bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing the national invasive cervical cancer audit: a local perspective
Authors: Moss EL , Pearmain P , Askew S , Owen G , Reynolds TM , Prabakar IM , Douce G , Parkes J , Menon V , Todd RW , Redman CWE 
Published: August 2010

Please cite this paper as: Moss E, Pearmain P, Askew S, Owen G, Reynolds T, Prabakar I, Douce G, Parkes J, Menon V, Todd R, Redman C. Implementing the national invasive cervical cancer audit: a local perspective. BJOG 2010;117:1411–1416.Objective  To monitor the effectiveness of the cervical screening programme and identify suboptimal management in order to improve patient care.Design  Retrospective study.Setting  A university hospital serving a population of 1 million people.Population  All women diagnosed with a cervical cancer between 2003 and 2006.Methods  Analysis of data from invasive cervical cancer reviews.Main outcome measure  Categorisation of cervical cancer cases according to the Invasive Cervical Cancer Audit classification.Results  Eighty‐seven women were diagnosed with cervical cancer during the 3‐year study period. The ‘lapsed attender’ group accounted for the greatest number of cases (30%), followed by screen detected (26%), interval cancers (13%), never attended (12%), lost to follow‐up (10%) and never invited (9%). Women who had never attended for cytology presented with higher stage disease, stage‐II or above, compared with the screen‐detected cases: 60% were stage II or above, compared with 13.0%, Chi‐square P = 0.018. The most frequently identified screening programme problem was patient compliance, which was determined to be the principle contributing factor in 39 cases (45%) and a secondary factor in a further ten cases.Conclusions  The categorisation of cervical cancer cases has the potential of yielding invaluable information for improving programme effectiveness. Patient compliance is the greatest challenge to the screening programme, and the need for regular screening and adherence to follow‐up regimens needs to be reinforced in order to maximise the efficacy of the national screening programme.
BIODIVERSITY RESEARCH: Turning up the heat: the impacts of Andropogon gayanus (gamba grass) invasion on fire behaviour in northern Australian savannas
Authors: Setterfield Samantha A. , Rossiter‐Rachor Natalie A. , Hutley Lindsay B. , Douglas Michael M. , Williams Richard J. 
Published: August 2010

AbstractAim  This study aimed to quantify changes in fire severity resulting from the invasion of Australia’s tropical savannas by the African grass Andropogon gayanus Kunth. (gamba grass).Location  Mesic savannas of the Northern Territory, Australia.Method  Byram’s fire‐line intensity (If), fuel load and architecture, and two post‐fire indicators of fire intensity – scorch height (SH) and char height (CH) of woody vegetation – were determined for fires in native grass savanna and A. gayanus invaded savanna. Leaf scorch is the height at which the fire’s radiant heat browns leaf tissue, and leaf char is the height that radiant heat blackens or consumes leaf tissue and provides an indirect measure of flame height. These data, and 5 years of similar data collected from the Kapalga Fire Project in Kakadu National Park, were used to develop empirical relationships between If and the post‐fire indices of fire intensity.Results  A relationship between A. gayanus If and SH could not be developed because complete canopy scorch occurred in most A. gayanus fires, even at low If. In contrast, A. gayanus If was strongly correlated with CH. This empirical relationship was substantially different from that for native grass fires. For a given If, there was a significantly greater CH in invaded sites. This increase in radiant heat is attributable to the increased biomass (mean 3.6 t ha−1 in native grasses compared to 11.6 t ha−1 in A. gayanus) and height (approximately 0.5 m in native grasses compared to 4 m in A. gayanus) of the standing fine fuel.Main conclusion  Andropogon gayanus invasion resulted in substantial changes in fire behaviour. This has important regional implications owing to the current (10,000–15,000 km2) and predicted (380,000 km2) area of invasion and the negative consequences for the native savanna biota that has evolved with frequent but relatively low‐intensity fire.
BIODIVERSITY RESEARCH: Conserving macroinvertebrate diversity in headwater streams: the importance of knowing the relative contributions of α and β diversity
Authors: Clarke Amber , Mac Nally Ralph , Bond Nick R. , Lake P. S. 
Published: August 2010

AbstractAim  We investigated partitioning of aquatic macroinvertebrate diversity in eight headwater streams to determine the relative contributions of α and β diversity to γ diversity, and the scale dependence of α and β components.Location  Great Dividing Range, Victoria, Australia.Methods  We used the method of Jost (Ecology, 2007, 88, 2427–2439) to partition γ diversity into its α and β components. We undertook the analyses at both reach and catchment scales to explore whether inferences depended on scale of observation.Results  We hypothesized that β diversity would make a large contribution to the γ diversity of macroinvertebrates in our dendritic riverine landscape, particularly at the larger spatial scale (among catchments) because of limited dispersal among sites and especially among catchments. However, reaches each had relatively high taxon richness and high α diversity, while β diversity made only a small contribution to γ diversity at both the reach and catchment scales.Main conclusions  Dendritic riverine landscapes have been thought to generate high β diversity as a consequence of limited dispersal and high heterogeneity among individual streams, but this may not hold for all headwater stream systems. Here, α diversity was high and β diversity low, with individual headwater stream reaches each containing a large portion of γ diversity. Thus, each stream could be considered to have low irreplaceability since losing the option to use one of these sites in a representative reserve network does not greatly diminish the options available for completing the reserve network. Where limited information on individual taxonomic distributions is available, or time and money for modelling approaches are limited, diversity partitioning may provide a useful ‘first‐cut’ for obtaining information about the irreplaceability of individual streams or subcatchments when establishing representative freshwater reserves.
Receipt of Care and Reduction of Lower Extremity Amputations in a Nationally Representative Sample of U.S. Elderly
Authors: Sloan Frank A. , Feinglos Mark N. , Grossman Daniel S. 
Published: August 2010

Objective. To determine effectiveness of receipt of care from podiatrist and lower extremity clinician specialists (LEC specialists) on diabetes mellitus (DM)‐related lower extremity amputation.Data Sources. Medicare 5 percent sample claims, 1991–2007.Study Design. Individuals with DM‐related lower extremity complications (LECs) were followed 6 years. Visits with podiatrists, LEC specialists, and other health professionals were tracked to ascertain whether receipt of such care reduced the hazards of an LEC amputation.Data Collection. Individuals were stratified based on disease severity, Stage 1—neuropathy, paresthesia, pain in feet, diabetic amyotrophy; Stage 2—cellutis, charcot foot; Stage 3—ulcer; Stage 4—osteomyelitis, gangrene.Principal Findings. Half the LEC sample died within 6 years. More severe lower extremity disease increased risk of death and amputation. Persons visiting a podiatrist and an LEC specialist within a year before developing all stage complications were between 31 percent (ulceration) and 77 percent (cellulitis and charcot foot) as likely to undergo amputation compared with individuals visiting other health professionals.Conclusions. Individuals with an LEC had high mortality. Visiting both a podiatrist and an LEC specialist in the year before LEC diagnosis was protective of undergoing lower extremity amputation, suggesting a benefit from multidisciplinary care.
A new Ser472Asn (Cab2a+) polymorphism localized within the αIIb “thigh” domain is involved in neonatal thrombocytopenia
Authors: Jallu Vincent , Dusseaux Mathilde , Kaplan Cecile 
Published: August 2010

BACKGROUND: A new platelet antigen, Cab2a+, was identified in a case of severe neonatal alloimmune thrombocytopenia (<8 × 109/L) in twins.STUDY DESIGN AND METHODS: Coding sequences of αIIb and β3 genes from parents were amplified and sequenced. CHO cell lines expressing wild‐type or mutated forms of the complex were established to study the role of the mutation in alloimmunization and in αIIbβ3 functions.RESULTS: The father and twins were heterozygous for a single αIIb c.1508G>A mutation leading to a Ser472Asn substitution. Immunologic assays with transfected CHO cells revealed the Asn472 form of αIIbβ3 responsible for the Cab2a+ epitope but not an Ala472 form. Using these cells lines we demonstrated that both Ser472Asn and Ser472Ala substitutions produced limited structural alteration as revealed by the reactivity of a panel of anti‐αIIbβ3 monoclonal antibodies (MoAbs). Activated Asn472 and Ala472 forms of αIIbβ3 supported 1) binding of soluble fibrinogen and of the ligand mimetic MoAb PAC‐1, 2) ligand‐induced binding site epitopes exposure (MoAbs AP‐5 and D3GP3), and 3) cell aggregation. Adhesion onto adsorbed fibrinogen was conserved and was specifically inhibited by MoAb AP‐2 or peptide RGDS. Finally outside‐in signaling was not affected.CONCLUSION: We have characterized a new low‐frequency alloantigen (<1%) resulting from the Ser472Asn substitution in αIIb and shown this polymorphism to have a limited effect, if any, on the αIIbβ3 complex functions.
Comparison of Sinus X‐rays with Computed Tomography Scans in Acute Sinusitis
Authors: Burke Thomas F. , Guertler Andrew T. , Timmons James H. 
Published: August 2010

ABSTRACT Objective:To determine the sensitivity and specificity of sinus x‐rays of patients clinically diagnosed as having acute sinusitis. Methods:Thirty consecutive adult, nonpregnant emergency department (ED) patients clinically diagnosed as having acute sinusitis and meeting study criteria were entered into the study. Sinus x‐rays were obtained immediately after study entry and sinus computed tomography (CT) scans were done within 72 hours. Radiologic criteria for sinusitis were defined as more than 3 mm of mucoperiosteal thickening (MPT), an air/fluid (A/F) level, or opacification. All films were read in a blinded fashion [CT scans by two radiologists and plain films by two emergency medicine (EM) staff members and the same radiologists]. A third radiologist interpreted CT scans when the initial radiologists disagreed. Results:Sinus CT scans were obtained for 29 of 30 patients. Radiologists interpreted 28 of 29 CT scans identically, with 21 being positive for sinusitis. Sensitivity and specificity of x‐rays were 57% and 88%, 62% and 88%, 67% and 75%, and 48% and 100% for the two radiologists and the two EM physicians, respectively. Four ethmoid, five frontal, and five sphenoid sinuses were opacified or had A/F levels on CT scan. No ethmoid, frontal, or sphenoid sinus was interpreted as being opacified or having an A/F level on plain film. Sensitivity and specificity of maxillary sinus opacification or A/F level on x‐ray were 70% and 100%, 70% and 100%, 70% and 96%, and 70% and 96% for the two radiologists and the two EM physicians, respectively. Mean concordances (kappa) of x‐ray and CT scan interpretations for the four reviewers were 0.34 (range, 0.30–0.39) for the diagnosis of sinusitis and 0.77 (range, 0.74–0.79) for maxillary sinus opacification or A/F level. Conclusion:Sinus x‐rays are less sensitive than sinus CT scans for demonstration of radiographic changes consistent with acute sinusitis. Sinus plain films may not be reliable enough to assist with clinical decision making. If severity of patient illness requires diagnostic certainty, more sensitive imaging studies, such as CT scans of the sinuses, should be considered.
The Effects of Lidocaine Pretreatment on Cocaine Neurotoxicity and Lethality in Mice
Authors: Heit Jeffrey , Hoffman Robert S. , Goldfrank Lewis R. 
Published: August 2010

ABSTRACTObjective:To evaluate the effects of an antiarrhythmic dose of lidocaine on cocaine‐induced ataxia, seizures, and death in mice.Methods:A randomized, controlled, blinded investigation was conducted using 220 female Swiss albino mice. Groups of 20 animals received intraperitoneal (IP) administration of either 31.6 mg/kg of lidocaine hydrochloride in 0.9% NaCl (ten animals) or an equal volume of 0.9% NaCl solution (ten animals). After 5 minutes, all the animals received IP cocaine in incremental doses ranging from 40 to 110 mg/kg. The animals were observed for ataxia, seizures, and death. The animals pretreated with lidocaine were compared with the control animals for the number of adverse effects from cocaine at each dose tested.Results:Lidocaine significantly increased the overall incidences of cocaine‐induced ataxia (p = 0.02) and seizures (p < 0.001). However, pretreatment with lidocaine offered protection against cocaine lethality (p < 0.0001).Conclusion:In this preexposure model, lidocaine protects mice against cocaine‐induced lethality. These effects seem to be independent of convulsive activity. Further study is required to determine the safety and efficacy of lidocaine for the management of cocaine‐induced arrhythmias.
The Evolution of Abdominal Compression in Cardiopulmonary Resuscitation
Authors: Babbs Charles F. 
Published: August 2010

ABSTRACT Objective: To review the history of external abdominal compression as an adjunct to cardiopulmonary resuscitation (CPR), tracking the development of five major themes over the course of the 20th century: 1) augmentation of peripheral resistance by physical means, 2) risk of hepatic injury with abdominal compression, 3) counterpulsation vs sustained compression, 4) the abdominal pump mechanism, and 5) contact compression techniques. Methods: Literature retrieved from successive MEDLINE English‐language searches was reviewed with a special emphasis on work and concepts highlighted by participants at the First Purdue Conference on Interposed Abdominal Compression‐CPR, September 1992. Results: External abdominal compression of one form or another has been studied as a means of resuscitation by many investigators throughout the 20th century. Experimental and clinical studies have shown generally consistent evidence of hemodynamic augmentation by abdominal compression during various forms of CPR. Recent advances include a modified theoretical understanding of hemodynamic mechanisms and demonstration of clinical potential in humans. Inconsistencies in published results may be due to differences in mechanical techniques of abdominal compression. Based on these studies, a modified manual technique for “contact compression” of the abdominal aorta is recommended. Conclusions: A technique for left‐of‐center, angled compression of the abdominal aorta against the crest of the spine is recommended. Further well‐supervised and controlled clinical trials using this standardized technique are warranted as a prelude to more widespread clinical application of abdominal compression in CPR.
Possible Reasons for the Variability of Human Responses to IAC‐CPR
Authors: Ward Kevin R. 
Published: August 2010

ABSTRACT Objective: To propose reasons for the variability of the hemodynamic responses and survival data observed when interposed abdominal compression cardiopulmonary resuscitation (IAC‐CPR) is performed on humans in cardiac arrest. Methods: Critical content review of all studies performed in the United States examining IAC‐CPR in humans and of selected animal studies addressing hemodynamic mechanisms of CPR. Articles in the English language dealing with human IAC‐CPR studies from 1970–1993 were retrieved using the MEDLINE database of the National Library of Medicine. Results: IAC‐CPR does not consistently improve coronary perfusion pressure (CPP) over standard CPR in humans and is capable of decreasing as well as increasing CPP. This variability does not seem dependent on the manner in which abdominal compressions are performed. Because of the limited response to standard CPR, significant increases in return of spontaneous circulation would be expected with IAC‐CPR if a large percentage of patients were to have favorable increases in CPP. However, other patients may be adversely affected by decreases in CPP during IAC‐CPR, with unsuccessful resuscitation of those individuals. Return of spontaneous circulation also may be enhanced using IAC‐CPR due to other factors reflected in the initial arrest rhythm and in arrest‐population demographics. Conclusion: IAC‐CPR should not be recommended for routine use until the mechanism of its beneficial effects is known and until those patients who are likely to benefit from the technique can be better identified.
Hemodynamics of Interposed Abdominal Compression during Human Cardiopulmonary Resuscitation
Authors: Adams Craig P. , Martin Gerard B. , Rivers Emanuel P. , Ward Kevin R. , Smithline Howard A. , Rady Mohamed Y. 
Published: August 2010

ABSTRACT Objective: Clinical studies of interposed abdominal compression CPR (IAC‐CPR) have had diverse outcomes. This study compared the hemodynamics of standard CPR and IAC‐CPR in humans. Methods: A 24‐month prospective nonrandomized analysis of hemo‐dynamic parameters was performed in a convenience cohort of 20 adults who had had out‐of‐hospital, nontraumatic, normothermic cardiac arrests. The study took place in the resuscitation unit of a large urban hospital. Thoracic aortic and right atrial catheters were inserted and pressures were recorded during standard CPR and IAC‐CPR. Coronary perfusion pressures (CPPs) were determined during standard CPR and IAC‐CPR. The patients were separated into two groups based upon their responses to IAC‐CPR. Responders had increases in CPP during IAC‐CPR; nonresponders had decreases or no change in CPP during IAC‐CPR. Aortic relaxation, right atrial relaxation, aortic compression, and right atrial compression phase pressures were compared between the two groups. Results: CPPs increased in 13 patients and decreased in seven patients. The mean change in CPP with IAC‐CPR was an increase of 5.8 ± 15.1 torr. An elevated right atrial compression phase pressure (RaComp) during standard CPR was predictive of an increase in CPP during IAC‐CPR (p = 0.047). In those patients who showed improvements in CPP during IAC‐CPR, mean aortic relaxation phase pressures (AoRelax) increased by 9.5 ± 14.2 torr (p = 0.026) and mean right atrial relaxation phase pressures (RaRelax) decreased by 2.6 ± 6.2 torr (p = 0.099) during IAC‐CPR. Conclusions: The variable effects of IAC‐CPR on CPP appear to be multifactorial. The improvement in CPP that occurred in responders to IAC‐CPR was secondary to an increase in AoRelax as well as a decrease in RaRelax.
A Comparative Study of the Percutaneous versus Intraoral Technique for Mental Nerve Block
Authors: Syverud Scott A. , Jenkins J. Matthew , Schwab Robert A. , Lynch Michael T. , Knoop Kevin , Trott Alexander 
Published: August 2010

ABSTRACT Objective: Mental nerve block is frequently used to aid repair of facial lacerations; both percutaneous and intraoral approaches to blocking this nerve are used, but have never been compared. The authors compared the two techniques for pain of administration and effectiveness of anesthesia. Methods: A prospective, randomized, single‐blind, crossover study was conducted using ten healthy volunteers aged 22 to 33 years. Patients having prior experience with mental nerve blocks, lidocaine allergy, active oral/facial infection, or previous facial fractures were excluded. Bilateral mental nerve blocks were done using intraoral technique on one side and percutaneous technique on the other. Both techniques were used by the same investigator and were carried out with 27‐gauge needles and 2.5 mL of 2% buffered lidocaine at room temperature injected over 20 seconds. The oral mucosa was topically anesthetized with viscous lidocaine for 1 minute prior to intraoral injection. The orders of the blocks and sides of the face anesthetized were randomized. Subjective and objective pain (visual‐analog scale), efficacy (anesthesia of lower lip), time to onset, and duration of anesthesia were evaluated. Results: The intraoral technique was subjectively less painful than the percutaneous approach in nine of ten subjects (p = 0.02). Scores on the visual‐analog pain scale were significantly lower for the intraoral technique (p = 0.03). Intraoral injection produced lower‐lip anesthesia in 10/10 subjects versus 7/10 for percutaneous (p = 0.25). Times to onset (approximately 1–2 minutes) and durations of anesthesia (approximately one hour) were similar for the two techniques. Conclusion: The intraoral approach to the mental nerve block with adjunctive topical anesthesia was subjectively and objectively less painful than the percutaneous approach without adjunctive anesthesia. While the intraoral approach had a greater efficacy of lower‐lip anesthesia and a longer duration of action, these differences were not statistically significant.
Percutaneous Central Venous Access for Resuscitation in Trauma
Authors: Scalea Thomas M. , Sinert Richard , Duncan Albert O. , Rice Phillip , Austin Reinaldo , Kohl Lewis , Trooskin Stanley Z. , Talbert Susan 
Published: August 2010

ABSTRACT Objective: To determine the safety of percutaneous central venous access when used for trauma resuscitation and whether the initial hemodynamic status of the patient or the site of placement affects the ease or success of line placement. Methods: Consecutive major‐trauma patients were managed using a resuscitation protocol guiding intravenous line use. Percutaneous peripheral venous access was initially attempted in all patients. If this approach was unsuccessful or proved to be inadequate for volume resuscitation, venous access was attempted using central venous catheter‐introducer sets. The site of the central venous access was determined by protocol. For thoracic injury, access was via the ipsilateral subclavian vein (SCV), the ipsilateral internal jugular vein (IJV), or the femoral vein. For suspected mediastinal injury, access was via the contralateral SCV or IJV, or the femoral vein. For abdominal or flank injury, access was via the SCV or IJV only. Multiple central venous access sites were used at the discretion of the trauma team. Results: Central venous access was successful at 144 of 147 sites (99%) used in 122 patients during the study period. There was only one major complication (rate = 0.7%; 95% CI 0.0–3.8%). Mean catheter placement time was 1.9 minutes, and cannulation occurred with a mean of 1.8 needle passes. Most patients (81/122) were hypotensive (blood pressure ≤90 torr) at the time of line placement, including 44 who were in cardiac arrest and four awake patients who had no obtainable blood pressure. Neither the access site nor the presence of hypotension was associated with the mean time to obtain central venous access, the mean number of attempts, or the complication rate. Conclusion: Percutaneous central venous access is relatively safe and reliable for gaining intravenous access when resuscitating trauma patients, when used in a center where physicians are experienced in the technique. Consideration should be given to expanding the use of central venous access in trauma resuscitation.