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High End (high + end)
Selected AbstractsThe Effect of Noise in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 7 2005Leslie S. Zun MD Abstract Background: It is hypothesized that high ambient noise in the emergency department (ED) adversely affects the ability of the examiner to hear heart and lung sounds. Objective: To determine the ability of various examiners to hear heart tones and lung sounds at the high end of loudness typically found in the ED setting. Methods: The study was divided into two parts. First, sound levels in the ED were measured over various times during the months of January through June 2001, using a sound level monitor. The second part of the study was the determination of the ability to hear heart and lung sounds on a young healthy volunteer using the same Littmann lightweight stethoscope at a predetermined ambient noise level of 90 dB. The results were entered into a database and analyzed using SPSS version 10 (Chicago, IL). Descriptive statistics, analysis of variance, frequencies, and correlation were calculated using this program. Results: Two hundred five sound measurements were taken in the ED during the study period in three locations at various hours. The mean noise level at the nursing station was 57.60 dB, with a minimum of 45.00 dB and a maximum of 70.00 dB. Four of the 104 test subjects (3.8%) were unable to hear the heart tones, and nine of the 104 (8.7%) were unable to hear the lung sounds. Fifty percent (27 of 54) of the test subjects reported diminished lung sounds and eight of 15 (53.3%) reported diminished heart sounds. No significant difference was found between hearing heart sounds and years of experience, age, professional position, and quality of the sound. Significant differences were found between hearing lung sounds and years of experience and professional position, but not with age, gender, and sound quality. Conclusions: This study demonstrated that most of the tested examiners have the ability to hear heart and lung sounds at the extreme of loudness found in one ED. [source] Kinetic uptake of bioavailable cadmium, selenium, and zinc by Daphnia magnaENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 11 2002Ri-Qing Yu Abstract Kinetic uptake of Cd, Se(IV), and Zn by Daphnia magna from the dissolved phase was determined using radiotracer techniques in moderately hard water. The metal influx rate and distribution in the soft tissue and the exoskeleton of the daphnids as influenced by metal concentration, inorganic ligands including pH, Ca2+ and SO42,, and body size were quantified. When the metal concentrations were <180 nM for Cd and <769 nM for Zn, the concentration factor in daphnids increased linearly within the 12 h of exposure. At a higher concentration, apparent steady state was reached after 3 h of exposure. Cadmium and Zn distribution in the soft tissues was not affected by the total ambient concentrations, whereas Se distribution in the soft tissue decreased by 7 to 10% with increasing Se concentration from 16 to 643 nM. A linear positive power relationship was found between the influx rates of the metals and the ambient concentrations. The concentration factor for Se, however, decreased significantly with increasing Se concentration in water. The influx rate of metals was inversely related to the body size in a power function. When the pH in ambient water increased from 5.0 to 7.0, the influx rate of Cd, Se, and Zn increased by 2.9, 16.6, and 4.1 times, respectively. The influx rates of Cd, Se, and Zn decreased by 6.9, 8.7, and 4.4 times, respectively, with an increase in Ca2+ concentration from 0.6 to 5.1 mM. In contrast, the uptake rates of all three metals were not significantly affected by the SO42, concentration. The majority of accumulated Se was distributed in the soft tissues after 12 h of exposure, whereas Cd and Zn were about evenly distributed in the soft tissue and exoskeleton. Any changes in pH, Ca2+, and SO42, concentrations did not apparently affect their distributions in the daphnids. Our study provides important kinetic data necessary for delineating the exposure routes and for further development of the biotic ligand model in Daphnia. Using a bioenergetic-based kinetic model, we showed that the dissolved uptake is dominant for Zn accumulation (>50%). For Cd and Se, dietary exposure is dominant when the bioconcentration factors of these metals in phytoplankton are at the high end. [source] Individual Male Calling Pattern and Male Mating Success in the European Treefrog (Hyla arborea): Is there Evidence for Directional or Stabilizing Selection on Male Calling Behaviour?ETHOLOGY, Issue 2 2006Thomas W.P. Friedl In anurans, call properties are commonly classified based on within-male variability as being either static or dynamic. Numerous playback experiments in the laboratory have indicated that female preferences based on dynamic call properties are usually strongly directional, while female preferences based on static call properties are often stabilizing or weakly directional. However, there are only few studies demonstrating that female preferences for high values of dynamic call properties indeed exert directional selection on male calling behaviour in natural populations. Moreover, field studies investigating whether female preferences for values of static call properties around the mean of the population lead to currently operating stabilizing selection on male calling patterns in natural populations are completely lacking. Here I investigate for two consecutive breeding seasons male calling patterns and male mating success in a population of individually marked European treefrogs (Hyla arborea), a hylid frog with prolonged breeding season and a lek mating system. Individual male calling pattern as analysed in terms of seven temporal and spectral call properties did not differ between males that survived from one breeding season to the next and those not surviving. None of the seven call properties investigated differed significantly between mated and unmated males, indicating that there is no strong directional selection on male calling behaviour in the study population. However, in one study season males that produced calls with a number of pulses around the mean of the population were significantly more likely to obtain matings than males that produced calls with a number of pulses at the low or high end of the distribution. Thus, this study provides preliminary evidence for the operation of stabilizing selection on a static call property (i.e. the number of pulses per call) in a natural population of an anuran amphibian. [source] Parents and Practitioners Are Poor Judges of Young Children's Pain SeverityACADEMIC EMERGENCY MEDICINE, Issue 6 2002Adam J. Singer MD Objective: Visual analog pain scales are reliable measures in older children and adults; however, pain studies that include young children often rely on parental or practitioner assessments for measuring pain severity. The authors correlated patient, parental, and practitioner pain assessments for young children with acute pain. Methods: This was a prospective, descriptive study of a convenience sample of 63 emergency department patients aged 4-7 years, with acute pain resulting from acute illness or painful invasive procedures. A trained research assistant administered a structured pain survey containing demographic and historical features to all parents/guardians. Children assessed their pain severity using a validated ordinal scale that uses five different faces with varying degrees of frowning (severe pain) or smiling (no pain). Each face was converted to a numeric value from 0 (no pain) to 4 (severe pain). Parents and practitioners independently assessed their child's pain using a validated 100-mm visual analog scale (VAS) marked "most pain" at the high end. Pairwise correlations between child, parent, and practitioner pain assessments were performed using Spearman's or Pearson's test as appropriate. The association between categorical data was assessed using ,2 tests. Results: Sixty-three children ranging in age from 4 to 7 were included. Mean age (±SD) was 5.7 (±1.1); 42% were female. Fifty-seven successfully completed the face scale. The distribution of the children's scores was 0-17%, 1-9%, 2-30%, 3-14%, and 4-30%. Mean parental and practitioner scores (±SD) on the VAS were 61 (±26) mm and 37 (±26) mm, respectively (maximal = 100 mm). Correlation between child and parent scores was 0.47 (p < 0.001). Correlation between child and practitioner scores was 0.08 (p = 0.54). Correlation between parent and practitioner scores was 0.04 (p = 0.001). Conclusions: There is poor agreement between pain ratings by children, parents, and practitioners. It is unclear which assessment best approximates the true degree of pain the child is experiencing. [source] A multi-trait test of the leaf-height-seed plant strategy scheme with 133 species from a pine forest floraFUNCTIONAL ECOLOGY, Issue 3 2010Daniel C. Laughlin Summary 1.,Westoby's [Plant and Soil (1998), 199, 213] Leaf-Height-Seed (LHS) plant strategy scheme quantifies the strategy of a plant based on its location in a three-dimensional space defined by three functional traits: specific leaf area (SLA), height, and seed mass. This scheme is based on aboveground traits and may neglect strategies of belowground resource capture if root functioning is not mirrored in any of the axes. How then do fine roots fit into the LHS scheme? 2.,We measured 10 functional traits on 133 plant species in a ponderosa pine forest in northern Arizona, USA. This data set was used to evaluate how well the LHS scheme accounts for the variation in above and belowground traits. 3.,The three most important plant strategies were composed of multiple correlated traits, but SLA, seed mass, and height loaded on separate principle components. The first axis reflected the widely observed ,leaf economics spectrum'. Species at the high end of this spectrum had high SLA, high leaf and fine root nitrogen (N) concentration, and low leaf dry matter content. The second axis reflected variation in seed mass and fine root morphology. Plants at the positive end of this spectrum were plants with large seeds and low specific root length (SRL). The third axis reflected variation in height and phenology. Plants at the positive end of this spectrum were tall species that flower late in the growing season. 4.,Leaf N concentration was positively correlated with fine root N concentration. SRL was weakly positively correlated with SLA. SRL was not correlated with fine root N concentration. Leaf litter decomposition rate was positively correlated with the leaf economics spectrum and was negatively correlated with the height and phenology spectrum. 5.,Leaf traits, seed mass, and height appear to be integrating properties of species that reflect much of the variation in plant function, including root function. Fine root N concentration was positively mirrored by the leaf economics spectrum, and SRL was inversely mirrored by seed mass. The leaf and height axes play a role in controlling leaf litter decomposability, indicating that these strategy axes have important consequences for ecosystem functioning. [source] Development and preliminary testing of a Paediatric Version of the Haemophilia Activities List (pedhal)HAEMOPHILIA, Issue 2 2010W. G. GROEN Summary., Worldwide, children with haemophilia suffer from limitations in performing activities of daily living. To measure such limitations in adults a disease-specific instrument, the Haemophilia Activities List (HAL), was created in 2004. The aim of this study was to adapt the HAL for children with haemophilia and to assess its psychometric properties. The structure and the main content were derived from the HAL. Additionally, items of the Childhood Health Assessment Questionnaire and the Activity Scale for Kids were considered for inclusion. This version was evaluated by health professionals (n = 6), patients (n = 4), and parents (n = 3). A pilot test in a sample of 32 Dutch children was performed to assess score distribution, construct validity (Spearman's rho) and reproducibility. Administration of the pedhal was feasible for children from the age of 4 years onwards. The pedhal scores of the Dutch children were in the high end of the scale, reflecting a good functional status. Most subscales showed moderate associations with the joint examination (rho = 0.42,0.63) and moderate-to-good associations with the physical function subscale of the CHQ-50 (rho = 0.48,0.74). No significant associations were found for the pedhal and the subscales mental health and behaviour, except for the subscales leisure and sport and mental health (rho = 0.47). Test,retest agreement was good. The pedhal is a promising tool, but further testing in populations with a higher level of disability is warranted to study the full range of its psychometric properties. [source] Damages Caps, Insurability, and the Performance of Medical Malpractice InsuranceJOURNAL OF RISK AND INSURANCE, Issue 1 2005W. Kip Viscusi This article uses the complete property-casualty insurance files of the National Association of Insurance Commissioners from 1984 to 1991 to assess the effect of medical malpractice reforms pertaining to damages levels and the degree to which these damages are insurable. Limits on noneconomic damages were most influential in affecting insurance market outcomes. Several punitive damages variables specifically affected the medical malpractice insurance market, including limits on punitive damage levels, prohibitions of the insurability of punitive damages, and prohibition of punitive damages awards. Estimates for insurance losses, premiums, and loss ratios indicate effects of reform in the expected directions, where the greatest constraining effects were for losses. The quantile regression analysis of losses indicates that punitive damages reforms and limits were most consequential for firms at the high end of the loss spectrum. Tort reforms also enhanced insurer profitability during this time period. [source] Pharmacokinetic measurements of IDN 5390 using electrospray ionization tandem mass spectrometry: structure characterization and quantification in dog plasmaRAPID COMMUNICATIONS IN MASS SPECTROMETRY, Issue 24 2005Liguo Song In this report, electrospray ionization tandem mass spectrometry (ESI-MS/MS) for a pharmacokinetic study of IDN 5390, a novel C- seco taxane derivative, which is under preclinical evaluation, has been investigated. Our results showed that IDN 5390 and other taxanes including paclitaxel and IDN 5109 could ionize well in not only positive-, but also in negative-ion mode. Under collision-induced dissociation (CID) conditions, these compounds could fragment into similar M- (molecular), T- (taxane ring) and S- (side chain) series ions. In positive-ion ESI, the formation of both T- and S-series ions involved the breaking of the C-13 ester bond. In negative-ion ESI, however, while the formation mechanism of S-series ions remained the same, the breaking of the C-1, carboxylic ester bond resulted in T-series ions. At optimum collision energy (CE) values, M-, T- and S-series ions of IDN 5390 in both positive- and negative-ion ESI-MS/MS spectra had good intensity. This phenomenon makes both positive- and negative-ion ESI-MS/MS good methods for IDN 5390 metabolite structural characterization, i.e. to reveal the location of modification groups in IDN 5390 metabolites versus IDN 5390 either on the side chain or the taxane ring. A liquid chromatography (LC)/ESI-MS/MS method using the multiple-reaction monitoring (MRM) technique was thereafter developed to quantify IDN 5390 in dog plasma using paclitaxel as internal standard. The method was validated using a concentration range between 5 and 1000,ng/mL and had a limit of detection of 1,ng/mL. The inter-day %CV (%coefficient of variation) of the calibration standards ranged between 4.36 and 9.64%, the intra-day %CV of the calibration standards between 0.61 and 13.44%, and the mean % accuracy of the quality control samples at the low, middle and high end of the concentration curves were 12.5, 6.8 and 9.6%, respectively. Copyright © 2005 John Wiley & Sons, Ltd. [source] | |||||||||||||