bluuebunny/crossref_metadata_2025_split huggingface dataset:
National Study of Patient, Visit, and Hospital Characteristics Associated With Leaving an Emergency Department Without Being Seen: Predicting LWBS
Authors: Pham Julius Cuong , Ho George K. , Hill Peter M. , McCarthy Melissa L. , Pronovost Peter J. 
Published: October 2009

AbstractObjectives:  The objective was to estimate the national left‐without‐being‐seen (LWBS) rate and to identify patient, visit, and institutional characteristics that predict LWBS.Methods:  This was a retrospective cross‐sectional analysis using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1998 to 2006. Bivariate and multivariate analyses were performed to identify predictors of LWBS.Results:  The national LWBS rate was 1.7 (95% confidence interval [CI] = 1.6 to 1.9) patients per 100 emergency department (ED) visits each year. In multivariate analysis, patients at extremes of age (<18 years, odds ratio [OR] = 0.80, 95% CI = 0.66 to 0.96; and ≥65 years, OR = 0.46, 95% CI = 0.32 to 0.64) and nursing home residents (OR = 0.29, 95% CI = 0.08 to 1.00) were associated with lower LWBS rates. Nonwhites (black or African American (OR = 1.41, 95% CI = 1.22 to 1.63) and Hispanic (OR = 1.25, 95% CI = 1.04 to 1.49), Medicaid (OR = 1.47, 95% CI = 1.27 to 1.70), self‐pay (OR = 1.96, 95% CI = 1.65 to 2.32), or other insurance (OR = 2.09, 95% CI = 1.74 to 2.52) patients were more likely to LWBS. Visit characteristics associated with LWBS included visits for musculoskeletal (OR = 0.70, 95% CI = 0.57 to 0.85), injury/poisoning/adverse event (OR = 0.65, 95% CI = 0.53 to 0.80), and miscellaneous (OR = 1.56, 95% CI = 1.19 to 2.05) complaints. Visits with low triage acuity were more likely to LWBS (OR = 3.59, 95% CI = 2.81 to 4.58), whereas visits that were work‐related were less likely to LWBS (OR = 0.19, 95% CI = 0.12 to 0.29). Institutional characteristics associated with LWBS were visits in metropolitan areas (OR = 2.11, 95% CI = 1.66 to 2.70) and teaching institutions (OR = 1.33, 95% CI = 1.06 to 1.67).Conclusions:  Several patient, visit, and hospital characteristics are independently associated with LWBS. Prediction and benchmarking of LWBS rates should adjust for these factors.
Feasibility of an Interactive Voice Response Tool for Adolescent Assault Victims
Authors: Blackstone Mercedes M. , Wiebe Douglas J. , Mollen Cynthia J. , Kalra Avash , Fein Joel A. 
Published: October 2009

AbstractBackground:  Assault‐injured adolescents who are seen in the emergency department (ED) are difficult to follow prospectively using standard research techniques such as telephone calls or mailed questionnaires. Interactive voice response (IVR) is a novel technology that promotes active participation of subjects and allows automated data collection for prospective studies.Objectives:  The objective was to determine the feasibility of IVR technology for collecting prospective information from adolescents who were enrolled in an ED‐based study of interpersonal violence.Methods:  A convenience sample of assault‐injured 12‐ to 19‐year‐olds presenting to an urban, tertiary care ED was enrolled prospectively. Each subject completed a brief questionnaire in the ED and then was randomly assigned to use the IVR system in differently timed schedules over a period of 8 weeks: weekly, biweekly, or monthly calls. Upon discharge, each subject received a gift card incentive and a magnetic calendar with his or her prospective call‐in dates circled on it. Each time a subject contacted the toll‐free number, he or she used the telephone’s keypad to respond to computer‐voice questions about retaliation and violence subsequent to the ED visit. Using Internet access, we added $5 to the gift card for each call and $10 if all scheduled calls were completed. The primary outcome was the rate of the first utilization of the IVR system. The numbers of completed calls made for each of the three call‐in schedules were also compared.Results:  Of the 95 subjects who consented to the follow‐up portion of the study, 44.2% (95% confidence interval [CI] = 34.0% to 54.8%) completed at least one IVR call, and 13.7% (95% CI = 7.5% to 22.3%) made all of their scheduled calls. There were no significant differences among groups in the percentage of subjects calling at least once into the system or in the percentage of requested calls made. The enrolled subjects had a high level of exposure to violence. At baseline, 85.3% (95% CI = 76.5% to 91.7%) had heard gunshots fired, and 84.2% (95% CI = 75.3% to 90.9%) had seen someone being assaulted. Twenty‐eight adolescents (29.5%, 95% CI = 20.6% to 39.7%) were reached for satisfaction interviews. All of those contacted found the IVR system easy to use and all but one would use it again.Conclusions:  Interactive voice response technology is a feasible means of follow‐up among high‐risk violently injured adolescents, and this relatively anonymous process allows for the collection of sensitive information. Further research is needed to determine the optimal timing of calls and cost‐effectiveness in this population.
Trends in Midlevel Provider Utilization in Emergency Departments from 1997 to 2006
Authors: Menchine Michael D. , Wiechmann Warren , Rudkin Scott 
Published: October 2009

AbstractObjectives:  The objective was to quantify the expansion of midlevel provider (MLP) practice in U.S. emergency departments (EDs) over the past decade. Specifically, we sought to quantify the absolute number of patients seen by MLPs, the annual growth rate of patients seen by MLPs, and the expansion in the proportion of EDs using MLPs.Methods:  Data were analyzed from the ED portion of the 10 most recent years (1997 to 2006) National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative survey of ED visits compiled by the Centers for Disease Control and Prevention (CDC). The main outcomes of interest were the proportion and absolute numbers of ED patients seen by MLPs during the 10‐year study period. National estimates derived from sample weights are reported. In addition, a multivariate logistic regression model was created with “seen by midlevel provider” as the dependent variable to determine factors associated with being seen by a MLP.Results:  Between 1997 and 2006, 8.23% (95% confidence interval [CI] = 7.31% to 9.15%) of ED patients were seen by a MLP. The proportion of ED patients seen by MLPs increased from 5.5% (95% CI = 3.8% to 7.1%) in 1997 to 12.7% (95% CI = 10.5% to 14.9%) in 2006 (13% annual growth). This corresponds to an increase in the number of ED patients seen by MLPs from 5.2 million in 1997 to 15.2 million in 2006. The proportion of hospitals using MLPs in the ED increased from 28.3% (95% CI = 22.4% to 34.1%) in 1997 to 77.2% (95% CI = 71.2% to 83.3%) in 2006 (17% annual growth). Slightly over half of MLP cases (54.9%; 95% CI = 49.1% to 60.7%) were also seen by staff physicians. On multivariate regression, younger patient age, non–southern geographic region, and triage acuity were associated with increased MLP use.Conclusions:  The number of ED patients seen by MLPs has increased sharply, from 5.2 million in 1997 (5.5% of all ED cases) to 15.2 million in 2006 (12.7% of all ED cases). Similarly, the proportion of EDs reporting use of MLPs has increased from 28.3% in 1997 to 77.2% in 2006.
Disconnect Between Charted Vestibular Diagnoses and Emergency Department Management Decisions: A Cross‐sectional Analysis From a Nationally Representative Sample
Authors: Newman‐Toker David E. , Camargo, Jr Carlos A. , Hsieh Yu‐Hsiang , Pelletier Andrea J. , Edlow Jonathan A. 
Published: October 2009

AbstractObjectives:  The most common vestibular disorders seen in the emergency department (ED) are benign paroxysmal positional vertigo (BPPV) and acute peripheral vestibulopathy (APV; i.e., vestibular neuritis or labyrinthitis). BPPV and APV are two very distinct disorders that have different clinical presentations that require different diagnostic and treatment strategies. BPPV can be diagnosed without imaging and is treated with canalith‐repositioning maneuvers. APV sometimes requires neuroimaging by magnetic resonance imaging (MRI) to exclude posterior fossa stroke mimics and should be treated with vestibular sedatives and corticosteroids. We sought to determine if emergency physicians (EPs) apply best practices to diagnose and treat these common vestibular disorders.Methods:  This was a cross‐sectional study of ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS). A weighted sample of U.S. ED visits (1993–2005) was used. Patients at least 16 years of age who were given a final ED diagnosis of BPPV (International Classification of Diseases, 9th Revision [ICD‐9], 386.11) or APV (ICD‐9 386.12 or 386.3x) comprised the study population. The frequency of imaging and drug therapy in those diagnosed as BPPV or APV versus controls was the main outcome measure.Results:  A total of 9,472 dizzy patient visits were sampled over 13 years (weighted estimate 33.6 million U.S. ED visits over that period). A weighted estimate of 2.5 million patients (7.4%) were given a vestibular diagnosis, mostly BPPV (weighted 0.2 million) or APV (weighted 1.9 million). Patients given BPPV (19%) and APV (19%) diagnoses were more likely to undergo imaging (all by computed tomography [CT]) than controls (7%; p < 0.001). Patients given BPPV (58%) and APV (70%) diagnoses were more likely to receive meclizine than controls (0.1%; p < 0.001). Corticosteroid administration was rarely documented (2% BPPV, 1% APV).Conclusions:  Patients given a vestibular diagnosis in the ED may not be managed optimally. Patients given BPPV and APV diagnoses undergo imaging (predominantly CT) with equal frequency, suggesting overuse of CT (BPPV) and probably underuse of MRI (APV). Most patients diagnosed with BPPV are given meclizine, which is not indicated. Specific therapy for APV (corticosteroids) is probably underutilized. Educational initiatives and clinical guidelines merit consideration.
Structure and Function of Emergency Care Research Networks: Strengths, Weaknesses, and Challenges
Authors: Papa Linda , Kuppermann Nathan , Lamond Katherine , Barsan William G. , Camargo Carlos A. , Ornato Joseph P. , Stiell Ian G. , Talan David A. 
Published: October 2009

AbstractThe ability of emergency care research (ECR) to produce meaningful improvements in the outcomes of acutely ill or injured patients depends on the optimal configuration, infrastructure, organization, and support of emergency care research networks (ECRNs). Through the experiences of existing ECRNs, we can learn how to best accomplish this. A meeting was organized in Washington, DC, on May 28, 2008, to discuss the present state and future directions of clinical research networks as they relate to emergency care. Prior to the conference, at the time of online registration, participants responded to a series of preconference questions addressing the relevant issues that would form the basis of the breakout session discussions. During the conference, representatives from a number of existing ECRNs participated in discussions with the attendees and provided a description of their respective networks, infrastructure, and challenges. Breakout sessions provided the opportunity to further discuss the strengths and weaknesses of these networks and patterns of success with respect to their formation, management, funding, best practices, and pitfalls. Discussions centered on identifying characteristics that promote or inhibit successful networks and their interactivity, productivity, and expansion. Here the authors describe the current state of ECRNs and identify the strengths, weaknesses, and potential pitfalls of research networks. The most commonly cited strengths of population‐ or disease‐based research networks identified in the preconference survey were access to larger numbers of patients; involvement of physician experts in the field, contributing to high‐level study content; and the collaboration among investigators. The most commonly cited weaknesses were studies with too narrow a focus and restrictive inclusion criteria, a vast organizational structure with a risk of either too much or too little central organization or control, and heterogeneity of institutional policies and procedures among sites. Through the survey and structured discussion process involving multiple stakeholders, the authors have identified strengths and weaknesses that are consistent across a number of existing ECRNs. By leveraging the strengths and addressing the weaknesses, strategies can be adopted to enhance the scientific value and productivity of these networks and give direction to future ECRNs.
Concurrence between Interpupillary Line and Tangent to the Incisal Edge of the Upper Central Incisor Teeth
Authors: MALAFAIA FABIANO MARTINS , GARBOSSA MARCELO FRANCISCO , NEVES ANA CHRISTINA CLARO , DA SILVA‐CONCÍLIO LAÍS REGIANE , NEISSER MAXIMILIANO PIERO 
Published: October 2009

ABSTRACTObjective:  Dento‐facial harmony is essential to obtain adequate esthetics and a successful treatment. Therefore, the aim of the present study was to analyze the existence of polar symmetry, obtained by two parallel lines, one along the pupils and another along the incisal edge of the upper central incisor teeth of 102 dental students distributed across five Brazilian dental schools.Materials and Methods:  One hundred and two students with no missing teeth, who had never been subjected to any kind of dental treatment, not even orthodontic treatment, were selected and photographed using a dental eye II camera (Yashica‐Kyocera Optics Inc., Somerset, NJ, USA) with a macro‐objective lens of 100 mm and using a scale of 1:10 of the natural size. All the individuals were positioned parallel to the plane of Frankfurt and to the ground, and were photographed smiling in order to expose the central incisors. The pictures were transformed into digital images (1,840 × 1,252 pixels) and analyzed later using Microsoft Office Power Point 2007 software. Two lines (along the pupils and another along the maxillary incisive teeth) were drawn, and the inclination obtained was generated by the program itself. Symmetrical cases were classified as “yes” (Y), and the remainder as “no” (N). Cases were also divided according to gender. Results were statistically assessed by analysis of variance and Student's t‐test (α = 0.05).Results:  There was a statistically significant correlation between the line parallel with the pupils and the tangent of the incisal edge of the incisors, irrespective of gender.Conclusion:  Regardless of gender, there is a correlation between the pupils and the tangent with the incisal edge of the maxillary central incisors.CLINICAL SIGNIFICANCEDespite diversity in individuals, facial and anatomic measurements may aid in the execution and planning of rehabilitation treatments.
Prevalence of Carious and Non‐carious Cervical Lesions in Archaeological Populations from North America and Europe
Authors: RITTER ANDRÉ V. , GRIPPO JOHN O. , COLEMAN THOMAS A. , MORGAN MICHÈLE E. 
Published: October 2009

ABSTRACTPurpose:  The purpose of this study was to report the prevalence of carious and non‐carious cervical lesions in the teeth of five archaeological populations. A secondary purpose was to report the association between age, gender, diet, tooth wear, carious cervical lesions, and non‐carious cervical lesions.Materials and Methods:  One hundred and four archaeological specimens from subjects originating from five distinct geographical areas were examined to detect the presence of carious cervical lesions, non‐carious cervical lesions, and tooth wear. Data were tabulated and statistics used to describe prevalence and non‐causal associations.Results:  Carious cervical lesions were prevalent in all populations except among Labradoreans, while non‐carious cervical lesions were found predominantly in Mexicans. The authors found no association between non‐carious cervical lesions and age, gender, and diet in any of the populations. Tooth wear was noted in all populations, but the highest rates of severe wear were noted among the Labradoreans and New Mexicans. Age was associated with tooth wear in all populations except Ohioans. There was no association between tooth wear and non‐carious cervical lesions.Conclusions:  The prevalence of carious cervical lesions among the five archaeological populations studied ranged from 0 to 65%. Non‐carious cervical lesions were not prevalent among these populations, being found predominantly in Mexicans (26%).CLINICAL SIGNIFICANCEHistorically, carious and non‐carious cervical lesions can be found in individuals with no access to modern oral hygiene tools. The findings of this study are not conclusive, however, as the associations described are not causal.
Metabolic stabilization of p53 by FE65 in the nuclear matrix of osmotically stressed cells
Authors: Nakaya Tadashi , Kawai Tomoko , Suzuki Toshiharu 
Published: October 2009

FE65 is a neural adaptor protein known to interact with a number of proteins, including Alzheimer’s amyloid β‐protein precursor (APP). Although several different functions have been proposed for FE65, its primary physiological role remains unclear. We previously showed that APP can liberate FE65 from the membrane as a result of APP phosphorylation, and that the liberated FE65 translocates into the nuclei of osmotically stressed cells. Within the nucleus, FE65 formed a patched structure at the nuclear matrix, which facilitated the induction of γH2AX [Nakaya T, Kawai T & Suzuki T (2008) J Biol Chem283, 19119–19131]. Here, we report that the tumor suppressor p53 is colocalized with FE65 in the nuclear patches and is stabilized by FE65 in sorbitol‐treated cells. In FE65 knockdown cells, protein levels of p53 targeted to the nuclear matrix were rapidly decreased through the proteasome degradation pathway after sorbitol treatment, as compared with control cells. These results suggest that the translocation of FE65 to the nuclear matrix, along with the formation of nuclear patches, is required for the stabilization of p53 by its suppression of the proteasome degradation pathway, thus facilitating the subsequent induction of γH2AX in osmotically stressed cells.Structured digital abstract
MINT‐7261896: Fe65 (uniprotkb:Q9QXJ1) and Tp53 (uniprotkb:P02340) colocalize (MI:0403) by fluorescence microscopy (MI:0416)
MINT‐7261912: p53 (uniprotkb:P02340) and Fe65 (uniprotkb:Q9QXJ1) colocalize (MI:0403) by cosedimentation through density gradients (MI:0029)
A Systematic Review of Literature About the Genetic Testing of Adolescents
Authors: Rew Lynn , Mackert Michael , Bonevac Daniel 
Published: October 2009

PURPOSE.  Mapping of the human genome raises interest in and concern about the genetic testing of adolescents. Our purpose was to determine the attitudes and knowledge adolescents and their parents have about genetic testing.DESIGN AND METHOD.  This paper is a report of a systematic review of the research literature (n = 56) about the attitudes and knowledge adolescents and their parents have about genetic testing.RESULTS.  The majority of studies, which were descriptive in design, focused on a specific heritable disorder, were conducted in the United States, and over sampled well‐educated White females.PRACTICE IMPLICATIONS.  Results suggest that adolescents and their families have relatively positive attitudes about genetic testing and may experience both harms and benefits from testing. Nurses may be in positions to assist adolescents and their families in making decisions about genetic testing, remaining sensitive to family dynamics and issues of privacy and autonomy.
A First Qualitative Project: Qualitative Descriptive Design for Novice Researchers
Authors: Magilvy Joan K. , Thomas Eileen 
Published: October 2009

Joan K. Magilvy and Eileen Thomas Column Editor: Anne Marie Kotzer Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.
The age rank of the nearest pre-main-sequence groups
Authors: Lawson Warrick A. , Lyo A-Ran , Bessell M. S. 
Published: October 2009

Abstract
We address the age rank of the nearest pre-main-sequence (PMS) associations, using low-resolution spectrophotometry to measure gravity-sensitive indices in these stars. We compare spectral index-colour sequences for the PMS populations and rank them according to the strength of their gravity-sensitive features. The age rank using the gravity method is in general agreement with the ranking of these groups suggested by colour–magnitude (CM) diagram placement. Several of the groups have a kinematic origin in the Oph-Sco-Cen OB association. For three of them, their age rank is also in agreement with epochs resulting from a formation scenario for the OB association.
Primary care management of childhood and adolescent hypertension
Authors: Anglum Abigail 
Published: October 2009

AbstractPurpose: To educate advance practice nurses on the diagnosis, pharmacologic, and nonpharmacologic management of hypertension in children and adolescents.Data sources: Information was collected through a search of published literature and clinical practice guidelines.Conclusions: Increasing rates of hypertension in children and adolescents are correlated to risk for coronary artery disease in adulthood. Nonpharmacologic management includes lifestyle modifications addressing weight reduction, physical activity, and dietary modification. Pharmacologic management is typically reserved for patients with severe hypertension or those who do not respond to lifestyle modifications. Early intervention is critical for preventing target‐organ damage and complications of long‐term hypertension.Implications for practice: Nurse practitioners must identify and address elevated blood pressure levels in children and adolescents. Many children and adolescents can successfully lower blood pressure readings through nonpharmacologic lifestyle changes. Education about lifestyle modification strategies should focus on family‐based changes in order to increase likelihood of successful implementation.