bluuebunny/crossref_metadata_2025_split huggingface dataset:
Doctors for the Poor in Urban Nepal
Authors: Allaby Martin A K 
Published: January 2017

Altruism on the part of doctors and other health workers may help make health services affordable for the poor, but the altruistic contribution of doctors who are nationals of developing countries has largely been ignored. This paper describes the results of two related surveys carried out between February and April 2001 to determine the characteristics of indigenous charitable clinics in Patan, Nepal, and the attitudes of the Nepali health professionals who work in them. In 2001, 33 Nepali health professionals were working without payment in 13 charitable clinics in Patan. Altogether they provided care to the same number of city residents as the general out-patient clinics of the city's 330-bed hospital. The scale of this activity had not previously been recognized. Half the clinics received an external subsidy; they were larger and had been running for longer than those without a subsidy. The most frequently mentioned reasons for deciding to work in a charitable clinic were a desire to serve the poor and improve society; to gain personal satisfaction; and a desire to help one's own community. To make best use of any indigenous professionals who do voluntary work for the poor, health planners should identify the number and type of charitable clinics in their area; provide them with small subsidies for essential drugs and equipment; publicize them to make sure they are well attended; and develop referral systems between charitable clinics and other local providers of primary healthcare.
Motives, Sexual Behaviour, and Risk Factors Associated with HIV in Individuals Seeking Voluntary Counselling and Testing in a Rural District of Malawi
Authors: Zachariah R , Spielmann M P , Harries A D , Buhendwa L , Chingi C 
Published: January 2017

A study was conducted among individuals seeking voluntary HIV counselling and testing (VCT) in order to (a) describe their motives and source(s) of information, (b) describe their sexual behaviour; and (c) identify risk factors associated with HIV infection. Of 723 individuals who sought VCT, the most common reason (50%) was recent knowledge of HIV/AIDS and a desire to know their HIV status. The majority (77%) underwent VCT after being encouraged by others who knew their status. Ninety five per cent reported sexual encounters, with 337 (49%) engaging in unprotected sex. HIV prevalence was 31% and an HIV-positive status was associated with being female, being over 25 years of age and/or being a farmer. There is a demand for VCT, and the service provides an opportunity for intensive education about HIV/AIDS prevention on a one-to-one basis. It could also be an entry point to prevention and care for those who are infected.
Training Teachers of Day Care Centres for Primary Ear Care
Authors: Abraham V J , Balraj Vinohar , Shankar N , Job Anand , Joseph A 
Published: January 2017

The feasibility of training teachers of day care centres for children (balwadi teachers) to recognize and manage common ear problems was studied so that they could provide primary care for ear related morbidity in the community. A training module was designed, piloted on grass root level workers and used to train 19 balwadi teachers. Their knowledge, skills and technique of examination was assessed following training. Pathways for referral were established between the balwadis, secondary and tertiary hospitals. The knowledge score of the balwadi teachers increased from a mean of 28.4% to 86%; they scored an average of 75% in an assessment of their examination technique. Their sensitivity in identifying overall ear related morbidity was 75%, and 96% in identifying children with ear discharge, specifically. Age, education and experience did not affect the outcome of their training. While it may be premature to comment on the impact of the training, periodic supervision, close monitoring and review sessions would sharpen the skills of the balwadi teachers and improve their efficiency.
Echocardiographic Diagnosis of Heart Disease in Uganda
Authors: Freers J , Mayanja-Kizza H , Ziegler J L , Rutakingirwa M 
Published: January 2017

Five hundred consecutive cardiological patients were reviewed and evaluated by echocardiography in Mulago Hospital as a referral service. All diagnostic problems in cardiology in the hospital and to a certain degree from other institutions were reviewed. The commonest diagnosis was endomyocardial fibrosis (EMF) 19.8%, followed by congenital heart disease (CHD) 15% and rheumatic heart disease (RHD) 11%. The anatomical distribution of fibrotic lesions in EMF (left, right or biventricular) correlated with that found in previous autopsy series from Mulago Hospital thus demonstrating the accuracy of echocardiography. We were able to quantify the contribution of echocardiography to a correct diagnosis which varied between 13% in RHD to 90% in mitral valve prolapse (MVP). Echocardiography was able to confirm the clinical diagnosis of subacute bacterial endocarditis (SBE) in 69% of cases. The obtained data suggests that EMF may be the most common heart disease in Uganda contrary to the pattern of heart disease outlined in earlier works. The favourable cost/benefit ratio of echocardiography (i.e. its easy availability and maintenance), as well as the absence of consumable materials in comparison to other cardiac diagnostic tools such as catheterization, chest X-ray and ECG is emphasized, together with the multipurpose use of the machine.
HIV and Syphilis Serostatus of Antenatals in Traditional Maasai Pasturalist Communities in Kajiado District, Kenya: 1989–1992
Authors: Valadez Joseph J , Loolpapit P Mores , Nyangao Ambrose , Dikir Francis 
Published: January 2017

Although much research has been carried out on high risk populations, little is known about HIV prevalence in traditional rural communities who limit contact with other tribes, non-traditional tribesman and Europeans. This study considers traditional Maasai living near a high HIV transmission area. A time series analysis assessed the trend of HIV-1 and syphilis prevalences in the study area. Data consist of antenatal blood specimens ( n = 2082 women) collected during 1989–1992. An estimated 100% of pregnant women residing in the study areas are included in the study. Standardized HIV-1 prevalences among women for 1989–1992 ranged between 0.95% and 2.23%. A χ2 test for trends was not significant, analysis of age-specific prevalences revealed no significant result. Standardized syphilis prevalence varied from 1.89% to 12.82% during the 3 years. Prevalence declined in 1990, but increased significantly thereafter. A steep 1992 increase in syphilis was not associated with an increase in HIV. Chi square test for trends for age-specific syphilis was not significant. In 2082 samples only one woman was positive for both HIV and syphilis. In 4 years no increase in HIV prevalence was detected among traditional Maasai woman living near a high transmission area. No significant variation across ages was detected. However, syphilis increased sharply in one time period, 1992. Despite the low HIV prevalence among Maasai, the higher prevalence of syphilis suggests that the HIV epidemic is at an early phase and may increase soon. It may also suggest that HIV does not yet have a high prevalence at markets where Maasai sell their herds, but is concentrated at truck stops.
The PPACA in Wonderland
Authors: Lawson Gary , Kopel David B. 
Published: January 2017

On August 22, 2009, when then-Speaker of the House Nancy Pelosi was asked by a reporter whether the Patient Protection and Affordable Care Act (PPACA) was constitutional, she answered: “Are you serious? Are you serious?” Two years later, many federal judges, more than half of the States, and a flood of distinguished constitutional scholars have examined the PPACA and found at least part of it to be unconstitutional. The question was indeed serious.It remains serious today, as a Supreme Court decision on the constitutionality of the PPACA is expected in June 2012. Because the legality of the PPACA has emerged as perhaps the most publicly visible constitutional question since Roe v. Wade, clarity is vital not only for the PPACA itself, but also for general public understanding of the Constitution. Accordingly, our goals in this Article are to provide an opinionated but hopefully fair-minded guide to the constitutional issues of the PPACA and to clarify some misunderstandings that plague both popular and professional discussions of the issues.
The Use and Misuse of Biomedical Data: Is Bigger Really Better?
Authors: Hoffman Sharona , Podgurski Andy 
Published: January 2017

Very large biomedical research databases, containing electronic health records (EHR) and genomic data from millions of patients, have been heralded recently for their potential to accelerate scientific discovery and produce dramatic improvements in medical treatments. Research enabled by these databases may also lead to profound changes in law, regulation, social policy, and even litigation strategies. Yet, is “big data” necessarily better data?This paper makes an original contribution to the legal literature by focusing on what can go wrong in the process of biomedical database research and what precautions are necessary to avoid critical mistakes. We address three main reasons for approaching such research with care and being cautious in relying on its outcomes for purposes of public policy or litigation. First, the data contained in biomedical databases is surprisingly likely to be incorrect or incomplete. Second, systematic biases, arising from both the nature of the data and the preconceptions of investigators, are serious threats to the validity of research results, especially in answering causal questions. Third, data mining of biomedical databases makes it easier for individuals with political, social, or economic agendas to generate ostensibly scientific but misleading research findings for the purpose of manipulating public opinion and swaying policymakers.In short, this paper sheds much-needed light on the problems of credulous and uninformed acceptance of research results derived from biomedical databases. An understanding of the pitfalls of big data analysis is of critical importance to anyone who will rely on or dispute its outcomes, including lawyers, policymakers, and the public at large. The Article also recommends technical, methodological, and educational interventions to combat the dangers of database errors and abuses.
An exploration of load-shifting potential in real in-situ heat-pump/gas-boiler hybrid systems
Authors: Stafford Anne 
Published: January 2017

Monitoring data from two hybrid air-source heat-pump/gas-boiler systems were used to explore the systems’ potential for energy flexibility, i.e. the potential for shifting electrical load in response to grid requirements while maintaining acceptable performance in the overall hybrid system. In both cases, a significant proportion of the heat-pump load could potentially be shifted to the gas boiler with only a modest increase in the overall energy consumption, provided certain operational conditions were met. Furthermore, under these operational conditions, it is possible to estimate this additional energy consumption for a given system from simple heat output, and gas and electricity consumption data. This provides a potential basis for groups of similar systems equipped with smart technology to offer flexibility to the grid, while minimising the resulting energy penalty by choosing to use the most appropriate systems at any given time with respect to their operating conditions at that time. In addition, this type of flexibility means that the thermal comfort within the dwelling remains unaffected since overall heating requirement is met at all times by one of the two heating sub-systems. Practical application: The ability to shift or shed electrical load in response to grid requirements is likely to become a significant, commercially incentivised aspect of building energy systems in the future, to mitigate the stress on electrical grids at times of peak consumption. For domestic systems, aggregation will be a key factor, requiring ‘smart’ systems to provide real-time information to potential aggregators or grid operators. This article explores what type of system information may be necessary in the case of hybrid heat-pump/gas-boiler systems if loads are to be shifted from the heat-pump to the gas-boiler element, while minimising the resulting energy penalties.
Language, the “Diabetes Restricted Code/Dialect,” and What It Means for People With Diabetes and Clinicians
Authors: Dunning Trisha , Speight Jane , Bennett Craig 
Published: January 2017

Purpose The purpose of the paper is to explore the notion of a diabetes language restricted code or “dialect” and its effect on people with diabetes. Language is a complex phenomenon comprising verbal and nonverbal components used to communicate in human interactions. Methods Information was collected from a literature review, during clinical consultations, and from an email survey. Results Language and the way clinicians use language affect motivation, behaviors, and outcomes of people with diabetes. Language is influenced by culture, experience, and familiarity with words and their use and is idiosyncratic. “Diabetes” is a particular restricted code or dialect that people with diabetes gradually learn to speak, usually after they are diagnosed with diabetes. The diabetes dialect contains many metric and target words and very few positive, encouraging words, and it is often discriminatory, negative, judgmental, labelling, distressing, and stigmatizing: for example, victim, sufferer, and lifestyle disease. Conclusion Language codes/dialects can compound the already high levels of emotional distress and self-care burden associated with living with diabetes and can affect outcomes. The information presented in this article will be useful for clinicians caring for people with diabetes and will be helpful for professionals who develop information for people with diabetes and those who create policies and guidelines.
Role of post-mapping computed tomography in virtual-assisted lung mapping
Authors: Sato Masaaki , Nagayama Kazuhiro , Kuwano Hideki , Nitadori Jun-ichi , Anraku Masaki , Nakajima Jun 
Published: January 2017

Background Virtual-assisted lung mapping is a novel bronchoscopic preoperative lung marking technique in which virtual bronchoscopy is used to predict the locations of multiple dye markings. Post-mapping computed tomography is performed to confirm the locations of the actual markings. This study aimed to examine the accuracy of marking locations predicted by virtual bronchoscopy and elucidate the role of post-mapping computed tomography. Methods Automated and manual virtual bronchoscopy was used to predict marking locations. After bronchoscopic dye marking under local anesthesia, computed tomography was performed to confirm the actual marking locations before surgery. Discrepancies between marking locations predicted by the different methods and the actual markings were examined on computed tomography images. Forty-three markings in 11 patients were analyzed. Results The average difference between the predicted and actual marking locations was 30 mm. There was no significant difference between the latest version of the automated virtual bronchoscopy system (30.7 ± 17.2 mm) and manual virtual bronchoscopy (29.8 ± 19.1 mm). The difference was significantly greater in the upper vs. lower lobes (37.1 ± 20.1 vs. 23.0 ± 6.8 mm, for automated virtual bronchoscopy; p < 0.01). Despite this discrepancy, all targeted lesions were successfully resected using 3-dimensional image guidance based on post-mapping computed tomography reflecting the actual marking locations. Conclusions Markings predicted by virtual bronchoscopy were dislocated from the actual markings by an average of 3 cm. However, surgery was accurately performed using post-mapping computed tomography guidance, demonstrating the indispensable role of post-mapping computed tomography in virtual-assisted lung mapping.
Prospective Randomised Trial Comparing Conventional (Babcock) Stripping with Inverting (Pin) Stripping of the Long Saphenous Vein
Authors: Butler C. M. , Scurr J. H. , Smith P. D. Coleridge 
Published: January 2017

Objective: To compare the postoperative morbidity of conventional stripping with inverting stripping of the long saphenous vein in a randomised prospective trial. Methods: One hundred and thirty-six patients with primary uncomplicated long saphenous vein incompetence were randomised to either conventional or inverting stripping of the long saphenous vein. Blood loss, operating time and length of vein stripped were measured intra-operatively. Number and size of haematomas, bruising and diameter of thethrombosed channel were assessed 1 week postoperatively by clinical examination and by duplex ultrasonography. Pain, mobility and analgesia consumption were noted in a daily diary for the postoperative week. Results: Blood loss was significantly lower in the inverting group than in the conventional group, with a median of 50 ml for the conventional group and 20 ml in the inverting group (p<0.0001, Mann-Whitney U-test). Operating time in the inverting group (median: 20 min, interquartile range (IQR): 15–25 min) was shorter than in the conventional group (median: 25 min, IQR 20–30 min; p = 0.0001). The percentage of length of vein removed was greater in the inverting group (p < 0.05). There was no difference between the groups as regards size of haematoma, bruising, or diameter of thrombosed channel, nor was there a difference in postoperative pain, mobility or analgesia consumption. Conclusions: Inverting stripping used less operating time and there was less blood loss perioperatively. There did not appear to be any further benefits to inverting stripping of the long saphenous vein during the early perioperative period.
How I Do Long Saphenous Vein Surgery
Authors: Braithwaite B. D. 
Published: January 2017

Objective: To describe the author's own technique for treating long saphenous vein incompetence. Method: The long saphenous vein is stripped using a disposable stripper with the patient under general anaesthesia. Saphenous varices are managed by hook phlebectomy. Conclusions: The author's technique is effective in the management of large saphenous varices associated with long saphenous incompetence. The result is cosmetically satisfactory. Any residual varices are dealt with by sclerotherapy.
A Randomised Trial to Compare the Effect of Pre- or Postoperative Nandroparin on Blood Loss during Elective Caesarean Section
Authors: Cornette J. , Jacquemyn Y. , Vercauteren M. , Buytaert P. 
Published: January 2017

Objective: To compare operative blood loss following caesarean section in relation to the timing of administration of nandroparin, given to prevent perioperative deep vein thrombosis. Patients: Forty-four patients undergoing scheduled, primary elective caesarean section in full-term singleton pregnancies were included in this study. Interventions: A prospective randomised trial was performed, in which 2850 IU of nandroparin was administered either 12 h prior to or 12 h following surgery. Outcome measures: Haemoglobin and haematocrit levels, as indirect measures of blood loss, were compared in the two groups before and 2 days after surgery. Findings: Both groups were composed of 22 women. No significant differences between the outcome measures were observered. Conclusions: Nandroparin can safely be administered 12 h before planned caesarean section without significantly increasing blood loss.
Preventing Venous Ulcer Recurrence: The Impact of the Well Leg Clinic
Authors: Fassiadis N. , Godby C. , Agland L. , Law N. 
Published: January 2017

Background: The aim of this prospective study was to evaluate the effectiveness of a nursing-led clinic within a District Hospital setting in detecting early skin break-down in healed venous ulcers. Patients and Methods: A total of 76 patients (45 women, 31 men; age range 24-91 years, mean 74 years) with healed venous ulcers were included in the study between July 1999 and April 2001. Patients were counselled about managemant of ulcers at their initial visit and followed up at 3 and 6 months. Results: We received 79 referrals and of those 76 (96%) accepted our invitation. Fifty-six patients did attend the first clinic appointment, 39 (67%) attended their second clinic visit at 3 months and 38 (68%) were followed up by a telephone call at 6 months. During this period 9 recurrent leg ulcers were noted which were referred for further intervention. Conclusion: It is important to provide follow-up for patients with healed ulcers in order to minimise the recurrence rate and to re-institute treatment soon, as recurrence can occur early following healing.
Our Experience on Light Reflection Rheography (LRR): A New Non-Invasive Method for Lower Limbs Venous Examination
Authors: Nuzzaci Giuseppe , Mangoni Nicola , Tonarelli Argene Patrizia , Lucente Eleonora , Righi Daniele , Borgioli Franco , Lucarelli Franco 
Published: January 2017

By means of a light reflection rheograph (LRR 100), the authors studied 353 lower limbs: 128 with primary varices, 41 with a post-phlebitic syndrome and 81 controls. The parameters that were selected were: VRT (venous refill time) and ΔLR (as expression of the venous emptying rate). In order to assess the accuracy of LRR measurements, simultaneous recordings of both LRR and venous pressure changes in 97 limbs (58 with primary varicose disease, 21 with post-phlebitic syndrome and 18 normals) were compared with each other. The correlation rate for VRT in the two methods revealed very high agreement, (r = 0.96). A fairly good correlation also occurred between changes in venous pressure and ΔLR (r = 0.74). The reproducibility rates ranged between ± 15.9% s.d. (VRT) and ± 7.7% s.d. (ΔLR), using 100 as the average value obtained from each subject. The authors conclude that LRR appears to offer high specificity, sensitivity and reproducibility rates for non-invasive assessment of valvular incompetence. It appears also potentially reliable for the evaluation of calf musculo-venous pump efficiency.
The So-Called Primary Venous Aneurysms
Authors: Zamboni P. , Cossu A. , Carpanese L. , Simonetti G. , Massarelli G. , Liboni A. 
Published: January 2017

The authors have observed numerous venous aneurysms among patients in Sardinia. In the past 3 years 30 venous aneurysms have been diagnosed and treated. In seven cases the aneurysms were undoubtedly primary; owing to their position in the very low pressure system of the superior vena cava and because trauma, arteriovenous fistulas and cardiac or thoracic malformations were completely excluded. After surgical excision the aneurysms were studied by histological and immunohistochemical methods. Antisera to desmin and to alfa-actin demonstrated significant depletion of smooth muscle cells in the wall of the aneurysm.