bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of laparoscopic skills courses
Authors: CONDOUS George , ALHAMDAN Dalya , BIGNARDI Tommaso , VAN CALSTER Ben , VAN HUFFEL Sabine , TIMMERMAN Dirk , LAM Alan 
Published: June 2009

Objectives: To evaluate the effectiveness of ‘hands‐on’ laparoscopic skills course.Methods: A prospective observational study conducted between May 2005 and June 2006. All gynaecologists who attended ‘hands‐on’ laparoscopic skills course held over a five‐day period were assessed initially and at the end of the intensive course. Subjective assessment involved each attendee self‐scoring their own knowledge in laparoscopy in different fields; this was done using visual analog scoring (VAS). Objective assessment was done through multiple choice questions (MCQs) and motor skill tasks. The difference between the performances of each of the candidates at pre‐ and post‐course periods was evaluated using the Wilcoxon signed rank test. P‐values < 0.05 represented statistical significance.Setting: Centre for Advanced Reproductive Endosurgery (CARE), Royal North Shore Hospital, University of Sydney, Sydney, Australia.Results:  Twenty‐four consecutive gynaecologists have been enrolled in the study – 14 were specialists and ten were obstetrics and gynaecology trainees. Mean age was 44.4 years (range 35–58 years). Pre‐ and post‐course subjective assessment measuring VAS improved significantly for all variables. Objective measurements of pre‐ and post‐course mean MCQ results also improved significantly from 71% to 84.5%, respectively (P‐value < 0.0001). There was dramatic improvement in the performing of motor skills in the dry laboratory.Conclusions: Laparoscopic skills workshops can improve both knowledge base and motor skills. Such courses result in a short‐term measurable improvement. Future studies should focus on assessing the impact of such ‘hands‐on’ courses to see if these skills are transferred to the operating room.
Cervical parakeratosis/hyperkeratosis as an important cause for false negative results of Pap smear and human papillomavirus test
Authors: XIAO Guang‐Qian , EMANUEL Patrick O. M. 
Published: June 2009

Like any screening method, Pap and HPV tests are subject to false negative results.Aim: We investigated the possible relationship between cervical parakeratosis/hyperkeratosis and a false negative result for both Pap and human papillomavirus (HPV) testing.Methods: A total of 551 cases with diagnostically adequate cervical biopsies and Pap tests performed concurrently were examined.Results: The vast majority of the cases (75.5%) were of concordance in diagnosis. Among the 135 discordant diagnoses were 98 with low‐grade squamous intraepithelial lesion (LSIL) biopsy and negative Pap test and 34 with negative biopsy and LSIL Pap test. With rare exceptions, no significant discordance between concurrent biopsy and Pap test was found in the cases of high‐grade squamous intraepithelial lesion (HSIL). Cervical parakeratosis/hyperkeratosis was noted in 87.8% of the LSIL biopsies with concurrent negative Pap tests. An 83.3% HPV‐negative rate was also observed in this group. By comparison, parakeratosis/hyperkeratosis was less frequent (62.6%) in the SIL biopsies with concordant concurrent SIL Pap tests and usually seen focally when present. The negative HPV rates for these concordant LSIL and HSIL groups were 12.7% and 0.0%, respectively.Conclusion: Cervical parakeratosis/hyperkeratosis is an important cause for the negative results of Pap and HPV tests in LSIL, and practising gynaecologist and pathologist should be aware of this possible diagnostic dilemma.
Genetic susceptibility to viral exposure may increase the risk of cerebral palsy
Authors: DJUKIC Michael , GIBSON Catherine S. , MacLENNAN Alastair H. , GOLDWATER Paul N. , HAAN Eric A. , McMICHAEL Gai , PRIEST Kevin , DEKKER Gustaaf A. , HAGUE William M. , CHAN Annabelle , RUDZKI Zbigniew , VAN ESSEN Phillipa , KHONG T. Yee , MORTON Mark R. , RANIERI Enzo , SCOTT Heather , TAPP Heather , CASEY Graeme 
Published: June 2009

Aim: Cytokine polymorphisms may alter the fetal inflammatory response, increasing susceptibility to cerebral palsy (CP). This study investigates associations between selected inflammatory mediator and cytokine gene polymorphisms (Toll‐like receptor‐4 (TLR‐4) Asp299Gly, interleukin‐6 G‐174C and interleukin‐4 C‐589T) and CP from 443 CP infants and 883 control infants. Results were correlated with viral nucleic acids in the same samples.Results: At all gestational ages (GA), TLR‐4 was associated with a decreased risk of developing CP (homozygous/heterozygous odds ratio (OR) 0.70, 95% confidence interval (CI) 0.50–0.98) and interleukin (IL)‐6 was associated with an increased risk of developing hemiplegia (OR 1.38, 95% CI 1.05–1.83). For infants born 32–36 weeks GA, there was a tenfold increase in the risk of quadriplegic CP with homozygous/heterozygous IL‐6 (OR 10.42, 95% CI 1.34–80.82). Viral exposure in combination with IL‐4 in preterm infants was associated with a fourfold increased risk of quadriplegia (homozygous/heterozygous OR 4.25, 95% CI 1.21–14.95). In very preterm infants, the absence of detectable viral exposure in combination with IL‐4 decreased the risk of developing CP (homozygous/heterozygous OR 0.31, 95% CI 0.13–0.76).Conclusion: Polymorphisms in TLR‐4 may be associated with a decreased risk of CP. Polymorphisms in IL‐6 or IL‐4 may act as susceptibility genes, in the presence of viral exposure, for the development of hemiplegic and quadriplegic CP. These associations require confirmation but they suggest a hypothesis for CP causation due to double jeopardy from neurotropic viral exposure and genetic susceptibility to infection.
The prevalence and significance of high‐risk human papillomavirus DNA test in southern Malaysia and Singapore
Authors: TAY Sun‐Kuie , TAY Yeng‐Kwang 
Published: June 2009

Aim of Study: To investigate the prevalence of high‐risk human papillomavirus (HPV) and its associated cytological abnormalities among women attending cervical screening clinics in southern Malaysia and Singapore.Method: Laboratory results of Hybrid Capture‐II (Digene) HPV DNA and liquid‐based cytology tests of consecutive women who had screening performed between January 2004 and December 2006 were studied retrospectively.Results: Of 2364 women studied, the overall prevalence of high‐risk HPV DNA detection rate was 25.6%. The prevalence peaked at 49.1% for women between 20 and 24 years old and declined to 23% among women between the age of 30 and 49 years. A small second peak of prevalence rate of 30% was observed among women above the age of 50 years old. 76.1% of the high‐risk HPV infection regressed within the study period. An incidence infection rate of 16% was noted among a small group of women who had a second HPV DNA test. A total of 1153 women had both the HPV DNA and the cytology tests. Cytological abnormality (ASCUS or more) was detected in 8.9% in HPV DNA‐positive group and in 3.1% in HPV DNA‐negative group (P < 0.001). The risk ratio for HSIL was 9.8 for HPV‐positive women compared to HPV‐negative women. The prevalence of cytological abnormalities increased with increasing age of the women.Conclusion: The epidemiology and clinical impact of high‐risk HPV infection for women in Southern Malaysia and Singapore were indistinguishable from experience elsewhere. The apparent moderately high incidence of cervical cancer was explainable by suboptimal screening program.
Exhumation of the Dayman dome metamorphic core complex, eastern Papua New Guinea
Authors: DACZKO N. R. , CAFFI P. , HALPIN J. A. , MANN P. 
Published: June 2009

AbstractThe ∼750 km2Dayman dome of the Late Cretaceous Suckling‐Dayman massif, eastern Papua New Guinea, is a domed landform that rises to an elevation of 2850 m. The northern edge of the dome is a fault scarp >1000 m high that is now part of an active microplate boundary separating continental crust of the New Guinea highlands from continental and oceanic crust of the Woodlark microplate. Previous work has shown that a parallel belt of eclogite‐bearing core complexes north‐east of the Dayman dome were exhumed from up to 24–28 kbar in the last few millions of years. The remarkably fresh and lightly eroded scarp of the Dayman dome exposes shallowly‐dipping mylonitic (S1) metabasite rocks (500 m thick) on the northern flank of Mount Dayman. Field relationships near the base of this scarp show a cross cutting suite of ductile and brittle meso‐structures that includes: (i) rare ductile S2 folia with a shallowly ESE‐plunging mineral elongation lineation defined by sodic‐calcic blue amphibole; (ii) narrow steeply‐dipping ductile D2 shear zones; and (iii) semi‐brittle to brittle fault zones. Pumpellyite‐actinolite facies assemblages reported by previous workers to contain local aragonite, lawsonite and/or glaucophane are found in the core of the complex at elevations greater than 2000 m. These assemblages indicate peak metamorphic pressures of 6–9.5 kbar, demonstrating exhumation of the core of the Dayman dome from depths of 20–30 km. The S1 metamorphic mineral assemblage in metabasite includes actinolite‐chlorite‐epidote‐albite‐quartz‐calcite‐titanite, indicative of greenschist facies conditions for the main deformation. New mineral equilibria modelling suggests that this S1 assemblage evolved at 5.9–7.2 kbar at ∼425 °C. Modelling variable Fe3+indicates that the sodic‐calcic blue amphibole (D2) formed under a higher oxidation state compared with the S1 assemblage, probably at <4.5 kbar. A SE‐dipping, Mio‐Pliocene sedimentary sequence (Gwoira Conglomerate) forms a hangingwall block juxtaposed by low‐angle fault contact with the metabasite footwall. Prehnite‐bearing D3 brittle fault zones separate the two blocks and likely accommodated the final exhumation of the S1 greenschist facies assemblage in the footwall. These results indicate that the extensive Mt Dayman fault surface coincides with a domed S1 greenschist facies foliation that was last active at >20 km depth. Exhumation of this foliation must therefore be controlled by brittle faults of the active microplate boundary that are largely not observed in the study area. The structural record of the final exhumation of the Dayman dome to the surface was likely lost as a result of erosion, poor exposure or wide spacing of semi‐brittle to brittle fault zones.
Photoelastic Study of the Support Structures of Distal‐Extension Removable Partial Dentures
Authors: Costa Marcio Magno , Da Silva Marco Antonio Moreira Rodrigues , Oliveira Sonia Aparecida Goulart , Gomes Vanderlei Luiz , Carvalho Polliane Morais , Lucas Barbara Lima 
Published: June 2009

Abstract Purpose: The double system of support, in which the distal‐extension removable partial denture adapts, causes inadequate stress around abutment teeth, increasing the possibility of unequal bone resorption. Several ways to reduce or more adequately distribute the stress between abutment teeth and residual ridges have been reported; however, there are no definitive answers to the problem. The purpose of this study was to analyze, by means of photoelasticity, the most favorable stress distribution using three retainers: T bar, rest, proximal plate, I bar (RPI), and circumferential with mesialized rest. Materials and Methods: Three photoelastic models were made simulating a Kennedy Class II inferior arch. Fifteen dentures with long saddles, five of each design, were adjusted to the photoelastic patterns and submitted first to uniformly distributed load, and then to a load localized on the last artificial tooth. The saddles were then shortened and the tests repeated. The quantitative and qualitative analyses of stress intensity were done manually and by photography, respectively. For intragroup analyses the Wilcoxon test for paired samples was used, while for intergroup analyses Friedman and Wilcoxon tests were used to better identify the differences (p < 0.05). Results: The RPI retainer, followed by the T bar, demonstrated the best distribution of load between teeth and residual ridge. The circumferential retainer caused greater concentration of stress between dental apexes. Stress distribution was influenced by the type of retainer, the length of the saddle, and the manner of load application. Conclusions: The long saddles and the uniformly distributed loads demonstrated better distribution of stress on support structures.
Improving platelet supply chains through collaborations between blood centers and transfusion services
Authors: Fontaine Magali J. , Chung Yenho T. , Rogers William M. , Sussmann Harry D. , Quach Peter , Galel Susan A. , Goodnough Lawrence T. , Erhun Feryal 
Published: June 2009

BACKGROUND: Blood centers and hospital transfusion services are challenged with maintaining an adequate platelet (PLT) inventory to minimize the number of outdated units without risking a major shortage. A novel approach to inventory management was established at our institution through a collaboration between the Stanford University Medical Center (SUMC) Transfusion Service, the Stanford Blood Center (SBC), and the Department of Management Science and Engineering.STUDY DESIGN AND METHODS: An analysis of the supply chain performance between SBC and SUMC Transfusion Service was performed. First, the interaction between processes, such as blood collection, rotation, and inventory management, was studied. Second, changes were implemented based on the recommendations from the analysis team. Finally, a postanalysis was performed reflecting on the improvement of the operations between SUMC and SBC.RESULTS: A comprehensive data analysis of the PLT supply chain allowed the identification of three series of improvements to be implemented: 1) on SBC's PLT collection, 2) on SBC's rotation process, and 3) on the PLT inventory management policy at SUMC. A postimplementation analysis showed a reduction in the overall PLT outdate rate from 19% in the first quarter of 2006, down to 9% in the third quarter of 2008.CONCLUSION: A multidisciplinary effort among SUMC Transfusion Service, SBC, and experts in supply chain management resulted in a process improvement, which reduced the rate of PLT outdate at both SBC and SUMC Transfusion Service down to 9%, with a significant cost reduction of more than half a million dollars per year.
Prevalence and risk factors of hepatitis C virus, hepatitis B virus, and human immunodeficiency virus in multiply transfused recipients in Mexico
Authors: Calderón Gloria M. , González‐Velázquez Felipe , González‐Bonilla Cesar R. , Novelo‐Garza Bárbara , Terrazas Jose J. , Martínez‐Rodríguez Maria L. , Cortés‐Márquez Silvia R. , Blanco‐Flores Juan P. , Rodríguez‐Rodríguez Arturo , Del Campo Maria A. , Cortés‐Gómez Rudy , Mejía‐Bocanegra M. Guadalupe 
Published: June 2009

BACKGROUND: Transfusion‐transmitted viral infection (TTI) is a major problem in patients receiving blood products. Monitoring high‐risk patients is essential for assessing the epidemiology of blood‐borne infections.STUDY DESIGN AND METHODS: A 1‐year, cross‐sectional seroprevalence study in patients with a history of multiple transfusions was conducted. Peripheral blood samples were titered to detect serologic markers of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The presence of these viruses and demographic, behavioral, and medical traits were assessed.RESULTS: A total of 300 male and female multiply transfused patients with a mean age of 30.7 (±17.5) years were studied. The prevalence was 13.7% for HCV, 7% for HBV, and 1.7% for HIV. Patients with hemophilia had the highest prevalence for HCV and HIV infections, and hemodialyzed patients, for HBV infection. The risk factors related to acquired HCV were hemophilia (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.5‐12.6), more than five hospitalizations (OR, 3.8; 95% CI, 1.6‐8.9), and having received a transfusion before mandatory screening in 1993 (OR, 8.4; 95% CI, 2.0‐34.6), and for HIV, having received a transfusion before 1987 (OR, 19.0; 95% CI, 2.0‐177.7). The main risk factors for HBV were having end‐stage renal disease and being treated with hemodialysis (OR, 3.7; 95% CI, 1.4‐9.9) and transplantation (OR, 4.2; 95% CI, 1.4‐12.1).CONCLUSIONS: This study showed that HCV infection was more frequently identified than HBV and HIV infections in multiply transfused Mexican patients. Additionally, several risk factors are associated with TTI such as mandatory screenings before 1987 and 1993, which were the most important for HIV and HCV infections but not for HBV.
Rejuvenation treatment of stored red blood cells reverses storage‐induced adhesion to vascular endothelial cells
Authors: Koshkaryev Alexander , Zelig Orly , Manny Noga , Yedgar Saul , Barshtein Gregory 
Published: June 2009

BACKGROUND: Blood banking procedures are associated with elevated adherence of red blood cells (RBCs) to blood vessel wall endothelial cells (ECs), which can introduce a circulatory risk to recipients. This study was undertaken to examine the possibility of repairing this damage by a poststorage “rejuvenation” procedure before transfusion.STUDY DESIGN AND METHODS: Stored RBCs were treated with rejuvenation solution (Rejuvesol, enCyte Systems, Inc.), and their adhesion to cultured human microvascular ECs was determined as a function of shear stress using a cell flow properties analyzer. The adherence of rejuvenation‐treated stored RBCs (stRBCs) was compared to that of untreated stRBCs and of freshly donated RBCs.RESULTS: Strong elevation of stRBC/EC adhesion was induced by cold storage and it correlated with translocation of phosphatidylserine (PS) to the RBC surface, a known mediator of RBC/EC adhesion. The role of RBC surface PS in stRBC/EC interaction was confirmed by the suppression of adhesion after the blocking of the stRBC surface PS with annexin V. Concomitantly, RBC storage elevated intracellular levels of reactive oxygen species (ROS) and Ca2+, the latter known to facilitate PS externalization. Poststorage rejuvenation treatment of stRBCs reversed all the above changes (ROS, Ca2+, PS), along with complete suppression of the enhanced RBC/EC adhesion, restoring it to that of normal, freshly collected RBCs.CONCLUSION: Poststorage RBC rejuvenation treatment is effective in reversing the storage‐induced RBC/EC interaction. This provides further documentation for the potential clinical benefit of poststorage rejuvenation.
Increasing Length of Stay Among Adult Visits to U.S. Emergency Departments, 2001–2005
Authors: Herring Andrew , Wilper Andrew , Himmelstein David U. , Woolhandler Steffie , Espinola Janice A. , Brown David F.M. , Camargo Jr. Carlos A. 
Published: June 2009

AbstractBackground:  Emergency departments (EDs) are traditionally designed to provide rapid evaluation and stabilization and are neither staffed nor equipped to provide prolonged care. Longer ED length of stay (LOS) may compromise quality of care and contribute to delays in the emergency evaluation of other patients.Objectives:  The objective was to determine whether ED LOS increased between 2001 and 2005 and whether trends varied by patient and hospital factors.Methods:  This was a retrospective analysis of a nationally representative sample of 138,569 adult ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 2001 to 2005. ED LOS was measured from registration to discharge.Results:  Median ED LOS increased 3.5% per year from 132 minutes in 2001 to 154 minutes in 2005 (p‐value for trend < 0.001). There was a larger increase among critically ill patients for whom ED LOS increased 7.0% annually from 185 minutes in 2001 to 254 minutes in 2005 (p‐value for trend < 0.01). ED LOS was persistently longer for black/African American, non‐Hispanic patients (10.6% longer) and Hispanic patients (13.9% longer) than for non‐Hispanic white patients, and these differences did not diminish over time. Among factors potentially associated with increasing ED LOS, a large increase was found (60.1%, p‐value for trend < 0.001) in the use of advanced diagnostic imaging (computed tomography [CT], magnetic resonance imaging [MR], and ultrasound [US]) and in the proportion of ED visits at which five or more diagnostic or screening tests were ordered (17.6% increase, p‐value for trend = 0.001). The proportion of uninsured patients was stable throughout the study period, and EDs with predominately privately insured patients experienced significant increases in ED LOS (4.0% per year from 2001 to 2005, p‐value for trend < 0.01).Conclusions:  Emergency department LOS in the United States is increasing, especially for critically ill patients for whom time‐sensitive interventions are most important. The disparity of longer ED LOS for African Americans and Hispanics is not improving.
Antibacterial Properties of an Iron‐based Hemostatic Agent In Vitro and in a Rat Wound Model
Authors: Bracho David O. , Barsan Lauren , Arekapudi Subramanyeswara R. , Thompson John A. , Hen John , Stern Susan A. , Younger John G. 
Published: June 2009

AbstractObjectives:  Topical hemostatic agents are currently employed on the battlefield for control of major hemorrhage and have potential for use in civilian settings. Some of these compounds may also be antibacterial. Given the behavior of these compounds, the purpose of this study was to assess the potential antibacterial properties of an iron oxyacid–based topical hemostatic agent against three problematic species of wound‐contaminating microorganisms: Pseudomonas aeruginosa, methicillin‐resistant Staphylococcus aureus, and methicillin‐resistant Staphylococcus epidermidis.Methods:  Bacteria were treated in vitro with the test powder for 30 minutes and then assessed for viability. Long‐term (8‐hour) inhibition of bacterial growth was also examined. In vivo, a rat full‐thickness 1‐cm2 skin wound was studied. Wounds were contaminated, treated, and then quantitatively cultured 24 hours later.Results:  The lethal dose for 99% of the organisms (LD99) for the compound against each organism ranged from 0.89 (±0.28) to 4.77 (±0.66) mg/mL (p < 0.05). The compound produced sustained inhibition over 8 hours at both 1 and 5 mg/mL (p < 0.05 for each), for P. aeruginosa, S. epidermidis, and S. aureus. In vivo, activity was noted against only P. aeruginosa, with the largest magnitude reduction being on the order of 3‐log colony‐forming units (CFU; p < 0.01).Conclusions:  The iron‐based agent studied possesses significant in vitro and lesser in vivo antibacterial effects. Further optimization of the delivery, dosing, and evaluation of this agent in a larger animal model with more humanlike skin structures may reveal important wound effects beyond control of bleeding.