bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term persistence of a positive plant diversity–productivity relationship in the absence of legumes
Authors: Van Ruijven Jasper , Berendse Frank
Published: December 2008

Most studies investigating the relationship between plant diversity and ecosystem functioning lasted only a few years. These studies generally showed a positive relationship between diversity and productivity that strengthened with time. This pattern suggests the experimental communities have not yet reached maturity, which raises the question whether a positive relationship between diversity and productivity will remain if communities approach equilibrium conditions. Here, we analyze eight years of data from a plant diversity experiment without legumes. A positive relationship between plant diversity and productivity arose in the second year and increased until the fifth year. This relationship persisted throughout the remainder of the experiment, but the slope of the relationship remained constant at approximately 50 g/m2/log2[richness]. The positive relationship between diversity and productivity was caused by strong complementarity effects, which initially increased but remained constant after the fourth year of the experiment. Our results show a positive relationship between diversity and productivity is a long‐term phenomenon, driven by complementary interactions.
CHARACTERIZATION OF THE MAGIC ANGLE EFFECT IN THE EQUINE DEEP DIGITAL FLEXOR TENDON USING A LOW‐FIELD MAGNETIC RESONANCE SYSTEM
Authors: SPRIET MATHIEU , McKNIGHT ALEXIA
Published: December 2008

Three isolated equine limbs were imaged with a low‐field magnetic resonance system with a vertical magnetic field. Each limb was scanned in multiple positions with mild variation of the angle between the magnetic field and the long axis of the limb. When the long axis of the limb was not perpendicular to the magnetic field, a linear hyperintense signal was present at the palmar aspect of one of the deep digital flexor tendon lobes, at the level of the navicular bone and collateral sesamoidean ligaments, in proton density and T1‐weighted pulse sequences. With increased angulation of the limb, the palmar hyperintense signal extended farther distally and proximally and additional signal hyperintensity was present at the dorsal aspect of the distal part of the other lobe of the deep digital flexor tendon. Increased signal intensity was also present in the collateral ligament of the distal interphalangeal joint on the same side as the palmar hyperintense signal in the tendon. The changes in the deep digital flexor tendon are due to the specific orientation of fibers at the palmar and dorsal aspect of the tendon, which is responsible for focal manifestation of the magic angle effect. Careful positioning of the limb perpendicular to the magnetic field can prevent this phenomenon. The association of palmar increased signal intensity in the deep digital flexor tendon with increased signal in the collateral ligament of the distal interphalangeal joint on the same side should be recognized as manifestations of the magic angle effect.
COMPUTED TOMOGRAPHIC FINDINGS OF FUNGAL RHINITIS AND SINUSITIS IN CATS
Authors: Karnik Ketaki , Reichle Jean K. , Fischetti Anthony J. , Goggin Justin M.
Published: December 2008

The computed tomographic (CT) findings of fungal rhinitis/sinusitis in cats were characterized. The CT images of 10 cats ranging in age from 7 to 13 years were examined. The mean age was 10.8 years and all were neutered males. Nasal aspergillosis was diagnosed in five cats, cryptococcosis in three cats, hyalohyphomycosis in one cat, and trichosporonosis in one cat. Bilateral disease was present in eight cats, seven had abnormal soft tissue attenuation in two‐thirds of the nasal cavity, and six had turbinate lysis. Seven cats had also lysis of the hard palate, nasal septum, or frontal bone. One cat had lysis of the cribriform plate. Five of the nine cats whose lymph nodes were imaged had lymph node enlargement. There was contrast medium enhancement in the nasal cavity in all cats, with either a primarily peripheral rim or heterogeneous pattern. There appears to be an overlap of clinical signs, age, and CT features of cats with nasal neoplasia and those with fungal rhinitis/sinusitis.
RADIOGRAPHIC DEFINITION OF THE ANTICLINAL VERTEBRA  IN THE DOG
Authors: BAINES ELIZABETH A. , GRANDAGE JOHN , HERRTAGE MICHAEL E. , BAINES STEPHEN J.
Published: December 2008

The anticlinal vertebra is a point in the caudal thoracic vertebral column at which vertebral anatomic features change. It may be used as a point of reference in diagnostic imaging studies. However, its exact definition and anatomic location are not consistent between anatomic texts. The position of the anticlinal vertebra was evaluated radiographically in 100 dogs, using three different definitions of the anticlinal vertebra. Definition P referred to perpendicularity of the spinous proceses, definition V referred to verticality of the spinous processes, and definition J referred to the orientation of the intervertebral joints. The anticlinal vertebra was assessed to be T11 in 85%, 75%, and 89% of dogs for definitions P, V, and J, respectively. Combining definitions improved the likelihood that the vertebra assessed to be the anticlinal vertebra was T11, if the combination included definition J, but at the expense of loss of sensitivity. The degree of agreement between the definitions ranged from fair to poor. The level of agreement between definitions P and J was improved for small and large dogs and the level of agreement between definitions V and J was improved for medium and large dogs. Compared with large breed dogs, small breed dogs were more likely to have T10 described as the anticlinal vertebra. The presence of transitional vertebra did not affect the position of the anticlinal vertebra. It should not be assumed that the anticlinal vertebra is T11 in all dogs. Care should be taken to define this anatomic feature accurately when using it as an anatomic landmark.
COMPUTED TOMOGRAPHIC IMAGING PROTOCOL FOR THE CANINE CERVICAL AND LUMBAR SPINE
Authors: DREES RANDI , DENNISON SOPHIE E. , KEULER NICHOLAS S. , SCHWARZ TOBIAS
Published: December 2008

Computed tomography (CT) has been applied previously for assessment of canine spinal disease using a multitude of different technical imaging parameters. The purpose of this study was to establish an optimized imaging protocol for the cervical and lumbar canine spine using a single‐detector‐row helical CT unit. Thin slice thickness (1–2 mm), low pitch (axial scan mode, helical pitch <2), and medium‐frequency image reconstruction algorithm significantly improved the visibility of the intervertebral disk and spinal cord. Tube current, helical reconstruction interval, and the use of an additional edge enhancement filter had no significant effect on the visibility of the intervertebral disk and spinal cord. There was also no interaction between the use of an additional edge enhancement filter and image reconstruction algorithm. Use of an additional edge enhancement filter introduced a double ring artifact in the periphery of the spinal canal lumen that did not correspond to the spinal cord or pachymeningeal margin.
SONOGRAPHIC ESTIMATION OF PLEURAL FLUID VOLUME IN DOGS
Authors: NEWITT ANNA L. M. , CRIPPS PETER J. , SHIMALI JERRY
Published: December 2008

The aim of this study was to find an ultrasonographic method to estimate pleural fluid volume in dogs. Nine canine cadavers of mixed breed were studied. Using a transsternal view, linear measurements from the pleural surface of the midline of the sternebra at the center of the heart to the furthest ventrolateral point of both right and left lung edges were recorded. Isotonic saline was injected using ultrasound guidance into both right and left pleural spaces and the measurements were repeated using standard increments until 1000 ml total volume was reached. No relationship was identified between mean distance and injected volume up to 100 ml. Thereafter, the mean distance increased in an approximately linear relationship with the cube root of fluid volume. There was a high correlation (r≥0.899) between the ultrasonographic measurement and fluid volume within individual dogs, but it was not possible to produce a useful equation to calculate absolute pleural fluid volume for new subjects. Nevertheless, ultrasonography may be used to semiquantitatively monitor pleural fluid volume, so that a decrease in the mean linear measurement obtained reflects a decrease in the total fluid volume.
ULTRASONOGRAPHIC ASSESSMENT OF LARYNGOHYOID POSITION AS A PREDICTOR OF DORSAL DISPLACEMENT OF THE SOFT PALATE IN HORSES
Authors: CHALMERS HEATHER J. , YEAGER AMY E. , DUCHARME NORM
Published: December 2008

Dorsal displacement of the soft palate is an important cause of poor performance in racehorses, yet its etiology is not fully understood. Diagnosis requires treadmill videoendoscopy, which is not widely available. The relationship of the larynx, the hyoid apparatus, and the remainder of the skull may be important in predisposing horses to dorsal displacement of the soft palate. We hypothesized that this relationship could be accurately assessed in unsedated horses through ultrasonographic examination. Fifty‐six racehorses presented for evaluation of poor performance were subjected to treadmill videoendoscopy and resting ultrasonography. Using ultrasound‐assisted percutaneous measures of laryngo‐hyoid position, the relationship between selected anatomic structures and the occurrence of dorsal displacement of the soft palate was evaluated. A significant relationship was found between the depth of the basihyoid bone at rest and the occurrence of dorsal displacement of the soft palate at exercise (P=0.03). Other measures of laryngohyoid position were not found to be associated with dorsal displacement of the soft palate. Thus, there is an association between the occurrence of dorsal displacement of the soft palate at exercise and the resting position of the basihyoid bone, whereby on average a more ventral location of the basihyoid bone is present in horses with dorsal displacement of the soft palate. The pathophysiologic implications of this finding are not fully understood but, based on our findings, ultrasound examination is of value in assisting in the diagnosis of dorsal displacement of the soft palate.
QUANTITATIVE ULTRASONOGRAPHY FOR ASSESSMENT OF BONE MINERAL DENSITY IN THE CANINE RADIUS AND TIBIA
Authors: LAUER SUSANNE K. , DAVIES EMMA S. , HOSGOOD GISELLE , CREMER JEANNETTE
Published: December 2008

Quantitative ultrasound allows noninvasive assessment of cortical bone density. Potential applications include monitoring of fracture healing, rehabilitation, and skeletal diseases. The objectives of this study were to determine the three most accessible portals to obtain speed of sound measurements of the radius and tibia with an Omnisense multisite quantitative ultrasound device and to determine probe‐dependent intra‐ and interoperator variability for speed of sound measurements of the radius and tibia in six healthy hounds. The radius was most accessible at the cranial proximal metaphysis, the cranial middiaphysis, and medial distal metaphysis. Speed of sound measurements were possible at these sites on the radius with acceptable intra‐ and interoperator variation (1.6–4.6%). Measurements differed significantly when performed with different probes at the cranial proximal radial metaphysis. The tibia was most accessible at the cranial proximal metaphysis, the medial middiaphysis, and medial distal metaphysis. The medial middiaphyseal and mediodistal tibial sites allowed measurements with lowest intra‐ and interoperator variation (<3.5%). A smaller probe allowed tibial measurements with lowest interoperator variation. Measurements did not differ significantly at each tibial site when different probes were used. Measurements did not differ significantly between observers when measuring with the same probe at each specific site on radius and tibia. A medium‐size probe allowed for most time‐efficient measurements and the least number of failed measurements on the radius and tibia. Speed of sound can be consistently measured by different observers on the radius and tibia in healthy hounds.
Arabidopsis thalianaCYP77A4 is the first cytochrome P450 able to catalyze the epoxidation of free fatty acids in plants
Authors: Sauveplane Vincent , Kandel Sylvie , Kastner Pierre‐Edouard , Ehlting Jürgen , Compagnon Vincent , Werck‐Reichhart Danièle , Pinot Franck
Published: December 2008

An approach based on anin silicoanalysis predicted that CYP77A4, a cytochrome P450 that so far has no identified function, might be a fatty acid‐metabolizing enzyme.CYP77A4was heterologously expressed in aSaccharomyces cerevisiaestrain (WAT11) engineered for cytochrome P450 expression. Lauric acid (C12:0) was converted into a mixture of hydroxylauric acids when incubated with microsomes from yeast expressingCYP77A4. A variety of physiological C18fatty acids were tested as potential substrates. Oleic acid (cis‐Δ9C18:1) was converted into a mixture of ω‐4‐ to ω‐7‐hydroxyoleic acids (75%) and 9,10‐epoxystearic acid (25%). Linoleic acid (cis,cis‐Δ9,Δ12C18:2) was exclusively converted into 12,13‐epoxyoctadeca‐9‐enoic acid, which was then converted into diepoxide after epoxidation of the Δ9unsaturation. Chiral analysis showed that 9,10‐epoxystearic acid was a mixture of 9S/10Rand 9R/10Sin the ratio 33 : 77, whereas 12,13‐epoxyoctadeca‐9‐enoic acid presented a strong enantiomeric excess in favor of 12S/13R, which represented 90% of the epoxide. Neither stearic acid (C18:0) nor linolelaidic acid (trans,trans‐Δ9,Δ12C18:2) was metabolized, showing that CYP77A4 requires a double bond, in thecisconfiguration, to metabolize C18fatty acids. CYP77A4 was also able to catalyze thein vitroformation of the three mono‐epoxides of α‐linolenic acid (cis,cis,cis‐Δ9,Δ12,Δ15C18:3), previously described as antifungal compounds. Epoxides generated by CYP77A4 are further metabolized to the corresponding diols by epoxide hydrolases located in microsomal and cytosolic subcellular fractions fromArabidopsis thaliana. The concerted action of CYP77A4 with epoxide hydrolases and hydroxylases allows the production of compounds involved in plant–pathogen interactions, suggesting a possible role for CYP77A4 in plant defense.
Coq10, a mitochondrial coenzyme Q binding protein, is required for proper respiration in Schizosaccharomyces pombe
Authors: Cui Tie‐Zhong , Kawamukai Makoto
Published: December 2008

It has been widely accepted that most coenzyme Q (CoQ) exists freely in the mitochondrial membrane as a CoQ pool. However, the recent identification of a mitochondrial CoQ‐binding protein, termed Coq10, in budding yeast has the potential to change our current view of CoQ status in membranes. Here, we studied the counterpart of budding yeast Coq10 (also termed Coq10) in fission yeast. Fission yeast coq10 null mutants exhibited a similar, but less severe, phenotype to CoQ‐deficient fission yeast, including the requirement for antioxidants for proper growth on minimal medium, increased sensitivity to H2O2, high levels of H2S production, and a deficiency in respiration. The coq10 null mutant produced nearly normal levels of CoQ10, suggesting that coq10 does not belong to the group of CoQ biosynthetic genes. To elucidate the role of Coq10, we expressed recombinant coq10 in Escherichia coli, and found that CoQ8 was present in purified recombinant Coq10. Mutational analysis of 13 conserved residues of Coq10 revealed that two hydrophobic amino acid residues, leucine 63 (L63) and tryptophan 104 (W104), play an important role in Coq10 binding to CoQ. An L63A/W104A double mutant of Coq10 exhibited lower CoQ‐binding activity than either of the single mutants, and was unable to complement the coq10 deletion in fission yeast. A human Coq10 ortholog was able to functionally compensate for the absence of coq10 in fission yeast, suggesting that Coq10 is important for proper respiration in a variety of organisms.
Combination of Doxazosin and Sildenafil Exerts an Additive Relaxing Effect Compared with Each Compound Alone on Human Cavernosal and Prostatic Tissue
Authors: Oger Stéphanie , Behr-Roussel Delphine , Gorny Diane , Lecoz Olivier , Lebret Thierry , Denoux Yves , Faix Antoine , Leriche Albert , Wayman Chris , Alexandre Laurent , Giuliano François
Published: December 2008

Introduction

Phosphodiesterase 5 inhibitors (PDE5) such as sildenafil are first-line treatment for erectile dysfunction (ED). Alpha1 (α1)-adrenoceptor antagonists such as doxazosin are indicated for the treatment of patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). ED and LUTS/BPH are conditions that are often associated. Accordingly, α1-adrenoceptor antagonists and PDE5 inhibitors will be often prescribed in real life setting together.

Aim

To evaluate the effects of the combination of sildenafil and doxazosin on human cavernosal and prostatic tissue.

Methods

Prostatic and erectile tissues were obtained from nine to 12 patients, respectively. Patients underwent cystoprostatectomy for infiltrating bladder cancer or penile surgery for penile implant, congenital curvature or Peyronie’s disease.

Main Outcome Measures

In organ baths, prostatic and cavernosal strips were submitted to either concentration-response curves (CRC) to phenylephrine (Phe) or norepinephrine (NE), respectively, in presence of vehicle, sildenafil (10−6 M, 10−5 M), doxazosin (10−8 M, 3.10−8 M, or 10−7 M), or a combination of both. Continuous electrical field stimulation (EFS; 32 Hz, 5 ms, 5 seconds, 300 mA) was performed on prostatic strips which were incubated with sildenafil 10−6 M or vehicle before the successive addition of doxazosin (10−7 M, 10−6 M) or vehicle. Cavernosal strips were pre-incubated with doxazosin (10−9 M, 10−8 M) or vehicle, then CRC to sildenafil were constructed on NE (3.10−6 M) precontracted cavernosal strips.

Results

Combination of sildenafil and doxazosin exerted a greater relaxing effect on CRC to Phe or NE compared with each compound alone in both tissues. Sildenafil significantly enhanced the relaxing effect of doxazosin on EFS-induced contractions in prostatic strips. Doxazosin significantly increased the ability of sildenafil to inhibit NE-induced contractions in cavernosal strips.

Conclusions

Sildenafil and doxazosin reduced adrenergic tone of prostatic and cavernosal smooth muscle and their combination provided a significant benefit when targeting relaxation of both tissues. These experiments provide support for further clinical evaluation of the sildenafil and doxazosin combination in ED patients with LUTS/BPH.
Sustaining the Rural Workforce: Nursing Perspectives on Worklife Challenges
Authors: Hunsberger Mabel , Baumann Andrea , Blythe Jennifer , Crea Mary
Published: December 2008

ABSTRACT: 
Context: Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses’ work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique requirements of nurses in rural practice environments. Purpose: To investigate whether nurses receive the resources and supports necessary to meet the challenges of rural practice. Methods: Semi‐structured interviews were conducted with 21 managers and 44 staff nurses in 19 selected rural hospitals in Ontario, Canada. The interviews were taped and transcripts interpreted through a thematic analysis. Major worklife themes were identified and analyzed within a healthy work environment model based on the work of Kristensen. Findings: Three interrelated dimensions of the model were relevant to workforce sustainability: the balance between demands and the resources of the person, the level of social support, and the degree of influence. The availability of resources and supports affected whether the nurses perceived challenges as stimulating or overwhelming. Deficits interfered with practice and the well‐being of the nurses and patients. Conclusions: The nurses felt frustrated and powerless when they lacked resources, support, and influence to manage negative situations. Strategies to achieve workforce sustainability include resources to reduce stress in the workplace, education to meet the needs of new and experienced nurses, and offering of employment preferences to the workforce. Addressing resources, support, and influence of rural nurses is essential to alleviate workplace challenges and sustain the rural nursing workforce.
Trends in the Rehabilitation Therapist Workforce in Underserved Areas: 1980‐2000
Authors: Wilson Richard D. , Lewis Steven A. , Murray Patrick K.
Published: December 2008

ABSTRACT: 
Context: There is little information about how increases in the rehabilitation therapist workforce have been distributed over the nation. There is evidence that rural areas continue to face a shortage of trained rehabilitation providers. There has also been little attention to therapist distribution in non‐rural settings where health professionals are in short supply. Purpose: To assess the change in the distribution of rehabilitation therapists in 1980, 1990, and 2000 across counties with different levels of health professional shortages and the difference between metropolitan and non‐metropolitan counties. Methods: A trend analysis of cross‐sectional data of employment of physical therapists, occupational therapists, and speech‐language pathologists from 1980 to 2000 by county, relative to population, was done. The groups were stratified by shortage area, partial shortage area, and non‐shortage counties and metropolitan and non‐metropolitan counties. Findings: There is a maldistribution of rehabilitation therapists in the United States. Although the absolute differences have remained the same or, in most instances, have increased, the relative change was greatest in the shortage areas and non‐metropolitan areas. If the trends in the relative changes continue, the absolute differences may begin to narrow. Conclusions: This study provides evidence that there are maldistributions of rehabilitation therapists in traditionally underserved areas. It is unclear if these maldistributions represent a shortage of rehabilitation therapists. Continued monitoring of the rehabilitation therapist workforce and the determination of the optimal supply should be undertaken in the future.
Exploring the Temperament and Character Traits of Rural and Urban Doctors
Authors: Eley Diann , Young Louise , Przybeck Thomas R.
Published: December 2008

ABSTRACT: 
Context: Australia shares many dilemmas with North America regarding shortages of doctors in rural and remote locations. This preliminary study contributes to the establishment of a psychobiological profile for rural doctors by comparing temperament and character traits with an urban cohort. Purpose: The aim was to compare the individual levels and combinations of temperament (mildly heritable and stable) and character (developmental and modifiable) traits of rural and urban general practitioners (GPs). Methods: Rural (n = 120) and urban (n = 94) GPs completed a demographic questionnaire and the TCI‐R 140 to identify levels of the 7 basic dimensions of temperament and character. These are Novelty Seeking (NS), Harm Avoidance (HA), Reward Dependence (RD), Persistence (PS), Self‐Directedness (SD), Cooperativeness (CO), and Self‐Transcendence (ST). Findings: Preliminary results show rural GPs were higher in the temperament traits of NS and lower in HA compared with the urban sample. All female GPs were higher in RD and CO compared with all males, and all older GPs (over 55 years) were lower in RD compared with all younger GPs. Conclusions: This preliminary work may be the precursor to a new approach for the recruitment and retention of rural doctors through a greater awareness of personality traits conducive to the rural workforce. Further work may help inform appropriate policies to attract and retain this workforce and be a useful adjunct to the counseling of students interested in rural medicine by providing a better understanding of “what it takes” to be a rural doctor.
Childhood Conduct Problems and Other Early Risk Factors in Rural Adult Stimulant Users
Authors: Kramer Teresa L. , Han Xiaotong , Leukefeld Carl , Booth Brenda M. , Edlund Carrie
Published: December 2008

ABSTRACT: 
Context: Understanding childhood risk factors associated with adult substance use and legal problems is important for treatment and prevention. Purpose: To examine the relationship of early substance use, conduct problems before age 15, and family history of substance abuse on adult outcomes in rural, stimulant users. Methods: Adult cocaine and methamphetamine users (N = 544) in rural Arkansas and Kentucky were interviewed. Data were analyzed using both bivariate analyses and multiple logistic and log‐linear regression models, with dependent variables being any substance abuse/dependence, stimulant abuse/dependence, total number of arrests since age 18 and days incarcerated since age 18. Findings: One third reported 3 or more conduct disorder problems prior to age 15; half reported initiation of substances (excluding alcohol) before age 15; and 60% reported family history of substance problems. All 3 variables were associated with adult substance abuse/dependence but only the latter two were associated with stimulant abuse/dependence. Conclusions: This study highlights early risk factors for adult substance abuse/dependence among rural stimulant users.
Rates of Physical Activity Among Appalachian Adolescents in Ohio
Authors: Hortz Brian , Stevens Emily , Holden Becky , Petosa R. Lingyak
Published: December 2008

ABSTRACT: 
Purpose: The purpose of this study was to describe the physical activity behavior of high school students living in the Appalachian region of Ohio. Methods: A cross‐sectional sample of 1,024 subjects from 11 schools in Appalachian Ohio was drawn. Previously validated instruments were used to measure physical activity behavior over 7 days. Findings: Appalachian adolescents fell short of recommended levels of activity. They reported high rates of sedentary behavior by 9th grade. Appalachian adolescents may be acquiring sedentary behaviors earlier than adolescents living in other regions. Low rates of activity make this population particularly at risk for the health consequences associated with inactivity.
Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non‐VA Hospitals?
Authors: Weeks William B. , Lee Richard E. , Wallace Amy E. , West Alan N. , Bagian James P.
Published: December 2008

ABSTRACT: 
Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non‐VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine 3,513,912 hospital admissions for older veterans that occurred in VA or non‐VA hospitals between 1997 and 2004. We calculated 30‐day readmission rates and odds ratios for rural and urban veterans, and we performed a logistic regression analysis to determine whether living in a rural setting or initially using the VA for hospitalization were independent risk factors for unplanned 30‐day readmission, after adjusting for age, sex, length of stay of the index admission, and morbidity. Findings: Overall, rural veterans had slightly higher 30‐day readmission rates than their urban counterparts (17.96% vs 17.86%; OR 1.006, 95% CI: 1.0004, 1.013). For both rural‐ and urban‐dwelling veterans, readmission after using a VA hospital was more common than after using a non‐VA hospital (20.7% vs 16.8% for rural veterans, 21.2% vs 16.1% for urban veterans). After adjusting for other variables, readmission was more likely for rural veterans and following admission to a VA hospital. Conclusions: Our findings suggest that VA should consider using the unplanned readmission rate as a performance metric, using the non‐VA experience of veterans as a performance benchmark, and helping rural veterans select higher performing non‐VA hospitals.
Factors Associated with Iowa Rural Hospitals' Decision to Convert to Critical Access Hospital Status
Authors: Li Pengxiang , Ward Marcia M. , Schneider John E.
Published: December 2008

ABSTRACT: 
Context: The Balanced Budget Act (BBA) of 1997 allowed some rural hospitals meeting certain requirements to convert to Critical Access Hospitals (CAHs) and changed their Medicare reimbursement from prospective to cost‐based. Some subsequent CAH‐related laws reduced restrictions and increased payments, and the number of CAHs grew rapidly. Purpose: To examine factors related to hospitals' decisions to convert and time to CAH conversion. Methods: Eighty‐nine rural hospitals in Iowa were characterized and observed from 1998 to 2005. Cox proportional hazards models were used to identify the determinants of time to CAH conversion. Findings: T‐test and one‐covariate Cox regression indicated that, in 1998, Iowa rural hospitals with more staffed beds, discharges, and acute inpatient days, higher operating margin, lower skilled swing bed days relative to acute days, and located in relatively high density counties were more likely to convert later or not convert before 2006. Multiple Cox regression with baseline covariates indicated that lower number of discharges and average length of stay (ALOS) were significant after controlling all other covariates. Conclusion: Iowa rural hospitals' decisions regarding CAH conversion were influenced by hospital size, financial condition, skilled swing bed days relative to acute days, length of stay, proportion of Medicare acute days, and geographic factors. Although financial concerns are often cited in surveys as the main reason for conversion, lower number of discharges and ALOS are the most prominent factors affecting rural hospitals' decision on when to convert.
Electronic Patient Registries Improve Diabetes Care and Clinical Outcomes in Rural Community Health Centers
Authors: Pollard Cecil , Bailey Kelly A. , Petitte Trisha , Baus Adam , Swim Mary , Hendryx Michael
Published: December 2008

ABSTRACT: 
Context: Diabetes care is challenging in rural areas. Research has shown that the utilization of electronic patient registries improves care; however, improvements generally have been described in combination with other ongoing interventions. The level of basic registry utilization sufficient for positive change is unknown. Purpose: The goal of the current study was to examine differential effects of basic registry utilization on diabetes care processes and clinical outcomes according to level of registry use in a rural setting. Methods: Patients with diabetes (N = 661) from 6 Federally Qualified Health Centers in rural West Virginia were entered into an electronic patient registry. Data from pre‐ and post‐registry were compared among 3 treatment and control groups that had different levels of registry utilization: low, medium, or high (for example, variations in the use of registry‐generated progress notes examined at the point‐of‐care and in the accuracy of registry‐generated summary reports to track patients' care). Data included care processes (annual exams, screens to promote wellness, education, and self‐management goal‐setting) and clinical outcomes (HbA1c, LDL, HDL, cholesterol, triglycerides, blood pressure). Findings: The registry assisted in significantly improving 12 of 13 care processes and 3 of 6 clinical outcomes (HbA1c, LDL, cholesterol) for patients exposed to at least medium levels of registry utilization, but not for the controls. For example, the percent of patients who had received an annual eye exam at follow‐up was 11%, 34%, and 38% for the low, medium, and high utilization groups, respectively; only the latter groups improved. Conclusions: As an initial step to achieving control of diabetes, basic registry utilization may be sufficient to drive improvements in provider‐patient care processes and in patient outcomes in rural clinics with few resources.
Racial Differences in HPV Knowledge, HPV Vaccine Acceptability, and Related Beliefs Among Rural, Southern Women
Authors: Cates Joan R. , Brewer Noel T. , Fazekas Karah I. , Mitchell Cicely E. , Smith Jennifer S.
Published: December 2008

ABSTRACT: 
Context: Because cervical cancer mortality in the United States is twice as high among black women as white women and higher in rural areas, providing human papillomavirus (HPV) vaccine to rural black adolescents is a high priority. Purpose: To identify racial differences in knowledge and attitudes about HPV, cervical cancer, and the HPV vaccine that may influence uptake of the vaccine. Methods: We interviewed women (91 black and 47 white) living in a rural area of the Southern United States in 2006. Analyses controlled for socioeconomic status, age, and recruitment location. Findings: More white respondents had heard of HPV than had black respondents (57% vs 24%, P < .001), and whites had higher HPV knowledge (42% vs 29% correct responses, P < .05). Blacks were less likely than whites to think that cervical cancer would be a serious threat to their daughters' health (75% vs 96%, P < .001). More blacks than whites thought the ideal age to receive the vaccine was 17 years or older (63% vs 40%, P < .05). Blacks reported lower intentions to vaccinate their daughters than whites (M = 4.14 vs 4.55, P < .05 in unadjusted analyses, but not statistically significant in adjusted analyses). Conclusions: Black and white respondents had different awareness, knowledge, and beliefs related to the HPV vaccine. Communication‐based interventions to maximize uptake of the HPV vaccine in the rural, Southern United States may need different messages for black parents of adolescent girls.
Health Care Utilization Among Migrant Latino Farmworkers: The Case of Skin Disease
Authors: Feldman Steven R. , Vallejos Quirina M. , Quandt Sara A. , Fleischer Alan B. , Schulz Mark R. , Verma Amit , Arcury Thomas A.
Published: December 2008

ABSTRACT: 
Context: Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources. Purpose: Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods: Three hundred and four migrant and seasonal Latino farmworkers in North Carolina were enrolled in a longitudinal study of skin disease and health care utilization over a single agricultural season. Self‐reported and dermatologist‐diagnosed skin condition data were collected at baseline and at up to 4 follow‐up assessments. Medical visit rates were compared to national norms. Findings: Self‐reported skin problems and diagnosed skin disease were common among farmworkers. However, only 34 health care visits were reported across the entire agricultural season, and none of the visits were for skin diseases. Nevertheless, self‐treatment for skin conditions was common, including use of non‐prescription preparations (63%), prescription products (9%), and home remedies (6%). General medical office visits were reported in 3.2% of the assessments, corresponding to 1.6 office visits per person year. Conclusions: The migrant farmworker population consists largely of young men who make little use of clinic services. Skin conditions are very common among these workers, but use of medical services for these conditions is not common. Instead, farmworkers rely primarily on self‐treatment. Clinic‐based studies of farmworker skin conditions will not account for most injury or disease in this population and have the potential for biased estimates.
Body Mass Index and Cancer Screening in Older American Indian and Alaska Native Men
Authors: Muus Kyle J. , Baker‐Demaray Twyla , McDonald Leander R. , Ludtke Richard L. , Allery Alan J. , Bogart T. Andy , Goldberg Jack , Ramsey Scott D. , Buchwald Dedra S.
Published: December 2008

ABSTRACT: 
Context: Regular screenings are important for reducing cancer morbidity and mortality. There are several barriers to receiving timely cancer screening, including overweight/obesity. No study has examined the relationship between overweight/obesity and cancer screening among American Indian/Alaska Natives (AI/ANs). Purpose: To describe the prevalence of fecal occult blood testing (FOBT) and prostate‐specific antigen (PSA) testing among AI/AN men within the past year by age and rurality, and determine if body mass index (BMI) is associated with screening. Methods: A national cross‐sectional survey was administered face‐to‐face to 2,447 AI/AN men at least 55 years of age in 2004‐2005. Participants were asked when they last had FOBT and PSA testing. BMI was derived from self‐reported height and weight, and rurality of residence was defined by rural‐urban commuting area codes. We assessed the association of cancer screening and BMI with logistic regression models, adjusting for demographic and health factors. Findings: Prevalence of up‐to‐date FOBT and PSA testing were 23% and 40%, respectively. Older men were more likely than younger men to have FOBT and PSA testing. BMI was not associated with receipt of FOBT or PSA testing. Conclusions: This is the first study to examine obesity and health care in AI/ANs. As in other populations, FOBT and PSA testing were suboptimal. Screening was not associated with BMI. Studies of AI/AN men are needed to understand the barriers to receiving timely screenings for prostate and colorectal cancer.
Objective evaluation of tongue base snoring after the use of an oral appliance: a prospective case series
Authors: Abo‐Khatwa M.M. , Osman E.Z. , Hill P.D. , Lee B.W.V. , Osborne J.E.
Published: December 2008

Summary:  Oral appliances have become increasingly popular for treatment of obstructive sleep apnoea especially for patients who are not able to tolerate continuous positive airway pressure devices. For simple snoring, oral appliances have become one of the treatments of choice despite a relative lack of scientific evidence of their efficiency.

Objectives:  This study was designed to objectively evaluate the clinical effectiveness of oral appliance in the treatment of simple snoring.

Design:  Prospective case series.

Participants:  Fifteen patients with confirmed simple tongue base snoring had pre‐ and post‐oral appliance objective assessment of their snoring loudness and duration at home.

Main outcome measures:  The Snore Index was calculated as the number of snores per hour slept. Patients bed partners were asked to rate the snoring severity on a Spouse Dissatisfaction Scale.

Results:  Overall there was no significant difference in the Snore Index in the pre‐ and post‐oral appliance recordings. Subjectively, there was a statistically significant decrease in the Spouse Dissatisfaction Scale following the use of oral appliance.

Conclusion:  Tongue base snorers had no significant reduction in their snoring with the oral appliances. There is a subjective benefit which may be due to the placebo effect.
Hemithyroidectomy for benign thyroid disease: who needs follow‐up for hypothyroidism?
Authors: Wormald R. , Sheahan P. , Rowley S. , Rizkalla H. , Toner M. , Timon C.
Published: December 2008

Objective:  To identify the incidence and possible risk factors for the development of hypothyroidism following hemithyroidectomy and to determine a simple protocol for the post‐op monitoring of thyroid function.

Design:  Prospective study.

Setting:  Tertiary Referral Centre.

Patients:  Eighty‐two consecutive patients who underwent hemi‐thyroidectomy between May 2003 and May 2005 were included. The clinical and pathological factors were obtained and statistically analysed.

Results:  Eighteen per cent of patients became hypothyroid post‐operatively. Multivariate analysis demonstrated that risk factors for hypothyroidism following hemithyroidectomy included a pre‐operative [TSH] >1.6 μIU/L [P = 0.008, hazard ratio (HR) 14, 95% confidence interval (CI) 2–54] and lymphocytic infiltration graded 3+ or more (P < 0.001, HR 42, 95% CI, 8–195%). There was no relationship between age, sex or weight of resected tissue and the risk of hypothyroidism.

Conclusion:  Patients with raised pre‐operative [TSH] or with lymphocytic infiltration of their thyroid specimen should undergo regular testing of thyroid function within the first year of surgery. In all other patients, thyroid function at 12 months is sufficient.
Treatment of non‐tuberculous mycobacterial cervicofacial lymphadenitis in children: critical appraisal of the literature
Authors: Timmerman M.K. , Morley A.D. , Buwalda J.
Published: December 2008

Background:  Surgical excision has historically been the treatment of choice for non‐tuberculous mycobacterial cervicofacial lymphadenitis. Emerging data suggests antibiotic treatment alone could be an attractive alternative to surgery. We questioned (1) what treatment offers best cure rates in children with this condition and (2) the evidence for antibiotic treatment alone.

Type of review:  Structured literature search according to the Evidence Based Medicine guidelines.

Search strategy/methods:  A structured search was conducted in PubMed, Embase and the Cochrane Library from 1966 up to November 2007. Relevant papers were critically appraised.

Results:  Six papers were included, one of which was a randomised controlled clinical trial (RCT). In general, treatment sequencing was not consistent. Surgery and medical treatment were often used in combination, resulting in high overall cure rates. In the RCT surgery and antibiotic treatment were compared as single modalities. The outcome of surgery was far superior (96%versus 66% cure rate, respectively). Other studies indicated that substantial cure rates (up to 67%) were achieved with medical management alone, but failed to identify factors predicting response.

Conclusion:  Surgical excision still is the backbone in the management of cervicofacial non‐tuberculous mycobacterial lymphadenitis, although a considerable number of children can be cured with antibiotics alone or combined modality treatment. To date it is unclear which subset of patients can benefit from antibiotic treatment only.
Combined electro‐acoustic stimulation: a beneficial union?
Authors: Talbot K.N. , Hartley D.E.H.
Published: December 2008

Background:  The most pressing problem facing cochlear implant research is no longer making artificial hearing a reality. Instead, it is to develop devices that can more clearly reflect the capabilities of the human auditory system. Current cochlear implants rarely provide adequate pitch perception. As hearing loss commonly affects higher, more than lower frequencies, a possible solution is to preserve acoustic hearing at low frequencies by inserting a short electrode array and thus deliver combined electro‐acoustic stimulation (EAS).

Objective of review:  To determine whether individuals with severe‐to‐profound high‐frequency hearing loss have realised this predicted benefit of combined EAS, over conventional cochlear implants, with respect to pitch.

Type of review:  A systematic review of publications pertaining to the benefits of combined EAS over conventional cochlear implantation, with specific reference to pitch perception.

Search strategy:  A systematic literature search was conducted across multiple databases and supplemented by searching the reference lists of relevant trials and identified reviews.

Results:  The included studies suggest an overall benefit of combined EAS, over conventional cochlear implants, with respect to pitch. In addition, (i) 13% sustained a total loss of low‐frequency hearing post‐implantation of the short electrode array and, (ii) 24% had >20 dB hearing loss across all frequencies and/or total hearing loss.

Conclusions:  For patients with severe‐to‐profound high‐frequency hearing loss combined EAS appears to offer a significant, everyday, long‐term benefit. However, further clinical trials with larger numbers of candidates are necessary to confirm this finding. The risks involved cannot be ignored, but there is potential for a variety of strategies to improve the safety margin.
Sensitivity and responsiveness of the medical research council dyspnoea scale to the presence and treatment of adult laryngotracheal stenosis
Authors: Nouraei S.A.R. , Nouraei S.M. , Randhawa P.S. , Butler C.R. , Magill J.C. , Howard D.J. , Sandhu G.S.
Published: December 2008

Objectives:  To assess the sensitivity and responsiveness of the Medical Research Council (MRC) scale, a psychophysical dyspnoea assessment instrument to the presence and treatment of adult laryngotracheal stenosis.

Design:  Prospective observational study.

Settings:  Tertiary/National referral airway reconstruction centre.

Participants:  Fourty tracheostomy‐free patients undergoing endoscopic airway examination/laryngotracheoplasty.

Main outcome measures:  Demographic and clinical information, obtained from patient records, lesion severity, which was recorded intraoperatively, standard spirometry, which was measured preoperatively, and the MRC dyspnoea scale, which was administered preoperatively and at the first outpatient visit 4–6 weeks later.

Results:  There were 16 males and 24 females. Mean age at presentation was 44 ± 14 years (± SD). Postintubation stenosis was the commonest aetiology (73%) followed by idiopathic subglottic stenosis and Wegener’s Granulomatosis. Six patients were examined post‐treatment and had minimal residual stenosis and the remaining patients had glottic stenosis (n = 11) or Myer–Cotton Grade I (n = 8), II (n = 7) or III (n = 8) tracheal stenoses. Pre‐treatment MRC dyspnoea scores and the degree of change in the MRC score following treatment strongly correlated with pre‐treatment stenosis severity (r = 0.75 and r = −0.71 respectively; P < .001). Moreover statistically significant correlations existed between preoperative peak expiratory flow and forced expiratory volume in 1 s and preoperative MRC dyspnoea scores (r = −0.34 and r = −0.35 respectively; P < 0.05).

Discussion:  Exertional dyspnoea is the hallmark symptom of laryngotracheal stenosis and for many patients it is the primary cause of disability. These findings confirm that the MRC dyspnoea scale is an appropriate outcome instrument for assessing dyspnoea associated with this condition.