bluuebunny/crossref_metadata_2025_split huggingface dataset:
New Vaccines for Developing Countries: Will it Be Feast or Famine?
Authors: Andrus Jon Kim , de Quadros Ciro , Matus Cuauhtemoc Ruiz , Luciani Silvana , Hotez Peter 
Published: January 2017

AbstractThe Revolving Fund of the Pan American Health Organization (PAHO) has an almost 30 year track record of providing access to essential vaccines for the entire population of Latin America and the Caribbean region. The activities of the PAHO Revolving Fund, coupled with the provision of high-quality technical assistance, were crucial to the successful control, elimination, or eradication of most of the region's great childhood killers, including measles and polio. Today, however, the Revolving Fund faces new challenges in the form of procuring a new generation of vaccines for human papillomavirus infection, rotavirus, and pneumococcal disease, which are priced orders of magnitude higher than the traditional childhood vaccines. The high cost of these essential new vaccines may require the PAHO Revolving Fund to establish innovative financial mechanisms for procuring these products at prices affordable for national immunization programs in Latin America and the Caribbean. The alternative, namely to bypass the Revolving Fund, could severely threaten the health of the region, especially Latin America's poorest people.
Confronting Conflict: Addressing Institutional Conflicts of Interest in Academic Medical Centers
Authors: Liang Bryan A. , MacKey Tim 
Published: January 2017

Individual conflicts of interest are rife in healthcare, and substantial attention has been given to address them. Yet a more substantive concern-institutional conflicts of interest (“ICOIs”) in academic medical centers (“AMCs”) engaged in research and clinical care—have yet to garner sufficient attention, despite their higher stakes for patient safety and welfare. ICOIs are standard in AMCs, are virtually unregulated, and have led to patient deaths. Upon review of ICOIs, we find a clear absence of substantive efforts to confront these conflicts. We also assess the Jesse Gelsinger case, which resulted in the death of a study participant exemplifying a deep-seated culture of institutional indifference and complicity in unmanaged conflicts. Federal policy, particularly the Bayh-Dole Act, also creates and promotes ICOIs. Efforts to address ICOIs are narrow or abstract, and do not provide for a systemic infrastructure with effective enforcement mechanisms. Hence, in this paper, we provide a comprehensive proposal to address ICOIs utilizing a “Centralized System” model that would proactively review, manage, approve, and conduct assessments of conflicts, and would have independent power to evaluate and enforce any violations via sanctions. It would also manage any industry funds and pharmaceutical samples and be a condition of participation in public healthcare reimbursement and federal grant funding.The ICOI policy itself would provide for disclosure requirements, separate management of commercial enterprise units from academic units, voluntary remediation of conflicts, and education on ICOIs. Finally, we propose a new model of medical education—academic detailing—in place of current marketing-focused “education.” Using such a system, AMCs can wean themselves from industry reliance and promote a culture of accountability and independence from industry influence. By doing so, clinical research and treatment can return to a focus on patient care, not profits.
Health Law 2010: It's Not All about the Money
Authors: Jacobson Peter D. , Mathur Soniya Keskar 
Published: January 2017

It would be naïve to argue that money isn't the driving force motivating health care delivery in 2010. At nearly 17% of GDP, health care delivery is a large and growing industrial enterprise that is the largest employer in many communities. Save for free clinics, generating revenue is fundamental to every aspect of the delivery system. From insurance reimbursement rates to the cost of purchasing the latest technology, the surest explanation for understanding changes in the health care system and concomitant development of legal doctrine is, indeed, to “follow the money.”Determining who controls the money flows usually explains who the dominant players are, and how they are able to organize and change the delivery system. Unquestionably, the most straightforward way to understand how the system functions, where its vulnerabilities lie, and why it is so difficult to institute significant reforms is to identify who controls the money.
Physical Test for Distant Metastases in Patients with Breast Cancer
Authors: Coombes R C , Powles T J , Abbott M , De Rivas L , Ford H T , McCready V R , Neville A M , Gazet J-C 
Published: January 2017

Of 312 patients presenting with breast cancer to a single clinic, 297 were screened for metastases in skin and nodes, bone, marrow, liver and lungs, using standard clinical, radiological scanning and cytological techniques. Thirty-four patients were found to have overt metastatic disease using these tests. Metastases were demonstrable on chest X-ray in 6.1% of the entire group of patients, on the bone scan in 4.2%, liver scan in 1.5%, liver ultrasound in 1.2% and in the bone marrow in only a single patient; 3.8% had contralateral or supraclavicular lymph node metastases or skin metastases. Twenty-eight of these 34 patients (82%) with overt metastases would have been classed as metastatic had only chest X-ray and clinical examination been carried out. A survey was then carried out to determine when tests for bone and liver metastases became abnormal. Bone scan and skeletal survey results were reviewed in 58 patients, 22 of whom had developed skeletal metastases and all of whom had regular skeletal scintigraphy carried out. Sixteen of 20 (80%) scans carried out within six months of the development of skeletal deposits were abnormal compared with 4 of 19 (21%) scans at the same follow-up time in those who failed to develop metastases, but few patients showed definite evidence of bone metastases on scanning prior to radiological metastases. Fifty-one patients who were found to have liver metastases at post-mortem were reviewed and most showed progressively rising alkaline phosphatase before death but only 11 of 57 (19.2%) and 14 of 50 (28%) had positive liver scintiscans and liver ultrasound examinations respectively from 3–12 months before death.
Intracellular Metabolites in Rat Muscle following Trauma: A 31P and 1H Nuclear Magnetic Resonance Study
Authors: Sprague D B , Gadian D G , Williams S R , Proctor E , Goode A W 
Published: January 2017

Hind limb skeletal muscle was studied in vivo in a rat trauma model using nuclear magnetic resonance (NMR) spectroscopy. The model used was a 25% body surface area, full-thickness burn administered under anaesthesia. Two groups of six rats were studied. Weight loss was observed in the experimental group whilst the control group continued to gain weight. Concentration ratios involving intramyocellular phosphocreatine (PCr), creatine (Cr), adenosine triphosphate (ATP), inorganic phosphate (Pi), anserine (Ans) and taurine (Tau) were measured. No change in the ratios of PCr/Pi, PCr/ATP, Ans/PCr + Cr and Tau/PCr + Cr were seen between the two groups. Intracellular pH was the same in the two groups. NMR spectroscopy in vivo gives values of Pi and PCr that differ from those obtained by conventional techniques. NMR values are probably more accurate as no degradation occurs during measurement, the measurements being repeatable and noninvasive.
Coxsackie B Viruses and Myalgic Encephalomyelitis
Authors: Bell E J , McCartney R A , Riding M H 
Published: January 2017

Data collected over the past 6 years suggest that Coxsackie B viruses (CBV) play an important role in myalgic encephalomyelitis (ME). Since psychological upset is a feature of this illness, 247 patients, recently admitted to a psychiatric hospital, were tested for neutralizing antibodies to CBV. A total of 12.5% had significantly raised CBV titres compared with 4–5% of ‘well’ control groups; the percentage positive was greatest (21%) in those aged 30–39 years. During 1985 and 1986 sera from 290 adults with ME were tested using the newly developed CBV IgM ELISA test; 37% were CBV IgM positive compared with 9% of 500 ‘well’ adult controls. Forty-seven children, with ME were similarly tested during this period; 38% were positive, implying recent or active CBV infection. The combined use of this ELISA test and the virus probe techniques now available should further help to elucidate the exact role of CBV in this disabling illness.
In Vitro Construction of Totally Autogenous Venous Valve: Early Experience
Authors: Hasaniya N. W. 
Published: January 2017

Objective: To construct in vitro and test a venous valve from bovine external jugular vein. Materials and methods: Sections of bovine jugular vein were trimmed and venous valves fashioned using the author's design. Outcome measures: The competence of the valves was tested by inflating them using saline on a test rig whilst assessing their competence using duplex ultrasonography. Results: Ten valves were constructed and all were patent; eight were completely competent at pressures up to 260 mmHg. Two valves required additional external sutures to be placed in order to achieve complete competence. Conclusions: The author's design allows construction of a venous valve in any straight segment of vein. In vivo studies will be required to assess the durability of this design.
Varicose Veins in Pregnancy: A Health Professional's Questionnaire
Authors: Coughlin L. B. , Gandy R. , Rosser S. , de Cossart L. 
Published: January 2017

Objective: To acertain the knowledge of varicose vein disease amongst health professionals dealing with pregnant women. Method: Postal questionnaire survey. Results: General practitioners (GPs) and midwives estimated an incidence of varicose veins in pregnancy of 20-50%. Factors associated with varicose veins included second and subsequent pregnancies, thrombophlebitis, family history and obesity, although obesity was thought to be less of an association by the vascular surgeons (57%). Half the respondents linked varicose veins to deep venous thrombosis. Support hosiery is the main management, with 10% of obstetricians asking for a vascular surgeon's opinion, but never vice versa. Surgical treatment was recommended on family completion but 38% of vascular surgeons will consider surgery between pregnancies. Eighty per cent of GPs and 91% of midwives would welcome guidelines. Fifty-seven per cent of vascular surgeons stated that they already have guidelines although these are the professionals least likely to deal with pregnant women. Conclusion: Knowledge amongst health professionals of varicose vein disease in pregnancy is generally good. However, guidelines would be welcomed.
Chronic Venous Insufficiency of the Upper Limb Due to Outflow Obstruction of Venous Access
Authors: Halevy A. , Zelikovski A. , Modai D. , Swissgarten Y. , Orda R. 
Published: January 2017

Two patients with angio-access for haemodialysis in whom the main venous outflow tract was thrombosed, developed severe chronic venous insufficiency (CVI) of the upper limb after a short period; one case developing a stasis ulcer of the cubital fossa. The angio-accesses were still functioning when the diagnosis was made. Treatment by surgery resulted in a dramatic regression of clinical signs of chronic venous insufficiency. CVI of the upper limb has not previously been described. CVI is a frequent and known complication after deep vein thrombosis (DVT) of the lower limbs, but never appears after DVT of the upper limbs. We describe two cases of upper limb CVI which developed as a complication of angio-access for haemodialysis treatment, and their successful treatment by surgery.
Functional Meaning of Different Injection Levels in the Course of Sclerotherapy
Authors: Kerner Jutta , Schultz-Ehrenburg Ulrich 
Published: January 2017

The successive changes of vein function in the course of sclerotherapy were studied by non-invasive photoplethysmography. The effect of injection at different levels was analysed in 30 patients, 22 with long saphenous varicosis, four with short saphenous varicosis and four with long saphenous varicosis and leg ulcers. The first two groups were treated by injections descending from the *crosse (saphenofemoral or saphenopo-pliteal junction) according to the method of Tournay. The third group (with leg ulcers) were treated by ascending injections, beginning adjacent to the ulcer and ending with crosse injection. Three case-reports are given, of one in each group, to show the typical changes of vein function in the different sclerosing methods. Crosse obliteration proved to be the most important step in improving vein function. It was followed by sclerosing of perforators of the lower leg, which influenced vein function in varying ways. Sclerosing remaining varicose dilations only optimized the cosmetic results without any measurable effect on vein function. According to our observations, failure to correct sapheno-femoral respectively sapheno-popliteal incompetence is inadequate treatment.
The Treatment of Varicose Veins Using the Venous Valve Cuff
Authors: Lane R. J. , McMahon C. , Cuzzilla M. 
Published: January 2017

Objective: To assess the safety and efficacy of venous valve cuffing for the treatment of varicose veins. Design: Three prospective studies were performed. The first study was the subjective and objective evaluation of venous valve cuffing in a series of unselected patients with varicose veins. Indications for use of the technique were defined in the first study, and applied in the second study, which focused on an evaluation of objective outcome criteria. The third study was an evaluation of the long-term effect of venous valve cuffing. Setting: Royal North Shore Public Hospital, Mater Private Hospital and Peninsula Private Hospital (Sydney, Australia). Patients: In the first series there were 93 limbs in 72 unselected patients with varicose veins. The second series consisted of 78 limbs in 62 patients who were selected based on the indications established in the first study. A third series of 100 limbs in 75 patients, selected at random, was reviewed to assess the long-term subjective and objective outcome. Measurements: All clinical outcome variables were observed subjectively. Photoplethysmographic recovery times and reflux at the sapheno-femoral junction (SFJ), at the knee, and below the knee were measured. Vein diameters at the groin and at the knee were measured pre- and postoperatively. Results: Unselected patients have a good clinical outcome, but approximatley one-third have residual venous reflux at the SFJ. Selected patients with mild to moderate varicose veins have an excellent result in all criteria investigated. Conclusions: After competence is restored to the SFJ, the saphenous vein decreases in size and achieves physiological one-way flow. Venous valve cuffing demonstrates a low incidence of symptoms and recurrence in both the short and long term.
Piracetam and Chlormethiazole in Acute Alcohol Withdrawal: A Controlled Clinical Trial
Authors: Dencker S J , Wilhelmson G , Carlsson E , Bereen F J 
Published: January 2017

Sixty in-patient alcoholics, presenting with an alcohol withdrawal syndrome after at least one week's drinking bout, were randomly allocated to fixed dose regimens of either piracetam or chlormethiazole in a one-week double-blind trial. The patients were studied in respect to physical and biochemical parameters as well as symptom reduction and side-effects. The battery of rating scales demonstrated a good symptom reduction in both drug groups. On the whole a small tendency to more symptom items being reduced on piracetam in comparison with chlormethiazole was found. But the three items, sleep disturbances, decreased libido at the initial phase, and the staffs assessment showed statistically significant differences in favour of chlormethiazole. This study demonstrated that piracetam was just as efficient as chlormethiazole in patients not requiring sedation.
Crowding and Violence on Psychiatric Wards: Explanatory Models
Authors: Kumar Shailesh , Ng Bradley 
Published: January 2017

Objective: Violence is widely prevalent on acute-care psychiatric wards, and crowding has been identified as a major risk factor. This paper explores why patients may respond to crowding with violence. Method: We carried out a literature review on Medline, using the key words “violence” and “crowding.” We conducted an additional hand search of the references collected from the reviewed papers. Results: Factors specific to the relation between crowding on acute-care inpatient psychiatric wards and violence can be divided under the following headings: 1) patient density, privacy, and control; 2) ward architecture; 3) the social organization of psychiatric wards; 4) interpersonal space; 5) phylogenic theories; and 6) anthropological theories of human behaviour. Conclusions: We offer explanatory models for this relation and suggest strategies to counter the effects of crowding. Recommendations are made for future studies. Objectif: La violence dans les unités de soins psychiatriques aigus est très répandue et l'on a reconnu que le surpeuplement est un important facteur de risque. Le présent article cherche à savoir pourquoi les patients peuvent répondre au surpeuplement par la violence. Méthode: Une revue de la documentation a été menée dans Medline à l'aide des mots clés violence et surpeuplement. Une recherche manuelle additionnelle des références recueillies dans les articles examinés a aussi été menée. Résultats: Les facteurs spécifiques de la relation entre le surpeuplement des unités de soins psychiatriques aigus et la violence peuvent se diviser selon les catégories suivantes: 1) la densité, l'intimité et le contrôle des patients, 2) l'architecture de l'unité, 3) l'organisation sociale des unités psychiatriques, 4) l'espace interpersonnel, 5) les théories phylogéniques et 6) les théories anthropologiques du comportement humain. Conclusions: Les modèles explicatifs de cette relation sont offerts et des stratégies sont suggérées pour contrer les effets du surpeuplement. Des recommandations sont faites pour de futures études.
An Open-Label Study of Nefazodone Treatment of Major Depression in Patients with Congestive Heart Failure
Authors: Lespérance François , Frasure-Smith Nancy , Laliberté Marc-André , White Michel , Lafontaine Sylvain , Calderone Angelino , Talajic Mario , Rouleau Jean-L 
Published: January 2017

Objectives: To evaluate the feasibility of screening and recruiting patients with major depression and congestive heart failure (CHF) in a tertiary care cardiology hospital and to obtain preliminary efficacy, tolerability, and safety data for nefazodone treatment of a major depressive episode in CHF patients. Method: We conducted a 12-week, open-label trial of nefazodone given in dosages up to 600 mg daily. We assessed patients at baseline, 1, 2, 4, 8, and 12 weeks. Measures used were the 17-item Hamilton Depression Rating Scale (HDRS), the Clinical Global Impression Scale, the Beck Depression Inventory, Spielberger's State-Trait Anxiety Inventory, and the Minnesota Living with Heart Failure Questionnaire. We also obtained pre- and poststudy ECGs, 24-hour Holter monitor recordings, and plasma levels of norepinephrine. Results: After screening 443 CHF patients, 28 patients with major depression met study eligibility criteria. The 23 patients who completed 4 or more weeks of medication showed significant improvement on all depression scales and in quality of life. Of 19 subjects who completed the full 12-week trial, 74% experienced a decline of 50% or more on HDRS scores. The completers also showed a significant reduction in heart rate, an increase in QT intervals (but not in the QTc), and a marginally significant decrease in plasma norepinephrine. There were no changes in heart rate variability. Conclusions: It is feasible to screen and recruit CHF patients with major depression for an antidepressant trial. Nefazodone seems sufficiently safe, tolerable, and efficacious to justify a larger, placebo-controlled trial.
EEG Abnormalities and Outcome in First-Episode Psychosis
Authors: Manchanda Rahul , Malla Ashok , Harricharan Rajendra , Cortese Leonardo , Takhar Jatinder 
Published: January 2017

Objective: There is widespread consensus that the EEG is not useful for the detection of clinically relevant abnormalities in patients with psychosis. Given that the EEG records brain dysfunction, this study examines whether an abnormal EEG in first-episode psychosis patients is associated with poorer prognosis, compared with a normal EEG. Method: At their initial assessment, 61 patients with first-episode psychosis had an EEG classified according to the following modified Mayo Clinic system: normal, essentially normal (that is, one or more elements of questionable normality), or dysrhythmia (grade I to V). We assessed psychiatric symptoms using the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS) on entry and after 1 year of treatment. Psychosis is considered to have remitted if there are no, or minimal, psychotic symptoms (that is, a rating of 2 or less on every SAPS global rating), maintained for 1 month. Results: At the end of 1 year, 19/21 (90.5%) patients with a normal EEG had a remission of their positive symptoms, compared with 18/28 (64.3%) of those with an essentially normal EEG and only 7/12 (58.3%) of those with dysrhythmia. Negative symptoms were reduced by more than 50% in 11/18 (61.1%) patients with a normal EEG, compared with 10/28 (35.7%) patients with an essentially normal EEG. None of the 8 patients with dysrhythmia on their EEG experienced reduced negative symptoms. Conclusion: The above findings suggest that an abnormal EEG in patients with first-episode psychosis is associated with a poorer prognosis.
Processes of In-Hospital Psychiatric Care and Subsequent Criminal Behaviour among Patients with Schizophrenia: A National Population-Based, Follow-up Study
Authors: Pedersen Charlotte Gjørup , Jensen Signe Olrik Wallenstein , Johnsen Søren Paaske , Nordentoft Merete , Mainz Jan 
Published: January 2017

Objectives: It is unknown whether evidence-based, in-hospital processes of care may influence the risk of criminal behaviour among patients with schizophrenia. Our study aimed to examine the association between guideline recommended in-hospital psychiatric care and criminal behaviour among patients with schizophrenia. Methods: Danish patients with schizophrenia (18 years or older) discharged from a psychiatric ward between January 2004 and March 2009 were identified using a national population-based schizophrenia registry ( n = 10 757). Data for in-hospital care and patient characteristics were linked with data on criminal charges obtained from the Danish Crime Registry until November 2010. Results: Twenty per cent ( n = 2175) of patients were charged with a crime during follow-up (median = 428 days). Violent crimes accounted for 59% ( n = 1282) of the criminal offences. The lowest risk of crime was found among patients receiving the most processes of in-hospital care (top quartile of received recommended care, compared with bottom quartiles, adjusted hazard ratio = 0.86, 95% CI 0.75 to 0.99). The individual processes of care associated with the lowest risk of criminal behaviour were antipsychotic treatment and staff contact with relatives. Conclusions: High-quality, in-hospital psychiatric care was associated with a lower risk of criminal behaviour after discharge among patients with schizophrenia. Processus des soins psychiatriques à l'hôpital et du comportement criminel subséquent chez des patients souffrant de schizophrénie: une étude populationnelle nationale de suivi