bluuebunny/crossref_metadata_2025_split huggingface dataset:
Failure to up-regulate VEGF165b in maternal plasma is a first trimester predictive marker for pre-eclampsia
Authors: Bills Victoria L. , Varet Julia , Millar Ann , Harper Steven J. , Soothill Peter W. , Bates David O. 
Published: October 2008

Pre-eclampsia is a pregnancy-related condition characterized by hypertension, proteinuria and endothelial dysfunction. VEGF165b, formed by alternative splicing of VEGF (vascular endothelial growth factor) pre-mRNA, inhibits VEGF165-mediated vasodilation and angiogenesis, but has not been quantified in pregnancy. ELISAs were used to measure means±S.E.M. plasma VEGF165b, sEng (soluble endoglin) and sFlt-1 (soluble fms-like tyrosine kinase-1). At 12 weeks of gestation, the plasma VEGF165b concentration was significantly up-regulated in plasma from women who maintained normal blood pressure throughout their pregnancy (normotensive group, 4.90±1.6 ng/ml; P&lt;0.01, as determined using a Mann-Whitney U test) compared with non-pregnant women (0.40±0.22 ng/ml). In contrast, in patients who later developed pre-eclampsia, VEGF165b levels were lower than in the normotensive group (0.467±0.209 ng/ml), but were no greater than non-pregnant women. At term, plasma VEGF165b concentrations were greater than normal in both pre-eclamptic (3.75±2.24 ng/ml) and normotensive (10.58 ng/ml±3.74 ng/ml; P&gt;0.1 compared with pre-eclampsia) pregnancies. Patients with a lower than median plasma VEGF165b at 12 weeks had elevated sFlt-1 and sEng pre-delivery. Concentrations of sFlt-1 (1.20±0.07 and 1.27±0.18 ng/ml) and sEng (4.4±0.18 and 4.1±0.5 ng/ml) were similar at 12 weeks of gestation in the normotensive and pre-eclamptic groups respectively. Plasma VEGF165b levels were elevated in pregnancy, but this increase is delayed in women that subsequently develop pre-eclampsia. In conclusion, low VEGF165b may therefore be a clinically useful first trimester plasma marker for increased risk of pre-eclampsia.
Assessing the Integration of Health Center and Community Emergency Preparedness and Response Planning
Authors: Wineman Nicole V. , Braun Barbara I. , Barbera Joseph A. , Loeb Jerod M. 
Published: October 2008

ABSTRACTBackground: To assess the state of health center integration into community preparedness, we undertook a national study of linkages between health centers and the emergency preparedness and response planning initiatives in their communities. The key objectives of this project were to gain a better understanding of existing linkages in a nationally representative sample of health centers, and identify health center demographic and experience factors that were associated with strong linkages.Methods: The objectives of the study were to gain a baseline understanding of existing health center linkages to community emergency preparedness and response systems and to identify factors that were associated with strong linkages. A 60-item questionnaire was mailed to the population of health centers supported by the Health Resources and Services Administration’s Bureau of Primary Health Care in February 2005. Results were aggregated and a chi square analysis identified factors associated with stronger linkages.Results: Overall performance on study-defined indicators of strong linkages was low: 34% had completed a hazard vulnerability analysis in collaboration with the community emergency management agency, 30% had their role documented in the community plan, and 24% participated in community-wide exercises. Stronger linkages were associated with experience responding to a disaster and a perception of high risk for experiencing a disaster.Conclusions: The potential for health centers to participate in an integrated response is not fully realized, and their absence from community-based planning leaves an already vulnerable population at greater risk. Community planners should be encouraged to include health centers in planning and response and centers should receive more targeted resources for community integration. (Disaster Med Public Health Preparedness. 2007;1:96–105)
Allocation of Ventilators in a Public Health Disaster
Authors: Powell Tia , Christ Kelly C. , Birkhead Guthrie S. 
Published: October 2008

ABSTRACTBackground: In a public health emergency, many more patients could require mechanical ventilators than can be accommodated.Methods: To plan for such a crisis, the New York State Department of Health and the New York State Task Force on Life and the Law convened a workgroup to develop ethical and clinical guidelines for ventilator triage.Results: The workgroup crafted an ethical framework including the following components: duty to care, duty to steward resources, duty to plan, distributive justice, and transparency. Incorporating the ethical framework, the clinical guidelines propose both withholding and withdrawing ventilators from patients with the highest probability of mortality to benefit patients with the highest likelihood of survival. Triage scores derive from the sepsis-related organ failure assessment system, which assigns points based on function in 6 basic medical domains. Triage may not be implemented by a facility without clear permission from public health authorities.Conclusions: New York State released the draft guidelines for public comment, allowing for revision to reflect both community values and medical innovation. This ventilator triage system represents a radical shift from ordinary standards of care, and may serve as a model for allocating other scarce resources in disasters. (Disaster Med Public Health Preparedness. 2008;2:20–26)
Rethinking Volunteer Management Using a Centralized Volunteer Staging and Training Area
Authors: Aakko Eric , Weed Nathan , Konrad Richard , Wiesman John 
Published: October 2008

ABSTRACTPublic health agencies simply do not have enough trained staff or volunteers to effectively respond to a large-scale disaster. Training volunteers “off the street” will be crucial—but time consuming—in a public health emergency. A centralized volunteer staging and training area can help to efficiently register, credential, and conduct just-in-time training of volunteers, while reducing stress, confusion, traffic congestion, and security issues at various mass dispensing clinics. (Disaster Med Public Health Preparedness. 2008;2:127–129)
A Consensus-based Educational Framework and Competency Set for the Discipline of Disaster Medicine and Public Health Preparedness
Authors: Subbarao Italo , Lyznicki James M. , Hsu Edbert B. , Gebbie Kristine M. , Markenson David , Barzansky Barbara , Armstrong John H. , Cassimatis Emmanuel G. , Coule Philip L. , Dallas Cham E. , King Richard V. , Rubinson Lewis , Sattin Richard , Swienton Raymond E. , Lillibridge Scott , Burkle Frederick M. , Schwartz Richard B. , James James J. 
Published: October 2008

ABSTRACTBackground: Various organizations and universities have developed competencies for health professionals and other emergency responders. Little effort has been devoted to the integration of these competencies across health specialties and professions. The American Medical Association Center for Public Health Preparedness and Disaster Response convened an expert working group (EWG) to review extant competencies and achieve consensus on an educational framework and competency set from which educators could devise learning objectives and curricula tailored to fit the needs of all health professionals in a disaster.Methods: The EWG conducted a systematic review of peer-reviewed and non–peer reviewed published literature. In addition, after-action reports from Hurricane Katrina and relevant publications recommended by EWG members and other subject matter experts were reviewed for congruencies and gaps. Consensus was ensured through a 3-stage Delphi process.Results: The EWG process developed a new educational framework for disaster medicine and public health preparedness based on consensus identification of 7 core learning domains, 19 core competencies, and 73 specific competencies targeted at 3 broad health personnel categories.Conclusions: The competencies can be applied to a wide range of health professionals who are expected to perform at different levels (informed worker/student, practitioner, leader) according to experience, professional role, level of education, or job function. Although these competencies strongly reflect lessons learned following the health system response to Hurricane Katrina, it must be understood that preparedness is a process, and that these competencies must be reviewed continually and refined over time. (Disaster Med Public Health Preparedness. 2008;2:57–68)
Secondary Contamination of Medical Personnel, Equipment, and Facilities Resulting From Hazardous Materials Events, 2003–2006
Authors: Horton D. Kevin , Orr Maureen , Tsongas Theodora , Leiker Richard , Kapil Vikas 
Published: October 2008

ABSTRACTBackground: When not managed properly, a hazardous material event can quickly extend beyond the boundaries of the initial release, creating the potential for secondary contamination of medical personnel, equipment, and facilities. Secondary contamination generally occurs when primary victims are not decontaminated or are inadequately decontaminated before receiving medical attention. This article examines the secondary contamination events reported to the Agency for Toxic Substances and Disease Registry (ATSDR) and offers suggestions for preventing such events.Methods: Data from the ATSDR Hazardous Substances Emergency Events Surveillance system were used to conduct a retrospective analysis of hazardous material events occurring in 17 states during 2003 through 2006 involving secondary contamination of medical personnel, equipment, and facilities.Results: Fifteen (0.05%) Hazardous Substances Emergency Events Surveillance events were identified in which secondary contamination occurred. At least 17 medical personnel were injured as a result of secondary contamination while they were treating contaminated victims. Of the medical personnel injured, 12 were emergency medical technicians and 5 were hospital personnel. Respiratory irritation was the most common injury sustained.Conclusions: Adequate preplanning and drills, proper decontamination procedures, good field-to-hospital communication, appropriate use of personal protective equipment, and effective training can help prevent injuries of medical personnel and contamination of transport vehicles and medical facilities. (Disaster Med Public Health Preparedness. 2008;2:104–113)
Ethics of Triage in the Event of an Influenza Pandemic
Authors: Tabery James , Mackett Charles W. ,   University of Pittsburgh Medical Center Pandemic Influenza Task Force's Triage Review Board
Published: October 2008

ABSTRACTThe prospect of a severe influenza pandemic poses a daunting public health threat to hospitals and the public they serve. The event of a severe influenza pandemic will put hospitals under extreme stress; only so many beds, ventilators, nurses, and physicians will be available, and it is likely that more patients will require medical attention than can be completely treated. Triage is the process of sorting patients in a time of crisis to determine who receives what level of medical attention. How will hospitals sort patients to determine priority for treatment? What criteria will be used? Who will develop these criteria? This article formulates an answer to these questions by constructing a conceptual framework for anticipating and responding to the ethical issues raised by triage in the event of a severe influenza pandemic. (Disaster Med Public Health Preparedness. 2008;2:114–118)
Hospital Response to a Major Freeway Bridge Collapse
Authors: Hick John L. , Chipman Jeffery , Loppnow Gregory , Conterato Marc , Roberts David , Heegaard William G. , Beilman Greg , Clark Michael , Pohland Jonathan , Ho Jeffrey D. , Brunette Douglas D. , Clinton Joseph E. 
Published: October 2008

ABSTRACTBackground: We describe the hospital system response to the Interstate 35W bridge collapse in Minneapolis into the Mississippi River on August 1, 2007, which resulted in 13 deaths and 127 injuries. Comparative analysis of response activities at the 3 hospitals that received critical or serious casualties is provided.Methods: First-hand experiences of hospital physicians, issues identified in after-action reports, injury severity scores, and other relevant patient data were collected from the 3 hospitals that received seriously injured patients, including the closest hospitals to the collapse on each side of the river.Results/Discussion: Injuries were consistent with major acceleration/deceleration force injuries. The most critical patients arrived first at each hospital, suggesting appropriate prehospital triage. Capacity of the health care system was not overwhelmed and the involved hospitals generally reported an overresponse by staff. Communication and patient tracking problems occurred at all of the hospitals. Situational awareness was limited due to the scope of structural collapse and incomplete information from the scene.Conclusions: Hospitals were generally satisfied with their surge capacity and incident management plan activation. Issues such as communications, patient tracking, and staff overreporting that have been identified in past incidents also were problematic in this event. Hospitals will need to address deficiencies and build on successful actions to cope with future, potentially larger incidents. (Disaster Med Public Health Preparedness. 2008;2(Suppl 1):S11–S16)
Evolving Need for Alternative Triage Management in Public Health Emergencies: A Hurricane Katrina Case Study
Authors: Klein Kelly R. , Pepe Paul E. , Burkle Frederick M. , Nagel Nanci E. , Swienton Raymond E. 
Published: October 2008

ABSTRACTIn many countries, traditional medical planning for disasters developed largely in response to battlefield and multiple casualty incidents, generally involving corporal injuries. The mass evacuation of a metropolitan population in the aftermath of Hurricane Katrina evolved into life-and-death triage scenarios involving thousands of patients with nontraumatic illnesses and special medical needs. Although unprecedented in the United States, triage management needs for this disaster were similar to other large-scale public health emergencies, both natural and human-generated, that occurred globally in the past half-century. The need for alternative triage-management processes similar to the methodologies of other global mass public health emergencies is illustrated through the experience of disaster medical assistance teams in the first 3 days following Katrina's landfall. The immediate establishment of disaster-specific, consensus-based, public health emergency–related triage protocols—developed with ethical and legal expertise and a renewed focus on multidimensional, multifactorial matrix decision-making processes—is strongly recommended. (Disaster Med Public Health Preparedness. 2008;2(Suppl 1):S40–S44)
Public Health Practice vs Research: Implications for Preparedness and Disaster Research Review by State Health Department IRBs
Authors: Perlman David 
Published: October 2008

ABSTRACTUnder the current US Department of Health and Human Services regulatory and ethical system for research involving human subjects, research is defined in terms of several key concepts: intent, systematic investigation, and generalizability. If an investigator engages in a systematic investigation designed or intended to contribute to generalizable knowledge, then he or she is engaged in research. If that research involves living individuals and the investigator will either interact or intervene with people or obtain their identifiable personal information, then the research must be prospectively reviewed by an institutional review board (IRB), a federally mandated committee that ensures the ethical and regulatory appropriateness of proposed research. In public health institutions, and especially at state departments of health, this definition of research may prove vexing for determining when particular public health activities must be reviewed by IRBs. This article outlines several reasons for such vexation and 2 key responses from major public health stakeholders. In the current climate of public health preparedness initiatives at state health departments for disasters and bioterrorism, how research is defined vis-à-vis public health interventions may add even more confusion to preparedness initiatives and pose difficulties in determining when IRB review and the added protections it affords are appropriate. This article suggests several practical ways to avoid confusion and attempts to strike a balance between the need for expeditious approvals of research-based responses to public health disasters and to ensure proper protections for human subjects at state health departments. It is hoped that these suggestions can assist not only state health departments but also academically based researchers who either collaborate with those departments or whose research will need to be reviewed by their IRBs. (Disaster Med Public Health Preparedness. 2008;2:185–191)
Dealing with virtual aggregation – a new index for analysing heterogeneous point patterns
Authors: Schiffers Katja , Schurr Frank M. , Tielbörger Katja , Urbach Carsten , Moloney Kirk , Jeltsch Florian 
Published: October 2008

Point pattern analyses such as the estimation of Ripley's K‐function or the pair‐correlation function g are commonly used in ecology to characterise ecological patterns in space. However, a major disadvantage of these methods is their missing ability to deal with spatial heterogeneity. A heterogeneous intensity of points causes a systematic bias in estimates of the K‐ and g‐functions, a phenomenon termed “virtual aggregation” in the recent literature.To address this problem, we derive a new index, called K2‐index, as an extension of existing point pattern characteristics. The K2‐index has a heuristic interpretation as an approximation to the first derivative of the g‐function.We estimate the K‐, g‐ and K2‐functions for six different types of simulated point patterns and show that the K2‐index may provide important information on point patterns that the other methods fail to detect. The results indicate that particularly the small‐scale distributions of points are better represented by the K2‐index. This might be important for testing hypotheses on ecological processes, because most of these processes, such as direct neighbour interactions, occur very locally.When applied to empirical patterns of molehill distribution, the results of the K2‐analysis show regularity up to distances between 0.1 and 0.4 m in most of the study areas, and aggregation of molehills up to distances between 0.2 and 1.1 m. The type and scale of these deviations from randomness agree with a priori expectations on the hill‐building behaviour of moles. In contrast, the estimated g‐functions merely indicate aggregation at the full range from 0 to 7 m (or even above).Considering the advantages and disadvantages of the different methods, we suggest that the K2‐index should be used as a complement to existing approaches, particularly for point patterns generated by processes that act on more than one scale.
Dynamic occupancy models reveal within‐breeding season movement up a habitat quality gradient by a migratory songbird
Authors: Betts Matthew G. , Rodenhouse Nicholas L. , Scott Sillett T. , Doran Patrick J. , Holmes Richard T. 
Published: October 2008

The timing of settlement decisions likely influences the quality of breeding site choices.This is particularly the case in migratory birds, because the conditions that enhance breeding success are often not apparent upon arrival after migration. A strategy that addresses this problem is to adjust settlement decisions when reliable information becomes available.We used a new indirect method – dynamic site occupancy modeling – to estimate apparent movement of black‐throated blue warblersDendroica caerulescensamong sites within a breeding season. Because individuals should disperse to sites that maximize their fitness, we hypothesized that warblers would move up a habitat quality gradient when opportunities arose. For our study species, that would involve moving into sites with greater shrub density and at higher elevation within northern hardwoods forest, as these two features are positively correlated with reproduction and apparent survival in this species.Although the probability of site occupancy in our study landscape remained consistent throughout the breeding season (range: 0.66–0.69), occupancy models revealed substantial support for apparent movement of individuals within the breeding season. The mean probability of emigration from a point count site was 0.21 (±0.03 SE), and the mean probability of immigration to a site not previously occupied was 0.51 (±0.05 SE). The spatial distribution of this movement was a function of habitat quality. A portion of the black‐throated blue warbler population appears to arrive on the breeding grounds and settle initially in sub‐optimal habitat, moving subsequently into high quality densely shrubbed habitat at higher elevations. This modeling approach provides a new means to test hypotheses about habitat selection and movement by using presence–non‐detection data.
Influence of cytoplasmic heat shock protein 70 on viral infection of Nicotiana benthamiana
Authors: CHEN ZHAORONG , ZHOU TAO , WU XUEHONG , HONG YIGUO , FAN ZAIFENG , LI HUAIFANG 
Published: October 2008

SUMMARYThe accumulation of heat shock protein 70 (Hsp70) generally occurs in plants infected with viruses. However, the effect of Hsp70 accumulation on plant viral infection and pathogenesis remains elusive. In this study, the expression of six Hsp70 genes was found to be induced by the four diverse RNA viruses, Tobacco mosaic virus, Potato virus X (PVX), Cucumber mosaic virus and Watermelon mosaic virus, in Nicotiana benthamiana. Heat treatment enhanced the accumulation and systemic infection of these viruses. Similar results were obtained for viral infection in plants heterologously expressing an Arabidopsis cytoplasmic Hsp70 through either a PVX vector or Agrobacterium infiltration. In contrast, viral infection was compromised in cytoplasmic NbHsp70c‐1 gene‐silenced plants. These data demonstrate that the cytoplasmic Hsp70s can enhance the infection of N. benthamiana by diverse viruses.
Nutritional management of patients with acute pancreatitis: a Dutch observational multicentre study
Authors: SPANIER B. W. M. , MATHUS‐VLIEGEN E. M. H. , TUYNMAN H. A. R. E. , VAN DER HULST R. W. M. , DIJKGRAAF M. G. W. , BRUNO M. J. ,   ON BEHALF OF THE OTHER MEMBERS OF THE EARL STUDY GROUP
Published: October 2008

SummaryBackground  Following a nil per os (NPO) regimen, most patients with acute pancreatitis (AP) can resume normal oral intake within 1 week. If not tolerated, it is recommended to initiate artificial feeding, preferably by the enteral route.Aim  To evaluate the nutritional management of patients with AP in a Dutch cohort (EARL study).Methods  Observational study in 18 hospitals. Total days of NPO, tube feeding (TF) with/without oral feeding, total parenteral nutrition (TPN) and total starvation time were analysed.Results  In mild AP, a majority of cases (80.7%, 117/145) were managed with an NPO regimen only. Twenty‐seven patients (18.6%) with mild AP additionally received TF; one received TPN. Of those with severe AP, more than half of the patients (56.2%, nine of 16) were treated with TF besides an NPO regimen; four received TPN. TF was delivered preferably via the jejunal route. The median period of total starvation was 2 days for both mild and severe AP. Only 5.5% (nine of 164) of patients had a prolonged starvation time of more than 5 days.Conclusions  The total time of starvation was limited in a majority of patients admitted for AP. According to international guidelines, additional nutritional interventions were quickly undertaken with enteral feeding via the jejunum as the preferred route.