bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Six‐item Screener to Detect Cognitive Impairment in Older Emergency Department Patients
Authors: Wilber Scott T. , Carpenter Christopher R. , Hustey Fredric M. 
Published: July 2008

AbstractBackground:  Cognitive impairment due to delirium or dementia is common in older emergency department (ED) patients. To prevent errors, emergency physicians (EPs) should use brief, sensitive tests to evaluate older patient’s mental status. Prior studies have shown that the Six‐Item Screener (SIS) meets these criteria.Objectives:  The goal was to verify the performance of the SIS in a large, multicenter sample of older ED patients.Methods:  A prospective, cross‐sectional study was conducted in three urban academic medical center EDs. English‐speaking ED patients ≥65 years old were enrolled. Patients who received medications that could affect cognition, were too ill, were unable to cooperate, were previously enrolled, or refused to participate were excluded. Patients were administered either the SIS or the Mini‐Mental State Examination (MMSE), followed by the other test 30 minutes later. An MMSE of 23 or less was the criterion standard for cognitive impairment; the SIS cutoff was 4 or less for cognitive impairment. Standard operator characteristics of diagnostic tests were calculated with 95% confidence intervals (CIs), and a receiver operating characteristic curve was plotted.Results:  The authors enrolled 352 subjects; 111 were cognitively impaired by MMSE (32%, 95% CI = 27% to 37%). The SIS was 63% sensitive (95% CI = 53% to 72%) and 81% specific (95% CI = 75% to 85%). The area under the receiver operating characteristic curve was 0.77 (95% CI = 0.72 to 0.83).Conclusions:  The sensitivity of the SIS was lower than in prior studies. The reasons for this lower sensitivity are unclear. Further study is needed to clarify the ideal brief mental status test for ED use.ACADEMIC EMERGENCY MEDICINE 2008; 15:613–616 © 2008 by the Society for Academic Emergency Medicine
Sixty‐four–slice Computed Tomography of the Coronary Arteries: Cost–Effectiveness Analysis of Patients Presenting to the Emergency Department with Low‐risk Chest Pain
Authors: Khare Rahul K. , Mark Courtney D. , Powell Emilie S. , Venkatesh Arjun K. , Lee Todd A. 
Published: July 2008

AbstractObjectives: The aim was to use a computer model to estimate the cost–effectiveness of 64‐slice multidetector computed tomography (MDCT) of the coronary arteries in the emergency department (ED) compared to an observation unit (OU) stay plus stress electrocardiogram (ECG) or stress echocardiography for the evaluation of low‐risk chest pain patients presenting to the ED.Methods: A decision analytic model was developed to compare health outcomes and costs that result from three different risk stratification strategies for low‐risk chest pain patients in the ED: stress ECG testing after OU care, stress echocardiography after OU care, and MDCT with no OU care. Three patient populations were modeled with the prevalence of symptomatic coronary artery disease (CAD) being very low risk, 2%; low risk, 6% (base case); and moderate risk, 10%. Outcomes were measured as quality‐adjusted life years (QALYs). Incremental cost–effectiveness ratios (ICERs), the ratio of change in costs of one test over another to the change in QALY, were calculated for comparisons between each strategy. Sensitivity analyses were conducted to test the robustness of the results to assumptions regarding the characteristics of the risk stratification strategies, costs, utility weights, and likelihood of events.Results: In the base case, the mean (±standard deviation [SD]) costs and QALYs for each risk stratification strategy were MDCT arm $2,684 (±$1,773 to $4,418) and 24.69 (±24.54 to 24.76) QALYs, stress echocardiography arm $3,265 (±$2,383 to $4,836) and 24.63 (±24.28 to 24.74) QALYs, and stress ECG arm $3,461 (±$2,533 to $4,996) and 24.59 (±24.21 to 24.75) QALYs. The MDCT dominated (less costly and more effective) both OU plus stress echocardiography and OU plus stress ECG. This resulted in an ICER where the MDCT arm dominated the stress echocardiography arm (95% confidence interval [CI] = dominant to $29,738) and where MDCT dominated the ECG arm (95% CI = dominant to $7,332). The MDCT risk stratification arm also dominated stress echocardiography and stress ECG in the 2 and 10% prevalence scenarios, which demonstrated the same ICER trends as the 6% prevalence CAD base case. The thresholds where the MDCT arm remained a cost‐saving strategy compared to the other risk stratification strategies were cost of MDCT, <$2,097; cost of OU care, >$1,092; prevalence of CAD, <70%; MDCT specificity, >65%; and a MDCT indeterminate rate, <30%.Conclusions: In this computer‐based model analysis, the MDCT risk stratification strategy is less costly and more effective than both OU‐based stress echocardiography and stress ECG risk stratification strategies in chest pain patients presenting to the ED with low to moderate prevalence of CAD.ACADEMIC EMERGENCY MEDICINE 2008; 15:1–10 © 2008 by the Society for Academic Emergency Medicine
Medical Malpractice: Utilization of Layered Simulation for Resident Education
Authors: Schlicher Nathaniel Ryan , Ten Eyck Raymond P. 
Published: July 2008

AbstractObjectives:  The authors present a novel approach to the use of simulation in medical education with a two‐event layered simulation. A patient care simulation with an adverse outcome was followed by a simulated deposition.Methods:  Senior residents in an academic emergency medicine (EM) program were solicited as simulation research volunteers. Other than stating that the research involved adverse outcomes, no identifying information was given. Seven volunteers participated in a simulation involving a forced error (nurse confederate gave an incorrect medication dose). Six weeks later based on the initial simulation, one physician completed a simulated deposition in a teaching conference conducted by a licensed attorney with malpractice experience. The audience, consisting of residents, attendings, and students, watched a recording of the patient care, witnessed the deposition, and evaluated the experience using a 17‐question survey with 5‐point Likert scales.Results:  Participants felt that overall the training program was a useful educational tool (mean ± standard deviation [SD] Likert score = 4.63 ± 0.49) that would change aspects of their practice (3.31 ± 0.85). Participants stated that they would be more careful in their documentation (3.88 ± 0.60), review high‐risk situations with staff (4.00 ± 0.71), and monitor more carefully for errors (3.95 ± 0.74). There was increased fear of the litigation process (3.95 ± 1.18), but participants felt the experience would help improve the risk profile of their practices (3.71 ± 0.68).Conclusions:  A novel approach to medical education was successful in changing attitudes and provided an expanded educational experience for participants. Layered simulation can be successfully incorporated into educational programs for numerous issues including medical malpractice.
Binding of Vigna unguiculata vicilins to the peritrophic membrane of Tenebrio molitor affects larval development
Authors: Paes E. V. , Uchôa A. F. , Pinto M. S. T. , Silva C. P. , Fernandes K. V. S. , Oliveira A. E. A. , Xavier‐Filho J. 
Published: July 2008

AbstractWe investigated the effects of vicilins (7S storage proteins) from Vigna unguiculata (L.) Walp. (Fabaceae), cultivars EPACE‐10 [genotype susceptible to the cowpea weevil, Callosobruchus maculatus (Fabricius)] and IT81D‐1045 [cowpea weevil‐resistant genotype], seeds on Tenebrio molitor L. (Coleoptera: Tenebrionidae) larval development. Toxicity of vicilins was investigated through the incorporation of these proteins in artificial diet offered to the larvae. Binding tests of vicilins to the peritrophic membranes (PM) were carried out by in vitro incubation of PM with solutions of vicilins. Bound proteins were desorbed from PM with 100 mm HCl. Desorbed vicilins were analyzed by sodium dodecyl sulfate–polyacrylamide gel electrophoresis followed by immunoprobing on Western blotting using an anti‐vicilin cv. EPACE‐10 antibody. The chitin content of the T. molitor PM was evaluated by the Von Wisselingh color test and presence of chitin in the larval PM was confirmed. Bioassays showed that both vicilins from EPACE‐10 and IT81D‐1045 genotypes were toxic to T. molitor larvae, and in vitro binding assays showed that these seed‐storage proteins were capable of binding to the larval PM.
Leaf surface preference in the cabbage worm, Pieris rapae crucivora, and parasitism by the gregarious parasitoid Cotesia glomerata
Authors: Tagawa J. , Matsushita A. , Watanabe T. 
Published: July 2008

AbstractLeaf surface preference of the cabbage worm, Pieris rapae crucivora Boisduval (Lepidoptera: Pieridae), for cabbage, Brassica oleracea L. var. capitata (Brassicaceae), and parasitism by the parasitoid Cotesia glomerata (L.) (Hymenoptera: Braconidae) were investigated experimentally in the laboratory. Female butterflies did not discriminate between the adaxial and abaxial surfaces of cabbage leaves when laying eggs on a vertically placed leaf. Larvae also did not discriminate between the adaxial and abaxial surfaces throughout their larval life. However, second and third instars preferred the lower surface of horizontally placed leaves to the upper surface, irrespective of whether they had hatched on the upper or lower side; other instars showed no preference for the lower surface. Parasitism rates of first and second instars on the upper surface were higher than those of larvae on the lower surface. Egg distribution on leaf surfaces and the leaf surface preference by young larvae are discussed in terms of avoidance of parasitism by the parasitoid C. glomerata.
The use of the OSCE in postgraduate education
Authors: Arnold R. C. , Walmsley A. D. 
Published: July 2008

AbstractBackground:  The Objective Structured Clinical Examination (OSCE) is a method of assessing the clinical skills of undergraduates in medicine, dentistry and other health sciences and is employed increasingly in postgraduate education.Aim:  To describe the application of the OSCE to the development of Lifelong Learning and Continuing Professional Development (CPD) for General Dental Practitioners (GDPs).Methods:  A postgraduate course was designed as an OSCE for GDPs. The OSCE comprised 12 stations covering different aspects of general dentistry. After an introductory seminar outlining the aim of the course, the participants spent 7 min at each station. Each question or task required 10 answers and was designed to highlight areas of weakness or interest and to stimulate further study of the presenting topic. Solutions and answers were provided at each station for self‐assessment along with a list of locally presented courses related to that subject. Participants were invited to leave contact details and to make suggestions for future postgraduate courses. The final session consisted of a group discussion and participants were invited to complete an evaluation form to express opinions on the course.Results:  The evaluation demonstrated that most candidates found participation in the OSCE stimulated their interest in CPD. The OSCE also highlighted areas of weakness in knowledge of certain clinical procedures. Group discussion confirmed that practitioners found the hands‐on component valuable and that they were likely to participate in further OSCEs to enhance their CPD. Suggestions received during the discussion were used to modify the course.Conclusions:  The OSCE course fulfilled its aim of assisting practitioners to organise their CPD. The reflective nature of the course was helpful in evaluating clinical knowledge and the unique multidisciplinary style fulfilled its objective in promoting thoughts regarding future study.
On the reliability of a dental OSCE, using SEM: effect of different days
Authors: Schoonheim‐Klein M. , Muijtens A. , Habets L. , Manogue M. , Van der Vleuten C. , Hoogstraten J. , Van der Velden U. 
Published: July 2008

AbstractAim:  The first aim was to study the reliability of a dental objective structured clinical examination (OSCE) administered over multiple days, and the second was to assess the number of test stations required for a sufficiently reliable decision in three score interpretation perspectives of a dental OSCE administered over multiple days.Materials and methods:  In four OSCE administrations, 463 students of the year 2005 and 2006 took the summative OSCE after a dental course in comprehensive dentistry. The OSCE had 16–18 5‐min stations (scores 1–10), and was administered per OSCE on four different days of 1 week. ANOVA was used to test for examinee performance variation across days. Generalizability theory was used for reliability analyses. Reliability was studied from three interpretation perspectives: for relative (norm) decisions, for absolute (domain) and pass–fail (mastery) decisions.As an indicator of reproducibility of test scores in this dental OSCE, the standard error of measurement (SEM) was used. The benchmark of SEM was set at <0.51. This is corresponding to a 95% confidence interval (CI) of <1 on the original scoring scale that ranged from 1 to 10.Results:  The mean weighted total OSCE score was 7.14 on a 10‐point scale. With the pass–fail score set at 6.2 for the four OSCE, 90% of the 463 students passed.There was no significant increase in scores over the different days the OSCE was administered. ‘Wished’ variance owing to students was 6.3%. Variance owing to interaction between student and stations and residual error was 66.3%, more than two times larger than variance owing to stations’ difficulty (27.4%). The SEM norm was 0.42 with a CI of ±0.83 and the SEM domain was 0.50, with a CI of ±0.98. In order to make reliable relative decisions (SEM <0.51), the use of minimal 12 stations is necessary, and for reliable absolute and pass–fail decisions, the use of minimal 17 stations is necessary in this dental OSCE.Conclusions:  It appeared reliable, when testing large numbers of students, to administer the OSCE on different days. In order to make reliable decisions for this dental OSCE, minimum 17 stations are needed. Clearly, wide sampling of stations is at the heart of obtaining reliable scores in OSCE, also in dental education.
A patient‐centred approach to teaching and learning in dental student clinical practice
Authors: Eriksen H. M. , Bergdahl J. , Bergdahl Maud 
Published: July 2008

AbstractA patient‐centred clinical teaching profile in the undergraduate dental curriculum at The University of Tromsø is described. This teaching profile implies that treatment planning is primarily based on the patients’ perceived needs and the students are trained to retrieve information from the patients in this context. The role of the clinical instructor is primarily as a facilitator rather than an expert. The ‘best interest of the patient’ is not always easy to disclose and consequences related to the patients’ levels of understanding, students competence, educational challenges and professional ethics are topics for discussion through the clinical education programme.
Reading, complexity and the brain
Authors: Goswami Usha 
Published: July 2008

AbstractBrain imaging offers a new technology for understanding the acquisition of reading by children. It can contribute novel evidence concerning the key mechanisms supporting reading, and the brain systems that are involved. The extensive neural architecture that develops to support efficient reading testifies to the complex developmental processes that underpin the acquisition of literacy. Here, I provide a brief overview of recent studies, analysed within a cognitive framework of reading development.
Can the simple view deal with the complexities of reading?
Authors: Kirby John R. , Savage Robert S. 
Published: July 2008

AbstractWe review the Simple View of Reading (SVR) model and examine its nature, applicability and validity. We describe the SVR as an abstract framework for understanding the relationship between global linguistic comprehension and word‐reading abilities in reading comprehension (RC). We argue that the SVR is neither a full theory of reading nor a blueprint for instruction. Nevertheless we argue that the model is helpful in conceptualising these broad skills and thus in planning for teaching and learning. We review empirical evidence concerning the SVR, suggesting that it provides a good fit to much scientific data on typical and atypical development, and variation among students across the school age range. We also indicate several areas in which we think the SVR is incomplete or in need of further empirical support. These include the way in which word decoding is conceptualised, the ways in which RC is measured, RC strategies, the role of reading fluency, reading with illustrations and second‐language reading.
An ecological view of literacy learning
Authors: Syverson Peg 
Published: July 2008

AbstractThis article refutes the common, persistent belief in literacy learning as a linear, sequential process best broken down into small steps that can be taught mechanically in order to produce timely, quantifiable ‘outcomes’, regardless of the vast diversity among learners, teachers, institutions of learning, communities, cultures, media and languages. This naïve and simplistic belief, which flies in the face of virtually all evidence from direct observation, research on literacy learning, evolutionary biology, cognitive science, psychological and social science research, neurophysiology, educational theory, public policy, anthropology and communication, nevertheless remains well entrenched, despite its destructive consequences. Presented here is the evidence in support of an alternative view, an ecological perspective which takes into account the complex ecosystems within which teachers and learners learn, adapt, interact, communicate and connect. Furthermore, it presents a sensible and humane model for documenting and assessing learning and teaching ecologically, the Learning Record. This model is well supported both theoretically and practically, with over 20 years of successful implementation for thousands of students at every level, from pre‐school to graduate school; in every discipline, from maths to biology to writing; and across diverse student populations, from inner‐city schools to reservation schools, migrant populations, students with disabilities and newly arrived English language learners.
Toward Quantifying the Relative Importance of Invertebrate Consumption and Bioturbation in Puerto Rican Streams
Authors: Cross Wyatt. F. , Ramírez A. , Santana A. , Santiago L. Silvestrini 
Published: July 2008

ABSTRACTAlthough many tropical stream consumers have large effects on resource quantity and quality, little is known about the relative importance of consumption versus bioturbation. We quantified egestion rates of freshwater shrimps (Atya spp. and Xiphocaris elongata) and mayflies (Leptophlebiidae) in two forest streams within the Luquillo Experimental Forest, Puerto Rico. Consumer body size was a strong predictor of egestion rates, with mass‐specific egestion rates declining with body size and per‐individual egestion rates increasing with body size. We used these egestion rates, together with published rates of epilithon removal by consumers and epilithon accrual by particle deposition and periphytic growth (i.e., with and without consumer access), to estimate the importance of consumption and bioturbation after storm events and during base‐flow conditions. Our estimates suggest that direct consumption of epilithon can only account for a minor proportion (< 5%) of material removed following storm events, with most removal likely resulting from bioturbation. During base‐flow conditions, we found that consumers (largely shrimps) may be capable of consuming a significant proportion of the material that would otherwise accrue on benthic substrata, but this result was limited to one high‐elevation site. Our study suggests that bioturbation is the dominant process that redistributes and entrains fine particles after storm events, and that a variable fraction of deposited and accrued benthic material may be consumed during base‐flow conditions. Our results underscore the importance of tropical stream animals in altering the benthic environment through both consumption and bioturbation, and suggest that consumer‐mediated material cycling is likely to be context dependent.
Weak Competition Among Tropical Tree Seedlings: Implications for Species Coexistence
Authors: Timothy Paine C. E. , Harms Kyle E. , Schnitzer Stefan A. , Carson Walter P. 
Published: July 2008

ABSTRACTThe intensity of competition among forest tree seedlings is poorly understood, but has important ramifications for their recruitment and for the maintenance of species diversity. Intense competition among seedlings could allow competitively dominant species to exclude subordinate species. Alternatively, the low density and small stature of forest tree seedlings could preclude intense interseedling competition. In this case, other processes, such as size‐asymmetric competition with adults, interactions with consumers, or neutral dynamics would prevail as those structuring the forest understory. We tested the intensity of, and potential for, intraspecific competition among tree seedlings of three species (Brosimum alicastrum, Matisia cordata, and Pouteria reticulata) in two Neotropical rain forests. We reduced stem densities by up to 90 percent and monitored individual growth and survival rates for up to 24 mo. Individual growth and survival rates were generally unrelated to stem density. Contrary to the predicted behavior of intensely competing plant populations, the distribution of individual heights did not become more left‐skewed with time for any species, regardless of plot density; i.e., excesses of short, suppressed individuals did not accumulate in high‐density plots. We further measured the overlap of zones of influence (ZOIs) to assess the potential for resource competition. Seedling ZOIs overlapped only slightly in extremely dense monodominant plots, and even less in ambient‐density plots of mixed composition. Our results thus suggest that interseedling competition was weak. Given the low density of tree seedlings in Neotropical forests, we infer that resource competition among seedlings may be irrelevant to their recruitment.
Preliminary Information on the Home Range and Movement Patterns of Sturnira lilium (Phyllostomidae) in a Naturally Fragmented Landscape in Bolivia
Authors: Loayza Andrea P. , Loiselle Bette A. 
Published: July 2008

ABSTRACTHere, we used radiotelemetry to determine home range and movement patterns of the frugivorous bat Sturnira lilium in a naturally fragmented landscape in Beni, Bolivia. Four females were monitored for up to 7 d. Based on 575 radiotelemetry positions, kernel home ranges were between 36.5 and 90.7 ha. During each night, bats visited most of their home range, which included forest islands and continuous forest; however activity was concentrated in core‐use areas representing 6–12 percent of the home ranges. There was moderate overlap in home range and core‐use areas among the four females. The mean long axis across the kernel home ranges was 1324 m. The results reported here show that S. lilium is able to move freely among forest elements in the landscape while crossing a savanna matrix. Hence, S. lilium may contribute to maintain connectivity and ecological processes in a fragmented landscape.