bluuebunny/crossref_metadata_2025_split huggingface dataset:
Doing unto Others? Emergency Medicine Residents' Willingness to Be Treated by Moonlighting Residents and Nonphysician Clinicians in the Emergency Department
Authors: Larkin Gregory L. , Kantor Walter , Zielinski John J. 
Published: January 2008

Abstract Objective: Contentious moonlighting policies and the proliferation of nonphysician clinicians (NPCs) in academic emergency departments (EDs) send conflicting messages to emergency medicine (EM) residents regarding appropriate ED staffing patterns. The objective was to assess EM resident (EMR) views on the ED utilization of unsupervised residents and NPCs from their perspectives as both physicians and prospective patients. Methods: A survey was mailed to a random sample of senior EMRs (sampling fraction, 68%) from the Emergency Medicine Residents Association membership list. Respondents were instructed to assume the role of patient when presented with hypothetical clinical scenarios of increasing severity; outcomes included provider preferences and the impacts of medical urgency, time delays, costs, and supervision on those preferences. Survey items asked about willingness to see residents, nurse practitioners (CRNPs), and physician assistants (PAs), and perceived impact of NPCs on professional identity. Results: A total of 251 EMRs responded. Senior EMRs are more willing to have their care handled by residents as opposed to mid‐level providers. For a moderate illness or injury scenario, 54% agreed to be seen by a resident alone compared with only 17% and 24% willing to be seen by a CRNP and PA, respectively. Only a small fraction of the residents (22.7%) would allow another resident to treat them for a major injury or illness. Residents are more willing to be seen by mid‐level providers if a savings in time can be realized but showed little interest in using NPCs to save money. Approximately one‐third (34%) of the residents view mid‐level providers as a professional threat, but logistic regression reveals this perception to be 2.25 (1.3, 4.0) times higher in male EMRs and 1.94 (1.1, 3.4) times higher in those with higher household incomes (≥$75,000). Conclusions: When assuming the patient role, senior EMRs have preferences for ED care that are consistent with restrictive EMR moonlighting and NPC staffing policies.
Evaluating Paramedic Comfort with Field Pronouncement: Development and Validation of an Outcome Measure
Authors: Morrison Laurie J. , Cheung Matthew C. , Redelmeier Donald A. 
Published: January 2008

Abstract Objectives: Interventions designed to improve cardiac resuscitation and the quality of field pronouncement need to consider outcomes on paramedic providers. The authors developed and evaluated the reliability and validity of a survey instrument measuring paramedic comfort with field pronouncement. Methods: A mail survey of 120 paramedics (EMT‐Ps) was performed using the Modified Dillman survey methodology. Questions were sorted for analysis into subgroups assessing psychological comfort and technical skills. Sixty‐five respondents were retested within two weeks. Results: The overall response rate was 96% (115). Respondents had an average age of 36 years (SD ± 5), with 5.2 years (SD ± 3.8) of out‐of‐hospital experience as an EMT‐P, and were involved in a median of ten field pronouncements annually (range = 2–60). The face and content validity of the survey instrument was consistent with a content matrix derived by a focus group. The Cronbach's alpha for the survey instrument was 0.91. The retest response rate was 76% (46). The test–retest reliability coefficient was 0.84. Conclusions: This survey is a valid and reliable instrument for measuring the paramedic psychological comfort with field pronouncement. The high response rate and intrareliability support its generalizability. This outcome measure may be helpful in evaluating the psychological impact of changes to emergency medical services (EMS) policy with respect to termination of resuscitation promoted by the National Association of EMS Physicians.
Bispectral Electroencephalographic Analysis of Patients Undergoing Procedural Sedation in the Emergency Department
Authors: Miner James R. , Biros Michelle H. , Heegaard William , Plummer David 
Published: January 2008

Abstract Objective: To determine whether there is a correlation between the level of sedation achieved during procedural sedation (PS) in the emergency department as determined by bispectral electroencephalographic (EEG) analysis (BIS) and the rate of respiratory depression (RD), the patient's perception of pain, recall of the procedure, and satisfaction. Methods: This was a prospective observational study conducted in an urban county hospital of adult patients undergoing PS using propofol, methohexital, etomidate, and the combination of fentanyl and midazolam. Consenting patients were monitored by vital signs, pulse oximetry, nasal‐sample end‐tidal carbon dioxide (ETCO2), and BIS monitors during PS. Respiratory depression (RD) was defined as an oxygen saturation <90%, a change from baseline ETCO2 of >10 mm Hg, or an absent ETCO2 waveform at any time during the procedure. After the procedure, patients were asked to complete three 100‐mm visual analog scales (VASs) concerning their perception of pain, recall of the procedure, and satisfaction with the procedure. Patients were divided into four groups based on the lowest BIS score recorded during the procedure, group 1, >85; group 2, 70–85; group 3, 60–69; group 4, <60. Rates of RD and VAS outcomes were compared between groups using chi‐square statistics. Results: One hundred eight patients were enrolled in the study. No serious adverse events were noted. RD was seen in three of 14 (21.4%) of the patients in group 1, seven of 34 (20.6%) in group 2, 16 of 26 (61.5%) in group 3, and 18 of 34 (52.9%) in group 4. The rate of RD in patients in group 2 was not significantly different from that in group 1 (p = 0.46). The rate of RD in group 2 was significantly lower than that in groups 3 (p = 0.0003) and 4 (p = 0.006). For the VAS data, when group 1 was compared with the combined groups 2, 3, and 4, it had significantly higher rates of pain (p = 0.003) and recall (p = 0.001), and a dissatisfaction rate (p = 0.085) that approached significance. When groups 2, 3, and 4 were compared with chi‐square test, there was not a significant difference in pain (p = 0.151), recall (p = 0.27), or satisfaction (p = 0.25). Conclusions: Patients with a lowest recorded BIS score between 70 and 85 had the same VAS outcomes as more deeply sedated patients and the same rate of RD as less deeply sedated patients. This range of scores represented the optimally sedated patients in this study.
Emergency Medicine Animal Research: Does Use of Randomization and Blinding Affect the Results?
Authors: Bebarta Vik , Luyten Dylan , Heard Kennon 
Published: January 2008

Abstract Objectives: It has been shown that human clinical trials that lack randomization (RND) or blinding (BLD) often overestimate the magnitude of treatment effects. However, no studies have evaluated the effect of RND and BLD on animal research. The authors' objectives were to determine the proportion of animal studies presented at a national academic emergency medicine meeting that utilize randomization, blinding, or both; and to determine whether failure to employ these techniques changes the likelihood of observing a difference between treatment groups. Methods: Two trained researchers reviewed abstracts presented at the 1997–2001 Society for Academic Emergency Medicine (SAEM) annual meetings using a standard data collection sheet. Studies that used an animal or cell line, compared two or more study groups, and measured an effect caused by the intervention or drugs were included. Studies were classified as randomized (RND+) if any part of the experiment involved random assignment of subjects to treatment groups, blinded (BLD+) if any assessment of the outcome was made by an investigator blinded to treatment group, and outcome‐positive (Outcome+) if any difference between the study groups met the author's definition of significant. Following the initial review, differences in classification were resolved by consensus. The association between outcome and study methodology (RND, BLD or both) was measured using odds ratios (ORs) with 95% confidence intervals (95% CIs). Results: A total of 2,592 studies were published as abstracts. Three hundred eighty‐nine were animal studies, and 290 of these studies had two or more study groups. RND− and BLD− studies were more likely to be Outcome+ than RND+ or BLD+ studies (OR = 3.4; 95% CI = 1.7 to 6.9 and OR = 3.2; 95% CI = 1.3 to 7.7, respectively). When studies that used both RND and BND were compared with studies that used neither, the OR for a positive study was 5.2 (95% CI = 2.0 to 13.5). Conclusions: These results suggest that animal studies that do not utilize RND and BLD are more likely to report a difference between study groups than studies that employ these methods.
Failed Validation of the Argall Weight Formula for Estimating Children's Weight in an Australian Emergency Department
Authors: Nguyen Kevin , Krieser David , Kerr Debra , Jolley Damien , Clooney Megan , Kelly Anne‐Maree 
Published: January 2008

BackgroundAn estimate of a child's weight is required for critical interventions, particularly pharmacotherapy. Weight measurement is not always practical, so weight estimation methods are used. Recently, a new weight estimation formula was suggested. The Argall formula estimates weight in kilograms as follows: (age in years + 2) × 3. ObjectivesTo validate the Argall weight formula. MethodsThis was a prospective, observational, cohort study conducted in the pediatric emergency department (ED) of Sunshine Hospital. Children aged up to 11 years who presented to the ED during August 18, 2005, to February 25, 2006, were included. Actual weight, height, age, and ethnicity were obtained. Data were analyzed by descriptive statistics (proportion, mean, median, and SD). Agreement between estimated weight using the Argall formula and measured weight is reported by using mean bias, SD, and root mean square error (RMSE) analysis. ResultsFour hundred ten cases were included, 46% were female, and the median age was 4 years. The Argall formula had a mean bias of −1.66 kg and RMSE of 5.65. Only 37% of Argall estimates were within 10% of the child's actual weight. The formula performed less well in children weighing more than 35 kg but performed better in Asian children than white children. ConclusionsThe Argall weight estimation formula has poor accuracy for weight estimation in Australian children, in particular those weighing more than 35 kg.
Lethal Mutagenesis of Picornaviruses with N-6-Modified Purine Nucleoside Analogues
Authors: Graci Jason D. , Too Kathleen , Smidansky Eric D. , Edathil Jocelyn P. , Barr Eric W. , Harki Daniel A. , Galarraga Jessica E. , Bollinger J. Martin , Peterson Blake R. , Loakes David , Brown Daniel M. , Cameron Craig E. 
Published: January 2008

ABSTRACTRNA viruses exhibit extraordinarily high mutation rates during genome replication. Nonnatural ribonucleosides that can increase the mutation rate of RNA viruses by acting as ambiguous substrates during replication have been explored as antiviral agents acting through lethal mutagenesis. We have synthesized novel N-6-substituted purine analogues with ambiguous incorporation characteristics due to tautomerization of the nucleobase. The most potent of these analogues reduced the titer of poliovirus (PV) and coxsackievirus (CVB3) over 1,000-fold during a single passage in HeLa cell culture, with an increase in transition mutation frequency up to 65-fold. Kinetic analysis of incorporation by the PV polymerase indicated that these analogues were templated ambiguously with increased efficiency compared to the known mutagenic nucleoside ribavirin. Notably, these nucleosides were not efficient substrates for cellular ribonucleotide reductase in vitro, suggesting that conversion to the deoxyriboucleoside may be hindered, potentially limiting genetic damage to the host cell. Furthermore, a high-fidelity PV variant (G64S) displayed resistance to the antiviral effect and mutagenic potential of these analogues. These purine nucleoside analogues represent promising lead compounds in the development of clinically useful antiviral therapies based on the strategy of lethal mutagenesis.
Reduced Susceptibility of
Proteus mirabilis
to Triclosan
Authors: Stickler David J. , Jones Gwennan L. 
Published: January 2008

ABSTRACT

Clinical isolates of
Proteus mirabilis
causing catheter encrustation and blockage are susceptible to the biocide triclosan (MICs of 0.2 mg/liter). Studies with laboratory models of the bladder have demonstrated that the inflation of catheter retention balloons with triclosan solutions rather than water results in the diffusion of triclosan from the balloons into the surrounding urine and the inhibition of catheter encrustation by
P. mirabilis
. The aim of this study was to test whether the exposure of
P. mirabilis
to triclosan under laboratory conditions resulted in the selection of strains with reduced susceptibilities to this biocide. Exposure to triclosan in agar was shown to select mutants with MICs elevated from 0.2 mg/liter up to 80 mg/liter. In a selection of 14 of these strains, the decreased susceptibility was found to be stable and not associated with increased resistance to antibiotics. Experiments with the laboratory models demonstrated that inflation of the catheter balloons with triclosan (10 mg/ml) prevented encrustation and blockage by the parent strain
P. mirabilis
B2 (MIC, 0.2 mg/liter) and the mutant strain M48 (MIC, 2.0 mg/liter) but had no effect on crystalline biofilm formation by strain M55 (MIC, 40 mg/liter). These results suggest that, in any clinical trial or subsequent clinical use of the strategy, it will be important to monitor the urinary flora of the catheterized patients for
P. mirabilis
strains with reduced susceptibility to triclosan. The emergence of these strains could undermine the ability of the triclosan strategy to control catheter encrustation.
Determinants of In Vitro Drug Susceptibility Testing of
Plasmodium vivax
Authors: Russell B. , Chalfein F. , Prasetyorini B. , Kenangalem E. , Piera K. , Suwanarusk R. , Brockman A. , Prayoga P. , Sugiarto P. , Cheng Q. , Tjitra E. , Anstey N. M. , Price R. N. 
Published: January 2008

ABSTRACT

In Papua, Indonesia, the antimalarial susceptibility of
Plasmodium vivax
(
n
= 216) and
P. falciparum
(
n
= 277) was assessed using a modified schizont maturation assay for chloroquine, amodiaquine, artesunate, lumefantrine, mefloquine, and piperaquine. The most effective antimalarial against
P. vivax
and
P. falciparum
was artesunate, with geometric mean 50% inhibitory concentrations (IC
50
s) (95% confidence intervals [CI]) of 1.31 nM (1.07 to 1.59) and 0.64 nM (0.53 to 0.79), respectively. In contrast, the geometric mean chloroquine IC
50
for
P. vivax
was 295 nM (227 to 384) compared to only 47.4 nM (42.2 to 53.3) for
P. falciparum
. Two factors were found to significantly influence the in vitro drug response of
P. vivax
: the initial stage of the parasite and the duration of the assay. Isolates of
P. vivax
initially at the trophozoite stage had significantly higher chloroquine IC
50
s (478 nM [95% CI, 316 to 722]) than those initially at the ring stage (84.7 nM [95% CI, 45.7 to 157];
P
< 0.001). Synchronous isolates of
P. vivax
and
P. falciparum
which reached the target of 40% schizonts in the control wells within 30 h had significantly higher geometric mean chloroquine IC
50
s (435 nM [95% CI, 169 to 1,118] and 55.9 nM [95% CI, 48 to 64.9], respectively) than isolates that took more than 30 h (39.9 nM [14.6 to 110.4] and 36.9 nM [31.2 to 43.7];
P
< 0.005). The results demonstrate the marked stage-specific activity of chloroquine with
P. vivax
and suggest that susceptibility to chloroquine may be associated with variable growth rates. These findings have important implications for the phenotypic and downstream genetic characterization of
P. vivax
.
A Class II Histone Deacetylase Acts on Newly Synthesized Histones in
Tetrahymena
Authors: Smith Joshua J. , Torigoe Sharon E. , Maxson Julia , Fish Lisa C. , Wiley Emily A. 
Published: January 2008

ABSTRACT

Newly synthesized histones are acetylated prior to their deposition into nucleosomes. Following nucleosome formation and positioning, they are rapidly deacetylated, an event that coincides with further maturation of the chromatin fiber. The histone deacetylases (HDACs) used for histone deposition and de novo chromatin formation are poorly understood. In the ciliate
Tetrahymena thermophila
, transcription-related deacetylation in the macronucleus is physically separated from deposition-related deacetylation in the micronucleus. This feature was utilized to identify an HDAC named Thd2, a class II HDAC that acts on newly synthesized histones to remove deposition-related acetyl moieties. The
THD2
transcript is alternatively spliced, and the major form contains a putative inositol polyphosphate kinase (IPK) domain similar to Ipk2, an enzyme that promotes chromatin remodeling by SWI/SNF remodeling complexes. Cells lacking Thd2, which retain deposition-related acetyl moieties on new histones, exhibit chromatin and cytological phenotypes indicative of a role for Thd2 in chromatin maturation, including the proteolytic processing of histone H3.
Peroxisome Proliferator-Activated Receptors Mediate Host Cell Proinflammatory Responses toPseudomonas aeruginosaAutoinducer
Authors: Jahoor Aruna , Patel Rashila , Bryan Amanda , Do Catherine , Krier Jay , Watters Chase , Wahli Walter , Li Guigen , Williams Simon C. , Rumbaugh Kendra P. 
Published: January 2008

ABSTRACTThe pathogenic bacteriumPseudomonas aeruginosautilizes the 3-oxododecanoyl homoserine lactone (3OC12-HSL) autoinducer as a signaling molecule to coordinate the expression of virulence genes through quorum sensing. 3OC12-HSL also affects responses in host cells, including the upregulation of genes encoding inflammatory cytokines. This proinflammatory response may exacerbate underlying disease duringP. aeruginosainfections. The specific mechanism(s) through which 3OC12-HSL influences host responses is unclear, and no mammalian receptors for 3OC12-HSL have been identified to date. Here, we report that 3OC12-HSL increases mRNA levels for a common panel of proinflammatory genes in murine fibroblasts and human lung epithelial cells. To identify putative 3OC12-HSL receptors, we examined the expression patterns of a panel of nuclear hormone receptors in these two cell lines and determined that both peroxisome proliferator-activated receptor beta/delta (PPARβ/δ) and PPARγ were expressed. 3OC12-HSL functioned as an agonist of PPARβ/δ transcriptional activity and an antagonist of PPARγ transcriptional activity and inhibited the DNA binding ability of PPARγ. The proinflammatory effect of 3OC12-HSL in lung epithelial cells was blocked by the PPARγ agonist rosiglitazone, suggesting that 3OC12-HSL and rosiglitazone are mutually antagonistic negative and positive regulators of PPARγ activity, respectively. These data identify PPARβ/δ and PPARγ as putative mammalian 3OC12-HSL receptors and suggest that PPARγ agonists may be employed as anti-inflammatory therapeutics forP. aeruginosainfections.
DNA Microarray Analysis of Central Carbohydrate Metabolism: Glycolytic/Gluconeogenic Carbon Switch in the Hyperthermophilic Crenarchaeum
Thermoproteus tenax
Authors: Zaparty Melanie , Zaigler Alexander , Stamme Claudia , Soppa Jörg , Hensel Reinhard , Siebers Bettina 
Published: January 2008

ABSTRACT

In order to unravel the role of regulation on transcript level in central carbohydrate metabolism (CCM) of
Thermoproteus tenax
, a focused DNA microarray was constructed by using 85 open reading frames involved in CCM. A transcriptional analysis comparing heterotrophic growth on glucose versus autotrophic growth on CO
2
-H
2
was performed.
Pseudomonas aeruginosa
AlgR Regulates Type IV Pilus Biosynthesis by Activating Transcription of the
fimU-pilVWXY1Y2E
Operon
Authors: Belete Belen , Lu Haiping , Wozniak Daniel J. 
Published: January 2008

ABSTRACT

The response regulator AlgR is required for
Pseudomonas aeruginosa
type IV pilus-dependent twitching motility, a flagellum-independent mode of solid surface translocation. Prior work showed that AlgR is phosphorylated at aspartate 54, and cells expressing an AlgR variant that cannot undergo phosphorylation (AlgRD54N) lack twitching motility. However, the mechanism by which AlgR controls twitching motility is not completely understood. We hypothesized that AlgR functioned by activating genes within the prepilin
fimU-pilVWXY1Y2E
cluster that are necessary for type IV pilin biogenesis. Reverse transcriptase PCR analysis showed that the
fimU-pilVWXY1Y2E
genes are cotranscribed in an operon, which is under the control of AlgR. This supports prior transcriptional profiling studies of wild-type strains and
algR
mutants. Moreover, expression of the
fimU-pilVWXY1Y2
E operon was reduced in strains expressing AlgRD54N. DNase footprinting and electrophoretic mobility shift assays demonstrate that AlgR but not AlgRD54N bound with high affinity to two sites upstream of the
fimU-pilVWXY1Y2E
operon. Altogether, our findings indicate that AlgR is essential for proper pilin localization and that phosphorylation of AlgR results in direct activation of the
fimU-pilVWXY1Y2E
operon, which is required for the assembly and export of a functional type IV pilus.
Functional Differences between Heme Permeases:
Serratia marcescens
HemTUV Permease Exhibits a Narrower Substrate Specificity (Restricted to Heme) Than the
Escherichia coli
DppABCDF Peptide-Heme Permease
Authors: Létoffé Sylvie , Delepelaire Philippe , Wandersman Cécile 
Published: January 2008

ABSTRACT

Serratia marcescens hemTUV
genes encoding a potential heme permease were cloned in
Escherichia coli
recombinant mutant FB827
dppF
::Km(pAM 238-hasR). This strain, which expresses HasR, a foreign heme outer membrane receptor, is potentially capable of using heme as an iron source. However, this process is invalidated due to a
dppF
::Km mutation which inactivates the Dpp heme/peptide permease responsible for heme, dipeptide, and δ-aminolevulinic (ALA) transport through the
E. coli
inner membrane. We show here that
hemTUV
genes complement the Dpp permease for heme utilization as an iron source and thus are functional in
E. coli
. However,
hemTUV
genes do not complement the Dpp permease for ALA uptake, indicating that the HemTUV permease does not transport ALA. Peptides do not inhibit heme uptake in vivo, indicating that, unlike Dpp permease, HemTUV permease does not transport peptides. HemT, the periplasmic binding protein, binds heme. Heme binding is saturable and not inhibited by peptides that inhibit heme uptake by the Dpp system. Thus, the
S. marcescens
HemTUV permease and, most likely, HemTUV orthologs present in many gram-negative pathogens form a class of heme-specific permeases different from the Dpp peptide/heme permease characterized in
E. coli
.