bluuebunny/crossref_metadata_2025_split huggingface dataset:
U.S. Federal Regulations for Emergency Research: A Practical Guide and Commentary
Authors: McRae Andrew , Weijer Charles 
Published: March 2008

AbstractEmergency medicine research requires the enrollment of subjects with varying decision‐making capacities, including capable adults, adults incapacitated by illness or injury, and children. These different categories of subjects are protected by multiple federal regulations. These include the federal Common Rule, the Department of Health and Human Services (DHHS) regulations for pediatric research, and the Food and Drug Administration’s (FDA) Final Rule for the Exception from the Requirements of Informed Consent in Emergency Situations. Investigators should be familiar with the relevant federal research regulations to optimally protect vulnerable research subjects, and to facilitate the institutional review board (IRB) review process. IRB members face particular challenges in reviewing emergency research. No regulations exist for research enrolling incapacitated subjects using proxy consent. The wording of the Final Rule may not optimally protect vulnerable subjects. It is also difficult to apply conflicting regulations to a single study that enrolls subjects with differing decision‐making capacities. This article is intended as a guide for emergency researchers and IRB members who review emergency research. It reviews the elements of Federal Regulations that apply to consent, subject selection, privacy protection, and the analysis of risks and benefits in all emergency research. It explores the challenges for IRB review listed above, and offers potential solutions to these problems.
Brief Screening for Adolescent Depressive Symptoms in the Emergency Department
Authors: Rutman Maia S. , Shenassa Edmond , Becker Bruce M. 
Published: March 2008

AbstractBackground:  Depression is the most common psychiatric disorder among adolescents and is more prevalent among those seeking care in the emergency department (ED). However, adolescents are rarely screened for depressive symptoms in the pediatric emergency department (PED).Objectives:  To evaluate the sensitivity and specificity of one‐ and two‐item screens for depressive symptoms compared to the 20‐question Center for Epidemiologic Studies Depression Scale (CESD) among adolescents seeking care in a PED.Methods:  This was a cross‐sectional study of a convenience sample of adolescents 12–17 years old presenting to an urban PED with subcritical illness or injury. Participants completed three screening instruments: the two‐question screen, the single‐question screen, and the CESD.Results:  A total of 321 patients were approached to enter the study, of whom 212 (66%) agreed to participate. Seventy‐eight (37%) of the study participants screened positive for depression on the CESD using a cutoff score of ≥16. The two‐question screen had a sensitivity of 78% (95% confidence interval [CI] = 73% to 84%) and specificity of 82% (95% CI = 77% to 87%) for depressive symptoms compared with the CESD. The single‐question screen had a sensitivity of 56% (95% CI = 50% to 63%) and specificity of 93% (95% CI = 90% to 96%) compared with the CESD.Conclusions:  The two‐question screen is a sensitive and specific initial screen for depressive symptoms in adolescents being seen in the PED. This quick, simple instrument would be ideal for use in the busy PED setting and would allow clinicians to identify adolescents who require more extensive psychiatric evaluation.
Differences in Long‐term Mortality for Different Emergency Department Presenting Complaints
Authors: Safwenberg Urban , Terént Andreas , Lind Lars 
Published: March 2008

AbstractObjectives:  To characterize long‐term mortality based on previous emergency department (ED) presenting complaints.Methods:  The authors followed, for 10 years, all of the 12,667 nonsurgical patients visiting an ED during 1995/1996. Differences in standardized mortality ratio (SMR) depending on presenting complaints were then investigated.Results:  During follow‐up, 5,324 deaths occurred (mortality rate 6.6 per 100 person‐years at risk), giving a SMR of 1.33 (95% CI = 1.30 to 1.37, p < 0.001) when compared with the expected mortality in the catchment area. Different presenting complaints were associated with different long‐term mortality rates, independent of age and gender (p < 0.0001). The subjects with seizures had the highest SMR (2.62, 95% CI = 2.13 to 3.22) followed by intoxications (2.51, 95% CI = 2.11 to 2.98), asthmalike symptoms (1.84, 95% CI = 1.65 to 2.06), and hyperglycemia (1.67, 95% CI = 1.42 to 1.95). The largest complaint group, chest pain, had a 20% higher mortality rate than the background population (95% CI = 1.13 to 1.26). Patients with a discharge diagnosis of myocardial infarction, but without chest pain as the presenting complaint, had an increased long‐term mortality (hazard ratio [HR] 1.70, 95% CI = 1.15 to 2.42) compared to the group with chest pain. In contrast, stroke patients without strokelike symptoms had a reduced mortality (HR 0.74, 95% CI = 0.65 to 0.84) compared to patients with strokelike symptoms.Conclusions:  Long‐term age‐ and gender‐adjusted mortality is the highest with seizures out of 33 presenting complaints and differs markedly between different ED admission complaints. Furthermore, depending on the admission complaint, long‐term mortality differs within the same discharge diagnosis. Hence, the presenting complaint adds unique information to the discharge diagnosis regarding long‐term mortality in nonsurgical patients.
Derivation of a Triage Algorithm for Chest Radiography of Community‐acquired Pneumonia Patients in the Emergency Department
Authors: Kyriacou Demetrios N. , Yarnold Paul R. , Soltysik Robert C. , Self Wesley H. , Wunderink Richard G. , Schmitt Brian P. , Parada Jorge P. , Adams James G. 
Published: March 2008

AbstractBackground:  Community‐acquired pneumonia (CAP) accounts for 1.5 million emergency department (ED) patient visits in the United States each year.Objectives:  To derive an algorithm for the ED triage setting that facilitates rapid and accurate ordering of chest radiography (CXR) for CAP.Methods:  The authors conducted an ED‐based retrospective matched case–control study using 100 radiographic confirmed CAP cases and 100 radiographic confirmed influenzalike illness (ILI) controls. Sensitivities and specificities of characteristics assessed in the triage setting were measured to discriminate CAP from ILI. The authors then used classification tree analysis to derive an algorithm that maximizes sensitivity and specificity for detecting patients with CAP in the ED triage setting.Results:  Temperature greater than 100.4°F (likelihood ratio = 4.39, 95% confidence interval [CI] = 2.04 to 9.45), heart rate greater than 110 beats/minute (likelihood ratio = 3.59, 95% CI = 1.82 to 7.10), and pulse oximetry less than 96% (likelihood ratio = 2.36, 95% CI = 1.32 to 4.20) were the strongest predictors of CAP. However, no single characteristic was adequately sensitive and specific to accurately discriminate CAP from ILI. A three‐step algorithm (using optimum cut points for elevated temperature, tachycardia, and hypoxemia on room air pulse oximetry) was derived that is 70.8% sensitive (95% CI = 60.7% to 79.7%) and 79.1% specific (95% CI = 69.3% to 86.9%).Conclusions:  No single characteristic adequately discriminates CAP from ILI, but a derived clinical algorithm may detect most radiographic confirmed CAP patients in the triage setting. Prospective assessment of this algorithm will be needed to determine its effects on the care of ED patients with suspected pneumonia.
Carbon Monoxide Has Direct Toxicity on the Myocardium Distinct from Effects of Hypoxia in an Ex Vivo Rat Heart Model
Authors: Suner Selim , Jay Gregory 
Published: March 2008

AbstractObjectives:  Carbon monoxide (CO) toxicity causes significant central nervous system and cardiac injury. Although the neurological damage caused by CO toxicity is extensively described, the mechanisms underlying myocardial insult are unclear. The authors used an externally perfused isolated rat heart model to examine the effects of a physiological saline solution (Krebs Henseleit HEPES, KHH) aerated with CO on cardiac function.Methods:  Fifteen rats were equally divided into three groups: the control group (KHH + 100% O2), the nitrogen control group (KHH + 70% O2, 30% N2), and the CO group (KHH + 70% oxygen, 30% CO). Left ventricular peak systolic pressure (LVPsP), end diastolic pressure (LVEdP), and coronary perfusion pressure were measured while the isolated heart was paced and perfused on a modified Langendorf apparatus.Results:  Left ventricular generated pressure (LVGP = LVPsP − LVEdP) decreased in the nitrogen control and CO groups compared to the control group. There was higher LVGP in the recovery phase between the nitrogen control group compared to the CO group. Both groups had increased lactic acid levels in the experimental phase.Conclusions:  Carbon monoxide with hypoxia and hypoxemic hypoxia both result in similar depression of cardiac function. Hearts poisoned with CO with hypoxia do not recover function to the extent that hearts rendered hypoxic with nitrogen do when perfused with 100% oxygen after the insult. This suggests that CO causes direct myocardial toxicity distinct from the effects of hypoxia.
Acute Ethanol Coingestion Confers a Lower Risk of Hepatotoxicity after Deliberate Acetaminophen Overdose
Authors: Waring W. Stephen , Stephen Alexandra F. , Malkowska Aleksandra M. , Robinson Oliver D.G. 
Published: March 2008

AbstractObjectives:  Little is known about the clinical significance of acute ethanol coingestion around the time of acetaminophen (paracetamol) overdose. This study prospectively examined the effect of acute ethanol coingestion on risk of hepatotoxicity among patients admitted to hospital for N‐acetylcysteine (NAC) therapy after deliberate acetaminophen overdose.Methods:  This was a prospective observational study and included sequential patients who presented within 24 hours of acute acetaminophen ingestion and required NAC therapy. Significant hepatotoxicity was defined by alanine transaminase > 1,000 U/L or the international normalized ratio > 1.3 after a standardized intravenous administration of 300 mg/kg NAC.Results:  There were 362 patients, including 178 (49.2%) who coingested ethanol acutely. The prevalence of hepatotoxicity was 5.1% (95% CI = 2.6% to 9.5%) in those who ingested ethanol, compared to 15.2% (95% CI = 10.7% to 21.2%) in those who did not (p = 0.0027 by chi‐square proportional test). Acute ethanol intake conferred a lower risk of hepatotoxicity in patients who had acetaminophen concentrations above or below the “200‐line” and was independent of the interval between ingestion and assessment.Conclusions:  Acute ethanol intake is associated with a lower risk of hepatotoxicity after acetaminophen overdose. This apparent protective effect cannot be explained solely by lower exposure to acetaminophen in this group, nor differences in the interval between ingestion and initiation of treatment. Further work is required to establish mechanisms by which ethanol might confer protection against hepatotoxicity, so as to identify novel strategies for reducing risk after acute acetaminophen ingestion.
The Challenge of Predicting Demand for Emergency Department Services
Authors: McCarthy Melissa L. , Zeger Scott L. , Ding Ru , Aronsky Dominik , Hoot Nathan R. , Kelen Gabor D. 
Published: March 2008

AbstractObjectives:  The objective was to develop methodology for predicting demand for emergency department (ED) services by characterizing ED arrivals.Methods:  One year of ED arrival data from an academic ED were merged with local climate data. ED arrival patterns were described; Poisson regression was selected to represent the count of hourly ED arrivals as a function of temporal, climatic, and patient factors. The authors evaluated the appropriateness of prediction models by whether the data met key Poisson assumptions, including variance proportional to the mean, positive skewness, and absence of autocorrelation among hours. Model accuracy was assessed by comparing predicted and observed histograms of arrival counts and by how frequently the observed hourly count fell within the 50 and 90% prediction intervals.Results:  Hourly ED arrivals were obtained for 8,760 study hours. Separate models were fit for high‐ versus low‐acuity patients because of significant arrival pattern differences. The variance was approximately equal to the mean in the high‐ and low‐acuity models. There was no residual autocorrelation (r = 0) present after controlling for temporal, climatic, and patient factors that influenced the arrival rate. The observed hourly count fell within the 50 and 90% prediction intervals 50 and 90% of the time, respectively. The observed histogram of arrival counts was nearly identical to the histogram predicted by a Poisson process.Conclusions:  At this facility, demand for ED services was well approximated by a Poisson regression model. The expected arrival rate is characterized by a small number of factors and does not depend on recent numbers of arrivals.
Heidelberg retina tomograph parameters of the optic disc in eyes with progressive retinal nerve fibre layer defects
Authors: Saarela Ville , Airaksinen P. Juhani 
Published: March 2008

Abstract.Purpose:  To determine the Heidelberg retina tomograph (HRT) parameters that identify glaucomatous changes in optic nerve head (ONH) topography associated with progression of retinal nerve fibre layer (RNFL) defects.Methods:  A total of 68 eyes with open‐angle glaucoma were included in this retrospective study: 34 eyes showed progression of an RNFL defect during the follow‐up period and 34 eyes did not. Successful RNFL photographs and scanning laser tomography examinations with the HRT were taken in all patients at each of three visits. The change in HRT parameter values during follow‐up was calculated.Results:  Progression of the RNFL defect was statistically significantly correlated (p = 0.049) with only one topographic ONH parameter, the cup shape measure. The best combination of two parameters (p = 0.009) included the maximum cup depth and the linear cup : disc area ratio; the best combination of three parameters (p = 0.007) included the maximum cup depth, the linear cup : disc area ratio and the horizontal cup : disc area ratio. Sensitivity and specificity values were 52.9% and 73.5%, respectively, for the cup shape measure, 70.6% and 73.5%, respectively, for the two‐parameter combination, and 76.5% and 79.4%, respectively, for the three‐parameter combination. The areas under the receiver operating characteristic curve were 0.617, 0.724 and 0.753, respectively.Conclusions:  The results indicate that the HRT parameters may be used to detect small ONH changes associated with progression of the RNFL defect. With the exception of the cup shape measure, the parameters which provide the best correlation with progression differ from those considered optimal for recognizing the presence or absence of glaucoma.
Type 2 diabetes has minimal effect on osseointegration of titanium implants in Psammomys obesus
Authors: Casap Nardy , Nimri Samer , Ziv Ehud , Sela Jona , Samuni Yuval 
Published: March 2008

AbstractObjectives: Dental implants are routinely used with high success rates in generally healthy individuals. In contrast, their use in patients with uncontrolled diabetes mellitus (DM) remains controversial as altered bone healing around implants has been reported. The majority of reports addressing the issue of osseointegration of implants in animals were performed in β‐cell cytotoxic‐induced Type I diabetes. In this study, we assessed the osseointegration of implants in Gerbil Psammomys obesus, a model of nutritionally induced Type 2 DM.Materials and methods: Titanium implants were inserted into the tibial medullary space of 140 male diabetic and control animals. One, 2, 4, and 8 weeks after implantation the tibias were removed for histomorphometric evaluation, which included trabecular bone volumes (TBV) and osseointegration.Results: Two weeks following implantation, diabetic animals had slightly less mature bone when compared with control animals. This distinction was not present 4 weeks after implantation. Interestingly, no correlation was found between ossetointegration or TBV and glucose and insulin levels. Furthermore, no difference in osseointegration and TBV values was seen between the groups. The heterogeneity of serum glucose and insulin levels in this model and the possible role of insulin in bone metabolism are discussed.Conclusions: No significant difference in osseointegration and TBV was seen between diabetic and control P. obesus, a model of nutritionally induced Type 2 DM.
Missing osteogenic effect of expanded autogenous osteoblast‐like cells in a minipig model of sinus augmentation with simultaneous dental implant installation
Authors: Liu Yanming , Springer Ingo N. G. , Zimmermann Corinna E. , Açil Yahya , Scholz‐Arens Katharina , Wiltfang Jörg , Terheyden Hendrik 
Published: March 2008

Abstract:Objectives: With natural bovine bone mineral (BioOss®) as carrier, the study aimed at investigating the effect of autogenous osteoblast‐like cells on bone regeneration in an orthotopic (maxillary sinus) and an ectopic (muscle) site.Materials and methods: Autogenous osteoblast‐like cells were isolated from iliac cancellous bone of six minipigs and expanded in an autogenous serum‐supplemented osteogenic medium. After confirmation of osteogenicity, the expanded cells were precultivated on BioOss® granules for 1 week. Four milliliter of cell‐seeded BioOss® were used for sinus augmentation of right sinus and a Straumann solid screw (dental) implant was simultaneously installed. The contralateral (control) side was filled with cell‐free BioOss®. Besides, 2 ml of the corresponding granules were placed in a pouch in the latissimus dorsi muscles bilaterally. Polychrome sequential labeling was performed postoperatively. Specimens were harvested at week 6. Undecalcified sections were evaluated with microradiography, fluorescence microscopy, histology and histomorphometry.Results: In the test side, the coronal part of dental implant demonstrated higher bone–implant contact (BIC) than the apical part (34.88±28.86% vs. 16.68±13.80%, P=0.039), as well as higher bone density (BD) in the corresponding zone (14.88±6.37% vs. 11.10±4.54%, P=0.021). However, the test side demonstrated no advantage over control side in either BD (12.25±4.22% vs. 8.45±11.04%, P=0.473) or BIC (24.15±21.97% vs. 22.05±19.00%, P=0.270). Rare bone was formed in the muscles in both sides.Conclusions: The expanded autogenous osteoblast‐like cells failed to enhance bone formation in the minipig model of sinus augmentation.
Histomorphometric assessment in human cadavers of the peri‐implant bone density in maxillary tuberosity following implant placement using osteotome and conventional techniques
Authors: Blanco Juan , Suárez Juan , Novio Silvia , Villaverde Gabriel , Ramos Isabel , Segade Luis Alberto G. 
Published: March 2008

AbstractObjective: To evaluate and compare peri‐implant bone condensation in the maxillary tuberosity of human cadavers following the osteotome and standard drilling techniques, and to determine whether peri‐implant bone condensation following the osteotome technique is localized or homogeneous.Material and methods: Twenty‐four cylinder‐threaded titanium implants (12 on each side) were placed in the left (standard technique) and right (osteotome technique with tapered osteotomes for bone condensation, Straumann®) maxillary tuberosities of 12 edentulous posterior maxillae of deceased people who had bequeathed their bodies to the University of Santiago de Compostela for medical‐scientific research. After surgery, the implants were removed with the surrounding bone, prepared using sawing and grinding technique and examined histomorphometrically. The bone density (bone area/analyzed area) of the entire, periapical (fifth apical) and pericylinder peri‐implant areas was calculated, statistically analyzed and compared with the bone density of the host cancellous maxillary bone.Results: The bone density of the entire peri‐implant area was statistically found to be greater with the osteotome technique (39.38 ± 9.67) than with conventional drilling technique (31.06 ± 5.9). This difference was greatest for the periapical zone (53.32 ± 12.26 vs. 34.18 ± 6.34). Nonetheless, in the pericylinder area no significant difference was found between the two techniques (32.30 ± 8.74 vs. 30.34 ± 7.2).Conclusion: Peri‐implant bone condensation following the osteotome technique is not homogeneously observed through the entire peri‐implant area. A greater bone density was achieved only in the fifth apical peri‐implant area.
Dermatologic subspecialties in German inpatient dermatology:a national survey
Authors: Hensen Peter , Müller Marcel L. , Stadler Rudolf , Luger Thomas A. 
Published: March 2008

Summary Background: In German‐speaking countries, the specialty of dermatology is characterized by a large amount of subspecialties. Data providing information whether and to what extent these subspecialties are represented in German dermatology departments and clinics is not available. Methods: A national questionnaire survey was performed to determine the extent of involvement of dermatological subspecialties in dermatologic hospitals.Methods of descriptive statistics were applied. Results: Overall, 90 dermatologic departments participated in this survey with a response rate of 78.3 %.The subspecialties allergology, dermatooncology,and dermatologic surgery are represented in over 90 % of departments; the sub‐specialties andrology, aesthetic dermatology, dermatopathology, microbiology,phlebology,photobiology,proctology, and wound healing are represented in over 50 % of clinics. Furthermore, the subspecialties allergology, dermato‐oncology, photobiology, and dermatopathology have strong research or academic representation. Conclusions: The present survey demonstrates that dermatologic subspecialties are widely represented in dermatologic departments and clinics not only by individuals with specialty training but also by those in higher academic posts. This demonstrated high expertise should be maintained in German dermatology and could be promoted by academic programs.
Anti‐inflammatory potential of a lipolotion containing coriander oil in the ultraviolet erythema test
Authors: Reuter Juliane , Huyke Constance , Casetti Federica , Theek Carmen , Frank Uwe , Augustin Matthias , Schempp Christoph 
Published: March 2008

Summary Background: Coriander oil is used as an antimicrobial agent and as a natural fragrance. The present study investigated the anti‐inflammatory potency of coriander oil in the ultraviolet (UV) erythema test in vivo. Methods: 40 volunteers were enrolled in this monocentric,randomized,placebo‐controlled double‐blind study.Test areas on the back were irradiated with the 1.5 fold minimal erythema dose UV‐B. Subsequently, the test areas were treated under occlusion for 47 hours with a lipolotion containing 0.5% or 1.0% essential coriander oil. Hydrocortisone (1.0%) and betamethasone valerate (0.1%) in the vehicle served as positive controls.The vehicle was used as place‐bo.The effect of the test substances on the UV‐induced erythema was measured photometrically after 48 hours.Additionally,the skin tolerance of the test preparations was assessed on non‐irradiated skin. Results: Compared to placebo, the lipolotion with 0.5% coriander oil significantly reduced the UV‐induced erythema, but it was not as effective as hydrocortisone. The skin tolerance of both coriander oil concentrations was excellent. Conclusions: The lipolotion containing coriander oil displayed a mild antiinflammatory effect in this study. It could be useful in the concomitant treatment of inflammatory skin diseases.