bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Accuracy of Predicting Cardiac Arrest by Emergency Medical Services Dispatchers: The Calling Party Effect
Authors: Garza Alex G. , Gratton Matthew C. , Chen John J. , Carlson Brent 
Published: September 2003

Abstract Objectives: To analyze the accuracy of paramedic emergency medical services (EMS) dispatchers in predicting cardiac arrest and to assess the effect of the caller party on dispatcher accuracy in an advanced life support, public utility model EMS system, with greater than 90,000 calls and greater than 60,000 transports per year. Methods: This was a retrospective analysis from January 1, 2000, through June 30, 2000, of 911 calls with dispatcher‐assigned presumptive patient condition (PPC) or field diagnosis of cardiac arrest. Sensitivity and positive predictive value (PPV) of the PPC code for cardiac arrest by calling parties were calculated. Homogeneity of sensitivity and PPV of the PPC code for cardiac arrest by calling parties was studied with chi‐square analysis. Relevant proportions, relative risk ratios, and associated 95% confidence intervals (95% CIs) were calculated. Student's t‐test was used to compare quality assurance scores between calling parties. Results: There were 506 patients included in the study. Overall sensitivity for dispatcher‐assigned PPC of cardiac arrest was 68.3% (95% CI = 63.3% to 73.0%) with a PPV of 65.0% (95% CI = 60.0% to 69.7%). There was a significant difference in the PPV for the EMS dispatcher diagnosis of cardiac arrest depending on the type of caller (χ2= 17.34, p < 0.001). Conclusions: A higher level of medical training may improve dispatch accuracy for predicting cardiac arrest. The type of calling party influenced the PPV of dispatcher‐assigned condition.
Accuracy of Emergency Physician Assessment of Left Ventricular Ejection Fraction and Central Venous Pressure Using Echocardiography
Authors: Randazzo Marco R. , Snoey Eric R. , Levitt M. Andrew , Binder Kevin 
Published: September 2003

Abstract Objectives: Emergency department (ED) bedside echocardiography may offer useful information on cardiac function and volume status. The authors evaluated the accuracy of emergency physician (EP) performance of echocardiography in the assessment of left ventricular ejection fraction (LVEF) and central venous pressure (CVP). Methods: The authors conducted a cross‐sectional observational study at an urban teaching ED, involving a convenience sample of patients presenting to the ED between September 2000 and February 2001. Level III–credentialed EP sonographers who had undergone a three‐hour training session in limited echocardiography, focusing on LVEF and CVP measurement, performed echocardiograms. Vital signs and indication for echocardiography were documented on a study data sheet. LVEF was rated as poor (<30%), moderate (30%–55%), or normal (>55%) and an absolute percentage. Central venous pressure categories included low (<5 cm), moderate (5–10 cm), and high (>10 cm). Formal echocardiograms were obtained within a four‐hour window on all patients and interpreted by a staff cardiologist. Correlation analysis was performed using the κ correlation coefficient for LVEF and CVP categories and a Pearson correlation coefficient for LVEF measurement. Results: A total of 115 patients were assessed for LVEF, and 94 patients had complete information for CVP. Indications for echocardiography included chest pain (45.1%), congestive heart failure (38.1%), dyspnea (5.7%), and endocarditis (10.6%). Results showed a LVEF correlation of r2= 0.712 with 86.1% overall agreement. Subgroup analysis revealed the highest agreement (92.3%) between EP and formal echocardiograms within the normal LVEF category, followed by 70.4% agreement in the poor LVEF category and 47.8% in the moderate LVEF category. Central venous pressure measurements resulted in 70.2% overall raw agreement between EP and formal echocardiograms. Subgroup analysis revealed the highest agreement (83.3%) within the high CVP category followed by 66.6% in the moderate and 20% in the low categories. Conclusions: Experienced EP sonographers with a small amount of focused additional training in limited bedside echocardiography can assess LVEF accurately in the ED.
Classroom Injuries in Utah Public Schools
Authors: Kramer Michael D. , Lightfoot Amy C. , Knight Stacey , Cazier Calvert F. , Olson Lenora M. 
Published: September 2003

Abstract Objectives: School injuries are a serious public health problem, yet classroom injuries have received little attention. The purpose of this study was to describe the epidemiology of classroom injuries in Utah public schools. Methods: Utah statewide school injury data on kindergarten through 12th grade students for 1996 through 1998 were used. The data were generated from a standardized Student Injury Report (SIR) form completed by school personnel for injuries that (1) caused loss of at least one half of a day of school or (2) warranted medical attention and treatment. Injuries occurring in laboratories, shop, and physical education classes were excluded. To determine the medical outcome and charges associated with classroom injuries, the authors probabilistically linked the SIR database to Utah statewide emergency department (ED) records and Utah statewide hospital inpatients discharge records for 1996 through 1998. Results: During the period 1996 through 1998, there were 1,366 classroom injuries. Nearly two thirds of the injuries occurred to male students. More than half the classroom injuries were related to equipment use. Weapon use was rare. Twenty percent of students injured in the classroom obtained treatment in an ED, where 71% of these injuries were determined to involve the head, neck, and upper extremity. Two incidents, one involving carbon monoxide and the other tear gas, accounted for 11% of the ED admissions. Conclusions: Classroom injuries are not sufficiently frequent, severe, or costly to justify special studies focused solely on acute injuries in standard classrooms. This does not negate the need for continued surveillance of classroom injuries along with other school injuries.
American Society of Clinical Oncology 2003 Update on the Role of Bisphosphonates and Bone Health Issues in Women With Breast Cancer
Authors: Hillner Bruce E. , Ingle James N. , Chlebowski Rowan T. , Gralow Julie , Yee Gary C. , Janjan Nora A. , Cauley Jane A. , Blumenstein Brent A. , Albain Kathy S. , Lipton Allan , Brown Susan 
Published: September 2003

Purpose: To update the 2000 ASCO guidelines on the role of bisphosphonates in women with breast cancer and address the subject of bone health in these women. Results: For patients with plain radiographic evidence of bone destruction, intravenous pamidronate 90 mg delivered over 2 hours or zoledronic acid 4 mg over 15 minutes every 3 to 4 weeks is recommended. There is insufficient evidence supporting the efficacy of one bisphosphonate over the other. Starting bisphosphonates in women who demonstrate bone destruction through imaging but who have normal plain radiographs is considered reasonable treatment. Starting bisphosphonates in women with only an abnormal bone scan but without evidence of bone destruction is not recommended. The presence or absence of bone pain should not be a factor in initiating bisphosphonates. In patients with a serum creatinine less than 3.0 mg/dL (265 μmol/L), no change in dosage, infusion time, or interval is required. Infusion times less than 2 hours with pamidronate or less than 15 minutes with zoledronic acid should be avoided. Creatinine should be monitored before each dose of either agent in accordance with US Food and Drug Administration (FDA) labeling. Oncology professionals, especially medical oncologists, need to take an expanded role in the routine and regular assessment of the osteoporosis risk in women with breast cancer. The panel recommends an algorithm for patient management to maintain bone health. Conclusion: Bisphosphonates provide a supportive, albeit expensive and non–life-prolonging, benefit to many patients with bone metastases. Current research is focusing on bisphosphonates as adjuvant therapy. Although new data addressing when to stop therapy, alternative doses or schedules for administration, and how to best coordinate bisphosphonates with other palliative therapies are needed, they are not currently being investigated.
Epidermal Growth Factor Receptor in Non–Small-Cell Lung Carcinomas: Correlation Between Gene Copy Number and Protein Expression and Impact on Prognosis
Authors: Hirsch Fred R. , Varella-Garcia Marileila , Bunn Paul A. , Di Maria Michael V. , Veve Robert , Bremnes Roy M. , Barón Anna E. , Zeng Chan , Franklin Wilbur A. 
Published: September 2003

Purpose: The epidermal growth factor receptor (EGFR) is frequently overexpressed in non–small-cell lung carcinoma (NSCLC), and EGFR inhibitors are promising new therapeutic agents. The molecular mechanisms responsible for EGFR overexpression are poorly understood. Materials and Methods: Gene copy number and protein status of EGFR were investigated in microarrayed tumors from 183 NSCLC patients, including squamous cell carcinoma (SCC; 89 patients) and non-SCC (94 patients) histologies. Protein expression was assessed by immunohistochemistry on a scale from 0 to 400 (percentage of positive cells × staining intensity). Gene and chromosome 7 copy numbers were identified by fluorescent in situ hybridization (FISH). Results: EGFR protein overexpression was observed in 62% of the NSCLC (25% scored 201 to 300; 37% scored 301 to 400), more frequently in SCC than non-SCC (82% v 44%; P < .001), and in 80% of the bronchioloalveolar carcinomas. The prevalent FISH patterns were balanced disomy (40%) and trisomy (38%) for EGFR gene and chromosome 7 (40%), whereas balanced polysomy was seen in 13% and gene amplification was seen in 9% of the patients. Gene copy number correlated with protein expression (r = 0.4; P < .001). EGFR overexpression or high gene copy numbers had no significant influence on prognosis. Conclusion: EGFR overexpression is frequent in NSCLC, is most prominent in SCC, and correlates with increased gene copy number per cell. High gene copy numbers per cell showed a trend toward poor prognosis. It will be important to evaluate EGFR gene and EGFR protein status and signal protein expression to properly interpret future clinical trials using EGFR inhibitors.
Coordination of medial gastrocnemius and soleus forces during cat locomotion
Authors: Kaya Motoshi , Leonard Tim , Herzog Walter 
Published: September 2003

SUMMARYWe studied force-sharing behavior between the cat medial gastrocnemius (MG)and soleus (SOL) muscles by direct measurement of the muscle forces and electromyographic activities (EMGs), muscle lengths, speeds of contraction,joint kinematics and kinetics, for a variety of locomotor conditions. Previous studies suggested that the modulation of MG force and activation is associated with movement demands, while SOL force and activation remain nearly constant. However, no systematic, quantitative analysis has been done to evaluate the degree of (possible) modulation of SOL force and activation across a range of vastly different locomotor conditions. In the present study, we investigated the effects of speed and intensity of locomotion on the modulation of SOL force and EMG activity, based on quantitative, statistical analyses. We also investigated the hypothesis that MG forces are primarily associated with MG activation for changing movement demands, while SOL forces are primarily associated with the contractile conditions, rather than activation. Seven cats were trained to walk, trot and gallop at different speeds on a motor-driven treadmill, and to walk up and down different slopes on a walkway. Statistical analysis suggested that SOL activation (EMG activity) significantly increased with increasing speeds and intensities of locomotion, while SOL forces remained constant in these situations. MG forces and EMG activities, however,both increased with increasing speeds and intensities of locomotion. We conclude from these results that SOL is not maximally activated at slow walking, as suggested in the literature, and that its force remains nearly constant for a range of locomotor conditions despite changes in EMG activity. Therefore, SOL forces appear to be affected substantially by the changing contractile conditions associated with changing movement demands. In contrast,MG peak forces correlated well with EMG activities, suggesting that MG forces are primarily associated with activation while its contractile conditions play a minor role for the movement conditions tested here.
Hypoxia induces adaptive and reversible gross morphological changes in crucian carp gills
Authors: Sollid Jørund , De Angelis Paula , Gundersen Kristian , Nilsson Göran E. 
Published: September 2003

SUMMARYWe show that crucian carp (Carassius carassius) living in normoxic(aerated) water have gills that lack protruding lamellae, the primary site of O2 uptake in fish. Such an unusual trait leads to a very small respiratory surface area. Histological examination showed that the lamellae(secondary lamellae) of these fish were embedded in a cell mass (denoted embedded lamellae). When the fish were kept in hypoxic water, a large reduction in this cell mass occurred, making the lamellae protrude and increasing the respiratory surface area by ∼7.5-fold. This morphological change was found to be reversible and was caused by increased apoptosis combined with reduced cell proliferation. Carp with protruding lamellae had a higher capacity for oxygen uptake at low oxygen levels than fish with embedded lamellae, but water and ion fluxes appeared to be increased, which indicates increased osmoregulatory costs. This is, to our knowledge, the first demonstration of an adaptive and reversible gross morphological change in the respiratory organ of an adult vertebrate in response to changes in the availability of oxygen.
Phenotypic flexibility in cutaneous water loss and lipids of the stratum corneum
Authors: Haugen Michael J. , Tieleman B. Irene , Williams Joseph B. 
Published: September 2003

SUMMARYWhen vertebrates invaded land during the Carboniferous period, they were exposed not only to new ecological opportunities but also to a desiccating environment. To maintain cellular water homeostasis, natural selection modified the integument of pioneering terrestrial animals, enabling them to reduce water loss through the skin. In desert environments, where ambient temperatures (Ta) can reach 50°C, relative humidities are low and drinking water is scarce, integumentary modifications that reduce cutaneous water loss (CWL) could be fundamental to survival. Previous research has shown that hoopoe larks (Alaemon alaudipes) from the Arabian desert reduced CWL when acclimated to 35°C compared with individuals at 15°C, but skylarks (Alauda arvensis) and woodlarks (Lullula arborea), from The Netherlands, and Dunn's larks (Eremalauda dunni), also from the Arabian desert, did not. Here, we test the idea that hoopoe larks acclimated to 35°C would alter the lipid composition of their stratum corneum (SC), resulting in a decrease in CWL, but that skylarks,woodlarks and Dunn's larks would not. Specifically, we hypothesized that hoopoe larks, acclimated to 35°C, would increase the proportions of polar ceramide content and decrease the proportions of free fatty acids in their SC compared with individuals acclimated to 15°C. Results showed that hoopoe larks at 35°C had lower CWL and higher proportions of total ceramides but lower proportions of free fatty acids and sterols in their SC. We demonstrate that adjustments in ratios of lipid classes in the SC are associated with changes in CWL in hoopoe larks.
Evidence for nest-odour recognition in two species of diving petrel
Authors: Bonadonna Francesco , Cunningham Gregory B. , Jouventin Pierre , Hesters Florence , Nevitt Gabrielle A. 
Published: September 2003

SUMMARYIn nearly every procellariiform species, the sense of smell appears to be highly adapted for foraging at sea, but the sense of smell among the diving petrels is enigmatic. These birds forage at considerable depth and are not attracted to odour cues at sea. However, several procellariiform species have recently been shown to relocate their nesting burrows by scent, suggesting that these birds use an olfactory signature to identify the home burrow. We wanted to know whether diving petrels use smell in this way. We tested the common diving petrel Pelecanoides urinatrix and the South-Georgian diving petrel Pelecanoides georgicus to determine whether diving petrels were able to recognise their burrow by scent alone. To verify the efficacy of the method, we also tested a bird that is known to use olfaction for foraging and nest recognition, the thin-billed prion Pachyptila belcheri. In two-choice T-maze trials, we found that, for all species,individuals significantly preferred the odour of their own nest material to that of a conspecific. Our findings strongly suggest that an individual-specific odour provides an olfactory signature that allows burrowing petrels to recognize their own burrow. Since this ability seems to be well developed in diving petrels, our data further implicate a novel adaptation for olfaction in these two species that have been presumed to lack a well-developed sense of smell.
Urea synthesis in the African lungfishProtopterus dolloi-hepatic carbamoyl phosphate synthetase III and glutamine synthetase are upregulated by 6 days of aerial exposure
Authors: Chew Shit F. , Ong Tan F. , Ho Lilian , Tam Wai L. , Loong Ai M. , Hiong Kum C. , Wong Wai P. , Ip Yuen K. 
Published: September 2003

SUMMARYLike the marine ray Taeniura lymma, the African lungfish Protopterus dolloi possesses carbamoyl phosphate III (CPS III) in the liver and not carbamoyl phosphate I (CPS I), as in the mouse Mus musculus or as in other African lungfish reported elsewhere. However,similar to other African lungfish and tetrapods, hepatic arginase of P. dolloi is present mainly in the cytosol. Glutamine synthetase activity is present in both the mitochondrial and cytosolic fractions of the liver of P. dolloi. Therefore, we conclude that P. dolloi is a more primitive extant lungfish, which is intermediate between aquatic fish and terrestrial tetrapods, and represents a link in the fish-tetrapod continuum. During 6 days of aerial exposure, the ammonia excretion rate in P. dolloi decreased significantly to 8-16% of the submerged control. However, there were no significant increases in ammonia contents in the muscle, liver or plasma of specimens exposed to air for 6 days. These results suggest that (1) endogenous ammonia production was drastically reduced and (2)endogenous ammonia was detoxified effectively into urea. Indeed, there were significant decreases in glutamate, glutamine and lysine levels in the livers of fish exposed to air, which led to a decrease in the total free amino acid content. This indirectly confirms that the specimen had reduced its rates of proteolysis and/or amino acid catabolism to suppress endogenous ammonia production. Simultaneously, there were significant increases in urea levels in the muscle (8-fold), liver (10.5-fold) and plasma (12.6-fold) of specimens exposed to air for 6 days. Furthermore, there was an increase in the hepatic ornithine-urea cycle (OUC) capacity, with significant increases in the activities of CPS III (3.8-fold), argininosuccinate synthetase + lyase(1.8-fold) and, more importantly, glutamine synthetase (2.2-fold). This is the first report on the upregulation of OUC capacity and urea synthesis rate in an African lungfish exposed to air. Upon re-immersion, the urea excretion rate increased 22-fold compared with that of the control specimen, which is the greatest increase among fish during emersion-immersion transitions and suggests that P. dolloi possesses transporters that facilitate the excretion of urea in water.
A Strongly Antiferromagnetically Coupled Dinickel(II) Center Bridged by One Azido and One Alkoxo
Authors: Fujii Mie , Goto Shoko , Nakao Yasuo , Shiro Motoo , Sato Tomohiko , Mori Wasuke 
Published: September 2003

Abstract
The dinuclear nickel(II) complexes [Ni2(L-Et)(μ-1,3-N3)(N3)(H2O)]·[Ni2(L-Et)(μ-1,3-N3)(N3)(CH3OH)](NO3)2·H2O, (1) and [Ni2(L-Et)(μ-1,3-N3)(N3)(H2O)]NO3·H2O, (1′) (HL-Et = N,N,N′,N′-tetrakis[(1-ethyl-2-benzimidazolyl)methyl]-2-hydroxy-1,3-diaminopropane) bridged by one alkoxo of L-Et− and one azido were prepared and the crystal structure of 1 was determined by X-ray crystallography. Magnetic susceptibility measurements for 1′ from liquid helium temperature to room temperature showed an antiferromagnetically strong interaction (2J = −187 cm−1, H = −2JS1·S2).
Perspectives on HAART: switch maintenance therapy
Authors: Leen C L S 
Published: September 2003

Switch studies have been carried out to explore changes in side effects in adherence. Discontinuing the protease inhibitor (PI) component of highly active antiretroviral therapy (HAART) regimen is often associated with improved adherence and improved quality of life. Following switching from a PI to a non-nucleoside reverse transcriptase inhibitor or abacavir, there is however a clear trend toward an improved metabolic profile particularly in insulin resistance and triglyceride levels when patients discontinue their PI. Peripheral wasting is likely to be associated with nucleoside analogues and for individuals with isolated fat accumulation, modification of HAART is not recommended. Virological suppression can be maintained following switch if adequate suppression of the virus has been achieved for at least six months prior to switch and the patient has not been previously exposed to suboptimal HAART. Discontinuing the PI preserves this class of agents for future use. Switching however may be associated with other side effects; hypersensitivity, skin rashes, hepatic or neuropsychiatric events.
Gonorrhoea in a south London genitourinary medicine department
Authors: Newell A , Herbert E , Vigus J , Grieg A , MRCOG M E Rodgers 
Published: September 2003

The management and outcome of all cases of gonorrhoea which presented to a south London genitourinary medicine clinic during 1999 were assessed and compared with published national guidelines. The incidence of penicillin resistance was calculated, as was the rate of co-infection with chlamydia and trichomonas. Information regarding demographic data, microscopy, culture results, test of cure, antibiotic use, sensitivity and health adviser contact was examined. A total of 257 cases of gonorrhoea were diagnosed in 238 patients. Heterosexual men constituted 52.9% of cases, 6.6% were in homosexual men and 40.5% in women. Direct microscopy was positive in 88.8% of men and in 40.5% of women. In women, the rate of gonorrhoea co-infection with chlamydia was 34.7% and with trichomonas was 11.5%. In men the rate of chlamydia co-infection was only 3.3%, however, we do not believe this to be an accurate figure as we are unable to routinely screen all men for chlamydia due to financial restrictions. Amoxicillin with probenecid were the most commonly used antibiotics in line with local guidelines. Penicillin resistance was demonstrated in 4.6% of infected cases. Health advisers saw 73.2% of patients.