from the Neuropathology Laboratory, Hanson Institute (wherein all adult muscle biopsies in SA are reported) from 1980 to 2009. Clinical correlation of these patients by review of medical records was undertaken. SA population denominator numbers were obtained from the Australian Bureau of Statistics.Results:  Three hundred and fifty‐two biopsy‐proven cases of IIM were identified between 1980 and 2009. The overall annual incidence of IIM appeared to be rising with a mean incidence of eight cases per million population (95% CI: 7.2–8.9). This corresponded with an increasing annual incidence of inclusion body myositis (IBM) (prevalence of 50.5 cases per million population in 2009, 95% CI: 40.2–62.7). A female preponderance was noted in both dermatomyositis (DM) (F : M = 2.75 : 1.00) and polymyositis (PM) (F : M = 1.55 : 1.00) but gender distribution was almost equal in IBM (F : M = 1.1 : 1.0). Mean age at diagnosis for IBM (67.5 years) was higher than for DM (55.1 years) and PM (59.0 years). A higher proportion of DM patients reported living in urban dwellings and DM patients tended to be predominantly professionals.Conclusions:  In SA there is an increasing incidence of IBM and the prevalence is one of the highest reported to date. This may reflect an increase in the number of biopsies performed, improved histological techniques or a genuine increase in incidence.
Asymptomatic celiac sprue in juvenile rheumatic diseases children
Authors: GHEITA Tamer A. , FAWZY Samar M. , NOUR EL‐DIN Abeer M. , GOMAA Howaida E. 
Published: October 2011

AbstractBackground:  Celiac disease (CD) is the most frequent enteropathy in adults and its coexistence with other autoimmune diseases is frequent.Objective:  To detect asymptomatic CD in children with rheumatic diseases by measuring tissue transglutaminase (tTG) antibodies and finding any relation to disease activity.Patients and methods:  Setting and study design: The study included 60 children with juvenile rheumatic diseases consecutively from those attending the Rheumatology Clinics of Cairo University Hospitals: 30 juvenile rheumatoid arthritis (JRA), 10 juvenile systemic lupus erythematosus (SLE), 12 juvenile seronegative spondyloarthropathy and eight juvenile systemic sclerosis/polymyositis (SSc/PM) overlap syndrome were recruited during 2010. There were 22 male and 38 female patients. Thirty matched healthy controls were included. All children were subjected to thorough history taking, clinical examination and laboratory investigations. The body mass index (BMI) for age was used. All subjects had no gastrointestinal tract symptoms suggestive of CD and the tTG antibodies (IgA and IgG) were assessed.Results:  The mean age of patients was 12.03 ± 3.3 years and disease duration 4.18 ± 3.24 years. The demographic, clinical and laboratory features of the children were studied and compared. The tTG was positive in 32 (53.3%) patients compared to 20% of the controls (P = 0.03), being higher in females. In tTG‐positive patients, the BMI was significantly lower, while white blood cell count, erythrocyte sedimentation rate and disease activity were significantly higher.Conclusions:  tTG antibodies may be used as a screening test to identify asymptomatic CD associated with juvenile rheumatic diseases, especially those with active JRA or marked reduction in BMI.
The dentine remineralization activity of a desensitizing bioactive glass‐containing toothpaste: an in vitro study
Authors: Wang Z , Jiang T , Sauro S , Pashley DH , Toledano M , Osorio R , Liang S , Xing W , Sa Y , Wang Y 
Published: October 2011

AbstractBackground:  Dentine hypersensitivity occurs easily on exposed dentine. This study aimed to evaluate the effectiveness of a novel bioactive glass‐containing toothpaste on dentine permeability and remineralization.Methods:  Thirty dentine discs were divided into three groups of 10 specimens each. The groups corresponded to the following brushing treatments: no brush, distilled water, and bioactive glass‐containing toothpaste (Novamin). The toothpaste was applied twice a day for 7 days. Dentine permeability was measured after ethylene‐diamine‐tetraacetic acid (EDTA) etching, initial application, 3‐day application, 7‐day application and citric acid challenge, respectively. The dentine morphology was investigated using scanning electron microscopy (SEM). Attenuated total reflection Fourier transform infrared (ATR/FTIR) spectroscopy was performed to monitor the mineral variation on demineralized dentine. Qualitative information of elemental variation before and after treatments on completely demineralized dentine was detected by energy dispersive X‐ray (EDX) analysis.Results:  The bioactive glass‐containing toothpaste significantly reduced dentine permeability after the 7‐day treatment and showed, under SEM, excellent resistance to acid challenge compared to the other groups. ATR/FTIR and EDX revealed increased mineral content after treatment with Novamin.Conclusions:  As the innovative bioactive glass‐containing toothpaste occlude dentinal tubules and resist acid challenge, it may be useful for the treatment of dentine hypersensitivity and dentine remineralization.
Efficacy and tolerability of vildagliptin in type 2 diabetic patients on hemodialysis
Authors: Kume Shinji , Uzu Takashi , Takagi Chieko , Kondo Morihiro , Okabe Tomoko , Araki Shin‐ichi , Isshiki Keiji , Takeda Naoko , Kondo Keiko , Haneda Masakazu , Koya Daisuke , Nishio Yoshihiko , Kashiwagi Atsunori , Maegawa Hiroshi 
Published: October 2011

AbstractAnti‐diabetic agent‐related hypoglycemia is a serious complication in type 2 diabetic patients on hemodialysis. Therefore, we assessed the efficacy and tolerability of 24 weeks of monotherapy with vildagliptin, a dipeptidyl peptidase four inhibitor, which is a new class of antidiabetic agent. This open‐label, single‐arm clinical trial was performed on 26 patients on hemodialysis. The primary assessments were changes in postprandial glucose level and glycated albumin (GA). During the study, three patients dropped out, and data from 23 patients were analyzed. Significant reductions were seen in postprandial glucose (−2.60 ± 3.80 mmol/L, P < 0.001) and GA (−2.59 ± 2.33%, P < 0.001) levels. No serious drug‐related adverse events were observed. Vildagliptin monotherapy can be recommended for glycemic control in type 2 diabetic patients on hemodialysis. This trial was registered with the University Hospital Medical Information Network (no. UMIN000003661). (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00169.x, 2011)