bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Product of the
fimI
Gene Is Necessary for
Escherichia coli
Type 1 Pilus Biosynthesis
Authors: Valenski Mary L. , Harris Sandra L. , Spears Patricia A. , Horton John R. , Orndorff Paul E. 
Published: August 2003

ABSTRACT

Site-directed mutagenesis was employed to create lesions in
fimI
, a gene of uncertain function located in the chromosomal gene cluster (
fim
) involved in
Escherichia coli
type 1 pilus biosynthesis. Chromosomal
fimI
mutations produced a piliation-negative phenotype. Complementation analysis indicated that a
fimI
′
-kan
insertion mutation and a
fimI
frameshift mutation produced polarity-like effects not seen with an in-frame
fimI
deletion mutation. Minicell analysis associated
fimI
with a 16.4-kDa noncytoplasmic protein product (FimI). We conclude that FimI has a required role in normal pilus biosynthesis.
Regulated Expression of the
Escherichia coli dam
Gene
Authors: Calmann Melissa A. , Marinus M. G. 
Published: August 2003

ABSTRACT

Regulated expression of the
Escherichia coli dam
gene has been achieved with the
araBAD
promoter lacking a ribosome binding site. Cultures of
dam
mutants containing plasmid pMQ430 show no detectable methylation in the absence of arabinose and complete methylation in its presence. Dam methyltransferase is a substrate for the Lon protease.
Escherichia coli
Cells Bearing a Ribosomal Ambiguity Mutation in
rpsD
Have a Mutator Phenotype That Correlates with Increased Mistranslation
Authors: Balashov Sergey , Humayun M. Zafri 
Published: August 2003

ABSTRACT

Escherichia coli
cells bearing certain mutations in
rpsD
(coding for the 30S ribosomal protein S4) show a ribosomal ambiguity (Ram) phenotype characterized by increased translational error rates. Here we show that spontaneous mutagenesis increases in Ram cells bearing the
rpsD14
allele, suggesting that the recently described translational stress-induced mutagenesis pathway is activated in Ram cells.
Osteoarthritis
Authors: Haq I , Murphy E , Dacre J 
Published: August 2003

Abstract
Osteoarthritis is a chronic degenerative disorder characterised by cartilage loss. It is extremely prevalent in society and is a major cause of disability. It is important to treat osteoarthritis effectively using a multidisciplinary approach tailored to the patient’s needs. This paper reviews current thinking on the aetiology, pathogenesis, investigations, and management of osteoarthritis. The paper also discusses the challenges for developing good quality outcome measures for use in large scale multicentre clinical trials for new osteoarthritis treatments, especially disease modifying osteoarthritis drugs.
Pulmonary manifestations of sickle cell disease
Authors: Siddiqui A K , Ahmed S 
Published: August 2003

Abstract
Pulmonary complications account for significant morbidity and mortality in patients with sickle cell disease. Clinical lung involvement manifests in two major forms: the acute chest syndrome and sickle cell chronic lung disease. Acute chest syndrome is characterised by fever, chest pain, and appearance of a new infiltrate on chest radiograph. Sickle cell chronic lung disease, on the other hand, manifests as radiographic interstitial abnormalities, impaired pulmonary function, and, in its most severe form, by the evidence of pulmonary hypertension. Progress has been made in understanding the pathophysiology and management of these complications. In this review the current knowledge of the mechanism, diagnosis, and treatment of pulmonary complications of sickle cell disease are discussed.
Autonomic neuropathy in patients with hepatic cirrhosis
Authors: Bajaj B K , Agarwal M P , Ram B Krishna 
Published: August 2003

Abstract

Background
Autonomic neuropathy has been reported in patients with alcoholic liver disease but information on its occurrence in patients with non-alcoholic liver disease is contradictory.

Aim
To assess autonomic functions in patients with alcoholic and non-alcoholic liver disease.

Study design
Autonomic function using five standard tests was examined in 20 cirrhotics (10 alcoholics and 10 non-alcoholics) and 20 age and sex matched controls. The extent of autonomic dysfunction was determined in the patients and a comparison between the characteristics of patients with and without autonomic neuropathy was made.

Results
Sixteen (80%) of the cirrhotic subjects were found to have evidence of autonomic neuropathy. Of these, three (15%) patients had early parasympathetic damage, five (25%) had definite parasympathetic damage, and eight (40%) had combined (that is, both parasympathetic and sympathetic) damage. Nine (90%) of the alcoholics and seven (70%) of the non-alcoholics had autonomic dysfunction. Only one patient belonging to the alcoholic group had clinical evidence of peripheral neuropathy. Moreover, there was no significant association between subjective symptoms of autonomic neuropathy and objective evidence of autonomic damage as assessed by autonomic function tests. Autonomic dysfunction was significantly more frequent in advanced liver disease compared with early liver damage. Nine (75%) out of 12 cirrhotic subjects belonging to Child class B and six (85.7%) of the seven patients belonging to Child class C had autonomic neuropathy.

Conclusion
This study shows that autonomic neuropathy is common in cirrhotic subjects, that it is found with comparable frequency in alcoholics and non-alcoholics, and that it increases in severity with increase in extent of liver damage, suggesting that liver damage contributes to the neurological deficit.
Metabolic alkalosis and myoclonus
Authors: Simons P , Nadra I , McNally P G 
Published: August 2003

Abstract
This is the first case reported of vomiting-induced metabolic alkalosis associated with myoclonus. The report describes an unusual presentation of myoclonus secondary to acid-base disturbance caused by recreational drug-induced vomiting. The severe derangement of hyponatraemia, hypokalaemia, and alkalosis appears to have been reasonably well tolerated due to the gradual onset and relatively long history. The causes, mechanism, and management of metabolic alkalosis are discussed.
Using Plane Waves as Base Functions for Solving Time Harmonic Equations with the Ultra Weak Variational Formulation
Authors: Cessenat Olivier , Després Bruno 
Published: August 2003

This article deals with the use of the Ultra Weak Variational Formulation to solve Helmholtz equation and time harmonic Maxwell equations. The method, issued from domain decomposition techniques, lies in partitioning the domain into subdomains with the use of adapted interface conditions. Going further than in domain decomposition, we make so that the problem degenerates into an interface problem only. The new formulation is equivalent to the weak formulation. The discretization process is a Galerkin one. A possible advantage of the UWVF applied to wave equations is that we use the physical approach that consists in approximating the solution with plane waves. The formulation allows to use a very large mesh as compared to the frequency, on the contrary to the Finite Element Method when applied to time harmonic equations. Furthermore, the convergence analysis shows the method is a high order one: the order evolves as the square root of the number of degrees of freedom.
Evidence-based mental health policy: Acritical appraisal
Authors: Cooper Brian 
Published: August 2003

BackgroundArguments for and against evidence-based psychiatry have mostly centred on its value for clinical practice and teaching. Now, however, use of the same paradigm in evaluating health care has generated new problems.AimsTo outline the development of evidence-based health care; to summarise the main critiques of this approach; to review the evidence now beingemployed to evaluate mental health care; and to consider how the evidence base might be improved.MethodThe following sources were monitored: pub ications on evidence-based psychiatry and health care since 1990; reports of randomised trials and meta-analytic reviews to the end of 2002; and official British publications on mental health policy.ResultsAlthough evidence-based health care is now being promulgated as a rational basis for mental health planning in Britain, its contributions to service evaluation have been distinctly modest. Only 10% of clinical trials and meta-analyses have been focused on effectiveness of services, and many reviews proved inconclusive.ConclusionsThe current evidence-based approach is overly reliant on meta-analytic reviews, and is more applicable to specific treatments than to the care agencies that control theirdelivery. A much broader evidence base is called for, extending to studies in primary health care and the evaluation of preventive techniques.
Depression status, medical comorbidity and resource costs
Authors: Chisholm Daniel , Diehr Paula , Knapp Martin , Patrick Donald , Treglia Michael , Simon Gregory 
Published: August 2003

BackgroundDespite the burden of depression, there remain few data on its economic consequences in an international context.AimsTo explore the relationship between depression status (with and without medical comorbidity), work loss and health care costs, using cross-sectional data from a multi-national study of depression in primarycare.MethodPrimarycare attendees were screened for depression. Those meeting eligibility criteria were categorised according to DSM – IV criteria for major depressive disorder and comorbid status. Unit costs were attached to self-reported days absent from work and uptake of health care services.ResultsMedical comorbidity was associated with a 17–46% increase in health care costs in five of the six sites, but a clear positive association between costs and clinical depression status was identified in only one site.ConclusionsThe economic consequences of depression are influenced to a greater (and considerable) extent by the presence of medical comorbidity than by symptom severity alone.
Clozapine v. conventional antipsychotic drugs for treatment-resistant schizophrenia: A re-examination
Authors: Moncrieff Joanna 
Published: August 2003

BackgroundAlthough there is a consensus that clozapine is more effective than conventional antipsychotic drugs for treatment-resistant schizophrenia, there is great heterogeneity among results of relevant trials.AimsTo re-evaluate the evidence comparing clozapine with conventional antipsychotics and to investigate sources of heterogeneity.MethodIndividual studies were inspected with assessment of clinical relevance of results. Meta-regression analysis was performed to investigate sources of heterogeneity.ResultsTen trials were examined. Recent large-scale studies have not found a substantial advantage for clozapine, especially in terms of a clinically relevant effect. Meta-regression showed that shorter study duration, financial support from a drug company and higher baseline symptom score consistently predicted greater advantage of clozapine.ConclusionsIt may be inappropriate to combine studies in meta-analysis, given the degree of heterogeneity between their findings. The benefits of clozapine compared with conventional treatment may not be substantial.
Adolescent units: a need for change?
Authors: Calton Tim , Arcelus Jon 
Published: August 2003

Aims and MethodTo describe the characteristics and diagnoses of patients admitted to a general adolescent psychiatric in-patient unit. We describe the age, gender and psychiatric diagnosis of the patient, as well as whether the patient exhibited violent behaviour in the ward, whether he/she needed to be transferred to a different service and whether he/she was admitted under a section of the Mental Health Act 1983.ResultsPatients were evenly distributed in terms of gender, with most being 14–16 years old. Diagnoses were varied with adjustment disorder predominating, but could be separated into four main groups. Levels of violence were high, being associated with detention under the Mental Health Act 1983, and often resulted in transfer to another service.Clinical ImplicationsThe needs of certain adolescents admitted to a general-purpose adolescent unit may not be best met in this environment. Current services must change to meet the needs of their patients. There may be a need for greater specialisation.
Impact of Helical Computed Tomography on the Outcomes of Emergency Department Patients with Suspected Appendicitis
Authors: Torbati Sam S. , Guss David A. 
Published: August 2003

Abstract Objectives: To assess the impact of an emergency department (ED) guideline employing selective use of helical computed tomography (CT) on clinical outcomes of female patients with suspected appendicitis. Methods: All patients presenting with suspected appendicitis were prospectively enrolled and managed in accordance with a guideline incorporating selective use of helical CT. Although not the objective of this investigation, male patients were included for purposes of comparison. Patients with clinically evident appendicitis were referred to the surgical service, and patients with equivocal presentations were studied with helical CT. Patients were followed to final surgical or clinical outcomes. Outcome measures included time from ED presentation to laparotomy and rate of appendiceal perforation. These measures were compared with those of a historical cohort of patients preceding the use of helical CT. Results: A total of 310 consecutive patients with suspected appendicitis were enrolled; 92 had appendicitis. Sixty patients were referred to the surgical service without helical CT, and 41 had appendicitis (68%). Helical CT was performed on 250 patients; 51 had appendicitis (20%). For males, the mean interval from ED presentation to laparotomy was 559 minutes (95% CI = 444 to 674 minutes) during guideline use and 480 minutes (95% CI = 405 to 555 minutes) before. This interval for females was 433 minutes (95% CI = 326 to 540 minutes) during guideline use and 710 minutes (95% CI = 558 to 862 minutes) before. Appendiceal perforation rate for males was 0.25 (95% CI = 0.14 to 0.36) during guideline use and 0.38 (95% CI = 0.29 to 0.47) before; perforation rate for females was 0.06 (95% CI =−0.05 to 0.17) during guideline use and 0.23 (95% CI = 0.14 to 0.32) before. Helical CT had 92% sensitivity, 97% specificity, and 96% accuracy in diagnosing appendicitis. Conclusions: Helical CT is highly accurate in detecting appendicitis in patients with equivocal ED presentations. The use of a guideline employing selective helical CT was associated with a decline in the time from ED presentation to operative intervention in females.
Arterial Blood Gas Results Rarely Influence Emergency Physician Management of Patients with Suspected Diabetic Ketoacidosis
Authors: Ma O. John , Rush Micheal D. , Godfrey Michelle M. , Gaddis Gary 
Published: August 2003

Abstract Objectives: To test the hypothesis that arterial blood gas (ABG) results for patients with suspected diabetic ketoacidosis (DKA) do not influence emergency physicians' management decisions and to assess correlation and precision between venous pH and arterial pH. Methods: Prospective, observational study of emergency physicians' decision making for consecutive ED patients with suspected DKA. Inclusion criteria were capillary blood glucose equal to or greater than 200 mg/dL, ketonuria, and clinical signs and symptoms of DKA. Venous pH, chemistry panel, and ABGs were drawn before treatment. Attending emergency physicians indicated planned management and disposition on a standardized form before and after reviewing ABG and venous pH results. This study was powered to detect a 10% difference in management decisions (n= 195). Pearson's correlation and Bland‐Altman bias plot were used to compare venous pH and arterial pH. Results: ABG analysis changed the emergency physicians' diagnosis in 2/200 cases (1.0%; 95% confidence interval [95% CI] = 0.3% to 3.6%), altered treatment in 7/200 cases (3.5%; 95% CI = 1.7% to 7.1%), and changed disposition in 2/200 cases (1.0%; 95% CI = 0.3% to 3.6%). The pH value of the ABGs changed the treatment or disposition in 5/200 patients (2.5%; 95% CI = 1.1% to 5.7%). The Po 2 and Pco 2 results of the ABGs altered treatment and disposition in 2/200 patients (1.0%; 95% CI = 0.3% to 3.6%). Venous pH correlated well with arterial pH (r= 0.951), and bias plotting yielded a bias value of −0.015 (± 0.006 pH units). Conclusions: ABG results rarely influenced emergency physicians' decisions on diagnosis, treatment, or disposition in suspected DKA patients. Venous pH correlated well and was precise enough with arterial pH to serve as a substitute.
Information Technology in Emergency Medicine Residency–Affiliated Emergency Departments
Authors: Pallin Daniel , Lahman MeeMee , Baumlin Kevin 
Published: August 2003

Abstract Objectives: To describe acquisition and implementation of information technology (IT) in U.S. emergency medicine (EM) residency–affiliated emergency departments (EDs), including automatic medication error checking. Methods: This was a survey of all U.S. EM residencies active in September 2000. Respondents specified whether specific IT tools had been “acquired” and “implemented fully.” EDs were categorized according to primary versus affiliated training site, trauma level, and census. Numbers of “yes” responses were compared according to ED type (Kruskal‐Wallis test, p ≤ 0.05 significant). Results: Of 121 residency programs, data were obtained from 93 (77%) for a total of 149 EDs. The percentages of EDs that reported full implementation for each technology are as follows: medication error checking, 7%; medication order entry, 18%; nonmedication orders, 7%; clinical documentation, 21%; old electrocardiograms, 62%; laboratory results, 84%; radiography order entry, 62%; image retrieval, 29%; radiologists' interpretations, 67%; cardiology reports, 62%; pathology reports, 70%; surgical reports/dictations, 60%; triage, 34%; tracking, 46%; electronic reference materials, 56%; registration, 84%; accounts, 72%; patient management software package, 20%; voice recognition, 7%. Trauma centers reported more IT tools than nontrauma centers (p = 0.01), and primary training sites reported fewer IT tools than affiliated EDs (p = 0.027). Conclusions: Incorporation of IT is not uniform in EDs where EM residents train. Acquisition of effective IT tools varies, and implementation lags behind acquisition. Fully implemented IT for medication error checking was reported in 7% of EDs; an additional 12% had acquired IT without implementing it fully.
Neighborhood Characteristics and Emergency Department Utilization
Authors: Li Guohua , Grabowski Jurek G. , McCarthy Melissa L. , Kelen Gabor D. 
Published: August 2003

Abstract Objectives: Neighborhood environments have been linked to the prevalence and incidence rates of a variety of diseases and injuries. This study assessed the relations between neighborhood demographic and socioeconomic characteristics and emergency department (ED) utilization. Methods: Billing data for the calendar year 2000 for adult patients residing within a one‐mile radius of the study ED were geo‐coded based on home addresses and merged with neighborhood data from the U.S. Census Bureau. Annual ED visit rates per 100 population were computed for each census block within the study area and analyzed in relation to neighborhood characteristics. Results: The study area consisted of 714 census blocks and 42,278 adult residents, with a total of 16,427 visits to the study ED. Annual ED visit rates increased from 17 visits per 100 population for neighborhoods where less than 50% of the population were African American to 51 visits per 100 population for neighborhoods where all residents were African American (p < 0.001). Annual ED visit rates decreased from 53% for neighborhoods where <20% of housing units were owner‐occupied to 27% for neighborhoods with >45% owner‐occupied housing units (p < 0.001). Multivariate linear regression modeling revealed that proportions of African American residents and owner‐occupied housing units were significantly associated with ED utilization, independent of age and gender compositions and the distance between residence and the study ED. Conclusions: Even within a small geographic area, ED utilization may vary greatly by neighborhood characteristics. Neighborhood racial composition and housing tenure are independent predictors of ED visit rates in this urban community.
Emergency Department Presentations of Naltrexone‐accelerated Detoxification
Authors: Armstrong Jason , Little Mark , Murray Lindsay 
Published: August 2003

Abstract Objectives: To analyze emergency department (ED) presentations after naltrexone‐accelerated detoxification. Methods: This was a retrospective cohort analysis of patient presentations to Sir Charles Gairdner Hospital Emergency Department over a six‐month period (November 2000 to April 2001). Results: During the six‐month study period, 42 patients presented to the ED after naltrexone‐accelerated detoxification. This represented 7% of patients treated at a single clinic over the same period. Presentation occurred within 24 hours in 40% of cases and within 48 hours in 74%. Clinical features on presentation included gastrointestinal (GI) symptoms (vomiting, 60%; abdominal pain, 55%; diarrhea, 45%), central nervous system [CNS] symptoms (excessive drowsiness, 55%; agitation requiring sedation, 50%), and respiratory symptoms (tachypnea, 33%; respiratory difficulties, 19%). Gastrointestinal symptoms were managed adequately with supportive therapy in most cases (intravenous fluids; antiemetics). Agitation sometimes required large doses of intravenous benzodiazepines (up to 730 mg in 44 hours), one‐to‐one nursing, and security staff. Two of 14 patients presenting with predominantly CNS disturbance required intubation (14%). Mean in‐hospital stay for all patients was 18 hours (range 1 to 92 hours). Conclusions: A few patients undergoing outpatient naltrexone‐accelerated detoxification during a six‐month period subsequently required ED management. The clinical features encountered in this group of patients can be subdivided into GI or CNS predominance, with different management strategies. Most presentations can be managed in the ED or an associated observation ward, but departmental resources must be available for one‐to‐one nursing and security personnel. Patients presenting with agitation should be sedated with benzodiazepines; large doses may be required. Close monitoring of respiratory function is mandatory, and advanced airway management may be required.