bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Conjoint Analysis to Assess Patients' Preferences When Visiting Emergency Departments in Hong Kong
Authors: Leung Gabriel M. , Chan Sarah S. C. , Chau Patsy Y. K. , Chua Shui Ching 
Published: January 2008

Abstract Objectives: To explore factors related to emergency department (ED) attendances in Hong Kong, the authors piloted the application of conjoint analysis in eliciting patient preferences regarding ED visits. Methods: The study recruited 390 semi‐urgent or non‐urgent patients from a targeted convenience sample of three large EDs. Respondents were asked to rank eight scenarios structured to explore the relative importances of three key attributes—self‐perceived illness severity, waiting time, and consultation fee—that may result in an ED visit. Results: Seventy‐eight percent of the respondents would consider visiting a parallel clinic instead of the ED for semiurgent and non‐urgent conditions. The relative importances attached to illness severity, waiting time, and consultation fee were 47.8%, 33.6%, and 18.7%, respectively. Conclusions: This study demonstrated that Hong Kong patients are receptive to the concept of parallel clinics, and illustrated that conjoint analysis is a rigorous survey technique for eliciting the views of patients on health care services in the ED setting.
Bench to Bedside Resuscitation from Prolonged Ventricular Fibrillation
Authors: Angelos Mark G. , Menegazzi James J. , Callaway Clifton W. 
Published: January 2008

AbstractVentricular fibrillation (VF) remains the most common cardiac arrest heart rhythm. Defibrillation is the primary treatment and is very effective if delivered early within a few minutes of onset of VF. However, successful treatment of VF becomes increasingly more difficult when the duration of VF exceeds 4 minutes. Classically, successful cardiac arrest resuscitation has been thought of as simply achieving restoration of spontaneous circulation (ROSC). However, this traditional approach fails to consider the high early post—cardiac arrest mortality and morbidity and ignores the reperfusion injuries, which are manifest in the heart and brain. More recently, resuscitation from cardiac arrest has been divided into two phases; phase I, achieving ROSC, and phase II, treatment of reperfusion injury. The focus in both phases of resuscitation remains the heart and brain, as prolonged VF remains primarily a two‐organ disease. These two organs are most sensitive to oxygen and substrate deprivation and account for the vast majority of early post‐resuscitation mortality and morbidity. This review focuses first on the initial resuscitation (achieving ROSC) and then on the reperfusion issues affecting the heart and brain.
Preventive Care in the Emergency Department A Systematic Literature Review on Emergency Department‐based Interventions that Address Smoke Detectors in the Home
Authors: Cortes Leslie Maas , Hargarten Stephen W. 
Published: January 2008

Abstract Objectives: To assess the effectiveness of an emergency department (ED)‐based strategy to identify and counsel selected patients about the importance of an operational smoke detector in the home and to offer a graded recommendation regarding such a strategy. Methods: A systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. Two Medline combined searches were performed using the following terms: emergency medical services and counseling, protective devices and smoke detectors, accidents, home, burns, fires, and residential fires. A free‐text search of indexed and nonindexed citations in Emergency Medical Abstracts from 1977 to 1999 and a search of the Cochrane Library were also performed. In addition, reviewers performed independent Medline searches and suggested four additional studies. Studies selected for inclusion in this systematic review were required to meet the following criteria: 1) report ED‐based research and 2) address the topic of fire and burn prevention with some pertinent discussion of ED‐based interventions. The initial inclusion criteria had restricted studies to those that reported the results of counseling strategies for smoke detectors. The authors later decided to consider, as indirectly relevant, studies that did not investigate counseling strategies. Data from the selected studies were extracted using the template form, and the validity and applicability of the results to emergency practice were assessed. Recommendations were derived following criteria developed by a systematic review of preventive interventions in the ED. Results: Six articles were closely reviewed. Four of the six studies met the inclusion criteria. One other study that did not meet the inclusion criteria was also considered. No study focused specifically on the counseling of ED patients about smoke detectors. Conclusions: Following the criteria of the graded recommendations used for the parent project. a recommendation cannot be made either for or against an ED‐based strategy to counsel patients on the importance of smoke detectors. No studies located in our review directly assessed the effectiveness of such a strategy. Based on the retrospective case series study of the potential opportunity for a home fire safety intervention during an emergency medical services visit and the Safe Block Project study, it may be worthwhile to consider further research on the effectiveness of systems‐level/structural interventions, with a targeted focus on strategies that attempt to overcome barriers associated with active interventions.
Smallpox Vaccination: A National Survey of Emergency Health Care Providers
Authors: Everett Worth W. , Coffin Susan E. , Zaoutis Theoklis , Halpern Scott D. , Strom Brian L. 
Published: January 2008

AbstractConcerns about bioterrorism have prompted a national voluntary smallpox (SP) vaccination program in the United States. Although emergency health care providers are among the first targeted for vaccination, little is known about how these providers view the risks and benefits of SP vaccination. Objectives: To assess the willingness of emergency health care personnel to receive pre‐event SP vaccination prior to the start of the national program. Methods: The authors conducted a national cross‐sectional, anonymous survey of 1,701 emergency physicians, nurses, and mid‐level practitioners working full time in 13 adult and pediatric academic emergency departments in large U.S. cities in November and December 2002. The main outcome measure was willingness to be vaccinated against SP. Secondary outcomes included the prevalence of self‐reported contraindications, and reasons for and against vaccination. Results: 732 emergency health care providers returned questionnaires (response rate 43%). Overall, 73% (95% CI = 66% to 80%) were willing to receive pre‐event SP vaccination. 18% (95% CI = 14% to 23%) reported contraindications to vaccination, and 50% (95% CI = 39% to 61%) of these providers were willing to receive pre‐event SP vaccination. Self‐protection (72%) was the most common reason cited for desiring vaccination against SP; concern about vaccine‐related adverse events (54%) was the most common reason cited for not wanting immunization. Conclusions: Most emergency health care providers express a willingness to receive pre‐event SP immunization; self‐protection is a principal motivating reason. A subset of health care providers, however, may place themselves at increased risk by desiring vaccination despite contraindications.
Bench to Bedside: Electrophysiologic and Clinical Principles of Noninvasive Hemodynamic Monitoring Using Impedance Cardiography
Authors: Summers Richard L. , Shoemaker William C. , Peacock W. Franklin , Ander Douglas S. , Coleman Thomas G. 
Published: January 2008

AbstractThe evaluation of the hemodynamic state of the severely ill patient is a common problem in emergency medicine. While conventional vital signs offer some insight into delineating the circulatory pathophysiology, it is often impossible to determine the true clinical state from an analysis of blood pressure and heart rate alone. Cardiac output measurements by thermodilution have been the criterion standard for the evaluation of hemodynamics. However, this technology is invasive, expensive, time‐consuming, and impractical for most emergency department environments. Impedance cardiography (ICG) is a noninvasive method of obtaining continuous measurements of hemodynamic data such as cardiac output that requires little technical expertise. ICG technology was first developed by NASA in the 1960s and is based on the idea that the human thorax is electrically a nonhomogeneous, bulk conductor. Variation in the impedance to flow of a high‐frequency, low‐magnitude alternating current across the thorax results in the generation of a measured waveform from which stroke volume can be calculated by a modification of the pulse contour method. To adequately judge the possible role of this technology in the practice of emergency medicine, it is important to have a sufficient understanding of the basic scientific principles involved as well as the clinical validity and limitations of the technique.
Magnesium–Aluminum Hydroxide Suspension for the Treatment of Dermal Capsaicin Exposures
Authors: Lee David C. , Ryan James R. 
Published: January 2008

Abstract Objectives: To determine whether magnesium–aluminum‐hydroxide–simethicone suspension (MgAl) is an effective treatment for dermal capsaicin exposures. Methods: The authors performed a double‐blind, randomized, controlled, pilot study comparing the effect of MgAl with that of saline in the treatment of dermal capsaicin exposures. Ten volunteers were sprayed with a commercial defensive spray containing 10% capsaicin on the flexor surface of both forearms. A dressing embedded with MgAl (Maalox) suspension was randomly applied to one arm and a saline‐embedded dressing was applied to the other arm. Pain was assessed on a 10‐cm visual analog scale at 0, 10, 20, 30, 60, 90, and 120 minutes. Results: Mean pain scores were significantly lower in the MgAl group as compared with the saline (S) group at 10, 20, and 30 minutes. Differences in pain scores were not statistically significant at times 60, 90, and 120 minutes. Conclusions: During the initial 30 minutes of treatment, there was a statistically significant decrease in pain scores with MgAl as compared with saline treatments. Although the difference in means may have questionable clinical significance, MgAl is cheap and readily available, and has minimal side effects. Thus, MgAl may be an appropriate treatment for dermal capsaicin exposure.
Teaching Techniques in the Clinical Setting: the Emergency Medicine Perspective
Authors: Wald David A. 
Published: January 2008

AbstractThe emergency department (ED) provides a unique educational experience that is distinct from both inpatient and ambulatory care settings. Because of the high acuity, interesting pathology, and rapid patient turnover, the ED is an ideal location to train medical students. Numerous teaching opportunities exist within the domain of the ED. In the preclinical years, the ED setting provides medical students with an introduction to clinical medicine and may serve as a venue for teaching basic history and physical examination skills. In the clinical years, medical students are exposed to a wide range of undifferentiated patients. Besides common medical and surgical complaints, many medical students will encounter clinical scenarios that they otherwise would have little direct contact with. Encounters such as the acutely poisoned or intoxicated patient, environmental emergencies, interaction with out‐of‐hospital providers, and patients requiring emergency procedures are just a few situations that make emergency medicine a distinct clinical specialty. These and other student–patient encounters can provide the teaching physician an opportunity to focus case‐based teaching on a number of elements including complaint‐directed medical interviewing and physical examination skills, development of case‐specific differential diagnosis, diagnostic evaluation, implementation of patient management plans, and patient disposition. In this review article, the authors discuss various ways to approach and improve clinical teaching of medical students, including: opportunities for teaching in the ED, teaching procedural skills, student case presentations, clinical teaching styles, qualities of an effective clinical teacher, and barriers to effective clinical teaching.
Diversity of Tn
1546
and Its Role in the Dissemination of Vancomycin-Resistant Enterococci in Portugal
Authors: Novais Carla , Freitas Ana R. , Sousa João C. , Baquero Fernando , Coque Teresa M. , Peixe Luísa V. 
Published: January 2008

ABSTRACT

We characterized the molecular diversity of
vanA
vancomycin-resistant enterococci (VRE; 176 isolates/87 pulsed-field gel electrophoresis types) from different sources and cities in Portugal (1996 to 2004): (i) food animals (FA;
n
= 38 isolates out of 31 samples), hospitalized humans (HH;
n
= 101/101), healthy human volunteers (HV;
n
= 7/4), and environmental sources (
n
= 30/10). Some strains were isolated from different hosts and persistently recovered for years. Twenty-four Tn
1546
variants were identified, all located on plasmids (30 to 250 kb). Some Tn
1546
variants were associated with specific sources such as FA (3 types), HH (11 types), or HV (1 type), while others were recovered from isolates of different origins (8 types). Polymorphisms in the central
vanRSHA
region of Tn
1546
were scarcely detected, while alterations upstream of
vanR
and downstream of
vanA
were frequently identified involving mutations (
vanS
and
vanX
), deletions (
vanY
), insertions (IS
1216V
, IS
Ef1
, and IS
19
; sequences with or without homology with others available in GenBank databases), and different genetic rearrangements. Most Tn
1546
variants contained IS
1216V
(14 types) or IS
Ef1
(6 types). IS
1216V
was found alone or associated with an IS
3
-like element at different orientations and positions in Tn
1546
from human, animal, and environmental samples. IS
Ef1
was located within
vanX
-
vanY
region at nucleotide 9044 of Tn
1546
variants mostly associated with clinical isolates, suggesting a common genetic platform. IS
19
was observed within the
vanX
-
vanY
region in one Tn
1546
variant from poultry. Recent spread of VRE in Portugal reflects a complex epidemiology involving both clonal spread and plasmid dissemination containing a variety of Tn
1546
types. Apparent Tn
1546
heterogeneity among enterococci from human, animal, and environmental sources might reflect frequent genetic exchange events and evolution of particular widely disseminated genetic elements.
Relationship between Antibiotic Use and Incidence of MexXY-OprM Overproducers among Clinical Isolates of
Pseudomonas aeruginosa
Authors: Hocquet Didier , Muller Arno , Blanc Karine , Plésiat Patrick , Talon Daniel , Monnet Dominique Louis , Bertrand Xavier 
Published: January 2008

ABSTRACT

In a university hospital, time-series analysis revealed a significant relationship between antibiotic (aminoglycoside, fluoroquinolone, and cefepime) use and incidence of MexXY-OprM-overproducing
Pseudomonas aeruginosa
. In vitro experiments confirm that such mutants were readily selected from both PAO1 and clinical strains when grown in the presence of these antibiotics.
Increase of Virulence and Its Phenotypic Traits in Drug-Resistant Strains of
Candida albicans
Authors: Angiolella Letizia , Stringaro Anna Rita , De Bernardis Flavia , Posteraro Brunella , Bonito Mariantonietta , Toccacieli Laura , Torosantucci Antonella , Colone Marisa , Sanguinetti Maurizio , Cassone Antonio , Palamara Anna Teresa 
Published: January 2008

ABSTRACT

There is concern about the rise of antifungal drug resistance, but little is known about comparative biological properties and pathogenicity of drug-resistant strains. We generated fluconazole (FLC; CO23
RFLC
)- or micafungin (FK; CO23
RFK
)-resistant strains of
Candida albicans
by treating a FLC- and FK-susceptible strain of this fungus (CO23
S
) with stepwise-increasing concentrations of either drug. Molecular analyses showed that CO23
RFLC
had acquired markedly increased expression of the drug-resistance efflux pump encoded by the
MDR1
gene, whereas CO23
RFK
had a homozygous mutation in the
FSK1
gene. These genetic modifications did not alter to any extent the growth capacity of the drug-resistant strains in vitro, either at 28°C or at 37°C, but markedly increased their experimental pathogenicity in a systemic mouse infection model, as assessed by the overall mortality and target organ invasion. Interestingly, no apparent increase in the vaginopathic potential of the strains was observed with an estrogen-dependent rat vaginal infection. The increased pathogenicity of drug-resistant strains for systemic infection was associated with a number of biochemical and physiological changes, including (i) marked cellular alterations associated with a different expression and content of major cell wall polysaccharides, (ii) more rapid and extensive hypha formation in both liquid and solid media, and (iii) increased adherence to plastic and a propensity for biofilm formation. Overall, our data demonstrate that experimentally induced resistance to antifungal drugs, irrespective of drug family, can substantially divert
C. albicans
biology, affecting in particular biological properties of potential relevance for deep-seated candidiasis.
Antimicrobial Activities of Ceftaroline and ME1036 Tested against Clinical Strains of Community-Acquired Methicillin-Resistant
Staphylococcus aureus
Authors: Sader Helio S. , Fritsche Thomas R. , Jones Ronald N. 
Published: January 2008

ABSTRACT

Two investigational anti-methicillin-resistant
Staphylococcus aureus
(anti-MRSA) β-lactams, ceftaroline (a cephalosporin) and ME1036 (a carbapenem), were subjected to susceptibility testing by reference broth microdilution methods using 152 strains of community-acquired MRSA from the United States (47 medical centers). Ceftaroline and ME1036 were 64- and >128-fold more potent than ceftriaxone, respectively. All isolates had the Panton-Valentine leukocidin genes and staphylococcal cassette chromosome
mec
type IV, while 67.8% of isolates displayed pulsed-field gel electrophoresis clonal type USA300-0114.
Plasmid-Borne
erm
(T) from Invasive, Macrolide-Resistant
Streptococcus pyogenes
Strains
Authors: Woodbury Robyn L. , Klammer Kathryn A. , Xiong Yang , Bailiff Timothy , Glennen Anita , Bartkus Joanne M. , Lynfield Ruth , Van Beneden Chris , Beall Bernard W. 
Published: January 2008

ABSTRACT

Twenty-three isolates of group A streptococci (GAS) recovered from population-based invasive GAS surveillance in the United States were erythromycin resistant, inducibly clindamycin resistant, and lacked known macrolide resistance determinants. These 23 isolates, representing four different clones, contained a broad-host-range plasmid carrying the
erm
(T) methylase gene, which has not been detected in GAS previously.
JET CORRELATIONS WITH IDENTIFIED PARTICLES FROM PHENIX: METHODS AND RESULTS
Authors:   for the PHENIX Collaboration, SICKLES ANNE 
Published: January 2008

Azimuthal angle two particle correlations have been shown to be a powerful probe for extracting novel features of the interaction between hard scattered partons and the medium produced in Au + Au collisions at RHIC. At intermediate pT, 2–5 GeV/c, the jets have been shown to be significantly modified in both their particle composition and their angular distribution compared to p + p collisions. Additionally, angular two particle correlations with identified hadrons provide information on the possible role of modified hadronization scenarios such as partonic recombination, which might allow medium modified jet fragmentation by connecting hard scattered partons to low pT thermal partons. PHENIX has excellent particle identification capabilities and has developed robust techniques for extracting jet correlations from the large underlying event. We present recent PHENIX results from Au + Au collisions for a variety of pT and particle type combinations. We also present p + p measurements as a baseline. We show evidence that protons and anti-protons in the pT region of enhanced baryon and anti-baryon single particle production are produced in close angle pairs of opposite charge and that the strong modifications to the away side shape observed for charged hadron correlations are also present when baryons are correlated.
Sarah and Hagar in Ibn 'Asākir's History of Damascus
Authors: Lindsay James 
Published: January 2008

AbstractThis article examines how Ibn 'Asākir (1105-76)—in keeping with the well-established fadā' il al-Shām (merits of bilād al-Shām) tradition—fashions portraits of Sarah and Hagar in his Ta'rīkh madīnat Dimashq (History of Damascus) to extol their special role in the sacred history of God working through his human agents in Syria's past. As is the case in his biographies of other sacred and pious figures in Syria's past, Ibn 'Asākir's biographies of Sarah and Hagar are also intended to provide a moral example as well as pious inspiration for the faithful.
A Hebrew Penitential Poem (Tokhahah) in the Macabre Style
Authors: Prats Arturo , Alfonso Esperanza 
Published: January 2008

AbstractHidden in a miscellaneous manuscript housed in El Escorial Library in Madrid lies an anonymous, undated Hebrew poem. Using a combination of tercets and quatrains, the poem's unknown author describes in every possible detail the corruption his body will undergo after death. This article reconstructs the history of this literary theme—the description of bodily corruption—within the Jewish, Christian and Muslim traditions. Building upon that evidence, the authors argue that the poem was written sometime before the end of the fifteenth century, probably in France.
Nuclear factor of activated T cells (NFAT) mediates CD154 expression in megakaryocytes
Authors: Crist Scott A. , Sprague Daniel L. , Ratliff Timothy L. 
Published: January 2008

AbstractPlatelets are an abundant source of CD40 ligand (CD154), an immunomodulatory and proinflammatory molecule implicated in the onset and progression of several inflammatory diseases, including systemic lupus erythematosus (SLE), diabetes, and cardiovascular disease. Heretofore considered largely restricted to activated T cells, we initiated studies to investigate the source and regulation of platelet-associated CD154. We found that CD154 is abundantly expressed in platelet precursor cells, megakaryocytes. We show that CD154 is expressed in primary human CD34+ and murine hematopoietic precursor cells only after cytokine-driven megakaryocyte differentiation. Furthermore, using several established megakaryocyte-like cells lines, we performed promoter analysis of the CD154 gene and found that NFAT, a calcium-dependent transcriptional regulator associated with activated T cells, mediated both differentiation-dependent and inducible megakaryocyte-specific CD154 expression. Overall, these data represent the first investigation of the regulation of a novel source of CD154 and suggests that platelet-associated CD154 can be biochemically modulated.