bluuebunny/crossref_metadata_2025_split huggingface dataset:
Constructing the health care system in Greece: responsibility and powerlessness
Authors: Lentza Vassiliki , Montgomery Anthony J. , Georganta Katerina , Panagopoulou Efharis 
Published: January 2013

ObjectivesBased on health care professionals' (HPs) and patients' interviews about work demands and quality of care in hospitals, the study explores the way that patients and HPs constructed their identities to describe and construct the health care system in Greece.DesignThis is a qualitative study using a focus group (FG) design.MethodsSeven FGs discussions were conducted: three FGs discussions were conducted for the assessment of job stressors (1 for doctors, 1 for nurses and 1 for residents) and four FGs discussions for the assessment of quality of care (1 for doctors, 1 for nurses, 1 for residents and 1 for patients). The sample consisted of health care professionals working in a teaching hospital in the region of Thessaloniki, Greece, and patients who had at least one experience of any kind in the same hospital. Transcripts of the FGs discussions underwent discourse analysis.ResultsThe results showed that both HPs and patients construct the health care system based on bipolar constructions of responsibility and powerlessness. In particular, participants use these constructions to allocate the responsibility to different levels of the health care system hierarchy or to the system per se constructing, at the same time, themselves as the ‘viewers’ of this system.ConclusionsThe study allowed a deeper understanding of issues related to quality of care in hospitals providing context‐specific information. Identity in health care organizations was inextricably linked to power and responsibility. The need to deconstruct this responsibility/powerlessness ideology is discussed.Statement of contributionWhat is already known on the subject? Relatively little is known about how both patients and health care professionals construct quality of care. Organizational cultures in health care settings are symbiotically linked with quality of care and medical errors.What does this study add? The constructions of health care professionals and patients create and recreate the organizational culture organically. The present study illuminates how health care professionals and patients negotiate their identities based on passivity and rejection of accountability, which contribute to medical errors and passivity.
Current role of image‐guided robotic radiosurgery (Cyberknife®) for prostate cancer treatment
Authors: Seisen Thomas , Drouin Sarah J. , Phé Véronique , Parra Jérome , Mozer Pierre , Bitker Marc‐Olivier , Cussenot Olivier , Rouprêt Morgan 
Published: January 2013

Objectives
To describe the most recent data from phase I and II clinical trials of stereotactic body radiation therapy (SBRT) using image‐guided robotic radiosurgery, specifically the Cyberknife® (Accuracy Incorporated, Sunnyvale, CA, USA).
To better determine thecurrent role of this type of radiosurgery in prostate cancer (PCa) management.
Materials and Methods
Current clinical trials and relevant retrospective studies were identified from the literature, clinical trial databases, websites and conference abstracts.
The indications, technical aspects, efficacy and toxicity of SBRT using the Cyberknife® system were summarized.
Results
The Cyberknife® system is an experimental treatment mostly used for localized PCa in stage cT1/T2a–b N0 M0 with a Gleason score ≤7 and PSA level ≤20 ng/mL. Hypofractionated radiation therapy was delivered in five fractions of 7–7.25 Gy for a total dose of 35–36.25 Gy.
After treatment, the median PSA levelfell from 4.9–8.3 ng/mL to 0.1–1.6 ng/mL at a median follow‐up of 4–60 months.
The biochemical progression‐free survival rates ranged from 78.3 to 100%.
Acute and late toxicities were mostly grade 1/2 rectal or urinary complications. Few grade 3 and no grade 4 toxicities occurred during follow‐up; however, erectile dysfunction and testes toxicity were also reported.
Conclusions
The use of the Cyberknife® system is limited mainly by its pretreatment and maintenance costs.
Despite encouraging preliminary results, longer‐term follow‐up and randomized controlled phase III clinical trials are necessary before the Cyberknife® system becomes a standard treatment method.
Impaired Cytoplasmic–Nuclear Transport of Hypoxia‐Inducible Factor‐1α in Amyotrophic Lateral Sclerosis
Authors: Nagara Yuko , Tateishi Takahisa , Yamasaki Ryo , Hayashi Shintaro , Kawamura Mami , Kikuchi Hitoshi , Iinuma Kyoko Motomura , Tanaka Masahito , Iwaki Toru , Matsushita Takuya , Ohyagi Yasumasa , Kira Jun‐ichi 
Published: January 2013

AbstractWe investigated the mechanisms underlying abnormal vascular endothelial growth factor (VEGF) production in amyotrophic lateral sclerosis (ALS). We immunohistochemically studied VEGF, its receptors VEGFR1 and 2, and hypoxia‐inducible factor‐1α (HIF‐1α) in autopsied ALS spinal cords. We also chronologically assessed the expression of HIF‐1α, karyopherin β1, karyopherin β‐cargo protein complex inhibitors and nuclear pore complex proteins in G93A mutant superoxide dismutase 1 (mSOD1) transgenic mice at presymptomatic, symptomatic and end stages. In ALS patients, compared with controls, HIF‐1α immunoreactivity in the cytoplasm of anterior horn cells (AHCs) was significantly increased, while immunoreactivities for VEGF and VEGFRs were significantly decreased. Similar changes in HIF‐1α and VEGF levels were observed in mSOD1 transgenic mice. HIF‐1α co‐localized with karyopherin β1 in the cytoplasm of AHCs and karyopherin β1 co‐localized with nucleoporin 62 (Nup62) on the nuclear envelope. From the presymptomatic stage of mSOD1 transgenic mice, karyopherin β1 immunoreactivity in AHC nuclei significantly decreased and morphological irregularities of the Nup62‐immunostained nuclear envelope became more pronounced with disease progression. Thus, in AHCs from mSOD1 transgenic mice, transport of cytoplasmic HIF‐1α to the nuclear envelope and into the nucleus is impaired from the presymptomatic stage, suggesting that impaired cytoplasmic–nuclear transport of HIF‐1α through the nuclear pore might precede motor neuron degeneration.
Social and Ecological Change over a Decade in a Village Hunting System, Central Gabon
Authors: COAD L. , SCHLEICHER J. , MILNER‐GULLAND E. J. , MARTHEWS T. R. , STARKEY M. , MANICA A. , BALMFORD A. , MBOMBE W. , DIOP BINENI T. R. , ABERNETHY K. A. 
Published: January 2013

AbstractDespite widespread recognition of the major threat to tropical forest biological diversity and local food security posed by unsustainable bushmeat hunting, virtually no long‐term studies tracking the socioecological dynamics of hunting systems have been conducted. We interviewed local hunters and collected detailed hunting data to investigate changes in offtake and hunter characteristics over 10 years (2001–2010) in Dibouka and Kouagna villages, central Gabon, in the context of hunter recollections of longer term trends since the 1950s. To control for changes in hunter behavior, such as trap location and characteristics, we report hunting offtake data per trap. Our results suggest the hunting area was already highly depleted by 2001; local hunters reported that 16 large‐bodied prey species had become rare or locally extirpated over the last 60 years. Overall, we observed no significant declines in hunting offtake or changes in species composition from 2001 to 2010, and offtakes per trap increased slightly between 2004 and 2010. However, trapping distance from the villages increased, and there was a switch in hunting techniques; a larger proportion of the catch was hunted with guns in 2010. The number of hunters declined by 20% from 2004 to 2010, and male livelihood activities shifted away from hunting. Hunters with the lowest hunting incomes in 2004 were more likely than successful hunters to have moved away from the village by 2010 (often in response to alternative employment opportunities). Therefore, changes in trap success (potentially related to biological factors) were interacting with system‐level changes in hunter number and composition (related to external socioeconomic factors) to produce a relatively static overall offtake. Our results highlight the importance of understanding the small‐scale context of hunting to correctly interpret changes or apparent stasis in hunting effort and offtake over time.Cambio Social y Ecológico a lo Largo de Una Década en un Sistema de Cacería Aldeana, Gabón Central
The concept of the onychodermis (specialized nail mesenchyme): an embryological assessment and a comparative analysis with the hair follicle
Authors: Sellheyer Klaus , Nelson Paula 
Published: January 2013

BackgroundRecently, an intriguing concept was introduced into the literature that defines the area underlying the nail bed as a specific mesenchymal substructure unique to the nail organ. It has been termed onychodermis. The onychodermis expresses CD10 with remarkable specificity. Herein, we compare adult and fetal human hair follicles with fetal nail organs in an attempt to draw analogies for the mesenchyme associated with both adnexal structures.MethodsWe examined immunohistochemically samples from adult and fetal hair follicles for the expression of CD10, CD34 and the mesenchymal stem cell marker nestin and compared the antigen profile with that of the fetal nail organ.ResultsThe CD10‐positive/CD34‐negative onychodermis is prominently visible at the end of the second trimester. A corresponding follicular structure was not identified, either in the adult or in the developing hair follicle. Nestin staining does not define the onychodermis.ConclusionsThe concept of the onychodermis is equally valid in the developing nail organ where it is also defined by its expression for CD10. Its function may be related to the anchorage of the overlying nail bed but may also involve a more dynamic role in the induction of hard keratins in the latter, contributing to the formation of the nail plate.
New insights into the survival strategy of the invasive soilborne pathogen Phytophthora cinnamomi in different natural ecosystems in Western Australia
Authors: Jung T. , Colquhoun I. J. , Hardy G. E. St. J. 
Published: January 2013

SummaryDespite its importance as one of the most notorious, globally distributed, multihost plant pathogens, knowledge on the survival strategy of Phytophthora cinnamomi in seasonally dry climates is limited. Soil and fine roots were collected from the rhizosphere of severely declining or recently dead specimens of 13 woody species at 11 dieback sites and two dieback spots and from healthy specimens of five woody species at four dieback‐free sites in native forests, woodlands and heathlands of the south‐west of Western Australia (WA). Phytophthora cinnamomi was recovered from 80.4, 78.1 and 100% of tested soil, fine root and soil–debris slurry samples at the 11 dieback sites, in some cases even after 18‐month storage under air‐dry conditions, but not from the small dieback spots and the healthy sites. Direct isolations from soil–debris slurry showed that P. cinnamomi colonies exclusively originated from fine roots and root fragments not from free propagules in the soil. Microscopic investigation of P. cinnamomi‐infected fine and small woody roots and root fragments demonstrated in 68.8, 81.3 and 93.8% of samples from nine woody species the presence of thick‐walled oospores, stromata‐like hyphal aggregations and intracellular hyphae encased by lignitubers, respectively, while thin‐walled putative chlamydospores were found in only 21.2% of samples from five woody species. These findings were confirmed by microscopic examination of fine roots from artificially inoculated young trees of 10 woody species. It is suggested that (i) the main function of chlamydospores is the survival in moderately dry conditions between consecutive rain events and (ii) selfed oospores, hyphal aggregations, and encased hyphae and vesicles in infected root tissue of both host and non‐host species are the major long‐term survival propagules of P. cinnamomi during the extremely dry summer conditions in WA.
Loss of retinal nerve fibre layer axons indicates white but not grey matter damage in early multiple sclerosis
Authors: Young K. L. , Brandt A. U. , Petzold A. , Reitz L. Y. , Lintze F. , Paul F. , Martin R. , Schippling S. 
Published: January 2013

Background and purposeOptical coherence tomography (OCT) has shown thinning of the retinal nerve fibre layer (RNFL) and total macular volume (TMV) in multiple sclerosis (MS) patients. Measures of retinal atrophy are associated with the brain parenchymal fraction (BPF) assessed by magnetic resonance imaging (MRI). However, in MS, data on the relation of OCT measures and grey and white matter volumes are contradictory. We performed a prospective cross‐sectional study with a statistically pre‐defined endpoint to test our hypothesis that OCT measures of neuro‐axonal degeneration are related to global and partial brain atrophy in early forms of MS.Methods and resultsForty‐four patients with clinically isolated syndrome (n = 10) or relapsing–remitting MS (n = 34; mean disease duration = 3.2 years, median EDSS = 1.5) were enrolled in the study. Peripapillary‐ and volumetric OCT scans of the macula were performed using latest spectral‐domain OCT technology. BPF as well as white and grey matter fractions (WMF/GMF) were assessed by 1.5 Tesla MRI scans. Generalized estimating equation models adjusted for age and linear regression statistics were used to assess the association between OCT and MRI measures. RNFL thickness, TMV and age were significantly associated with BPF. RNFL thickness and TMV independently predicted WMF (P = 0.003 and P = 0.032) but not GMF (P = 0.717 and P = 0.357) when corrected for age. In contrast, age was strongly associated with GMF (P < 0.001) but not WMF.ConclusionOur study suggests that, in early MS, OCT measures of retinal atrophy are related to volumetric changes in the white but not grey matter compartment as assessed by MRI. It further substantiates the association of retinal thinning and brain tissue loss in MS.
A new COL3A1 mutation in Ehlers–Danlos syndrome type IV
Authors: Eder Johanna , Laccone Franco , Rohrbach Marianne , Giunta Cecilia , Aumayr Klaus , Reichel Christofer , Trautinger Franz 
Published: January 2013

AbstractThe vascular type of the Ehlers–Danlos syndrome (Ehlers–Danlos syndrome type IV, EDS IV; OMIM #130050) is a rare connective tissue disorder with autosomal dominant transmission caused by mutations in the COL3A1 gene resulting in increased fragility of connective tissue with arterial, intestinal, and uterine ruptures and premature death. We present a 28‐year‐old female who in addition to typical EDS IV symptoms had severe peripheral artery occlusive disease (PAOD) and subtotal stenosis of the abdominal aorta. COL3A1 sequencing resulted in detection of an as yet undescribed mutation in exon 36 at position 2465 leading to a nucleotide replacement (c.2465G>C; p.G822A). Ultrastructural analysis of a skin biopsy revealed abnormal morphology and distribution of dermal collagen fibres. We conclude that PAOD is a possible manifestation of EDS IV and that further research is required to define its true prevalence among patients with EDS IV and its molecular pathology including genotype–phenotype correlation.
A 2 °C warmer world is not safe for ecosystem services in theEuropeanAlps
Authors: Elkin Ché , Gutiérrez Alvaro G. , Leuzinger Sebastian , Manusch Corina , Temperli Christian , Rasche Livia , Bugmann Harald 
Published: January 2013

AbstractLimiting the increase in global average temperature to 2 °C is the objective of international efforts aimed at avoiding dangerous climate impacts. However, the regional response of terrestrial ecosystems and the services that they provide under such a scenario are largely unknown. We focus on mountain forests in theEuropeanAlps and evaluate how a range of ecosystem services (ES) are projected to be impacted in a 2 °C warmer world, using four novel regional climate scenarios. We employ three complementary forest models to assess a wide range ofESin two climatically contrasting case study regions. Within each climate scenario we evaluate if and whenESwill deviate beyond status quo boundaries that are based on current system variability. Our results suggest that the sensitivity of mountain forestESto a 2 °C warmer world depends heavily on the current climatic conditions of a region, the strong elevation gradients within a region, and the specificESin question. Our simulations project that large negative impacts will occur at low and intermediate elevations in initially warm‐dry regions, where relatively small climatic shifts result in negative drought‐related impacts on forestES. In contrast, at higher elevations, and in regions that are initially cool‐wet, forestESwill be comparatively resistant to a 2 °C warmer world. We also found considerable variation in the vulnerability of forestESto climate change, with some services such as protection against rockfall and avalanches being sensitive to 2 °C global climate change, but other services such as carbon storage being reasonably resistant. Although our results indicate a heterogeneous response of mountain forestESto climate change, the projected substantial reduction of some forestESin dry regions suggests that a 2 °C increase in global mean temperature cannot be seen as a universally ‘safe’ boundary for the maintenance of mountain forestES.
Volume estimation in dialysis patients: The concordance of brain‐type natriuretic peptide measurements and bioimpedance values
Authors: Tapolyai Mihály , Faludi Mária , Réti Virág , Lengvárszky Zsolt , Szarvas Tibor , Fülöp Tibor , Bekő Gabriella , Berta Klára 
Published: January 2013

AbstractCorrect estimation of the dialysis patients' hydration status remains an important clinical challenge. Bioimpedance measurements have been validated by various physiological tests, and the use of brain‐type natriuretic peptide (BNP) has been validated by inferior vena cava diameter measurements. This is an observational cohort study that evaluated the correspondence between bioimpedance‐measured overhydration percentage (OH%) and BNP. We measured predialysis OH% by bioimpedance apparatus (Body Composition Monitor) and BNP by microparticle enzyme‐linked immunoassay in 41 prevalent stable hemodialysis patients, 19 (46%) women, aged 58.9 ± 14.5 years. The cohort's average BNP was 2694 ± 3278 pg/mL and 10 (24.4%) of these 41 patients had BNP < 500 pg/mL (average 260.7 ± 108.5). The OH% was 8.5 ± 7.0% among those with a BNP < 500 pg/mL, while the rest of the population had an OH% of 21.4 ± 8.0%, corresponding to excess volumes of 1.6 ± 1.3 and 4.4 ± 3.8 L, respectively. The OH% vs. BNP relationship was best described by the exponential regression of y = 216.4e0.097x, predicting a BNP of 216.4 pg/mL at 0% overhydration status (r 0.61). Receiver‐operating curves revealed an area under the curve of 0.885 for BNP when the OH% was set ≥15% of overhydration and an area under the curve of 0.918 for OH% when the BNP was set ≥500 pg/mL for being abnormal. We conclude that in our cohort there was a high degree of correspondence between these two tests with an exponential relationship between the measurements.
Examination of the predictive validity of theDynamicAppraisal ofSituationalAggression in two mental health units
Authors: Griffith Jessica J. , Daffern Michael , Godber Timothy 
Published: January 2013

AbstractEmpirically derived structured violence risk assessment instruments are increasingly used by nurses in forensic mental health settings, typically demonstrating stronger predictive validity than unaided clinical risk assessments, and associated with reduced aggression and reduced restrictive practices including seclusion. However, these instruments are less often used in non‐forensic mental health settings despite frequent aggression in these settings. This study represents the first test of theDynamicAppraisal ofSituationalAggression (DASA‐IV), a structured instrument used to appraise risk for imminent aggression in a non‐forensic mental health hospital. Predictive validity ofDASA‐IV, and unaided clinical and structured clinical judgements made afterDASA‐IVassessments were compared. Participants included 105 nurses at two mental health inpatient units in ruralVictoria,Australia. During the study, 482DASA‐IVassessments and structured clinical judgements were compared with 997 unaided clinical risk judgements.DASA‐IVtotal scores predicted aggression significantly better than unaided clinical risk ratings over the subsequent 24 hours and for the next shift. Nurses' structured clinical judgement ratings were more accurate than unaided clinical appraisals but less accurate than actuarial (DASA‐IVderived) scores. TheDASA‐IVpresents as a valid measure for appraising risk of imminent aggression in mainstream mental health inpatient settings.
Trauma‐informed care in inpatient mental health settings: A review of the literature
Authors: Muskett Coral 
Published: January 2013

AbstractTrauma‐informed care is an emerging value that is seen as fundamental to effective and contemporary mental health nursing practice. Trauma‐informed care, like recovery, leaves mental health nurses struggling to translate these values into day‐to‐day nursing practice. Many are confused about what individual actions they can take to support these values. To date, the most clearly articulated policy to emerge from the trauma‐informed care movement in Australia has been the agreement to reduce, and wherever possible, eliminate the use of seclusion and restraint. Confronted with the constant churn of admissions and readmissions of clients with challenging behaviours, and seemingly intractable mental illness, the elimination of seclusion and restraint is seen to be utopian by many mental health nurses in inpatient settings. Is trauma‐informed care solely about eliminating seclusion and restraint, or are there other tangible practices nurses could utilize to effect better health outcomes for mental health clients, especially those with significant abuse histories? This article summarizes the findings from the literature from 2000–2011 in identifying those practices and clinical activities that have been implemented to effect trauma‐informed care in inpatient mental health settings.
A comparison of the in vitro moisture vapour transmission rate and in vivo fluid‐handling capacity of six adhesive foam dressings to a newly reformulated adhesive foam dressing
Authors: Zehrer Cindy L. , Holm David , Solfest Staci E. , Walters Shelley‐Ann 
Published: January 2013

AbstractThis study compared moisture vapour transmission rate (MVTR) and wear time or fluid‐handling capacities of six adhesive foam dressings to a reformulated control dressing. Standardised in vitro MVTR methodology and a previously published in vivo artificial wound model (AWM) were used. Mean inverted MVTR for the reformulated dressing was 12 750 g/m2/24 hours and was significantly higher than four of the six comparator dressings (P < 0·0001), which ranged from 830 to 11 360 g/m2/24 hours. Mean upright MVTR for the reformulated dressing was 980 g/m2/24 hours and was significantly different than all of the comparator dressings (P < 0·0001), which ranged from 80 to 1620 g/m2/24 hours (three higher/three lower). The reformulated dressing median wear time ranged from 6·1 to >7·0 days, compared with 1·0 to 3·5 days for the comparator dressings (P = 0·0012 to P < 0·0001). The median fluid volume handled ranged from 78·0 to >87 ml compared with 13·0 to 44·5 ml for the comparator dressings (P = 0·0007 to P < 0·001). Interestingly, inverted MVTR did not correspond well to the AWM. These results suggest that marked differences exist between the dressings in terms of both MVTR and wear time or fluid‐handling capacity. Furthermore, high inverted MVTR does not necessarily predict longer wear time or fluid‐handling capacities of absorbent dressings.