bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Study of Accuracy and Outcome of Emergency Ultrasound for Abdominal Aortic Aneurysm over Two Years
Authors: Tayal Vivek S. , Graf Christian D. , Gibbs Michael A. 
Published: August 2003

AbstractDetermination of the presence of an abdominal aortic aneurysm (AAA) is essential in the management of the symptomatic emergency department (ED) patient. Objectives: To identify whether emergency ultrasound of the abdominal aorta (EUS‐AA) by emergency physicians could accurately determine the presence of AAA and guide ED disposition. Methods: This was a prospective, observational study at an urban ED with more than 100,000 annual patient visits with consecutive patients enrolled over a two‐year period. All patients suspected to have AAA underwent standard ED evaluation consisting of EUS‐AA, followed by a confirmatory imaging study or laparotomy. AAA was defined as any measured diameter greater than 3 cm. Demographic data, results of confirmatory testing, and patient outcome were collected by retrospective review. Results: A total of 125 patients had EUS‐AA performed over a two‐year period. The patient population had the following characteristics: average age 66 years, male 54%, hypertension 56%, coronary artery disease 39%, diabetes 22%, and peripheral vascular disease 14%. Confirmatory tests included radiology ultrasound, 28/125 (22%); abdominal computed tomography, 95/125 (76%); abdominal magnetic resonance imaging, 1/125 (1%); and laparotomy, 1/125 (1%). AAA was diagnosed in 29/125 (23%); of those, 27/29 patients had AAA on confirmatory testing. EUS‐AA had 100% sensitivity (95% CI = 89.5 to 100), 98% specificity (95% CI = 92.8 to 99.8), 93% positive predictive value (27/29), and 100% negative predictive value (96/96). Admission rate for the study group overall was 70%. Immediate operative management was considered in 17 of 27 (63%) patients with AAA; ten patients were taken to the operating room. Conclusions: EUS‐AA in a symptomatic population for AAA is sensitive and specific. These data suggest that the presence of AAA on EUS‐AA should guide urgent consultation. Emergency physicians were able to exclude AAA regardless of disposition from the ED.
Comparative Analysis of Adult versus Adolescent Sexual Assault: Epidemiology and Patterns of Anogenital Injury
Authors: Jones Jeffrey S. , Rossman Linda , Wynn Barbara N. , Dunnuck Chris , Schwartz Natalie 
Published: August 2003

Abstract Objectives: To compare the characteristics of sexual assault in pubertal girls (<18 years old) and adults in a community‐based population of women presenting to an urban sexual assault clinic. Methods: This case‐series analysis evaluated consecutive female patients presenting to a sexual assault clinic during a three‐year study period. The clinic is associated with a university‐affiliated emergency medicine residency program and is staffed by forensic nurses trained to perform medicolegal examinations using colposcopy with nuclear staining. Patient demographics, assault characteristics, and injury patterns were recorded using a standardized classification system. Data from the two patient groups (adolescents vs. women ≥18 years of age) were analyzed using chi‐square test and t‐test. Results: A total of 766 cases were identified: 43% of the victims were 13 to 17 years old (mean 15.0 years old), and 57% were older than 17 years old (mean 30.8 years old). Adolescents were more likely to be assaulted by an acquaintance or relative (84% vs. 50%, p < 0.001) and to delay medical evaluation (17 hours vs. 12 hours, p < 0.001) than were older women. Adolescent sexual assault was less likely to involve weapons or physical coercion (29% versus 57%, p < 0.001) and was associated with fewer nongenital injuries (33% vs. 55%, p < 0.001). Adolescents had a greater frequency of anogenital injuries (83% vs. 64%, p < 0.001), however, compared with older women. Common sites of injury in adolescents were posterior, including the fossa navicularis, hymen, fourchette, and labia minora. The injuries showed consistent topologic features, varying with the site and nature of tissue. Adult victims of sexual assault had a less consistent pattern of anogenital injuries with fewer hymenal injuries, greater injury to the perianal area, and widespread erythema. Conclusions: Of women presenting to an urban sexual assault clinic, 43% were adolescents. The epidemiology of sexual trauma and the pattern of anogenital trauma in this age group are unique and may pose special challenges to emergency health care providers.
Faculty Development: How to Evaluate the Effectiveness of a Faculty Development Program in Emergency Medicine
Authors: Ramalanjaona Georges 
Published: August 2003

AbstractEvaluation of the effectiveness of any faculty development program (FDP) is crucial to provide assessment of existing programs and to yield valid recommendations for designing future programs that better address the needs of individual faculty members and the sponsoring institutions. The author chose the validated Kirkpatrick's model with four levels of program outcomes (satisfaction data, learning data, performing data, and career change) to evaluate the effectiveness of an FDP in emergency medicine. Assessment of the effectiveness of this FDP can be performed by sponsoring organizations or by independent evaluators experienced in the field for better objectivity.
Factors Affecting the Risk of Blood Bank Specimen Hemolysis
Authors: Tanabe Paula , Kyriacou Demetrious N. , Garland Franklyn 
Published: August 2003

Abstract Objectives: To evaluate simultaneously several possible risk factors for blood bank specimen hemolysis. Methods: This was a prospective cohort study of emergency department and labor and delivery patients to estimate the effect of various factors on the risk of blood bank specimen hemolysis. Study variables included patient demographics, type and gauge of needle or catheter, anatomic location of venipuncture, and patient care area. Hemolysis was determined by blood bank laboratory technicians. Cox proportional hazards multivariate regression modeling was performed to estimate the adjusted relative risks for hemolysis. Results: Of the 605 subjects with complete data, 194 (32.1%) subjects had blood specimens drawn directly with a steel needle, and 411 (69.1%) had specimens drawn through a Vialon (BD Medical Systems, Inc., Sandy, UT) intravenous (IV) angiocatheter. The overall risk of hemolysis for all was 7%, 10% for Vialon IV angiocatheters and 1.5% for steel needles. In the multivariate analysis, the factors most closely associated with hemolysis were the use of Vialon IV catheters and sampling from an anatomic site other than the antecubital area. Conclusions: Blood bank specimens drawn from Vialon IV catheters (particularly smaller gauge catheters) and from veins outside the antecubital area are at significantly increased risk to hemolyze.
U.S. Allopathic Emergency Medicine Residency Programs: A Descriptive Review
Authors: Lathrop George R. , Wilkinson Keith C. 
Published: August 2003

Abstract Objective: To use collected data from all 124 allopathic emergency medicine residency (EMR) programs in existence in 2001 to describe allopathic EMR training programs in the United States. Methods: The authors performed a cross‐sectional review of all 124 EMRs using self‐reported, standardized data from regularly updated sources: the SAEM Residency Catalog and the AMA's FREIDA (Fellowship and Residency Electronic Interactive Database Access). The authors report median values, ranges, and interquartile ranges (IQRs) on a variety of variables. Results: Median values for EMR programs included a class size of 10 per year; a total faculty‐to‐resident ratio of 0.78 (1:1.29); an annual primary emergency department (ED) census of 66,000 (IQR = 53,000 to 80,000), with an annual combined primary and secondary ED census of 95,500 (IQR = 75,000 to 126,000); a combined pediatric census of 20,000 (IQR = 15,000 to 32,500) at the primary and secondary sites; an annual combined ED visit per resident of 3,181 (IQR = 2,542 to 3,949), including 733 pediatric visits per resident, at the primary and secondary sites; an admission rate of 20% (IQR = 17% to 23%); and an intensive care unit admission rate of 13% (IQR = 5% to 20%). Despite a wide variability in ranges and IQR in most characteristics pertaining to training setting, the overall reported completion rate of training for residents was high (99%). Conclusions: This summary description provides median values and ranges for important components of the emergency medicine training environment and provides a basis of comparison for medical students and graduate medical educators.
Development and Implementation of a Relative Value Scale for Teaching in Emergency Medicine: The Teaching Value Unit
Authors: Khan Naghma S. , Simon Harold K. 
Published: August 2003

AbstractRelative value units exist for measuring clinical productivity. Limited objective measures exist, however, for nonclinical activities, specifically teaching.Objective:To develop an objective measure of teaching productivity linked to a performance‐based incentive plan.Methods:Teaching goals and objectives were identified before the 1998–1999 academic year. Teaching value units (TVUs), objective measures for quantifying teaching activities, were developed and assigned based on an estimation of time needed to complete each activity and weighted for importance to the teaching mission. Each physician was allocated teaching time based on past performance and future goals. Targeted TVUs necessary to meet expectations were proportionate to allocated teaching time. Teaching productivity was defined as a percentage of targeted TVUs achieved. Incentive dollars for teaching were distributed based on percentage of targeted TVUs achieved, weighted individually for teaching load.Results:Teaching productivity was evaluated over a three‐year period. In year 1, mean TVUs allocated/physician were 181 units (range 25 to 449). Four of 18 physicians (22%) met expectations. The mean individual TVUs achieved were 54% of expected (range 0% to 114%). By year 3, mean TVUs allocated/physician were 179 (range 45 to 629). Twelve of 22 physicians (55%) met expectations. The mean individual TVUs achieved were 82% of expected (range 11% to 146%). Between year 1 and year 3, group productivity increased from 73% to 88%, and mean individual productivity increased from 54% to 82% (p = 0.01).Conclusions:The development of a TVU‐based system enabled objective quantification and monitoring of a broad range of teaching activities. The TVU‐based system linked to an incentive plan helped to increase individual and group teaching productivity.
Prediction of Milk/Plasma Concentration Ratio of Drugs
Authors: Larsen Line Alleslev , Ito Shinya , Koren Gideon 
Published: August 2003

OBJECTIVE: The milk to plasma (m/p) concentration ratio of drugs is used to estimate the amount of drug offered to the suckling infant. Published literature was reviewed to identify drugs for which sufficient data exist for calculation of m/p ratio and to examine whether the existing empiric data agree with the published method of Atkinson for mathematical prediction of m/p ratios based on physiochemical characteristics. METHODS: Using a comprehensive reference text, we identified studies reporting sufficient data to calculate m/p ratio based on the AUC for milk and plasma. Subsequently, we calculated the m/p ratio with Atkinson's formula based on pKa, lipophilicity, and protein binding. We then correlated the empiric versus predicted (calculated) m/p ratios. RESULTS: Of 192 drugs of which at least some data on milk accumulation have been published, there were sufficient data to quantify m/p ratios for only 69 medications (78 studies). There was no significant correlation between the empiric m/p ratios and the predicted values using the Atkinson's model. CONCLUSIONS: Reliable data on m/p concentration ratios exist for few medications. Presently, there is no appropriate model to predict milk concentrations of drugs in humans.
Long-Acting Inhaled β2-Agonists for Stable COPD
Authors: Dougherty John A , Didur Bethany L , Aboussouan Loutfi S 
Published: August 2003

OBJECTIVE: To describe the pathogenesis of chronic obstructive pulmonary disease (COPD) and mechanisms of benefit, formulations available, drug costs, pharmacokinetic profiles, and pertinent clinical studies for long-acting β2-agonists. DATA SOURCES: A MEDLINE search was conducted from July 1966 through October 2002. STUDY SELECTION AND DATA EXTRACTION: Pertinent articles related to COPD and long-acting β2-agonists. DATA SYNTHESIS: The incidence and subsequent morbidity and mortality of COPD have increased during the last 4 decades, prompting worldwide initiatives to formulate guidelines to decrease the burden of this disease. COPD is a progressive, irreversible disease state characterized by chronic cough, dyspnea, sputum production, and wheezing, in which no medication has been shown to decrease mortality, excluding oxygen supplementation. Bronchodilators have been a mainstay of COPD treatment through their ability to work by both smooth- and non–smooth-muscle mechanisms. Long-acting β2-agonists (i.e., formoterol, salmeterol) dosed twice daily provide more convenient dosing than 4-times-daily regimens of traditional short-acting bronchodilators. Both formoterol and salmeterol have acceptable adverse event profiles when used at recommended doses. There have been no direct clinical outcome studies comparing formoterol and salmeterol, but both have shown some benefits over ipratropium and theophylline in improving the symptoms, spirometric indices, exacerbations, and quality of life of patients with COPD. CONCLUSIONS: Based on current evidence, long-acting β2-agonists are acceptable first-line agents for patients with COPD.
Successful Meropenem Desensitization in a Patient with Cystic Fibrosis
Authors: Wilson Diana L , Owens Robert C , Zuckerman Jonathan B 
Published: August 2003

Objective To report a case of successful meropenem desensitization in a patient with cystic fibrosis (CF) with documented hypersensitivity to multiple antibiotics including carbapenems. Case Summary A 20-year-old white man with CF was admitted to the hospital for treatment of an acute pulmonary exacerbation caused by multidrug-resistant Burkholderia cepacia complex and methicillin-resistant Staphylococcus aureus (MRSA). Past treatments of his CF exacerbations were complicated by urticarial eruptions following administration of β-lactams, including meropenem, and ototoxicity from aminoglycosides. Skin testing revealed hypersensitivity reactions to β-lactam antibiotics including penicillin, piperacillin/tazobactam, ceftazidime, and imipenem. A literature review (MEDLINE, January 3, 2002) and communication with the manufacturer of meropenem revealed no specific information on desensitizing patients to this agent. Because of meropenem's activity against B. cepacia complex alone and in combination with other antimicrobials, a desensitization protocol was adapted and applied to meropenem in an effort to provide the most beneficial treatment available. A 12-dose escalation protocol was successfully employed without incident. Discussion Antimicrobial therapy is limited in CF patients by susceptibility profiles of common infecting organisms (e.g., Pseudomonas spp., B. cepacia complex, MRSA). Unfortunately, host responses may further reduce the utility of many effective antibiotic classes due to hypersensitivity and/or adverse reactions. Desensitization is a useful alternative that allows the administration of beneficial medications to patients with documented allergy histories. Conclusions Meropenem is an important treatment option in the CF population, particularly due to its activity against B. cepacia complex. Successful desensitization using a dose-escalation protocol in patients with a documented carbapenem allergy will allow the most beneficial therapy to continue.
Increased Topical Tacrolimus Absorption in Generalized Leukemic Erythroderma
Authors: Teshima Daisuke , Ikesue Hiroaki , Itoh Yoshinori , Urabe Kazunori , Furue Masutaka , Oishi Ryozo 
Published: August 2003

Objective To report a case of elevated blood tacrolimus concentration after application of topical tacrolimus ointment in an erythrodermic patient. Case Summary A 44-year-old man developed generalized erythroderma and itching due to infection with human T-cell lymphotropic virus. Despite application of strong glucocorticosteroid ointments, the symptoms and area of erythroderma were not alleviated. Daily topical application of tacrolimus 0.1% ointment was added and therapeutic drug monitoring was started. The dose and applied area of tacrolimus were gradually increased from 2.5 to 12.5 g/d and from 10% to 90% of body surface area, respectively. Because the trough concentration of tacrolimus in whole blood increased from 7.5 ng/mL on treatment day 9 to 15.4 ng/mL on day 13, the dose was reduced to 10 g/d. However, the concentration further elevated to 16.5 ng/mL. Therefore, the applied area was reduced to 20% of body surface area, and the tacrolimus concentration decreased gradually thereafter. Although the transient increase of blood tacrolimus concentration was observed on day 23, treatment with 20% applied area and 5 g/d were maintained. Discussion Topically applied tacrolimus was substantially absorbed with the expansion of its applied area and dose. Increased tacrolimus concentrations may have a tendency to depend on the increase of the percent of body surface area per dose. Our findings showing the elevation of blood tacrolimus concentration after application of the ointment to a large area of the body suggest that the applied area should be as narrow as possible in a barrier-disrupted condition such as erythroderma. However, the safety of tacrolimus ointment has not been established in patients with generalized erythroderma. Conclusions Tacrolimus concentrations in whole blood should be carefully monitored to prevent nephrotoxicity. Based on the results of that monitoring, the application area and dose of tacrolimus ointment should be closely adjusted, especially in generalized erythrodermic cases.
Modular stability tools for distributed computation and control
Authors: Slotine Jean‐Jacques E. 
Published: August 2003

AbstractMuch recent functional modelling of the central nervous system, beyond traditional ‘neural net’ approaches, focuses on its distributed computational architecture. This paper discusses extensions of our recent work aimed at understanding this architecture from an overall non‐linear stability and convergence point of view, and at constructing artificial devices exploiting similar modularity. Applications to synchronization and to schooling are also described. The development makes extensive use of non‐linear contraction theory. Copyright © 2003 John Wiley & Sons, Ltd.
A robust on‐line learning algorithm for intelligent control systems
Authors: Efe Mehmet Önder , Kaynak Okyay , Wilamowski Bogdan M. , Yu Xinghuo 
Published: August 2003

AbstractThis paper describes a novel error extraction approach for exploiting the strength of Levenberg–Marquardt (LM) optimization technique in intelligent control systems. Since the target value of the control signal is unknown, tuning of the controller parameters becomes a tedious task if the knowledge about the system and the environment is limited. The suggested methodology utilizes the sliding model control (SMC) technique. The error extraction scheme postulates the form of error on the applied control signal using the discrepancy from the prescribed reaching dynamics. The devised approach has been tested on the non‐linear Duffing oscillator, which has been forced to follow a periodic orbit radically different from the natural one. The results obtained through a series of simulations have confirmed the high precision and robustness advantages without knowing the analytical details of the system under investigation. The issues of observation noise and the stability in the parametric space have approximately been addressed from the point of SMC perspective. Copyright © 2003 John Wiley & Sons, Ltd.
Adaptive critic design using non‐linear network structures
Authors: Kuljaca Ognjen , Lewis Frank L. 
Published: August 2003

AbstractA neural net (NN)/fuzzy logic (FL) adaptive critic controller is described. This structure takes advantage of the decision‐making properties of a FL system to critique and tune a NN action‐generating network. The stability of the proposed structure is proven. NN and fuzzy weight tuning algorithms are given that do not require complicated initialization procedures or any off‐line learning phase. Tracking and bounded NN weights and control signals are guaranteed. The adaptive fuzzy critic controller given here is a model‐free controller' in the sense that it works for any system in a prescribed class without the need for extensive modeling and preliminary analysis to find a regression matrix'. There is no linearity in the parameter (LIP) requirement. Copyright © 2003 John Wiley & Sons, Ltd.
Novel mutation in the gene encoding c‐Abl‐binding protein SH3BP2 causes cherubism
Authors: Lo Bryan , Faiyaz‐Ul‐Haque M. , Kennedy S. , Aviv R. , Tsui L.‐C. , Teebi Ahmad S. 
Published: July 2003

AbstractCherubism is a rare autosomal dominant inherited condition caused by mutations in the c‐Abl‐binding protein SH3BP2. It is characterized by multiple cystic giant cell lesions of the jaw appearing in early childhood with stabilization and remission after puberty. In the present study, we used direct sequence analysis of the SH3BP2 gene of several individuals from a family with cherubism to search for additional SH3BP2 mutations resulting in cherubism. In affected relatives, we found a previously unreported G to A transition in exon 9 leading to a Gly to Arg substitution at amino acid position 420. G420R has been reported previously with a G to C transversion. To date there have been no disease causing mutations outside exon 9. Therefore, the amino acid sequence from positions 415 to 420 may represent a specific protein domain which, when disrupted, leads to the cherubism phenotype. © 2003 Wiley‐Liss, Inc.
Clinical features of boys with fragile X premutations and intermediate alleles
Authors: Aziz Monica , Stathopulu Eleni , Callias Maria , Taylor Catherine , Turk Jeremy , Oostra Ben , Willemsen Rob , Patton Mike 
Published: July 2003

AbstractFragile X syndrome has a characteristic behavioural and physical phenotype. Clinical experience and case reports suggest that boys with premutations and intermediate alleles may have similar, but possibly milder, clinical features than those with the full mutation. We conducted detailed physical, psychiatric, psychological and speech and language evaluations on a clinical series of 10 boys, with either premutation or intermediate CGG triplet expansions. Wherever possible we measured the levels of FMR1 protein in participants' hair roots. Many participants demonstrated striking resemblance in their clinical picture, behavioural and physical, to individuals with the fragile X syndrome full mutation. However, protein expression was normal in all participants where it was assessed, despite large variation in CGG triplet repeats. We propose that the findings are unlikely to be attributable to ascertainment bias alone. Replication on larger independent samples is required to confirm our impression that fragile X premutations and intermediate alleles may be associated with important developmental disabilities and physical features. © 2003 Wiley‐Liss, Inc.