bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of the financial performance of Ontario hospitals: A Test of Environmental Determinist and Adaptationist Perspectives
Authors: Narine L. , Pink G. , Leatt P. 
Published: January 2017

While other industries for many years have been concerned with the problem of financial distress, it is only recently that this issue has become a matter of interest to hospital managers, policy makers, and the general public. However, the determinants of hospital financial performance are neither well studied nor understood. The objectives of this study were to identify factors that affect the financial performance of Ontario hospitals and to construct a model that could be used to predict financial performance in the future. A number of organization and environmental factors that could influence financial performance were postulated and then tested for their statistical impact and predictive ability. Cross-sectional data over the 3-year-period 1986–1988 for 223 Ontario public hospitals were used. The first 2 years of data served as a derivation sample for hypothesis testing and development of a predictive model. The third year of data was used as a holdout sample for cross validation. Information on the variables investigated came from secondary sources, in particular Statistics Canada's Annual Hospital Returns. Univariate analyses revealed distressed hospitals were more likely to earn more revenues from non-government sources, to be non-teaching institutions and have longer chronic lengths of stay, and to be found in areas with higher per capita incomes, number of females in the population, physician supply, and area wage rates. A five variable prediction model was developed which accounted for 25% of the variance in financial performance in the derivation sample and on cross validation dropped to 21%. The model identified greater hospital size, older plants, higher technological complexity, more intensive care services, and location in areas with more females to be significant predictors of financial distress. Overall, environmental factors (community and structural characteristics) were more important in influencing financial performance. The implication for hospital managers is to underscore that an important dimension of successful leadership requires they remain outwardly focused and involved in managing the external environment. For policy makers the need is to develop funding formulae which encourage efficiency and are also responsive to differences in community and structural characteristics across hospitals.
Financial Performance of Safety-Net Hospitals in a Changing Health Care Environment
Authors: Gautam K. , Campbell C. , Arrington B. 
Published: January 2017

Safety-net hospitals serving the poor and indigent in inner-cities have received inadequate research attention regarding the determinants of their financial performance in the changing health care environment. We analyze how the 1990–1992 financial performance of 275 such hospitals is related to exogenous and endogenous factors such as payer mix, service mix, staffing and ownership. Models of hospital financial performance are developed using operating margin, cost per discharge and revenue per discharge as measures of performance. Stepwise regression is used to test the model with data from the American Hospital Association (AHA) and Health Care Investment Analysts (HCIA). Results suggest that: 1) The profitability of inner-city hospitals appears positively related with technical complexity of care; 2) High interest and low operating surplus may constrain the addition of technically sophisticated services to enhance profitability; 3) There is some evidence that new governmental programs, e.g. Medicaid managed care and Medicaid Diagnosis Related Groups (DRGs), may not have improved operating margins, though Medicaid DRGs appear to have contained costs. Follow-up research is needed on this issue; 4) Given external fiscal realities, internal management strategies for inner-city hospitals require research, e.g. developing appropriate managed care systems and timely expansion of sub-acute services and; 5) Services such as AIDS treatment and community health education represent opportunities to respond to community needs, especially since unit cost of such services will decline with high volume.
Syphilis as a Social Disease: Experience from the Post-Communist Transition Period in Estonia
Authors: Uusküla Anneli , Nygård Jan F , Kibur-Nygård Mari 
Published: January 2017

Increased incidence of sexually transmitted diseases (STD) and radical social changes have taken place at the same time in Estonia. Our aim was to study the trends in syphilis incidence, selected sociodemographic factors and health status indicators during the economic transition. Associations were estimated by the ordinary least square regression method for change in and actual values of syphilis and tuberculosis incidence rate (IR), percentage of non-ethnic Estonians and urban population, homicides rate, unemployment rate and, birth rate. The analysis was performed by counties at three different time periods. Syphilis IR significantly correlated with the proportion of non-ethnic Estonians, urban population, tuberculosis IR and birth rate. Change of syphilis IR correlated significantly with concurrent changes in unemployment rate and tuberculosis IR. Our findings support the theory that syphilis is a social disease, thus emphasizing the importance of social factors in the occurrence of STDs.
Clinical Applications of the Polymerase Chain Reaction
Authors: Kitchin P A 
Published: January 2017

The polymerase chain reaction (PCR) is a technique that allows a million-fold, or greater, amplification of defined regions of DNA or RNA. It is potentially capable of detecting a single copy of a gene, present only once in 105 eukaryotic cells. This remarkable level of sensitivity has allowed the development of many diagnostic assays for human pathogens and disease states. These include: the detection of viral, bacterial and protozoal agents; diagnosis and genetic analysis of inherited diseases such as β-thalassaemia, sickle cell disease, haemophilia, Tay-Sachs disease and many others; diagnosis and analysis of neoplastic disorders such as, chronic myelogenous leukaemia (CML), acute lymphocytic lymphoma (ALL), follicular lymphomas and various other cancers, including the detection of activated oncogenes; prenatal and pre-implantation diagnosis; and the development of genetic risk prediction. The PCR can greatly simplify diagnostic processes that were previously difficult to perform, particularly where the initial amounts of biological material were very limited. In other cases, PCR provides the only method available for detection and diagnosis. However, although simple in theory, the PCR technique remains, for routine clinical diagnostic purposes, currently in the domain of the specialist laboratory. This is because of its sensitivity to nucleic acid contamination from other sources that can cause misleading results. Procedures and precautions are being developed to minimize this problem and there is little doubt that, in many instances, the PCR will be the diagnostic method of choice within the next few years.
Sexually Transmitted Diseases in Lesbians
Authors: Edwards Anne , Thin R Nicol 
Published: January 2017

The limited published data support the assumption that lesbians are a low risk group for sexually transmitted diseases (STDs). However there are virtually no contemporary data and the older papers do not take into account genital wart virus infection, now the third most prevalent STD in Britain. One of the dangers in assuming that lesbians are a ‘safe group’ for STD and allied disorders is that patients may not attend for regular cervical cytology and could be at risk of developing cervical cancer. In an unselected series of 27 lesbians attending a genitourinary medicine clinic, the most important findings were a relatively high prevalence of the viral STDs, herpes simplex and human papillomavirus. Additionally, 10 patients had abnormal cytology ranging from inflammation to dyskaryosis. There is a need for more information about the true prevalence of STDs in this group and evaluation of the risk factors for female-to-female transmission of infections. Lesbians should continue to have regular cervical smears, especially as many have had earlier heterosexual intercourse.
Value of Examining the Sexual Partners of Women Suffering from Initial Genital Herpes
Authors: Woolley P D 
Published: January 2017

In a retrospective clinical audit of patient records to determine the value of examining the sexual partners of women with initial genital herpes, it was evident that only the regular partners attended for screening. Twenty-six per cent of women with initial genital herpes and 19% of male partners had some form of other lower genital tract infection. Of 164 male partners of women with initial genital herpes, 30 (18.3%) also suffered from initial genital herpes at the same time, 22 (13.4%) gave a history of, or had signs consistent with, recurrent genital herpes, and 3 (1.8%) asymptomatic male partners without a previous history of genital ulceration had herpes simplex virus isolated from the urethra on routine screening.
Significance of Barteroides Ureolyticus in the Lower Genital Tract
Authors: Woolley P D , Kinghorn G R , Bennett K W , Eley A 
Published: January 2017

In a study to determine the significance of Bacteroides ureolyticus in the lower urogenital tract using a new selective and differential medium, this organism was isolated from 30.1% of asymptomatic men, 37.8% of men with genital warts, and 26.3% of men with non-gonococcal urethritis. Using the same selective medium B. ureolyticus was isolated from 49% of women attending the same genitourinary clinic with symptoms of vaginal discharge and/or pruritis vulvae, 44.1% of asymptomatic women, and 50% of asymptomatic women attending a local family planning clinic. Furthermore, this organism was isolated from 27.1% of women whose vaginal specimens isolated commensal organisms only, 43.2% with C. albicans, 59.4% with U. urealyticum, 74.4% with M. hominis, and 76.8% with G. vaginalis. On testing with the API ATB 32A test strips, 86% of the positive isolates of B. ureolyticus from the female genital tract were indistinguishable from those isolated from the male genital tract indicating that this organism is common to the lower genital tract of both sexes. These results indicate that B. ureolyticus is a commensal in the lower genital tract.
The Prevalence of Hairy Leukoplakia in HIV Seropositive and HIV Seronegative Immunocompromised Patients
Authors: Ramael M , Colebunders R , Colpaert C , Goeman J , Schrijvers D , Lachenal M , Vandenbruaene M , Blot K , Van Marck E 
Published: January 2017

The prevalence of hairy leukoplakia was determined among 176 symptomatic HIV seropositive patients seen at the outpatient department of the Institute of Tropical Medicine in Antwerp, Belgium. Moreover, systematic tongue biopsies were performed during postmortem examination of 21 patients with AIDS, 100 HIV seronegative immunocompromised patients with haematologic or other malignancies and 100 HIV seronegative non-immunocompromised patients who died at the University Hospital Antwerp. Hairy leukoplakia was observed in 52 (29.5%) of the outpatients, but only in one (5%) of the AIDS patients in the postmortem study ( P=0.03). An explanation for this difference may be that significantly more AIDS patients who died had received either acyclovir or ganciclovir during the 3 months prior to the postmortem examination than the HIV seropositive outpatients during the 3 months prior to examination. Hairy leukoplakia occurred more often in Caucasian homosexual men with HIV infection (38%) than among heterosexual Africans with HIV infection (17%) ( P=0.06). Hairy leukoplakia was observed in none of the HIV seronegative patients.
Megestrol Acetate Vs Cyproheptadine in the Treatment of Weight Loss Associated with HIV Infection
Authors: Summerbell C D , Youle M , McDonald V , Catalan J , Gazzard B G 
Published: January 2017

Two appetite stimulants, megestrol acetate and cyproheptadine were administered in a randomized trial to 14 patients who had no evidence of opportunistic infection or malabsorption but were wasted (had lost more than 5 kg body weight) as a result of human immunodeficiency virus (HIV) infection. Energy intakes were calculated from a 7 day weighed dietary record. Mean energy intakes per kilogramme body weight were similar in both treatment groups (greater than 34 kcal/kg) and were higher than that in well British males. Energy intakes increased by just over 500 kcal during both treatments, but fell to pretreatment levels after therapy. Patients in both treatment groups gained a moderate amount of weight. Megestrol acetate was associated with impotence in 4 patients. Insufficient calorie intake alone is not a common cause of wasting associated with HIV and the role of appetite stimulants is likely to be limited.
Empirically Treated Pneumocystis Carinii Pneumonia in London, 1983–1989
Authors: Beck E J , French P D , Helbert M H , Robinson D S , Moss F M , Harris J R W , Pinching A J , Mitchell D M 
Published: January 2017

For 227 episodes of Pneumocystis carinii pneumonia (PCP) treated at St Mary's between 1983 and 1989, factors predictive of fatal outcome were age, haemoglobin levels, peripheral lymphocyte count and alveolar-arterial oxygen gradient. Case fatality for the 47 empirically-treated episodes was significantly higher compared with the 180 cytologically proven episodes (55% vs 18%, χ2 = 25.7, P<0.0001). Case fatality for episodes which could not be bronchoscoped was significantly higher compared with bronchoscopy negative cases (66% vs 25%, χ2 = 4.5, P<0.05). Predictive factors for fatal outcome differed significantly for cases which could not be bronchoscoped and cytologically proven cases: haemoglobin level (10.7 g/dl vs 12.0 g/dl, P<0.001), lymphocyte count (0.64 × 109/l vs 0.87×109/l, P=0.05) and oxygen gradient (77.7 mmHg vs 58.9 mmHg, P<0.02). Such differences were not observed between bronchoscopy negative and cytologically proven cases. Case fatality decreased significantly over time ( b = –0.39, SE=0.14, P<0.05). Total and non-fatal first time episodes displayed an inverse relationship between oxygen gradient and time ( r = −0.22, P<0.006 and r = −0.24, P<0.01, respectively). Mean oxygen gradient of fatal episodes for sequential years increased significantly from 73 mmHg in 1983 to 102 mmHg in 1989 ( r = 0.92, P<0.01). This suggests that medical intervention as well as presentation with less severe disease both contributed to improved case fatality over time.
Human Immunodeficiency Virus and Treponema Pallidum Infections in Nigerian Patients with Leprosy
Authors: Nwosu C M , Nwosu S N N , Okoye K C 
Published: January 2017

Fifty-one patients were selected from 4 leprosaria in eastern Nigeria and were examined for evidence of syphilis. They were screened serologically for treponemal and human immunodeficiency virus (HIV) infections. Information about their sexual behaviour and demographic data were obtained to determine the factors associated with increased risk of contracting sexually transmitted diseases (STD). They were compared with 115 controls. The results showed that positive treponemal tests were more common in those patients living outside the leprosaria ( P<0.05). Age and sex of the patients living inside the leprosaria were not factors associated with treponemal infections. Leprosy appeared to be a factor for T. pallidum infection when compared with the control group ( P < 0.05; OR 476; CI 1.16,19.5). One leprosy patient and one control subject had positive HIV tests and there was no significant association between leprosy and HIV infection. These findings suggest the possibility of the spread of sexually transmitted diseases amongst the leprosy patient population. The importance with respect to control measures is that leprosy patients living outside leprosaria may constitute a potential reservoir for introducing sexually transmitted diseases into the leprosaria.
Prevalence and Incidence of Syphilis and its Association with HIV-1 Infection in a Population-Based Study in the Kagera Region of Tanzania
Authors: Killewo J Z J , Sandström A , Råden U Bredberg , Mhalu F S , Biberfeld G , Wall S 
Published: January 2017

Population-based prevalence and incidence studies on HIV-1 infection were started in the Kagera region of Tanzania in 1987. The prevalence and incidence of infection with Treponema pallidum was studied to enable development of better strategies for STD control. Serological diagnosis of a past or treated infection with Troponema pallidum was made by seropositivity only to TPHA testing while active syphilis was diagnosed by seropositivity to both VDRL and TPHA tests. Seroconversion was measured in 1989 by finding TPHA serologically positive individuals during the follow-up period among the initially seronegative study population of 1987. The overall prevalence of active syphilis in the total sample of adults in the region was found to be 5.9% while that of past syphilis was 13.5%. The association between the prevalence of HIV-1 infection and syphilis of both types was found to be highly significant. However, the association between one pre-existing infection and seroconversion in the other was present but not statistically significant. The overall incidence of syphilis based on seroconversion in a cohort of adults in the region was found to be 11.6 per 1000 person-years at risk. In view of these findings, syphilis is a significant health problem in the region with a high level of transmission and efforts should be made to control it. Intervention studies should use these base-line data and monitor changes in syphilis incidence which may indicate changes in sexual behaviour. Such indicators could also be useful for evaluating the impact of interventions directed at reducing the transmission of HIV, syphilis and other STDs in the region.
Vasculopathy of the Antiphospholipid Syndromes Revisited: Thrombosis is the Culprit and Vasculitis the Consort
Authors: Lie JT 
Published: January 2017

Whether the vasculopathy in APS is thrombosis or vasculitis is more than a mere academic interest; the distinction is important not only for unravelling the pathogenesis of vascular injuries in APS but also for selecting the appropriate choice of drug treatment. A diagnosis of vasculitis would call for treatment with corticosteroids and cytotoxic agents which are not without serious side effects and drug toxicity. The same powerful but potentially dangerous drugs are clearly quite ineffectual in treating or preventing thrombosis associated with APS which has been known to respond in the lowly and inexpensive aspirin. The vasculopathy of APS remains almost exclusively thrombotic in nature according to our current state of knowledge, even if one were to accept capillaritis as a bona fide member in the family of vasculitides, the ‘microangiitis’. Vasculitis secondary to an independent underlying disease, such as SLE, may coexist with APS in a patient. In the management of APS patients, the distinction between a true vasculitis coincidental with and one that is causally related to APS affects clinical decision making, and not just a matter of semantics or an academic curiosity. In vasculopathy of APS, thrombosis is the culprit and vasculitis, when present, is the consort. This is still true until newer and more convincing evidence emerges and proves to be contrary.
Antiphospholipid Antibodies and Atherosclerosis
Authors: Vaarala O 
Published: January 2017

The family of antiphospholipid antibodies includes antibodies binding to cardiolipin in serological test for syphilis, antibodies prolonging the clotting time in lupus anticoagulant test, antibodies reacting with plasma phospholipid-binding proteins, such as β2-glycoprotein I and prothrombin, and antibodies binding to oxidized low-density lipoprotein (LDL). Antiphospholipid antibodies are traditionally associated with arterial and venous thrombosis in patients with primary or secondary antiphospholipid syndrome. The recent studies, especially those on patients with myocardial infarction, extend the concept of antiphospholipid antibodies, and suggest that they play a role also in atherosclerosis. Based on the clinical studies and immunological findings, it seems that the differences in the specificity of antiphospholipid antibodies may reflect to their pathogenetic mechanisms and, finally, to their clinical consequences. The present review suggests that antibodies to oxidized LDL may not interfere directly with blood coagulation, but seem to have importance in the inflammation of the vessel wall in atherosclerosis and in vasculitis. Instead, antibodies to β2-glycoprotein I and to prothrombin show a closer association with thrombosis. It is possible that in the atherosclerotic plaque, the plasma proteins, such as β2-glycoprotein I or prothrombin, are bound to the endothelial surface and antibodies to cryptic epitopes revealed in these proteins are induced. These antibodies may contribute to the formation of atherosclerotic thrombosis by changing the balance of hacmostasis towards hypercoagulative state.
Regulatory Mechanisms in Maintenance and Modulation of Transmembrane Lipid Asymmetry: Pathophysiological Implications
Authors: Bevers EM , Comfurius P , Zwaal RFA 
Published: January 2017

The two leaflets of the plasma membrane of eukaryotic cells differ in lipid composition: the outer leaflet comprises mainly neutral choline containing phospholipids, whereas the aminophospholipids reside almost exclusively in the cytoplasmic leaflet. The importance of transmembrane lipid asymmetry may be judged from the fact that the cell invests energy to maintain this situation for which at least two regulatory mechanisms are held responsible. A translocase, selective for aminophospholipids, acts as an ATP-dependent pump for rapid inward movement of phosphatidylserine (PS) and phosphatidylethanolamine; in addition, a non-selective, but also ATP-dependent pump causes outward movement of phospholipids, be it at a much lower rate compared to the inward transport by the aminophospholipid translocase. These two systems, acting in concert, are thought to be the main players in the maintenance of a dynamic equilibrium of the phospholipids over both membrane leaflets. Dissipation of membrane lipid asymmetry can be elicited in different cell types under a variety of conditions; in particular, platelets upon activation rapidly lose their normal plasma membrane lipid distribution, but also in other blood cells, lipid asymmetry can be lost, be it at a much lower rate and extent than in platelets. A putative protein, referred to as ‘scramblase’ has been described, which requires the continuous presence of elevated intracellular Ca2+-levels, to allow a rapid, nonselective and bidirectional transbilayer movement of phospholipids. Although scrambling of lipids does not require ATP as such, preliminary studies suggest the possible involvement of one or more phosphorylated proteins. The most prominent consequence of the loss of phospholipid asymmetry is exposure of PS in the outer leaflet of the plasma membrane. Surface-exposed PS serves several important physiological functions: it promotes assembly of enzyme complexes of the coagulation cascade, it forms a signal for cell-cell recognition, which is important for cell scavenging processes. Surface-exposure of PS is an early phenomenon of apoptosis and appears to be involved in efficient removal of these cells. In addition, PS in the outer leaflet of cells is thought to play a role in cell fusion processes. It may be clear from the foregoing, that the amount of PS present at the cell surface needs to be tightly controlled, and that an impairment of this process leads to either excessive- or diminished exposition of PS which may have several pathophysiological consequences.