bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison Of Three Versus Two Sputum Smear Microscopy In A Government Medical College, Patiala, India
Authors: Kishan J , Kaur P , Mahajan A , Monika M , Navneet K , Dulloo S
Published: February 2012

Introduction: Under the Revised National Tuberculosis Control Programme of India, three sputum samples are examined and 2 samples positivity criteria are used for labeling the patient as sputum positive pulmonary tuberculosis. Recent studies advocate use of two samples (one spot & one morning) for diagnosis of Tuberculosis. The objective was to compare three versus two sputum smears and to study the relevance of third sputum sample for microscopy in the current practice under Revised National Tuberculosis and Control Programme. Methodology: A study of the laboratory register of the designated microscopic centre for the calendar year 2008 was undertaken. In all 9028 suspects were examined. An analysis of contribution of various sputum samples, S1 (fi rst spot sample), M (early morning) & S2 (second spot) towards diagnosis of Pulmonary Tuberculosis was undertaken. Results: Sputum smear examination results of all the patients examined during 2008 were analyzed. Twelve hundred and eighty eight patients (99.3%) were labeled as smear positive tuberculosis when three sputum samples positivity criteria was considered. By applying two samples and any smear positivity criteria 1296 (99.9%) patients were labeled as sputum smear positive. Among 1296 smears, S1 was positive in 1088 (83.8%) and M in 1293 (99.6%) patients. Early morning sample positivity yield was found higher. Conclusion: Considering 2 samples for examination with at least one morning specimen and one sample positivity criteria, the work load on laboratory can be reduced by 1/3rd without affecting case detection rate. DOI: http://dx.doi.org/10.3126/saarctb.v8i2.5898 SAARCTB 2011; 8(2): 28-30
Ocular Manifestations In Hiv Positive Patients Attending Khyber Teaching Hospital Peshawar
Authors: Alam M , Akbar S , Khan A , Aqbal M
Published: February 2012

Introduction: Human immunodefi ciency virus (HIV) infection is a global health problem. Around 90% of infected persons live in developing countries, particularly those in sub-Saharan Africa and Southeast Asia. Ocular manifestations occur in approximately 70% of these patients. The objective of this study was to document ocular manifestations in HIV positive patients attending Khyber Teaching Hospital Peshawar, Pakistan. Methodology: It was a descriptive case series. The study was conducted at Khyber Teaching Hospital Peshawar from January to December 2007. A total of 14 patients were examined. These patients underwent complete ocular examination including assessment of visual acuity, pupillary reaction, ocular motility, ocular adnexa, anterior segment and posterior segment. CD4 count was done in all the patients. Results: Out of the 14 patients examined 6 (42.9%) had ocular manifestations, all of whom were male. The ocular manifestations included herpes simplex keratitis, herpes zoster ophthalmicus with neurotrophic keratitis, iridocyclitis, HIV retinopathy, retinal vasculitis and cytomegalovirus retinitis in one patient each. Amongst those with ocular manifestations, 5 patients (83.3%) had CD4 cell count of 100/mm3 or less and 1 patient (16.7%) had CD4 count between 101 and 200/mm3; and the mode of transmission was homosexual contact in 5 patients (83.3%) and vertical transmission in 1 patient (16.7%). Conclusion: Ocular manifestations occur in a considerable number of HIV positive patients particularly in those with CD4 cell count less than 100/mm3. Therefore, all HIV positive patients should be screened for ocular manifestations. DOI: http://dx.doi.org/10.3126/saarctb.v8i2.5899 SAARCTB 2011; 8(2): 31-36
Awareness Regarding Hiv/Aids Among College Students In Khyber Pakhtunkhwa
Authors: Khan S , Fatima S , Afridi NK , Salhotra VS , Jha KK
Published: February 2012

Introduction: HIV is still a major global health problem. In 2009, globally there were an estimated 2.6 million (2.3 million–2.8 million) incident cases of HIV. According to UNAIDS in 2009 a total of 98,000 (79,000 – 120,000) people are living with HIV in Pakistan. Pakistan was classifi ed as a low-prevalence country with many risk factors that could lead to the rapid development of an epidemic. In 2004, a concentrated outbreak of HIV was found among Injecting Drug Users (IDUs) in Karachi, where over 20 percent of those tested were found to be infected. Prevention efforts are beginning to bear fruit, with indications of behaviour change and declines in prevalence rates in a number of high-burden countries. The study aimed to determine the level of awareness among college students regarding HIV/AIDS in Khyber Pakhtunkhwa. Methodology: This cross sectional study was conducted in the two colleges of Peshawar. A total of sixty students were enrolled in the study thirty from each college through random sampling. The students were from second year class. One of the colleges was from Public Sector, Government College Peshawar and the other was from private sector Peshawar Model College (PMC). Results: It was interesting to note that 60% of the students of Government (Govt.) college and 70% of the students of PMC knew that a person having a healthy look might have been infected with HIV. Seventy percent of the students of Govt. college and 60% of the students of PMC reported that there is no curative treatment for HIV/AIDS. Major source of information regarding HIV/AIDS was through TV and friends. Condoms were regarded as main protection from HIV/AIDS as 35% of the students of Govt. College and 40% of the students of PMC reported as a method of prevention, Other preventive methods were also reported by the students. Conclusion: The study depicted that there remain gaps in certain areas of awareness of the students which needs initiation of HIV/AIDS awareness programmes among college students. DOI: http://dx.doi.org/10.3126/saarctb.v8i2.5900 SAARCTB 2011; 8(2): 37-41
Editorial Vol.2(1)
Authors: Ara Rowshan
Published: February 2012

DOI: http://dx.doi.org/10.3329/bioethics.v2i1.9800 Bangladesh Journal of Bioethics 2011; 2(1): 3
Ethical Poems
Authors: Osman Yeafesh
Published: February 2012

DOI: http://dx.doi.org/10.3329/bioethics.v2i1.9801 Bangladesh Journal of Bioethics 2011; 2(1): 4
UNESCO Core Curriculum and Teaching Resources
Authors: Macer Darryl
Published: February 2012

DOI: http://dx.doi.org/10.3329/bioethics.v2i1.9802 Bangladesh Journal of Bioethics 2011; 2(1): 5-6
Gender Imbalance in Policy Making Level in Science and Ethical Issue
Authors: Lasker Shamima Parvin
Published: February 2012

When the achievement of women leadership in Science and technology (S&T) is heighten in developed nations in comparison to women in developing countries, it is unfortunate that women are invariably left below, rarely reaching decision-making positions in S&T in Bangladesh. In Bangladesh, Prime Minister and Leader of Opposition are female but when it comes to leadership in science, it is difficult to find a Marie Curie in Bangladesh. Men are twenty times more likely than women to reach the top level positions in research. Women are underrepresented in almost in all scientific boards. The scarcity of women in senior positions in such bodies inevitably means that their opinions are less likely to be voiced in policy and decisionmaking processes, which may lead to bias decision-making and priority setting in scientific research. The causes of lower representation of women in S&T are discussed. All the causes raise ethical questions and violate the Universal Declaration of Human Rights (UDTH). Millennium development goals can never be accomplished without the active participation of women who represent 50 percent of the population, particularly their involvement in science education. Based on this analysis, a change of culture is required to improve gender imbalance in decision-making level in science.DOI: http://dx.doi.org/10.3329/bioethics.v2i1.9812  Bangladesh Journal of Bioethics 2011; 2(1): 13-17
Biomedical Consideration in the Manufacture, Clinical Trial and Bioequivalence Studies of Pharmaceuticals
Authors: Faroque ABM
Published: February 2012

Bangladesh pharmaceutical sector has been growing at a remarkable speed since 1982. From the meager 30% national market share, now it is supplying 97% of our annual demand. Around 1,100 generics are now available in a total of around 12,000 trade name products. The national market size has crossed 6,000 crore taka per annum, where the local multinational share is only 7%. Our industries are now exporting drugs to 72 countries. But just because our pharmaceutical sector has developed its own backbone does not meant that our pharmaceutical industries have solved the relevant bioethical questions. There are complaints that some companies do not pursue necessary bioethical norm as at various levels of its manufacturing processes. Still a good number of small companies sell sub-standard and counterfeit drugs, and yet some are not following accepted GMP standards. Moreover, for capturing foreign markets we need clinical trials and bioequivalence study results. These study needs human subjects as volunteers. In a poverty-stricken country like us, if we do not establish these clinical trial and bioequivalence norms, everything becomes irrelevant. If we can establish theses norms, this could be the beginning of a new era for further growth of our pharmaceutical industries vis-à-vis our public health national economy.DOI: http://dx.doi.org/10.3329/bioethics.v2i1.9813  Bangladesh Journal of Bioethics 2011; 2(1): 18-21
Fabrication of Biocompatible, Vibrational Magnetoelastic Materials for Controlling Cellular Adhesion
Authors: Holmes Hal R. , Tan Ee Lim , Ong Keat Ghee , Rajachar Rupak M.
Published: February 2012

This paper describes the functionalization of magnetoelastic (ME) materials with Parylene-C coating to improve the surface reactivity to cellular response. Previous study has demonstrated that vibrating ME materials were capable of modulating cellular adhesion when activated by an externally applied AC magnetic field. However, since ME materials are not inherently biocompatible, surface modifications are needed for their implementation in biological settings. Here, the long-term stability of the ME material in an aqueous and biological environment is achieved by chemical-vapor deposition of a conformal Parylene-C layer, and further functionalized by methods of oxygen plasma etching and protein adsorption. In vitro cytotoxicity measurement and characterization of the vibrational behavior of the ME materials showed that Parylene-C coatings of 10 µm or greater could prevent hydrolytic degradation without sacrificing the vibrational behavior of the ME material. This work allows for long-term durability and functionality of ME materials in an aqueous and biological environment and makes the potential use of this technology in monitoring and modulating cellular behavior at the surface of implantable devices feasible.
Low-Carbon Development Patterns: Observations of Typical Chinese Cities
Authors: Su Meirong , Liang Chen , Chen Bin , Chen Shaoqing , Yang Zhifeng
Published: February 2012

Threatened by the huge pressure caused by climate change, low-carbon cities have become an inevitable part of urban evolution. It is essential to evaluate urban low-carbon development levels to smoothly promote the construction of low-carbon cities. This paper proposes an evaluation index system for urban low-carbon development from the points of view of economic development and social progress, energy structure and usage efficiency, living consumption, and development surroundings. A weighted sum model was also established. Selecting 12 typical Chinese cities as cases studies, an integrated evaluation was conducted based on the index system and the assessment model. The development speed and limiting factors of different cities were also analyzed. The 12 cities were ultimately classified into three groups in terms of their low-carbon development patterns by integrating all of the analysis results. Furthermore, suitable regulation and management for different patterns were suggested. This study both aids in assessing the executive effect of low-carbon city construction and helps to determine existing problems and suggest effective solutions.
Tumor Heterogeneity: Mechanisms and Bases for a Reliable Application of Molecular Marker Design
Authors: Diaz-Cano Salvador J.
Published: February 2012

Tumor heterogeneity is a confusing finding in the assessment of neoplasms, potentially resulting in inaccurate diagnostic, prognostic and predictive tests. This tumor heterogeneity is not always a random and unpredictable phenomenon, whose knowledge helps designing better tests. The biologic reasons for this intratumoral heterogeneity would then be important to understand both the natural history of neoplasms and the selection of test samples for reliable analysis. The main factors contributing to intratumoral heterogeneity inducing gene abnormalities or modifying its expression include: the gradient ischemic level within neoplasms, the action of tumor microenvironment (bidirectional interaction between tumor cells and stroma), mechanisms of intercellular transference of genetic information (exosomes), and differential mechanisms of sequence-independent modifications of genetic material and proteins. The intratumoral heterogeneity is at the origin of tumor progression and it is also the byproduct of the selection process during progression. Any analysis of heterogeneity mechanisms must be integrated within the process of segregation of genetic changes in tumor cells during the clonal expansion and progression of neoplasms. The evaluation of these mechanisms must also consider the redundancy and pleiotropism of molecular pathways, for which appropriate surrogate markers would support the presence or not of heterogeneous genetics and the main mechanisms responsible. This knowledge would constitute a solid scientific background for future therapeutic planning.
Strategies for Successful Information Technology Adoption in Small and Medium-sized Enterprises
Authors: Ghobakhloo Morteza , Hong Tang Sai , Sabouri Mohammad Sadegh , Zulkifli Norzima
Published: February 2012

Information Technology (IT) adoption is an important field of study in a number of areas, which include small and medium-sized enterprises (SMEs). Due to the numerous advantages of IT, SMEs are trying to adopt IT applications to support their businesses. IT adoption by SMEs differs from larger organizations because of their specific characteristics, such as resources constraints. Therefore, this research aims to provide a better and clearer understanding of IT adoption within SMEs by reviewing and analyzing current IT literature. In this research, the review of literature includes theories, perspectives, empirical research and case studies related to IT adoption, in particular within SMEs from various databases such as Business Premier, Science Direct, JStor, Emerald Insight and Springer Link. The proposed model of effective IT adoption is believed to provide managers, vendors, consultants and governments with a practical synopsis of the IT adoption process in SMEs, which will in turn assist them to be successful with IT institutionalization within these businesses.
Crack Propagation in Honeycomb Cellular Materials: A Computational Approach
Authors: Paggi Marco
Published: February 2012

Computational models based on the finite element method and linear or nonlinear fracture mechanics are herein proposed to study the mechanical response of functionally designed cellular components. It is demonstrated that, via a suitable tailoring of the properties of interfaces present in the meso- and micro-structures, the tensile strength can be substantially increased as compared to that of a standard polycrystalline material. Moreover, numerical examples regarding the structural response of these components when subjected to loading conditions typical of cutting operations are provided. As a general trend, the occurrence of tortuous crack paths is highly favorable: stable crack propagation can be achieved in case of critical crack growth, whereas an increased fatigue life can be obtained for a sub-critical crack propagation.
Two New Iridoid Glycosides from the Root Barks of Sambucus williamsii Hance
Authors: Kuang Hai-Xue , Han Hua , Yang Bing-You , Yang Liu , Jiang Hai , Wang Qiu-Hong
Published: February 2012

Two new iridoid glycosides, named williamsoside C (1) and williamsoside D (2) were isolated from the root barks of Sambucus williamsii Hance. Their structures were established on the basis of extensive spectroscopic analysis (1D, 2D NMR and HRESIMS) and chemical studies as α-D-glucopyranosyl (1→2)-β-D-fructofuranosyl (4→6)-β-morroniside (1) and 7β-O-ethyl morroniside-(6′-O-7′′)-β-morroniside (2), respectively.
Identifying Geriatric Malnutrition in Nursing Practice: The Mini Nutritional Assessment (MNA®)—An Evidence-Based Screening Tool
Authors: Skates Janet J. , Anthony Patricia S.
Published: February 2012

Protein calorie malnutrition (PCM) is common and often undiagnosed in older adults. Left untreated, PCM carries both clinical and financial risks, including decreased quality of life, declining functionality, the inability to live independently, and increased health care costs. The prevalence of PCM in older adults calls for a systematic and standardized approach to nutrition screening that includes the use of a validated screening tool. Recommended by international organizations, the Mini Nutritional Assessment® (MNA) is highly specific and reliable and the most well-validated nutrition screening tool for adults 65 and older. Simple, noninvasive, inexpensive, and easy for nurses and other clinicians to use, the newest MNA-short form (MNA-SF) can quickly and easily identify older adults who are at risk for malnutrition or malnourished. Nurses are key players in successful malnutrition screening in hospitals, long-term care, home care, and community settings. It is strongly recommended that nurses incorporate the newest MNA-SF into all practice settings where older adults receive care.
Caregivers’ Desired Patterns of Communication with Nursing Home Staff—
Just TALKKK!
Authors: Palmer Janice L.
Published: February 2012

Individuals with cognitive impairment often represent a significant percentage of the residents in a nursing home nurse’s care. With years of experience caring for their placed family members, caregivers of these residents are often experts in knowing the resident’s needs, habits, behaviors, and moods. Caregivers often wish to convey this insider knowledge to nursing home staff. Furthermore, communication with caregivers promotes trust that personalized, safe, and effective care occurs when they are not there. Based on an interpretive study of the experiences of caregivers who place a family member with Alzheimer’s disease in the nursing home, six preferred patterns of communication are presented in this article. The six patterns are represented by the acronym TALKKK (tell them; ask them; listen to them; know their family member by relating and communicating; be knowledgeable about dementia, its progression, dementia-specific care, and commonly used medications; and share that knowledge with them).
Progressive Supranuclear Palsy
Authors: Mazorra Loretta , Cadogan Mary P.
Published: February 2012

Progressive supranuclear palsy (PSP) is the second-most-common parkinsonian neurodegenerative disorder following Parkinson’s disease. Although PSP was first identified clinically more than 40 years ago, it remains poorly recognized and underdiagnosed. Using an individual example, this article describes the epidemiology, neuropathology, clinical course, supportive management strategies, and resources for patients with PSP and their families.
An Assessment of Ocular Morbidities of Children Born Prematurely in Early Childhood
Authors: Goktas Altan , Sener Emin Cumhur , Sanac Ali Sefik
Published: February 2012

Purpose:

To assess the ocular morbidities of premature children in early childhood.

Methods:

One hundred seventeen children with a history of gestational age of less than 37 weeks at birth underwent ophthalmic examination including visual acuity testing with Lea symbols, anterior and posterior segment examination, refraction, orthoptic examination for strabismus, and ocular biometry. They were subdivided into three groups according to gestational age (28 or less, 29 to 32, and 33 to 36 weeks). The prevalence of ocular morbidities and mean value of refractive errors were studied.

Results:

The mean age of the subjects at examination was 37.6 ± 1.1 months (range: 20 to 65 months). Only 62.4% of the eyes had visual acuity better than 20/32. The prevalence of high myopia (above −5.0 diopters [D]), myopia (below −5.0 D), and strabismus was 12.5%, 22.5% and 33.3% in the 28 weeks or less group and 3.6%, 18.9%, and 24.1% in the 29 to 32 weeks group, respectively, whereas 7.9% of the 33 to 36 weeks group had myopia and 13.2% had strabismus. Spherical equivalent in eyes that received cryotherapy and with macular heterotopia was −2.7 ± 3.9 and - 4.4 ± 3.4 D, respectively. Biometric measurements showed that high myopic eyes had statistically significantly thicker lenses compared to myopic and hyperopic eyes (
P
= .01).

Conclusion:

This study confirms that children born prematurely are at increased risk of ocular morbidities such as defective visual acuity, myopia, and strabismus. High myopic eyes have thicker lenses compared to myopic and hyperopic eyes, and eyes with macular heterotropia and treated with cryotherapy are more prone to development of high myopia.
Outcomes of Strabismus Surgery for Esotropia in Children With Down Syndrome Compared With Matched Controls
Authors: Motley W. Walker , Melson Andrew T. , Gray Michael E. , Salisbury Shelia R.
Published: February 2012

Purpose:

Strabismus surgery dosages used in children with various neurodevelopmental disorders have been the subject of controversy. Few data have been reported regarding surgical results in individuals with Down syndrome (DS).

Methods:

A retrospective, case–control study was performed in which children with DS and previous bilateral medial rectus recession surgery were matched with similar control patients without DS. Surgical results were compared using a random coefficients model for repeated measurements for each group.

Results:

Sixteen patients with DS were matched with 16 control patients. Mean preoperative esotropia was 28.4 prism diopters (PD) in the DS group and 27.9 PD in the control group. No significant difference was found in surgical dosages between the two groups (
P
= .2402). Median surgical dosage was 4.4 mm in the DS group and 4.5 mm in the control group. Preoperative and 4-month and 24-month postoperative mean angles of esotropia were not different between groups (
P
= .8050). The 4-month postoperative mean angles of esotropia for the DS and control groups were 3.15 and 2.66 PD, respectively. The 24-month mean angles of esotropia for the DS and control groups were 7.09 and 6.60 PD, respectively.

Conclusion:

Standard bilateral medial rectus recession surgical dosages need not be modified for individuals with DS.
Traumatic Brain Injury and Suicide
Authors: Reeves Roy R. , Laizer Janet T.
Published: February 2012

A number of psychiatric and neurological problems may occur following traumatic brain injury (TBI). Anxiety and depression are common. There is evidence that there may be a correlation between TBI and increased risk of suicide. This article will explore current literature on the risk of suicidal behavior in people who have experienced TBI. Risk factors for suicide, recognition and assessment of suicidal behavior, and treatment issues will be discussed.
Youth Advisors Driving Action: Hearing the Youth Voice in Mental Health Systems of Care
Authors: Davis-Brown Karen , Carter Naeemah , Miller Bethany D.
Published: February 2012

The Children’s Mental Health Initiative (CMHI) is funded by the Center for Mental Health Services within the Substance Abuse and Mental Health Services Administration. CMHI assists communities in developing comprehensive, coordinated services for children with serious emotional disturbances and their families. Broadly speaking, these systems are designed to be child centered, youth guided, family driven, community based, and culturally competent. To assure implementation of the “youth-guided” core value in the national evaluation, an advisory group of youth coordinator/youth teams representing communities across the country was developed. This group chose the name YADA—Youth Advisors Driving Action. YADA has made a substantive contribution to national evaluation efforts by bringing the youth perspective and voice to its audience at the community and national levels. This article describes YADA’s founding and development, as well as related implications for psychosocial nurses.
In Vivo Confocal Microscopic Evaluation of Corneal Wound Healing After Femtosecond Laser-Assisted Keratoplasty
Authors: Shtein Roni M. , Kelley Kurt H. , Musch David C. , Sugar Alan , Mian Shahzad I.
Published: February 2012

BACKGROUND AND OBJECTIVE:

To evaluate corneal wound healing after femtosecond laser-assisted keratoplasty (FLAK) using in vivo confocal microscopy (IVCM).

PATIENTS AND METHODS:

Prospective, interventional, consecutive case series of 17 eyes after mushroom-shaped FLAK. IVCM was performed preoperatively and at 1, 3, 6, and 12 months postoperatively to assess wound healing.

RESULTS:

Mean keratocyte activation grade increased from preoperative levels to 1 month postoperatively in both the central (0.41 ± 0.62 to 1.73 ± 1.03) and peripheral (0.47 ± 0.52 to 1.57 ± 1.09) cornea, then gradually decreased through 12 months. Dendritic cells increased from preoperatively to 1 month postoperatively in both the central (0.71 ± 0.83 to 1.33 ± 0.98) and peripheral (0.79 ± 0.70 to 1.42 ± 0.90) cornea, then gradually decreased until 6 months postoperatively. Stromal reinnervation was 1 month postoperatively in 8 patients (50%). By 12 months, sub-epithelial nerves were observed centrally in 5 patients (45.5%).

CONCLUSION:

IVCM after FLAK shows an initial increase in keratocyte activation and dendritic cells that decrease over time. Corneal reinnervation is seen as early as 1 month postoperatively.
Unusual Presentation of Eosinophilic Enteritis as Multiple Strictures of Small Intestine
Authors: Jagtap Sunil V. , Nikumbh Dhiraj B. , Kshirsagar Ashok Y. , Ahuja Neha
Published: February 2012

Eosinophilic enteritis is a rare disease of unknown etiology. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract depending upon the predominant layer involved. Diagnosis of eosinophilic enteritis requires a high index of suspicion and exclusion of various disorders that are associated with peripheral eosinophilia. We report a case of unusual presentation of eosinophilic enteritis clinically presenting as intestinal obstruction due to multiple strictures of the small bowel in an adult male.
Improvement interventions: To what extent are they manifestations of social defences?
Authors: De Klerk Jeremias J.
Published: February 2012

Orientation: The statistical record of change and improvement interventions to deliver on expectations is notoriously poor. Yet, new interventions are started constantly.Research purpose: The aim is to provide an explanation to the lure behind interventions and to contribute to building a theory on plausible systems psychodynamic drivers and mechanisms of recurrent change interventions.Motivation for the study: This study provides insights into social defences in ways that did not receive much attention previously; specifically how defence mechanisms act as drivers for new change and improvement interventions.Research design, approach and method: A literature study, consisting of a literature review and a phenomenological analysis. The study was conducted from the systems psychodynamic approach.Main findings: Improvement interventions often represent defences that serve to contain anxieties or maintain fantasies. Four specific themes emerged: interventions defend the perception of being in control, they maintain the fantasy that one is busy with worthy actions to overcome challenges, they are defences against boredom or contain anxieties about incompetence, and they maintain the fantasy of being heroic leaders.Practical/managerial implications: The findings can assist leaders to understand their own defences in order to avoid embarking on non-essential interventions. This can free up much time, energy and effort to spend on other priorities, assisting organisations to achieve better results.Contribution/value-add: The study refutes the notion that improvement interventions are always rational coping mechanisms and highlights the role of improvement interventions as defences to reduce anxiety, even though they may contribute little to organisational survival in real terms.
Payment Incentives and Integrated Care Delivery: Levers for Health System Reform and Cost Containment
Authors: Korda Holly , Eldridge Gloria N.
Published: February 2012

The Patient Protection and Affordable Care Act encourages use of payment methods and incentives to promote integrated care delivery models including patient-centered medical homes, accountable care organizations, and primary care and behavioral health integration. These models rely on interdisciplinary provider teams to coordinate patient care; health information and other technologies to assure, monitor, and assess quality; and payment and financial incentives such as bundling, pay-for-performance, and gain-sharing to encourage value-based health care. In this paper, we review evidence about integrated care delivery, payment methods, and financial incentives to improve value in health care purchasing, and address how these approaches can be used to advance health system change.
Health Information Technology and its Effects on Hospital Costs, Outcomes, and Patient Safety
Authors: Encinosa William E. , Bae Jaeyong
Published: February 2012

Underlying many reforms in the Patient Protection and Affordable Care Act (ACA) is the use of electronic medical records (EMRs) to help contain costs. We use MarketScan® claims data and American Hospital Association information technology (IT) data to examine whether EMRs can contain costs in the ACA's reforms to reduce patient safety events. We find EMRs do not reduce the rate of patient safety events. However, once an event occurs, EMRs reduce death by 34%, readmissions by 39%, and spending by $4,850 (16%), a cost offset of $1.75 per $1 spent on IT capital. Thus, EMRs contain costs by better coordinating care to rescue patients from medical errors once they occur.
The Impact of Accelerating Electronic Prescribing on Hospitals' Productivity Levels: Can Health Information Technology Bend the Curve?
Authors: Ford Eric W. , Huerta Timothy R. , Thompson Mark A. , Patry Roland
Published: February 2012

This paper examines how different strategies for implementing computerized prescriber order entry (CPOE) impact hospitals' productivity. We used the American Hospital Association's Annual Survey to construct hospital-level measures for 1,812 facilities and analyzed the productivity indices against CPOE use rates. The relationship between CPOE use rates and indices for “technical efficiency change” and “total factor productivity” was significant. Hospitals introducing CPOE facilitywide in a one-year period (where usage went from zero to more than 50%) experienced declines in both productivity indices. One implication is that hospitals achieving the goals of the “meaningful use program promoted by the Centers for Medicare and Medicaid Services may do so at the expense of productivity.
Long-term validation of total and tropospheric column-averaged CH4 mole fractions obtained by mid-infrared ground-based FTIR spectrometry
Authors: Sepúlveda E. , Schneider M. , Hase F. , García O. E. , Gomez-Pelaez A. , Dohe S. , Blumenstock T. , Guerra J. C.
Published: February 2012

Abstract. At the Izaña Atmospheric Research Center high-resolution middle infrared solar absorption spectra have been recorded for more than 12 years using Fourier Transform InfraRed (FTIR) spectrometers. We use the spectral fitting algorithm PROFFIT to retrieve long-term time series of methane (CH4) from the measured spectra. We investigate the total column-averaged dry-air mole fractions of methane (totXCH4) obtained from a scaling and a profile retrieval, and apply two approaches for deriving the tropospheric column-averaged dry-air mole fractions: firstly, we use the FTIR Hydrogen Fluoride (HF) total column amounts as an estimator for the stratospheric CH4 contribution and a posteriori correct the totXCH4 data of a profile scaling retrieval accordingly (troXCH4post), and secondly, we directly determine the tropospheric column-averaged dry-air mole fractions of methane (troXCH4retr) from retrieved CH4 profiles. Our theoretical estimation indicates that the scaling retrieval leads to totXCH4 amounts that are subject to a large smoothing error, which can be widely avoided by applying a profile retrieval (for the latter we estimate an overall precision of 0.41%). We compare the different FTIR CH4 data to Izaña's Global Atmospheric Watch (GAW) surface in-situ CH4 data (CH4GAW), which in the case of the Izaña Atmospheric Research Center high mountain observatory are well representative for the free tropospheric CH4 amounts. Concerning totXCH4 the agreement between the FTIR data product and the in-situ measurement is rather poor documenting that totXCH4 is no valid free tropospheric CH4 proxy instead it is significantly affected by the varying stratospheric CH4 contribution and it rather follows the variation in the tropopause altitude. The a posteriori correction method only removes a part of this stratospheric CH4 contribution. On the contrary the profile retrieval allows for a direct estimation of the tropospheric column-averaged CH4 amounts. This troXCH4retr data correlates well with the CH4GAW data (correlation coefficient of 0.60, FTIR-GAW scatter of 0.97%) and both data show very similar annual cycles and trend behaviour (for the 2001–2010 time period). Furthermore, we find a very good absolute agreement between the troXCH4retr and CH4GAW (middle infrared FTIR/GAW scaling factor of 0.9987) suggesting that middle infrared FTIR data can be well combined with the surface in-situ GAW data. Our study proves the significance of middle infrared ground-based FTIR CH4 profile retrievals as well as the robustness of the approach for achieving total and tropospheric column-averaged XCH4 data of high quality.
Development of a sensitive long pathlength absorbance photometer to quantify peroxides in aerosol particles (Peroxide-LOPAP)
Authors: Mertes P. , Pfaffenberger L. , Dommen J. , Kalberer M. , Baltensperger U.
Published: February 2012

Abstract. A new off-line instrument to quantify peroxides in aerosol particles using iodometry in long pathlength absorption spectroscopy has been developed and is called peroxide long pathlength absorbance photometer (Peroxide-LOPAP). The new analytical setup features important technical innovations compared to hitherto published iodometric peroxide measurements. Firstly, the extraction, chemical conversion and measurement of the aerosol samples are performed in a closed oxygen-free (∼1 ppb) environment. Secondly, a 50-cm optical detection cell is used for an increased photometric sensitivity. The limit of detection was 0.1 μM peroxide in solution or 0.25 nmol m−3 with respect to an aerosol sample volume of 1000 l. The test reaction was done at a constant elevated temperature of 40 °C and the reaction time was 60 min. Calibration experiments showed that the test reaction with all reactive peroxides, i.e. hydrogen peroxide (H2O2), peracids and peroxides with vicinal carbonyl groups (e.g. lauroyl peroxide) goes to completion and their sensitivity (slope of calibration curve) varies by only ±5%. However, very stable peroxides have a lower sensitivity. For example tert-butyl hydroperoxide shows only 37% sensitivity compared to H2O2 after 1h. A kinetic study revealed that even after 5 h only 85% of this stable compound had reacted. The time trends of the peroxide content in secondary organic aerosol (SOA) from the ozonolysis and photo-oxidation of α-pinene in smog chamber experiments were measured. The highest amount of peroxides with 34% (assuming a MW of 300 g mol−1) was found in freshly generated SOA from α-pinene ozonolysis. Contents decreased with increasing NO levels in the photo-oxidation experiments. A decrease of the peroxide content was observed with aging of the aerosol indicating a decomposition of peroxides in the particles.
The physical basis of ionospheric electrodynamics
Authors: Vasyliūnas V. M.
Published: February 2012

Abstract. The conventional equations of ionospheric electrodynamics, highly succesful in modeling observed phenomena on sufficiently long time scales, can be derived rigorously from the complete plasma and Maxwell's equations, provided that appropriate limits and approximations are assumed. Under the assumption that a quasi-steady-state equilibrium (neglecting local dynamical terms and considering only slow time variations of external or aeronomic-process origin) exists, the conventional equations specify how the various quantities must be related numerically. Questions about how the quantities are related causally or how the stress equilibrium is established and on what time scales are not anwered by the conventional equations but require the complete plasma and Maxwell's equations, and these lead to a picture of the underlying physical processes that can be rather different from the commonly presented intuitive or ad hoc explanations. Particular instances include the nature of the ionospheric electric current, the relation between electric field and plasma bulk flow, and the interrelationships among various quantities of neutral-wind dynamo.
Assimilation of OMI NO2 retrievals into the limited-area chemical transport model DEHM (V2007.0) with a 2-D OI algorithm
Authors: Silver J. D. , Brandt J. , Hvidberg M. , Frydendall J.
Published: February 2012

Abstract. Data assimilation is the process of combining real-world observations with a modelled geophysical field. The increasing abundance of satellite retrievals of atmospheric trace gases makes chemical data assimilation a powerful tool for improving air quality forecasts. We implemented a two-dimensional optimal interpolation (OI) algorithm to assimilate satellite-derived estimates of tropospheric NO2 column concentrations into the Danish Eulerian Hemispheric Model (DEHM, version V2007.0), a three-dimensional, European-scale, chemical transport model. In particular, we describe how we used observational data to estimate the background error covariance matrix, B. In the assimilation, the tropospheric column NO2 field was adjusted and the modelled NO2 profile was scaled accordingly; other species were only adjusted indirectly via changes to NO2 concentrations. We ran a number of experiments to compare different parameterisations of B; this involved varying the length scale used in B, the relative weighting of the background and observation errors, the errors assigned to observations and the influence of clustered observations. We assessed model performance by comparing the analysed fields to an independent set of observations: ground-based measurements of NO2 concentrations. Ozonosonde profiles were also used for verification. The analysed NO2 and O3 concentrations were more accurate than those from a reference simulation without assimilation, with lower bias for both species and improved correlation for NO2. The experiments showed that appropriately chosen parameters for the B matrix, estimated using innovation statistics, yielded more accurate surface NO2 concentrations. There was good agreement between the seasonally-averaged observed and modelled O3 profiles. The simple OI scheme was effective and computationally feasible in this context, where only a single species was assimilated and only a two-dimensional field was adjusted. However there are certain limitations to using this assimilation scheme for more highly multi-dimensional problems. Although forecast accuracy was not examined here, we discuss the potential for improving NO2 forecasts by using assimilation to generate initial conditions.
Technical Note: Analytical sensitivity analysis of a two parameter recursive digital baseflow separation filter
Authors: Eckhardt K.
Published: February 2012

Abstract. A sensitivity analysis for a well-established baseflow separation technique, a two parameter recursive digital filter, is presented. The sensitivity of the calculated baseflow index to errors or uncertainties of the two filter parameters and of the initial baseflow value is analytically ascertained. It is found that the influence of the initial baseflow value is negligible for long time series. The propagation of errors or uncertainties of the two filter parameters into the baseflow index is expressed by a dimensionless sensitivity index, the ratio between the relative error of the baseflow index and the relative error of the respective parameter. Representative index values are derived by application of the resulting equations to 65 North American catchments. In the mean the parameter a, the recession constant, has a stronger influence on the calculated baseflow index than the second filter parameter BFImax. This is favourable in that a can be determined by a recession analysis and therefore should be less uncertain. Whether this finding also applies for a specific catchment can easily be checked by means of the derived equations.
Irrigania – a web-based game about sharing water resources
Authors: Seibert J. , Vis M. J. P.
Published: February 2012

Abstract. For teaching about collaboration and conflicts with regard to shared water resources various types of games offer valuable opportunities. Single-player computer games often give much power to the player and ignore the fact that the best for some group might be difficult to achieve in reality if the individuals have their own interests. Here we present a new game called Irrigania, which aims at representing water conflicts among several actors in a simplified way. While simple in its rules, this game illustrates several game-theoretical situations typical for water-related conflicts. The game has been implemented as a web-based computer game, which allows easy application in classes. First classroom applications of the game indicated that, despite the simple rules, interesting patterns can evolve when playing the game in a class. These patterns can be used to discuss game theoretical considerations related to water resource sharing.
Spatial patterns of linear and nonparametric long-term trends in Baltic sea-level variability
Authors: Donner R. V. , Ehrcke R. , Barbosa S. M. , Wagner J. , Donges J. F. , Kurths J.
Published: February 2012

Abstract. The study of long-term trends in tide gauge data is important for understanding the present and future risk of changes in sea-level variability for coastal zones, particularly with respect to the ongoing debate on climate change impacts. Traditionally, most corresponding analyses have exclusively focused on trends in mean sea-level. However, such studies are not able to provide sufficient information about changes in the full probability distribution (especially in the more extreme quantiles). As an alternative, in this paper we apply quantile regression (QR) for studying changes in arbitrary quantiles of sea-level variability. For this purpose, we chose two different QR approaches and discuss the advantages and disadvantages of different settings. In particular, traditional linear QR poses very restrictive assumptions that are often not met in reality. For monthly data from 47 tide gauges from along the Baltic Sea coast, the spatial patterns of quantile trends obtained in linear and nonparametric (spline-based) frameworks display marked differences, which need to be understood in order to fully assess the impact of future changes in sea-level variability on coastal areas. In general, QR demonstrates that the general variability of Baltic sea-level has increased over the last decades. Linear quantile trends estimated for sliding windows in time reveal a wide-spread acceleration of trends in the median, but only localised changes in the rates of changes in the lower and upper quantiles.
How reversible is sea ice loss?
Authors: Ridley J. K. , Lowe J. A. , Hewitt H. T.
Published: February 2012

Abstract. It is well accepted that increasing atmospheric CO2 results in global warming, leading to a decline in polar sea ice area. Here, the specific question of whether there is a tipping point in the sea ice cover is investigated. The global climate model HadCM3 is used to map the trajectory of sea ice area under idealised scenarios. The atmospheric CO2 is first ramped up to four times pre-industrial levels (4 × CO2), then ramped down to pre-industrial levels. We also examine the impact of stabilising climate at 4 × CO2 prior to ramping CO2 down to pre-industrial levels. Against global mean temperature, Arctic sea ice area is reversible, while the Antarctic sea ice shows some asymmetric behaviour – its rate of change slower, with falling temperatures, than its rate of change with rising temperatures. However, we show that the asymmetric behaviour is driven by hemispherical differences in temperature change between transient and stabilisation periods. We find no irreversible behaviour in the sea ice cover.
Standard Pharmacological Treatment and New Therapies for Overactive Bladder
Authors: Del Popolo Giulio , Mencarini Marco , Li Marzi Vincenzo
Published: February 2012

The prevalence of overactive bladder (OAB) in adult males varies from 10.2% to 17.4%, and in females from 7.7 to 31.3. 16.5% of the adult population presents symptoms consistent with OAB; of these, 37.2% are actually affected. The OAB has a significant effect on the quality of life. Initial treatment includes behavioral therapy, physiotherapy and antimuscarinic drugs. In patients where behavioral modifications fail, treatment is associated with antimuscarinics. The antimuscarinic agents used to treat OAB showed some efficacy, but adverse events too, such as dry mouth, constipation, headache and blurred vision. In selected cases unresponsive to antimuscarinic therapy, it is possible to use second-line treatments represented by sacral neuromodulation and botulinum toxin type A both for idiopathic detrusor overactivity, where it is still an experimental treatment, and for neurogenic cases with 2011 FDA approval. Surgical options represent the last choice for selected cases.
Exact Solutions for the Axial Couette Flow of a Fractional Maxwell Fluid in an Annulus
Authors: Imran M. , Awan A. U. , Rana Mehwish , Athar M. , Kamran M.
Published: February 2012

The velocity field and the adequate shear stress corresponding to the rotational flow of a fractional Maxwell fluid, between two infinite coaxial circular cylinders, are determined by applying the Laplace and finite Hankel transforms. The solutions that have been obtained are presented in terms of generalized Ga,b,c(·,t) and Ra,b(·,t) functions. Moreover, these solutions satisfy both the governing differential equations and all imposed initial and boundary conditions. The corresponding solutions for ordinary Maxwell and Newtonian fluids are obtained as limiting cases of our general solutions. Finally, the influence of the material parameters on the velocity and shear stress of the fluid is analyzed by graphical illustrations.