bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Herniation and Intracranial Shift on Cranial Tomography in Patients With Subarachnoid Hemorrhage and a Normal Neurologic Examination
Authors: Baraff Larry J. , Byyny Richard L. , Probst Marc A. , Salamon Noriko , Linetsky Michael , Mower William R. 
Published: April 2010

AbstractObjectives:  Patients frequently present to the emergency department (ED) with headache. Those with sudden severe headache are often evaluated for spontaneous subarachnoid hemorrhage (SAH) with noncontrast cranial computed tomography (CT) followed by lumbar puncture (LP). The authors postulated that in patients without neurologic symptoms or signs, physicians could forgo noncontrast cranial CT and proceed directly to LP. The authors sought to define the safety of this option by having senior neuroradiologists rereview all cranial CTs in a group of such patients for evidence of brain herniation or midline shift.Methods:  This was a retrospective study that included all patients with a normal neurologic examination and nontraumatic SAH diagnosed by CT presenting to a tertiary care medical center from August 1, 2001, to December 31, 2004. Two neuroradiologists, blinded to clinical information and outcomes, rereviewed the initial ED head CT for evidence of herniation or midline shift.Results:  Of the 172 patients who presented to the ED with spontaneous SAH diagnoses by cranial CT, 78 had normal neurologic examinations. Of these, 73 had initial ED CTs available for review. Four of the 73 (5%; 95% confidence interval [CI] = 2% to 13%) had evidence of brain herniation or midline shift, including three (4%; 95% CI = 1% to 12%) with herniation. In only one of these patients was herniation or shift noted on the initial radiology report.Conclusions:  Awake and alert patients with a normal neurologic examination and SAH may have brain herniation and/or midline shift. Therefore, cranial CT should be obtained before LP in all patients with suspected SAH.ACADEMIC EMERGENCY MEDICINE 2010; 17:423–428 © 2010 by the Society for Academic Emergency Medicine
The Use of Impedance Cardiography in Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock
Authors: Napoli Anthony M. , Machan Jason T. , Corl Keith , Forcada Ahteri 
Published: April 2010

AbstractObjectives:  Pulmonary artery catheterization poses significant risks and requires specialized training. Technological advances allow for more readily available, noninvasive clinical measurements of hemodynamics. Few studies exist that assess the efficacy of noninvasive hemodynamic monitoring in sepsis patients. The authors hypothesized that cardiac index, as measured noninvasively by impedance cardiography (ICG) in emergency department (ED) patients undergoing early goal‐directed therapy (EGDT) for sepsis, would be associated with in‐hospital mortality.Methods:  This was a prospective observational cohort study of patients age over 18 years meeting criteria for EGDT (lactate > 4 or systolic blood pressure < 90 after 2 L of normal saline). Initial measurements of cardiac index were obtained by ICG. Patients were followed throughout their hospital course until discharge or in‐hospital death. Cardiac index measures in survivors and nonsurvivors are presented as means and 95% confidence intervals (CI). Diagnostic performance of ICG in predicting mortality was tested by receiver operating characteristic (ROC) curve and areas under the ROC curves (AUC) were compared using Wilcoxon test.Results:  Fifty‐six patients were enrolled; one was excluded due to an inability to complete data acquisition. The mean cardiac index in nonsurvivors (2.3 L/min·m2, 95% CI = 1.6 to 3.0) was less than that for survivors (3.2, 95% CI = 2.9 to 3.5) with mean difference of 0.9 (95% CI = 0.12 to 1.71). The AUC for ICG in predicting mortality was 0.71 (95% CI = 0.58 to 0.88; p = 0.004). A cardiac index of < 2 L/min·m2 had a sensitivity of 43% (95% CI = 18% to 71%), specificity of 93% (95% CI = 80% to 95%), positive likelihood ratio of 5.9, and negative likelihood ratio of 0.6 for predicting in‐hospital mortality.Conclusions:  Early, noninvasive measurement of the cardiac index in critically ill severe sepsis and septic shock patients can be performed in the ED for those who meet criteria for EGDT. There appears to be an association between an initial lower cardiac index as measured noninvasively and in‐hospital mortality.ACADEMIC EMERGENCY MEDICINE 2010; 17:452–455 © 2010 by the Society for Academic Emergency Medicine
The Usefulness of Design of Experimentation in Defining the Effect Difficult Airway Factors and Training Have on Simulator Oral–Tracheal Intubation Success Rates in Novice Intubators
Authors: Thomas Frank , Carpenter Judi , Rhoades Carol , Holleran Renee , Snow Gregory 
Published: April 2010

AbstractObjectives:  This exploratory study examined novice intubators and the effect difficult airway factors have on pre‐ and posttraining oral–tracheal simulation intubation success rates.Methods:  Using a two‐level, full‐factorial design of experimentation (DOE) involving a combination of six airway factors (curved vs. straight laryngoscope blade, trismus, tongue edema, laryngeal spasm, pharyngeal obstruction, or cervical immobilization), 64 airway scenarios were prospectively randomized to 12 critical care nurses to evaluate pre‐ and posttraining first‐pass intubation success rates on a simulator. Scenario variables and intubation outcomes were analyzed using a generalized linear mixed‐effects model to determine two‐way main and interactive effects.Results:  Interactive effects between the six study factors were nonsignificant (p = 0.69). For both pre‐ and posttraining, main effects showed the straight blade (p = 0.006), tongue edema (p = 0.0001), and laryngeal spasm (p = 0.004) significantly reduced success rates, while trismus (p = 0.358), pharyngeal obstruction (p = 0.078), and cervical immobilization did not significantly change the success rate. First‐pass intubation success rate on the simulator significantly improved (p = 0.005) from pre‐ (19%) to posttraining (36%).Conclusions:  Design of experimentation is useful in analyzing the effect difficult airway factors and training have on simulator intubation success rates. Future quality improvement DOE simulator research studies should be performed to help clarify the relationship between simulator factors and patient intubation rates.ACADEMIC EMERGENCY MEDICINE 2010; 17:460–463 © 2010 by the Society for Academic Emergency Medicine
Out‐of‐hospital Cardiac Arrest in Denver, Colorado: Epidemiology and Outcomes
Authors: Haukoos Jason S. , Witt Gary , Gravitz Craig , Dean Julianne , Jackson David M. , Candlin Thomas , Vellman Peter , Riccio John , Heard Kennon , Kazutomi Tom , Luyten Dylan , Pineda Gilbert , Gunter Jeff , Biltoft Jennifer , Colwell Christopher ,   for the Colorado Cardiac Arrest & Resuscitation Collaborative Study Group* and the Denver Metro EMS Medical Directors†
Published: April 2010

AbstractObjectives:  The annual incidence of out‐of‐hospital cardiac arrest (OOHCA) in the United States is approximately 6 per 10,000 population and survival remains low. Relatively little is known about the performance characteristics of a two‐tiered emergency medical services (EMS) system split between fire‐based basic life support (BLS) dispersed from fixed locations and hospital‐based advanced life support (ALS) dispersed from nonfixed locations. The objectives of this study were to describe the incidence of OOHCA in Denver, Colorado, and to define the prevalence of survival with good neurologic function in the context of this particular EMS system.Methods:  This was a retrospective cohort study using standardized abstraction methodology. A two‐tiered hospital‐based EMS system for the County of Denver and 10 receiving hospitals were studied. Consecutive adult patients who experienced nontraumatic OOHCA from January 1, 2003, through December 31, 2004, were enrolled. Demographic, prehospital arrest characteristics, treatment data, and survival data using the Utstein template were collected. Good neurologic survival was defined by a Cerebral Performance Categories (CPC) score of 1 or 2.Results:  During the study period, 1,985 arrests occurred. Of these, 715 (36%) had attempted resuscitation by paramedics and constitute our study sample. The median age was 65 years (interquartile range = 52–78 years), 69% were male, 41% had witnessed arrest, 25% had bystander cardiopulmonary resuscitation (CPR) performed, and 30% had ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as their initial rhythm. Of the 715 patients, 545 (76%) were transported to a hospital, 223 (31%) had return of spontaneous circulation (ROSC), 175 (25%) survived to hospital admission, 58 (8%) survived to hospital discharge, and 42 (6%, 95% confidence interval [CI] = 4% to 8%) had a good neurologic outcome.Conclusions:  Out‐of‐hospital cardiac arrest survival in Denver, Colorado, is similar to that of other United States communities. This finding provides the basis for future epidemiologic and health services research in the out‐of‐hospital and ED settings in our community.ACADEMIC EMERGENCY MEDICINE 2010; 17:391–398 © 2010 by the Society for Academic Emergency Medicine
Effect of an Electronic Control Device Exposure on a Methamphetamine‐intoxicated Animal Model
Authors: Dawes Donald M. , Ho Jeffrey D. , Cole Jon B. , Reardon Robert F. , Lundin Erik J. , Terwey Karen S. , Falvey Dan G. , Miner James R. 
Published: April 2010

AbstractObjectives: Because of the prevalence of methamphetamine abuse worldwide, it is not uncommon for subjects in law enforcement encounters to be methamphetamine‐intoxicated. Methamphetamine has been present in arrest‐related death cases in which an electronic control device (ECD) was used. The primary purpose of this study was to determine the cardiac effects of an ECD in a methamphetamine intoxication model.Methods: Sixteen anesthetized Dorset sheep (26–78 kg) received 0.0 mg/kg (control animals,n = 4), 0.5 mg/kg (n = 4), 1.0 mg/kg (n = 4), or 1.5 mg/kg (n = 4) of methamphetamine hydrochloride as a slow intravenous (IV) bolus during continuous cardiac monitoring. The animals received the following exposures in sequence from a TASER X26 ECD beginning at 30 minutes after the administration of the drug: 1) 5‐second continuous exposure, 2) 15‐second intermittent exposure, 3) 30‐second intermittent exposure, and 4) 40‐second intermittent exposure. Darts were inserted at the sternal notch and the cardiac apex, to a depth of 9 mm. Cardiac motion was determined by thoracotomy (smaller animals, ≤ 32 kg) or echocardiography (larger animals, > 68 kg). Data were analyzed using descriptive statistics and chi‐square tests.Results: Animals given methamphetamine demonstrated signs of methamphetamine toxicity with tachycardia, hypertension, and atrial and ventricular ectopy in the 30‐minute period immediately after administration of the drug. Smaller animals (n = 8, ≤ 32 kg, mean = 29.4 kg) had supraventricular dysrhythmias immediately after the ECD exposures. Larger animals (n = 8, > 68 kg, mean = 72.4) had only sinus tachycardia after the exposures. One of the smaller animals had frequent episodes of ventricular ectopy after two exposures, including runs of delayed onset, nonsustained six‐ to eight‐beat unifocal and multifocal ventricular tachycardia that spontaneously resolved. This animal had significant ectopy prior to the exposures as well. Thoracotomy performed on three smaller animals demonstrated cardiac capture during ECD exposure consistent with previous animal studies. In the larger animals, none of the methamphetamine‐intoxicated animals demonstrated cardiac capture. Two control sheep showed evidence of capture similar to the smaller animals. No ventricular fibrillation occurred after the exposure in any animal.Conclusions: In smaller animals (32 kg or less), ECD exposure exacerbated atrial and ventricular irritability induced by methamphetamine intoxication, but this effect was not seen in larger, adult‐sized animals. There were no episodes of ventricular fibrillation after exposure associated with ECD exposure in methamphetamine‐intoxicated sheep.ACADEMIC EMERGENCY MEDICINE 2010; 17:436–443 © 2010 by the Society for Academic Emergency Medicine
Complement Activation in Emergency Department Patients With Severe Sepsis
Authors: Younger John G. , Bracho David O. , Chung‐Esaki Hangyul M. , Lee Moonseok , Rana Gurpreet K. , Sen Ananda , Jones Alan E. 
Published: April 2010

AbstractObjectives:  This study assessed the extent and mechanism of complement activation in community‐acquired sepsis at presentation to the emergency department (ED) and following 24 hours of quantitative resuscitation.Methods:  A prospective pilot study of patients with severe sepsis and healthy controls was conducted among individuals presenting to a tertiary care ED. Resuscitation, including antibiotics and therapies to normalize central venous and mean arterial pressure (MAP) and central venous oxygenation, was performed on all patients. Serum levels of Factor Bb (alternative pathway), C4d (classical and mannose‐binding lectin [MBL] pathway), C3, C3a, and C5a were determined at presentation and 24 hours later among patients.Results:  Twenty patients and 10 healthy volunteer controls were enrolled. Compared to volunteers, all proteins measured were abnormally higher among septic patients (C4d 3.5‐fold; Factor Bb 6.1‐fold; C3 0.8‐fold; C3a 11.6‐fold; C5a 1.8‐fold). Elevations in C5a were most strongly correlated with alternative pathway activation. Surprisingly, a slight but significant inverse relationship between illness severity (by sequential organ failure assessment [SOFA] score) and C5a levels at presentation was noted. Twenty‐four hours of structured resuscitation did not, on average, affect any of the mediators studied.Conclusions:  Patients with community‐acquired sepsis have extensive complement activation, particularly of the alternative pathway, at the time of presentation that was not significantly reversed by 24 hours of aggressive resuscitation.ACADEMIC EMERGENCY MEDICINE 2010; 17:353–359 © 2010 by the Society for Academic Emergency Medicine
Irradiance Uniformity and Distribution from Dental Light Curing Units
Authors: PRICE RICHARD B. T. , RUEGGEBERG FREDERICK A. , LABRIE DANIEL , FELIX CHRISTOPHER M. 
Published: April 2010

ABSTRACTProblem:  The irradiance from dental light‐curing units (LCUs) is commonly reported as a single number, but this number does not properly describe the light output.Purpose:  This study examined the irradiance uniformity and distribution from a variety of LCUs as well as the effect of different light guides.Materials and Methods:  Five LCUs representing quartz‐tungsten‐halogen, plasma arc, and light emitting diode units were evaluated. One LCU was evaluated using two different light guides (Standard or Turbo style). The total power emitted from each LCU was measured and the irradiance calculated using conventional methods (ICM). In addition, a beam profiler was used to determine the optically active emitting area, the mean irradiance (IBP), the irradiance distribution, and the Top Hat Factor (THF). Five replications were performed for each test and compared using analysis of variance with Fisher's PLSD tests at a pre‐set alpha of 0.05.Results:  The spatial distribution of the irradiance from LCUs was neither universally symmetrical nor was it uniformly distributed across the tip end. Significant differences in both the emitted power and THF were found among the LCUs. The THF values ranged from a high of 0.74 ± 0.01 to a low of 0.32 ± 0.01. Changing from a standard to a turbo light guide increased the irradiance, but significantly reduced beam homogeneity, reduced the total emitted power, and reduced the optical tip area by 60%.Conclusions:  Using different light guides on the same LCU significantly affected the power output, irradiance values, and beam homogeneity. For all LCUs, irradiance values calculated using conventional methods (ICM) did not represent the irradiance distribution across the tip end of the LCU.CLINICAL SIGNIFICANCEIrradiance values calculated using conventional methods assume power uniformity within the beam and do not validly characterize the distribution of the irradiance delivered from dental light curing units.(J Esthet Restor Dent 22:86–103, 2010)
Effect of Finishing Instrumentation on the Marginal Integrity of Resin‐based Composite Restorations
Authors: MARESCA CRISTINA , PIMENTA LUIZ A. F. , HEYMANN HARALD O. , ZIEMIECKI THOMAS L. , RITTER ANDRÉ V. 
Published: April 2010

ABSTRACTPurpose:  This study evaluated the effect of the use of different finishing instruments on the marginal integrity of resin composite restorations.Materials and Methods:  Bovine incisors (N = 75) embedded in epoxy resin had the facial enamel ground and polished to 1200‐grit. A standardized cavity (3 × 3 mm, 2 mm deep) was prepared on each specimen and restored with a 2‐step total‐etch adhesive (Single Bond, 3M ESPE, St. Paul, MN, USA) and a hybrid resin composite (Filtek Z250, 3M ESPE) in a single increment. The restorations were mechanically polished to 1200‐grit. Specimens were randomized into different groups (N = 5) according to finishing technique: positive control (1200‐grit paper), negative control (regular‐grit diamond), fine cross‐cut laminated burs, straight‐cut laminated burs, spiral‐cut laminated burs, and finishing diamonds. The straight‐cut burs, spiral‐cut burs, and finishing diamonds were tested individually as fine, extra‐fine, and ultra‐fine, as well as sequentially as a series. A high‐speed, water‐cooled handpiece under standardized pressure (0.5 N) and time (40 seconds) was used for all finishing procedures. Specimens were processed for scanning electron microscope, and margin gaps were systematically measured. Data were analyzed with one‐way analysis of variance and Duncan test.Results:  The negative control specimens (course diamond) presented the largest gaps, whereas the positive control specimens (mechanically polished) generated the smallest gaps. No statistically significant difference was noted between the finishing diamonds and the positive control. The negative control exhibited significantly larger gaps when compared with the other finishing instruments. Intermediate results were observed for cross‐cut, straight‐cut, and spiral‐cut laminated burs. Fine, extra‐fine and ultra‐fine finishing diamonds generated smaller gaps compared with laminated burs, but the differences were not always statistically significant.Conclusion:  Fine, extra‐fine and ultra‐fine finishing diamonds used to finish composite restorations generated better marginal integrity when compared with carbides and regular‐grit diamonds.CLINICAL SIGNIFICANCEWhen finishing composite restorations, finishing diamond burs result in better composite margins than carbide laminated burs.(J Esthet Restor Dent 22:104–113, 2010)
Comparison of Various Resin Composite Shades and Layering Technique with a Shade Guide
Authors: DA COSTA JULIANA , FOX PAUL , FERRACANE JACK 
Published: April 2010

ABSTRACTPurpose: The purpose of this study was to compare the final shade of different shades of composites (enamel shades) over a white backing (WB) and black backing (BB), and a layering technique (enamel over dentin composite) with the corresponding Vita Classical Shade tabs (VST).Materials and Methods: Composite disk specimens enamel (N = 5) shades B1, B2, A1, and A2, and dentin (N = 1) shades A1, A2, and A3 were made. The color of the VST B1, B2, A1, and A2, enamel shade disks, and layering composites of the same brand and different brands were assessed using a colorimeter over a WB and BB. The total color difference (ΔE*ab = [(ΔL*)2 + (Δa*ab)2 + (Δb*ab)2]1/2) between the VST and the corresponding resin composite was calculated. The results were analyzed by one‐way analysis of variance/Tukey's test (p < 0.05).Results: Overall, theL*,a*, andb* values of the enamel composite shades were significantly different from the corresponding VST. Only a few layered composites matched theL*,a*, andb* of the keyed VST. Out of the 72 combinations, 20 (28%) resulted in ΔE*abbelow the 3.3 clinically perceptible limit.CLINICAL SIGNIFICANCEComposite shades do not match well to the Vita shade guide tabs, even when the layering technique is used. As demonstrated in this study, only a few composites matched the corresponding Vita shade guide tabs.(J Esthet Restor Dent22:114–126, 2010)
Effect of Finishing/Polishing Systems on the Surface Roughness of Novel Posterior Composites
Authors: MARGHALANI HANADI Y. 
Published: April 2010

ABSTRACTPurpose:  The aim of this in vitro study was to evaluate and compare the surface finish of some direct posterior resin composites with new novel ones, which are based on a resin matrix other than the ordinary dimethacrylate, after fine finishing and polishing with eight different systems.Materials and Methods:  Forty‐eight disk‐shaped specimens of the posterior composites were prepared in a split Teflon mold and irradiated by an Astralis 10 light cure (560 mW/cm2 for 10 seconds) at four quadrants on each sample's side. The specimens were divided into eight groups according to the designed finishing and/or polishing protocols. The surface roughness in the form of surface finish (Ra) was recorded using a contact profilometer. The surface of the specimens was observed under the scanning electron microscope.Results:  Analysis of variance revealed highly significant differences between the materials for the Ra roughness parameter at each finishing and polishing system used (p < 0.05). On the one hand, Filtek P90 (3M ESPE Dental Products, Seefeld, Germany) and Definite (Degussa, Dental Centrum, Hanau, Germany) provided the smoothest surface finish (Ra) when they were finished and polished with a series of Sof‐Lex pop‐on disks (3M ESPE Dental Products) and Astropol (Ivoclar Vivadent, Schaan, Liechtenstein), respectively. On the other hand, Filtek P60 (3M ESPE Dental Products) presented the roughest surface when it was finished with Fini disks (Jeneric/Pentron Clinical Technologies, Wallingford, CT, USA). Scanning electron microscope images indicated a uniform surface topography for Filtek P90 with most finishing/polishing systems. Contrary to CompoSite polishers (Shofu Inc., Kyoto, Japan), Astropol showed the smoothest surface finish with most of the investigated composites.CLINICAL SIGNIFICANCEThe smoothest surface finish was achieved by most of the finishing/polishing systems investigated specifically on cationic (Filtek P90) and organically modified ceramics (Definite) composites compared with dimethacrylate‐based composites, suggesting their successful clinical use.(J Esthet Restor Dent 22:127–138, 2010)