bluuebunny/crossref_metadata_2025_split huggingface dataset:
The golden hour of shock – how time is running out: prehospital time intervals in Germany—a multivariate analysis of 15, 103 patients from the TraumaRegister DGU®
Authors: Wyen Hendrik , Lefering Rolf , Maegele Marc , Brockamp Thomas , Wafaisade Arasch , Wutzler Sebastian , Walcher Felix , Marzi Ingo ,   the TraumaRegister DGU
Published: December 2012

ObjectivesAlthough prehospital treatment algorithms have changed over the past years, the prehospital time of multiple trauma patients of some 70 min and the on-scene-treatment time (OST) of some 30 min have not changed since 1993. The aim of this study was to critically assess specific interventions and conditions at the scene in relation to their impact on prehospital rescue intervals.MethodsWe performed a retrospective data analysis of all multiple injured patients from the TraumaRegister DGU (English: German Trauma Society) from January 1993 to December 2010. Exclusion criteria were missing or implausible data regarding prehospital timelines. With OST as an independent variable, different models of multivariate regression were performed to identify parameters with relevant impact on the OST.Results15 103 datasets were included in this study. Based on the mean OST of 32.7 (±18.6) min and a constant absolute term of 16.2 (±1.5) min, we identified seven procedures and nine environmental parameters with significant impact on OST. Intubation (9.3±0.8 min) and being a car occupant (8.0±0.8 min) were associated with the most prolonged OSTs. A Glasgow Coma Scale ≤8 (−4.5±0.7 min) and cardiopulmonary resuscitation (−2.8±1.7 min) resulted in its most relevant reduction. Admission to a Level III facility led to a reduced overall prehospital time (60.0±24.6 min) compared with Level I (70.0±28.5 min) and II (66.8±27.4 min) trauma centres.ConclusionsThis study identified characteristic interventions and conditions with significant impact on prehospital treatment times. Current treatment concepts should be re-evaluated with respect to these results.
Attracting public service motivated employees: how to design compensation packages
Authors: Andersen Lotte Bøgh , Eriksson Tor , Kristensen Nicolai , Pedersen Lene Holm 
Published: December 2012

Public sector managers want to attract employees with high public service motivation as they are expected to perform better. The public service motivation literature rarely gives practical advice on how this can be done. Recognizing that compensation packages act as a sorting device that can be used to attract specific types of workers, we combine empirical measures of public service motivation with a newly developed approach to employees’ monetary valuation of compensation packages. This tool can be used to improve recruitment and retention of employees with high public service motivation. We find that public service motivated employees have a lower preference for bonus payments and stronger preferences for health care packages, but the associations depend on the specific context in which the employees work. This implies that the employees’ perceptions of the compatibility between the compensation package elements and societal interest should be taken into account, when the employees are motivated by doing good for society. Points for practitioners The findings of the article have implications for public managers who want to improve performance in their organizations by attracting employees with a high level of public service motivation. Our results indicate that bonuses should then be avoided, especially in administrative positions and when an emotion-based orientation towards doing good for others and society is important. Health care packages are generally a good idea, when it is important to attract employees who want to do good for the specific users of the service. Private health packages should, however, be avoided in public health care organizations.
The application of information technology and environmental protection
Authors: Ivanović Mirjana Drenovak 
Published: December 2012

The Aarhus Convention became a part of the Serbian legal system through the adoption of the Law on Ratification of the Convention on Access to Information, Public Participation in Decision Making and Access to Justice in Environmental Matters in May 2009. Although the legislation in Serbia, prior to the ratification of the Aarhus Convention, pointed, to some extent, to the realization of ideas promoted by it, following the ratification, there was the formal possibility of the consistent application of rights stipulated by the Convention. This article analyses the role of information technology (IT) in providing public access to environmental information. There are three basic ways IT may be applied in environmental protection. First, through the use of IT for environmental matters, the public can be informed about the general condition of the environment. In the legal system of Serbia, the Agency for Environmental Protection is obliged to collect environmental information from local government and compile annual reports on the environment that should be presented on the Agency website. This article analyses the information systems of the Serbian Agency for Environmental Protection and the further possibilities of using these. Second, IT can be used as a way of regular communication between government and citizens. In accordance with the principle of transparency, government bodies are obliged to provide an adequate way for the public to have an insight into their work. In addition, the authorized person is responsible for the accuracy of this information and for providing public access within a reasonable timeframe. In this sense, the article analyses the legal framework of e-access to environmental information and the relevant practice of the Commissioner for Information of Public Importance and Personal Data Protection. Third, the application of IT in environmental matters can promote public participation in environmental decision-making. If there were a legal framework, the public would be able to participate in procedures, such as environmental impact assessments, by submitting their opinions as e-documents. This article points out the relations between the application of IT and the level of public awareness about the environment, and the impact these relations have on environmental protection. Points for practitioners The article examines whether there is a possibility of using IT as a means of achieving daily communication between government and citizens in matters of the protection, preservation and improvement of the environment in Serbia, how the application of information technology achieves wider public participation in environmental decision-making, and whether the application of IT can eliminate deficiencies in the assessment of environmental impacts which occur in practice. The article provides an overview of environmental legislation in Serbia, which regulates the possibility of using IT in environmental protection and administrative practice.
The role of social capital within policy networks: evidence from EU cohesion policy in Spain
Authors: Jordana Jacint , Mota Fabiola , Noferini Andrea 
Published: December 2012

This article focuses on the policy process stemming from European cohesion policy at the regional level and at its programming stage (which precedes the implementation phase). It aims to explain how the formally introduced EU ‘partnership’ principles and rules work in practice in different political environments. The article argues that externally introduced procedural decision rules have different impacts on effective policymaking processes. In particular, we suggest that the patterns of social capital linkages carried by the actors involved produce different regional policy networks, even though the existing formal rules are similar. Relying on social network analysis as its main methodological tool, the article presents empirical evidence drawn from two similar Spanish regions, identifies the characteristics of the actors’ social capital and compares the structures of the policy networks dealing with the programming tasks in the two regions. Our findings suggest that the structures differ according to the amount of linking social capital displayed by the actors involved in the policy networks. We discuss in detail our exploratory hypothesis, considering also other possible variables that might account for these variations. Points for practitioners In this article we demonstrate that the EU partnership principle, as a set of formal rules, does not always work in practice as expected; we found that only when the actors involved share a certain level of trust does it produce and reinforce the expected pluralist and deliberative contexts for decision-making. In fact, EU partnership rules contribute to making policymaking more transparent and better procedurally organized by essentially sorting out the social capital resources already possessed by public and private actors involved in the policy network. This suggests that investing in the creation of social capital for regional elites might significantly improve the current EU institutional design of regional policy. More generally, we argue that partnership designs that provide stronger incentives for political and social elites to build their own social capital resources could make the implementation of decentralized regional policies more effective.
Autonomy and local democracy in Africa: an illustration using the case of Senegal
Authors: Touré Ibrahima 
Published: December 2012

This contribution analyzes from a retrospective and synchronous perspective the often conflicting power relations between the French colonial, the Senegalese post-colonial central states and the decentralized collectivities. Reflecting on the effective autonomy of the local collectivities in the management and running of the competences which are transferred to them through the decentralization laws, the article shows how, on the basis of real cases, the intervention of the central power in local affairs not only questions democracy but also and above all diverts the regionalization policies from their initial objectives. Points for practitioners This article is a reference tool for understanding the history and evolution of decentralization in Senegal. By examining several questions, it supplies evidence on the functioning of decentralized communities, local governance, land management and the system of financial adjustment. It proposes means of decision-making and useful actions for those who are interested in the feasibility of democracy and local development in Senegal.
The post-independence civil service in Kosovo: A message of politicization
Authors: Doli Dren , Korenica Fisnik , Rogova Artan 
Published: December 2012

This contribution discusses the politicization of the civil service system in Kosovo as a framework through which politicians exert influence in the system. The article employs the concept of formal-political discretion, as a means of explaining and elucidating the extent to which both the United Nations Interim Administration Mission in Kosovo (UNMIK) and current legislation regulating civil service preconditions/pre-favours the politicization of the senior civil service in Kosovo. It first discusses the concept of politicization based upon current scholarship and gives hints on the way in which these concepts fit with both UNMIK and Kosovo’s current situation. Next, the article discusses and compares the previous civil service system built by UNMIK with the current one – built in post-independence Kosovo based upon the formal-political discretion model. The article further argues that the former system of civil service – in contrast to the current system – provided less formal-political discretion to political elites with which to politicize the senior civil service. The article concludes by suggesting that the current post-independence legislation regulating the civil service grants the executive institutions a significant level of formal-political discretion in the appointment, dismissal and promotion of civil servants. Points for practitioners The articles offers a thorough, both theoretical and practical, policy explanation of the model and structure of Kosovo's civil service, hinting on the previous and current legislative gaps that allow for partisan influence and control. The article also portrays the routes via which the politicization of the civil service in Kosovo is being developed, giving insights on how civil servants perceive such a process. Comparing the previous civil service system with the current one, the article informs practitioners on the directions that the new reform on Kosovo's civil service should take. Finally, the article provides in-depth policy information on the means to redesign the key protection mechanisms of Kosovo's senior civil service management.
From performance measurement to learning: a new source of government overload?
Authors: Lewis Jenny M , Triantafillou Peter 
Published: December 2012

Over the last few decades accountability has accommodated an increasing number of different political, legal and administrative goals. This article focuses on the administrative aspect of accountability and explores the potential perils of a shift from performance measurement to learning. While this is inherently positive in its intentions, we argue that it might constitute a new source of government overload. We propose four explanations for why this may be so. First, a learning approach is more likely to supplement than replace performance management. Second, more rather than less data will be needed to comply with accountability requirements, because of the first point. Third, the costs of compliance are likely to increase because learning requires more participation and dialogue. Fourth, accountability as learning may generate a ‘change for the sake of change’ mentality, creating further government overload. We conclude with some comments on limiting the undesirable consequences of such a move. Points for practitioners Public administrators need to identify and weigh the (human, political and economic) benefits and costs of accountability regimes. While output-focused performance measurement regimes increase transparency and improve value for money in many cases, there are also undesirable side-effects. Accountability regimes attuned to learning appear conducive to quality improvement, but may also become new sources of government overload. This article examines the potential problems of such a move, and considers how these possible perils might be limited by managers and practitioners. Public managers must ask themselves just how much accountability is actually necessary. More specifically, they may want to delimit the scope of the accountability regimes employed, undertake a cost–benefit evaluation of these, and consult those subjected to such regimes, in order to ensure a suitable design.
The impact of cyclophosphamide on menstruation and pregnancy in women with rheumatologic disease
Authors: Harward LE , Mitchell K , Pieper C , Copland S , Criscione-Schreiber LG , Clowse MEB 
Published: December 2012

Background While cyclophosphamide (CYC) can save the life of a young woman with severe rheumatologic disease, it may lead to the long-term side-effects of infertility and premature menopause. We compared the reproductive health histories of young women with rheumatologic disease with and without prior CYC exposure to identify the impact of this medication on this important component of health. Methods This research includes a case-series study of women diagnosed with SLE, vasculitis, and scleroderma prior to age 35. Each patient completed a questionnaire about desired childbearing, menstrual regularity, infertility, and pregnancy history. Women with prior CYC therapy were queried about the use of gonadotropin-releasing hormone agonists (GnRH-a) for fertility preservation. The responses to this questionnaire were compared for women with and without CYC exposure. Results Of the 43 participants, 23 had prior CYC exposure and 20 were CYC naïve. The current age of these groups was similar (average age 32), but women with prior CYC were four years younger at diagnosis than women without CYC. More women with prior CYC had cessation of menses in the year prior to the study (30.4% vs 0%, p < 0.05). Of the women with prior CYC exposure, those with loss of menses were older at study enrollment, older at CYC treatment, and had a higher cumulative CYC dose than those with preserved menstruation. While more women with GnRH-a co-therapy during CYC had maintained menses, this difference did not reach statistical significance. Women with prior CYC without GnRH-a co-therapy had a higher frequency of nulliparity and had greater trouble conceiving than women with GnRH-a co-therapy. Few pregnancies were conceived following CYC exposure and all resulted in elective termination, miscarriage, or preterm birth. Conclusion In this cohort of young women with rheumatologic disease, more women with prior CYC than without had amenorrhea, nulliparity, and infertility. GnRH-a co-therapy may prevent these adverse effects of CYC.
Site differences in mild cognitive dysfunction (MCD) among patients with systemic lupus erythematosus (SLE)
Authors: Kozora E , Erkan D , West SG , Filley CM , Zhang L , Ramon G , Duggan E , Lockshin MD 
Published: December 2012

Background Mild cognitive dysfunction (MCD) is common in patients with systemic lupus erythematosus (MCD-SLE) but few studies have investigated potential site differences. Methods SLE patients from Denver, CO, and New York, NY, were enrolled in two different cognition studies employing similar screening methods. Using the resulting neuropsychological scores, cognitive impairment was calculated using a cognitive impairment index (CII). Results The rate of MCD-SLE was 24% at the Denver, CO, site and 60% at the New York, NY, site. The mean CII was 2.6 ± 2.3 versus 4.4 ± 2.7, respectively ( p = 0.005). The NY participants had a significantly longer disease duration ( p = 0.13) and higher American College of Rheumatology SLE criteria scores ( p > 0.001). NY participants had a higher frequency of impairment in semantic verbal fluency ( p = 0.005), visuomotor speed ( p = 0.013), and motor sequencing ( p = 0.001). A correlation was found between cognitive impairment and SLE disease duration ( p = 0.03). Conclusions The rate of MCD-SLE was greater in SLE patients from New York, NY, compared to patients in the Denver, CO, area. The greater duration of disease and higher prevalence of medical complications in the NY group might contribute to this difference. Findings suggest that MCD-SLE may differ by site, but future studies that better evaluate site or selection bias are recommended.
Increased incidence of herpes zoster among patients with systemic lupus erythematosus
Authors: Chakravarty EF , Michaud K , Katz R , Wolfe F 
Published: December 2012

Herpes zoster (HZ) is the painful reactivation of latent varicella zoster virus infection. The incidence of HZ may be increased in some autoimmune diseases, including systemic lupus erythematosus (SLE). We examined the incidence and risk factors for HZ in a prospective cohort of patients with physician-diagnosed SLE compared to those diagnosed with non-inflammatory musculoskeletal conditions (MSK). After excluding participants with a history of prior HZ at enrollment, we followed 1485 SLE patients and 2775 MSK with semi-annual mailed questionnaires for incident HZ between 2001 and 2010. Age-adjusted incidences were calculated for each group and Cox proportional hazard models were used to identify predictors of HZ. Zostavax® vaccination rates were compared between groups. Participants had a mean age of 60 years at enrollment, with 13.9 years of disease. SLE patients had more HZ at all ages, with an age-adjusted incidence of 12.0/1000 person-years compared to MSK (8.7/1000 person-years) and a hazard ratio of 1.7 (95% CI 1.08–2.71) for SLE. Increasing age and reduced functional status were independent predictors of HZ. In SLE, prednisone and mycophenolate mofetil use conferred additional risk. SLE had the lowest HZ vaccination rates among age-eligible subjects.
Autologous haematopoietic stem cell transplantation for systemic lupus erythematosus: data from the European Group for Blood and Marrow Transplantation registry
Authors: Alchi B , Jayne D , Labopin M , Kotova O , Sergeevicheva V , Alexander T , Gualandi F , Gruhn B , Ouyang J , Rzepecki P , Held G , Sampol A , Voswinkel J , Ljungman P , Fassas A , Badoglio M , Saccardi R , Farge D ,   on behalf of the EBMT Autoimmune Disease Working Party members
Published: December 2012

Objectives Patients with systemic lupus erythematosus (SLE) refractory to conventional immunosuppression suffer substantial morbidity and mortality due to active disease and treatment toxicity. Immunoablation followed by autologous stem cell transplantation (ASCT) is a novel therapeutic strategy that potentially offers new hope to these patients. Methods This retrospective survey reviews the efficacy and safety of ASCT in 28 SLE patients from eight centres reported to the European Group for Blood and Marrow Transplantation (EBMT) registry between 2001 and 2008. Results Median disease duration before ASCT was 52 (nine to 396) months, 25/28 SLE patients (89%) were female, age 29 (16–48) years. At the time of ASCT, eight (one to 11) American College of Rheumatology (ACR) diagnostic criteria for SLE were present and 17 (60%) patients had nephritis. Peripheral blood stem cells were mobilized with cyclophosphamide and granulocyte-colony stimulating factor in 93% of patients, and ex vivo CD34 stem cell selection was performed in 36%. Conditioning regimens were employed with either low ( n = 10) or intermediate (18) intensities. With a median follow-up of 38 (one to 110) months after ASCT, the five-year overall survival was 81 ± 8%, disease-free survival was 29 ± 9%, relapse incidence (RI) was 56 ± 11% and non-relapse mortality was 15 ± 7%. Graft manipulation by CD34+ selection was associated with a lower RI ( p = 0.001) on univariate analysis. There were five deaths within two years after ASCT: three caused by infection, one by secondary autoimmune disease and one by progressive SLE. Conclusions Our data further support the concept of immunoablation and ASCT to re-induce long-term clinical and serologic remissions in refractory SLE patients even in the absence of maintenance therapy. This study also suggests a beneficial effect of ex vivo graft manipulation on prevention of relapses post-transplantation in SLE.