bluuebunny/crossref_metadata_2025_split huggingface dataset:
Failure of the Miller Criteria to Predict Significant Intracranial Injury in Patients with a Glasgow Coma Scale Score of 14 after Minor Head Trauma
Authors: Holmes James F. , Baier Mark E. , Derlet Robert W. 
Published: September 2008

ABSTRACTObjective: To determine the utility of the Miller criteria (presence of headache, nausea, vomiting, and signs of depressed skull fracture) for predicting the need for CT in patients with minor head trauma and a Glasgow Coma Scale score (GCS) of 14.Methods: The study was a prospective, consecutive series of all patients undergoing head CT scans with a GCS of 14 following head trauma. A data sheet was completed for all patients prior to obtaining a head CT scan.Results: 264 patients were entered into the study and 35 patients were found to have traumatic abnormalities on head CT scan. The use of the Miller criteria to select those patients who would require head CT scan would have resulted in missing 17 of the 35 abnormal scans, including 2 patients who required neurosurgical intervention. These 2 patients were markedly intoxicated upon presentation.Conclusion: The use of the Miller criteria as the only criteria for screening patients with a GCS of 14 after minor head trauma who require a head CT scan is not recommended. While the authors have identified ethanol intoxication as one confounding factor, further refinement of this risk‐stratification tool is required.
Utility of Urine and Blood Cultures in Pyelonephritis
Authors: Thanassi Mark 
Published: September 2008

ABSTRACTObjective: To determine how often the results of urine and blood cultures led to changes in antibiotic therapy for patients discharged from the hospital with the diagnosis of pyelonephritis.Methods: A retrospective chart review was performed of consecutively admitted patients, 10–90 years old, with an ICD‐9 discharge diagnosis of acute pyelonephritis. All patients were admitted to a university‐based, tertiary care center and a large HMO medical center from 1993 to 1994. The association of urine and blood culture results with a change in antibiotic therapy was assessed.Results: Of the 194 patients who met inclusion criteria, 189 (97%) had urine cultures obtained at the time of admission and 139 (71%) had blood cultures obtained. Ampicillin, gentamicin, or both were given as initial antibiotics 81% of the time, and isolated organisms from urine or blood were sensitive to the empiric antibiotics 95% of the time. Most (171/189; 90%) urine cultures were positive, but only 9 (5%) of these led to a change in antibiotic therapy. 80% of the urinary pathogens were Escherichia coli, 5% Enterococcus, 5% Proteus, and 4% Klebsiella. Only 40 (29%) of the 139 blood cultures were positive; none prompted a change in antibiotics. There were no cases in which blood and urine cultures grew different pathogens.Conclusions: Urine cultures are useful in directing antibiotic therapy in patients with the discharge diagnosis of acute pyelonephritis and support a change in therapy in 5% of cases. Among the patients in this study, blood culture results did not lead to changes in antibiotic therapy. These findings warrant prospective, mul‐ticenter evaluation.
Predictive Value of Letters of Recommendation vs Questionnaires for Emergency Medicine Resident Performance
Authors: Schaider Jeffrey J. , Rydman Robert J. , Greene Constance S. 
Published: September 2008

ABSTRACTObjective: To evaluate the predictive value of standard letters of recommendation (LORs) vs preprinted questionnaires (PPQs) for resident performance at one emergency medicine (EM) residency program.Methods: A retrospective association of LORs and PPQs with intraining resident performance ratings was done at one EM residency program. The residency application files of EM residents who completed the program were reviewed to locate files that had LORs and PPQs written by the same author. Seventeen resident files contained 32 LOR/PPQ pairs. These LORs and PPQs were submitted in a blinded fashion to 3 outside EM residency directors. Each LOR and PPQ was evaluated for the applicant's suitability for the speciality of EM, medical knowledge, procedural skills, interpersonal skills, motivation, and overall rank. The scores given by the outside reviewers were compared with resident performance ratings determined by 5 EM attending physicians who evaluated the residents along the same 6 dimensional ratings.Results: Statistically, no differences were found between the LORs and PPQs in predicting resident performance.Conclusions: PPQs may substitute for LORs in the evaluation of resident applicants.
Statistical Methodology: III. Receiver Operating Characteristic (ROC) Curves
Authors: Grzybowski Mary , Younger John G. 
Published: September 2008

ABSTRACTMeasures including sensitivity, specificity, and positive and negative predictive values have been traditionally used to assess a diagnostic test's ability to detect the presence or absence of disease. Receiver operating characteristic (ROC) curve analysis allows visual evaluation of the trade‐offs between sensitivity and specificity associated with different values of the test result, or different “cutpoints” for defining a positive result. The purpose of this article is to define, construct, and interpret a ROC curve using a hypothetical example applicable to emergency medicine practice.
Response to Dopamine vs Norepinephrine in Tricyclic Antidepressant‐induced Hypotension
Authors: Tran T. Paul , Panacek Edward A. , Rhee Kenneth J. , Foulke Garrett E. 
Published: September 2008

ABSTRACTObjective: To compare the efficacy of dopamine (DA) with that of norepinephrine (NE) in the treatment of refractory hypotension caused by tricyclic antidepressants (TCAs).Methods: A retrospective analysis was used to compare blood pressure responses in concurrent case series of patients treated with vasopressors for TCA‐associated hypotension. The patients were adults (aged ≥16 years) treated at 2 urban teaching hospitals from 1983 to 1994. All patients were diagnosed as having TCA ingestion (positive serum toxicologic assay), were hypotensive [systolic blood pressures (SBPs) ≤90 mm Hg], and required vasopressor therapy. The patients were grouped by initial vasopressor treatment (i.e., NE vs DA).Results: There were 26 hypotensive adult patients who met study criteria. All 26 patients remained hypotensive after initial treatment of their TCA‐associated hypotension with crystalloid infusion and alkalinization. The NE and DA groups were similar in age, sex, and proportion of patients with single and co‐drug ingestion. The NE group, however, had a significantly lower average SBP at study entry (56 vs 74 mm Hg, p = 0.04). Nine of 15 (60%) patients responded to DA (5–10 μg/kg/min) and 11/11 (100%) patients responded to NE (5–53 μg/min). The difference in response rates was statistically significant (p = 0.02). Six patients in whom DA (max rate 10–50 μg/min/kg) failed to raise the SBP subsequently responded to NE (max rate 5–74 μg/ min) when this drug was later used. One patient receiving NE (12 μg/min) developed ventricular ectopy, successfully treated with lidocaine. There were no ischemic complications from either NE or DA. Patients who failed DA therapy tended to be older (39 vs 30 years, p = O.OS), to be more hypotensive at study entry (64 vs 81 mm Hg, p = 0.008), and to remain hypotensive even at higher doses of DA (24 vs 7 p, g/min/kg, p = 0.002).Conclusion: While this was not a prospective randomized study, NE appears advantageous over DA as the first‐line vasopressor agent for those patients who require vasopressor support in the setting of TCA‐induced hypotension that is refractory to IV fluid and serum alkalinization.
Serial Creatine Kinase‐MB Results Are a Sensitive Indicator of Acute Myocardial Infarction in Chest Pain Patients with Nondiagnostic Electrocardiograms: The Second Emergency Medicine Cardiac Research Group Study
Authors: Young Gary P. , Gibler W. Brian , Hedges Jerris R. , Hoekstra James W. , Slovis Corey , Aghababian Richard , Smith Mark , Rubison Mike , Ellis Jack 
Published: September 2008

ABSTRACTObjective: To determine the test performance characteristics of serial creatine kinase‐MB (CK‐MB) mass measurements for acute myocardial infarction (MI) in patients presenting to the ED with chest pain and nondiagnostic ECGs.Methods: A prospective, observational test performance study was conducted. Hemodynamically stable patients aged ≥25 years with chest discomfort, but without ECGs diagnostic for MI, were enrolled at 7 university teaching hospitals. Presenting ECGs showing >1‐mV ST‐segment elevation in ≥2 electrically contiguous leads were considered diagnostic for MI; patients with diagnostic ECGs on presentation were excluded. Real‐time, serial CK‐MB mass levels were obtained using a rapid serum immunochernical assay at the time of ED presentation (0‐hour) and 3 hours later (3‐hour). The following testing schemes were evaluated for their sensitivity and specificity for detection of MI during patient evaluation in the ED: 1) an elevated (≥8 ng/mL) presenting CK‐MB level; 2) an elevated presenting and/or 3‐hour CK‐MB level; 3) a significant increase (i.e., ≥3 ng/mL) within the range of normal limits for CK‐MB concentrations during the 3‐hour period (A CK‐MB); andor 4) development of ST‐segment elevation during the 3 hours (second ECG).Results: Of the 1,042 patients enrolled, 777 (74.6%) were hospitalized, including all 67 MI patients (8.6% of admissions). As a function of duration of time in the ED, the test performance characteristics of serial CK‐MBs for MI (and cumulative data for the additional ECG) were:0‐hour CK‐MB Plus 3‐hour CK‐MB Plus A CK‐MB Plus Second ECGSensitivity 38/67 = 57% 59/67 = 88% 62/67 = 93% 64/67 = 96%(95% CI) (44–69%) (78–95%) (83–98%) (88–99%)Specificity 9431976 = 97% 9351976 = 96% 9291976 = 95% 9311976 = 95%(95% CI) (95–98%) (94–97%) (94–96%) (94–97%)The 0‐hour to 3‐hour CK‐MB positive and negative predictive values were 52% to 55% and 96% to 99%, respectively. The sensitivities of serial CK‐MB results as a function of the interval following chest discomfort onset were:Interval Since Onset Sensitivity (95% CI) Interval Since Onset Sensitivity (95% CI)Less than 3 hours 38% (21–58%) 6 hours to 12 hours 92% (78–98%)3 hours to 6 hours 75% (60–87%) More than 12 hours 100% (77–100%)Conclusion: Serial CK‐MB monoclonal antibody mass measurements in the ED can identify MI patients with initially nondiagnostic ECGs. CK‐MB sensitivity significantly increases over 3 hours of observation of stable chest discomfort patients in the ED; it also increases as a function of the total interval from onset until enzyme measurement.
Termination of Nontraumatic Cardiac Arrest Resuscitative Efforts in the Field: A National Survey
Authors: Jaslow David , Barbera Joseph A. , Johnson Erik , Moore Wayne 
Published: September 2008

ABSTRACTObjectives: 1) To describe elements of adult nontraumatic cardiac arrest protocols in those U.S. cities in which resuscitative efforts are being terminated in the out‐of‐hospital setting. 2) To determine the prevalence and methods of on‐scene family grief counseling delivered in this setting.Methods: Emergency medical services (EMS) systems in each of the 200 largest cities in the United States were surveyed by telephone regarding the content of their adult cardiac arrest protocols. Type of arrest (medical vs trauma), final dysrhythmia, termination policies, and presence or absence of a grief counseling protocol were recorded.Results: All of the target population responded to the telephone survey. Most (135; 68%) EMS systems currently have written protocols that allow in‐field termination of resuscitative efforts for adult nontraumatic cardiac arrest patients who remain asystolic. Only 47 (24%) EMS systems allow cessation of efforts for patients without return of spontaneous circulation regardless of the dysrhythmia. Base station contact is required for authorization to end resuscitative efforts in 120/135 (89%) EMS systems. Only 26/135 (19%) EMS systems that cease efforts in the field have written policies concerning on‐scene family grief counseling. This counseling is most likely to be conducted by the out‐of‐hospital providers themselves.Conclusion: Many U.S. urban EMS systems are terminating efforts for selected adult nontraumatic cardiac arrest patients, although few have written policies to address grief intervention for family members at the scene.
Lidocaine in the Treatment of Status Epilepticus
Authors: MD L. Anderson Walkes , Slovis Corey M. 
Published: September 2008

ABSTRACTIntravenous lidocaine has the potential to control seizures. This article reviews the available evidence related to lidocaine's efficacy and clarifies its potential role in the management of status epilepticus (SE). Although there are no large, double‐blind, placebo‐controlled studies of lidocaine's efficacy in SE, numerous case reports and case series support its use. Most of the reported cases involve patients who were refractory to multiple antiseizure medications. Additional support for lidocaine's efficacy in SE comes from the pediatric literature, where lidocaine has been very effective in controlling SE in neonates who have not responded to barbiturates. Initial lidocaine doses used to stop seizures have ranged from 1 to 3 mag. Most reports recommend a maintenance infusion of lidocaine after initial termination of SE, and a continuous infusion is almost universally recommended for neonates. Toxicity from a 1.5–2.0 mgkg dose of lidocaine for the control of SE is rare; the authors found only 1 case of a possible side effect at that dose. The article provides a 5‐step approach to treating SE that includes lidocaine.
Low‐carbohydrate (low & high‐fat) versus high‐carbohydrate low‐fat diets in the treatment of obesity in adolescents
Authors: Demol S , Yackobovitch‐Gavan M , Shalitin S , Nagelberg N , Gillon‐Keren M , Phillip M 
Published: September 2008

AbstractAim: To compare the impact of low‐carbohydrate diets of different fat content to high‐carbohydrate low‐fat diet on weight and metabolic parameters in obese adolescents.Methods: Fifty‐five patients aged 12–18 years with a body mass index (BMI) above the 95th percentile were randomly allocated to one of three isoenergetic diet regimens. Anthropometric and metabolic measurements were taken after overnight fast, at baseline, after the 12‐week intervention and after nine month of follow‐up.Results: No significant differences were found among the groups in changes in BMI, BMI‐percentile, fat percentage, or metabolic markers at the end of the intervention and at the end of follow‐up. Insulin level and homeostasis model assessment (HOMA) level decreased significantly at both time points only in the two low carbohydrate diet groups.Conclusion: All diet regimens are associated with a significant reduction in BMI and improvement of some metabolic parameters in obese adolescents. Low‐carbohydrate diets apparently have no advantage over high‐carbohydrate low‐fat diets. The significant drop in insulin level and HOMA in the low carbohydrate diet groups is noteworthy given the increasing frequency of type‐2 diabetes as part of metabolic syndrome in children and youth. The impact of low carbohydrate diets in obese and insulin‐resistant youth warrants further investigation.
A Preliminary Study of the Temporal and Spatial Biomass Patterns of Herbaceous Vegetation Consumed by Mountain Gorillas in an Afromontane Rain Forest
Authors: Ganas Jessica , Nkurunungi John Bosco , Robbins Martha M. 
Published: September 2008

ABSTRACTAlthough many animal species consume herbaceous vegetation found in African tropical forests, little is known of the temporal and spatial availability of these plants. From September 2004 to August 2005 we conducted a study that quantified the temporal and spatial biomass availability of 20 species of herbs frequently consumed by endangered mountain gorillas at two locations (Buhoma and Ruhija) in Bwindi Impenetrable National Park, Uganda. In general, the biomass of herbs varied over the study period, but these changes were relatively small. For 12 of 18 and nine of 11 species in Buhoma and Ruhija, respectively, herb biomass differed significantly among habitat types. Of the nine species found in both locations, seven species had a higher biomass at Ruhija, one species had a higher biomass at Buhoma, and one species showed no difference. These results demonstrate that herb biomass varied little temporally but spatial differences in herb biomass were more pronounced. Future studies should investigate the variables that may influence herb phenological patterns such as rainfall, light, soil quality, previous disturbance regimes, and animal foraging and trampling damage.
Ulrich Zwingli
Authors: Opitz Peter 
Published: September 2008

AbstractUlrich Zwingli1 can be called the father of Reformed Protestantism, which has its historical origins in Zurich. Zwingli's role as a reformer was deeply influenced by his already developed humanist values, integrating them into his reformation theology. Although his final development into a reformer and the Zurich Reformation could hardly be imagined without Luther and the events around the ‘Luther‐Affair’, Zwingli represents an independent form of reformation theology. Different perspectives, which have their origin in different biographical roots and circumstances, play a role here. Although Reformed Protestantism was later equated with ‘Calvinism’, it owes its fundamental design to a considerable degree to the Zurich reformer.
Decision-making under Risk: An fMRI Study
Authors: Hewig Johannes , Straube Thomas , Trippe Ralf H. , Kretschmer Nora , Hecht Holger , Coles Michael G. H. , Miltner Wolfgang H. R. 
Published: September 2008

AbstractRecent research has focused on decision-making under risk and its neural bases. Two kinds of bad decisions under risk may be defined: too risky decisions and too cautious decisions. Here we show that suboptimal decisions of both kinds lead to increased activity in the anterior cingulate cortex in a Blackjack gambling task. Moreover, this increased activity is related to the avoidance of the negatively evaluated decision under risk. These findings complement other results suggesting an important role of the dorsal anterior cingulate cortex in reward-based decision-making and conflict resolution.
Conceptual Processing in Music as Revealed by N400 Effects on Words and Musical Targets
Authors: Daltrozzo Jérôme , Schön Daniele 
Published: September 2008

Abstract
The cognitive processing of concepts, that is, abstract general ideas, has been mostly studied with language. However, other domains, such as music, can also convey concepts. Koelsch et al. [Koelsch, S., Kasper, E., Sammler, D., Schulze, K., Gunter, T., & Friederici, A. D. Music, language and meaning: Brain signatures of semantic processing. Nature Neuroscience, 7, 302–307, 2004] showed that 10 sec of music can influence the semantic processing of words. However, the length of the musical excerpts did not allow the authors to study the effect of words on musical targets. In this study, we decided to replicate Koelsch et al. findings using 1-sec musical excerpts (Experiment 1). This allowed us to study the reverse influence, namely, of a linguistic context on conceptual processing of musical excerpts (Experiment 2). In both experiments, we recorded behavioral and electrophysiological responses while participants were presented 50 related and 50 unrelated pairs (context/target). Experiments 1 and 2 showed a larger N400 component of the event-related brain potentials to targets following a conceptually unrelated compared to a related context. The presence of an N400 effect with musical targets suggests that music may convey concepts. The relevance of these results for the comprehension of music as a structured set of conceptual units and for the domain specificity of the mechanisms underlying N400 effects are discussed.
A Multisensory Cortical Network for Understanding Speech in Noise
Authors: Bishop Christopher W. , Miller Lee M. 
Published: September 2008

Abstract
In noisy environments, listeners tend to hear a speaker's voice yet struggle to understand what is said. The most effective way to improve intelligibility in such conditions is to watch the speaker's mouth movements. Here we identify the neural networks that distinguish understanding from merely hearing speech, and determine how the brain applies visual information to improve intelligibility. Using functional magnetic resonance imaging, we show that understanding speech-in-noise is supported by a network of brain areas including the left superior parietal lobule, the motor/premotor cortex, and the left anterior superior temporal sulcus (STS), a likely apex of the acoustic processing hierarchy. Multisensory integration likely improves comprehension through improved communication between the left temporal–occipital boundary, the left medial-temporal lobe, and the left STS. This demonstrates how the brain uses information from multiple modalities to improve speech comprehension in naturalistic, acoustically adverse conditions.
Mind Your Left: Spatial Bias in Subcortical Fear Processing
Authors: Siman-Tov Tali , Papo David , Gadoth Natan , Schonberg Tom , Mendelsohn Avi , Perry Daniella , Hendler Talma 
Published: September 2008

Abstract
Hemispheric lateralization of emotional processing has long been suggested, but its underlying neural mechanisms have not yet been defined. In this functional magnetic resonance imaging study, facial expressions were presented to 10 right-handed healthy adult females in an event-related visual half-field presentation paradigm. Differential activations to fearful versus neutral faces were observed in the amygdala, pulvinar, and superior colliculus only for faces presented in the left hemifield. Interestingly, the left hemifield advantage for fear processing was observed in both hemispheres. These results suggest a leftward bias in subcortical fear processing, consistent with the well-documented leftward bias of danger-associated behaviors in animals. The current finding highlights the importance of hemifield advantage in emotional lateralization, which might reflect the combination of hemispheric dominance and asymmetric interhemispheric information transfer.
The Role of Serotonin in Nonnormative Risky Choice: The Effects of Tryptophan Supplements on the “Reflection Effect” in Healthy Adult Volunteers
Authors: Murphy Susannah E. , Longhitano Carlo , Ayres Rachael E. , Cowen Philip J. , Harmer Catherine J. , Rogers Robert D. 
Published: September 2008

Abstract
Risky decision-making involves weighing good and bad outcomes against their probabilities in order to determine the relative values of candidate actions. Although human decision-making sometimes conforms to rational models of how this weighting is achieved, irrational (or nonnormative) patterns of risky choice, including shifts between risk-averse and risk-seeking choices involving equivalent-value gambles (the “reflection effect”), are frequently observed. In the present experiment, we investigated the role of serotonin in decision-making under conditions of uncertainty. Fifteen healthy adult volunteers received a treatment of 3 g per day of the serotonin precursor, tryptophan, in the form of dietary supplements over a 14-day period, whereas 15 age- and IQ-matched control volunteers received a matched placebo substance. At test, all participants completed a risky decision-making task involving a series of choices between two simultaneously presented gambles, differing in the magnitude of their possible gains, the magnitude of their possible losses, and the probabilities with which these outcomes were delivered. Tryptophan supplements were associated with alterations in the weighting of gains and small losses perhaps reflecting reduced loss-aversion, and a marked and significant diminution of the reflection effect. We conclude that serotonin activity plays a significant role in nonnormative risky decision-making under conditions of uncertainty.