bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does a palliative care consult decrease the cost of caring for hospitalized patients with dementia?
Authors: Araw Marissa , Kozikowski Andrzej , Sison Cristina , Mir Tanveer , Saad Maha , Corrado Lauren , Pekmezaris Renee , Wolf-Klein Gisele 
Published: October 2013

AbstractObjective:Advanced dementia (AD) is a terminal disease. Palliative care is increasingly becoming of critical importance for patients afflicted with AD. The primary objective of this study was to compare pharmacy cost before and after a palliative care consultation (PCC) in patients with end-stage dementia. A secondary objective was to investigate the cost of particular types of medication before and after a PCC.Method:This was a retrospective study of 60 hospitalized patients with end-stage dementia at a large academic tertiary care hospital from January 1, 2010 to October 1, 2011, in order to investigate pharmacy costs before and after a PCC. In addition to demographics, we carried out a comparison of the average daily pharmacy cost and comparison of the proportion of subjects taking each medication type (cardiac, analgesics, antibiotics, antipsychotics and antiemetics) before and after a PCC.Results:There was a significant decrease in overall average daily pharmacy cost from before to after a PCC ($31.16 ± 24.71 vs. $20.83 ± 19.56;p< 0.003). There was also a significant difference in the proportion of subjects taking analgesics before and after PCC (55 vs. 73.3%;p< 0.009), with a significant average daily analgesic cost rise from pre- to post-PCC: $1.36 ± 5.07 (median = $0.05) versus. $2.35 ± 5.35 (median = $0.71), respectively,p< 0.011; average daily antiemetics cost showed a moderate increase from pre- to post-PCC: $0.08 ± 0.37 (median = $0) versus $0.23 ± 0.75 (median = $0), respectively,p< 0.047.Significance of results:Our findings indicate that PCC is associated with overall decreased medication cost in hospitalized AD patients. Additionally, receiving a PCC was related to greater use of pain medications in hospitalized dementia patients. Our study corroborates the benefits of palliative care team intervention in managing elderly hospitalized dementia patients.
Delirium in palliative care: Detection, documentation and management in three settings
Authors: Hey Jennifer , Hosker Christian , Ward Jason , Kite Suzanne , Speechley Helen 
Published: October 2013

AbstractObjectives:Delirium is characterized by disturbances of consciousness and changes in cognition that develop rapidly and fluctuate. It is common in palliative care, affecting up to 88% of patients with advanced cancer, yet often remains insufficiently diagnosed and managed. This study sought to compare rates of screening, documentation, and management of delirium across three palliative care settings — two hospices and one hospital team — and to determine whether definitive documentation of delirium as a diagnosis is associated with improved management of the disorder.Methods:A retrospective review of patient case notes was performed in three U.K. palliative care settings for the presence of: cognitive screening tools on first assessment; the term “delirium” as a stated documented diagnosis; documented terms, descriptions, and synonyms suggestive of delirium; and management plans aimed at addressing delirium.Results:We reviewed 319 notes. The prevalence of delirium as a documented diagnosis ranged from 0 to 8.4%, rising to 35.7–39.2% when both documented delirium and descriptions suggestive of delirium were taken into account. An abbreviated mental test score (AMTS) was determined for 19.6 (H1) and 26.8% (H2) of hospice admissions and for 0% of hospital assessments. Symptoms suggestive of delirium were managed in 56.3% of cases in hospital, compared with 66.7 (H1) and 72.2% (H2) in hospices.Significance of results:Use of the term “delirium” was infrequent in both hospital and hospice palliative care settings, as was the use of routine screening. Many identified cases did not receive targeted management. The definitive use of the term as a diagnosis was associated with clearer management plans in hospital patients. The authors suggest that better screening and identification remains the first step in improving delirium management.
An anatomy of CBT training: trainees’ endorsements of elements, sources and modalities of learning during a postgraduate CBT training course
Authors: Rakovshik Sarah G. , McManus Freda 
Published: October 2013

AbstractThis study examines trainees’ evaluations of a postgraduate CBT training course to determine which aspects are perceived as having the greatest effect on competence. A course evaluation was completed by three cohorts (n = 73) of a yearlong master's-level CBT training course, and statistical comparisons were conducted to examine the perceived impact of discrete aspects of training. There were significant differences between endorsements of the impact of various aspects of the learning experience. Overall, supervision was perceived to have a greater influence on trainees’ competence than clinical instruction. Interactions with trainers were given the highest rating, followed by learning from personal reflection and peer interactions. The varied aspects of extensive CBT training were perceived by students to be differentially effective in enhancing CBT skills. Supervision was perceived to have the strongest impact on competence, and trainees’ own reflections on their practice in preparation for supervision perceived as an important contributor to supervision's efficacy. The relatively low rating of peer-related learning suggests acceptability for distance training (e.g. internet-based), which excludes peer interaction found in traditional training. Due to limitations inherent in study design, only tentative conclusions can be offered. Further research involving more rigorous hypothesis testing is recommended.
The European Union and equal opportunities policies
Authors: Walby Sylvia 
Published: October 2013

Abstract
The impact of the European Union policy on gender relations is often underestimated, while the significance of gender has often been underestimated in analyses of the EU. Yet the EU has made significant changes to the governance of gender relations. This has been significantly achieved through the legal regulation of equal opportunities in employment. This paper subjects to detailed critique those arguments that equal opportunities policies can do little to enhance the position of women. The impact of EU equal opportunities policies have been underestimated as a result of: the traditional focus of the social dimension on welfare rather than on social regulation; the theorization of gender relations through the lens of the family and welfare rather than employment, and the underestimation of the power of law.
Private and public transfers between generations: linking the family and the state
Authors: Kohli Martin 
Published: October 2013

Abstract
In the conventional story of modernization, the emergence of the nuclear family and of public old age security have been seen as parallel and mutually reinforcing processes. According to this view, the traditional intergenerational transfers in the family have been crowded out and replaced by those in the public sphere. In recent years, a growing body of research has demonstrated that substantial transfers between adult generations in the family beyond the nuclear households still exist. Their direction has been reversed, however. The new evidence shows that there is a net downward flow of private resources from the older generations to their adult offspring, i.e. counter to the public transfers. Two questions then arise: How are private and public transfers linked, i.e. to what extent do the private transfers from the older to the younger generations in the family depend on public transfers through old age pensions? And what are the effects of channelling public resources to younger family generations by way of older pension recipients? The paper addresses these questions by taking Germany as the model case.
Starting with a handicap: phenotypic differences between early‐ and late‐born king penguin chicks and their survival correlates
Authors: Stier Antoine , Viblanc Vincent A. , Massemin‐Challet Sylvie , Handrich Yves , Zahn Sandrine , Rojas Emilio R. , Saraux Claire , Le Vaillant Maryline , Prud'homme Onésime , Grosbellet Edith , Robin Jean‐Patrice , Bize Pierre , Criscuolo Francois 
Published: October 2013

Summary

The exceptionally long (c. 11 months) growth period of king penguin chicks (Aptenodytes patagonicus) is interrupted by the Austral winter. As a consequence, penguin chicks born late in the breeding season have little time to build‐up their energy reserves before the drastic energy bottleneck they experience during winter and face greater risks of mortality than early‐born chicks.

Whereas it is well known that breeding adults alternate between early‐ and late‐breeding attempts, little is known on the phenotype of early‐ and late‐chicks, and on the potential existence of specific adaptive phenotypic responses in late‐born individuals.

We investigated phenotypic differences between early‐ and late‐chicks and tested their survival correlates both before the winter and at fledgling. Chicks were sampled 10 days after hatching to measure body mass, plasma corticosterone levels, oxidative stress parameters and telomere length.

Late‐chicks were heavier than early‐chicks at day 10. Late‐chicks also had higher corticosterone and oxidative stress levels, shorter telomere lengths and suffered from higher mortality rates than early‐chicks. For both early‐ and late‐chicks, high body mass close to hatching was a strong predictor of survival up to, and over, the winter period.

In late but not early‐chicks, high corticosterone levels and long telomeres were significant predictors of survival up to winter and fledging, respectively.

Our study provides evidence that late‐ and early‐king penguin chicks showed marked phenotypic differences 10 days after hatching. We provide an integrative discussion on whether these differences may be adaptive or not, and to what extent they may be driven by active maternal effects, indirectly induced by environmental effects, or stem from individual differences in parental quality.
Connectivity between flyway populations of waterbirds: assessment of rates of exchange, their causes and consequences
Authors: Madsen Jesper , Tjørnløv Rune S. , Frederiksen Morten , Mitchell Carl , Sigfússon Arnór Th. 
Published: October 2013

SummaryConservation and management of migratory waterbirds use flyway populations as the basic unit, and knowledge of the delineation, rate of exchange and gene flow between populations is fundamental. However, for the majority of global flyway populations, information is too fragmentary to address connectivity between populations and, hence, insufficient to inform management.We investigated the demographic connectivity between the eastern (breeding in Svalbard and wintering in Denmark, the Netherlands and Belgium) and western (breeding in Greenland or Iceland and wintering in Britain) flyway populations of pink‐footed geeseAnser brachyrhynchusbased on resightings of marked geese from both populations. Previous genetic analyses suggested a modest gene flow between the two populations.Capture–recapture analysis conservatively estimated that mean annual movement probabilities were low (eastern to western population: 0·071%, 95%CI = 0·033–0·15%; western to eastern: 0·076%, 95%CI = 0·031–0·18%). Movement probability from eastern to western flyway populations increased in years with high snow cover in the southernmost winter range inBelgium. Life histories of exchanged individuals from eastern to western (32 different individuals during 1988–2010) revealed that the majority enteredBritain viaBelgium and theNetherlands during winter; some returned to the eastern population viaBelgium and/or theNetherlands, others moved northwards inBritain during the spring and appear to have migrated directly fromBritain (western population) toNorway (eastern population). None of the birds from the eastern population emigrated permanently, but some individuals turned up inBritain in consecutive years. Out of nine individuals switching from western to eastern flyway populations, three returned toBritain; the others were not subsequently resighted. An alternative winter strategy and spring flyway overBritain toNorway is suggested, used by hundreds to thousands of eastern birds, particularly following severe winters. Thus, the two populations currently appear to be demographically closed; low genetic connectivity probably reflects dispersal over longer time.Synthesis and applications. Current initiatives to internationally manage the eastern population of pink‐footed geese do not need to consider net immigration in predictive harvest models. For waterbirds in general, a targeted approach to evaluate connectivity, using classic marking studies in combination with molecular methods and focussed sampling on breeding grounds, is recommended to better underpin management decisions at population levels.
Assessing Progress toward Becoming a Patient‐Centered Medical Home: An Assessment Tool for Practice Transformation
Authors: Daniel Donna M. , Wagner Edward H. , Coleman Katie , Schaefer Judith K. , Austin Brian T. , Abrams Melinda K. , Phillips Kathryn E. , Sugarman Jonathan R. 
Published: October 2013

ObjectiveTo describe the properties of the Patient‐Centered Medical Home Assessment (PCMH‐A) as a tool to stimulate and monitor progress among primary care practices interested in transforming to patient‐centered medical homes (PCMHs).Study SettingSixty‐five safety net practices from five states participating in a national demonstration program for PCMH transformation.Study DesignLongitudinal analyses of PCMH‐A scores were performed. Scores were reviewed for agreement and sites were categorized over time into one of five categories by external facilitators. Comparisons to key activity completion rates and NCQA PCMH recognition status were completed.Data Collection/Extraction MethodsMultidisciplinary teams at each practice completed the 33‐item self‐assessment tool every 6 months between March 2010 and September 2012.Principal FindingsMean overall PCMH‐A scores increased (7.2, March 2010, to 9.1, September 2012; [p < .01]). Increases were statistically significant for each of the change concepts (p < .05). Facilitators agreed with scores 82% of the time. NCQA‐recognized sites had higher PCMH‐A scores than sites that were not yet recognized. Sites that completed more transformation activities and progressed over defined tiers reported higher PCMH‐A scores. Scores improved most in areas where technical assistance was provided.ConclusionsThe PCMH‐A was sensitive to change over time and provided an accurate reflection of practice transformation.
Hospital Costs and Inpatient Mortality among Children Undergoing Surgery for Congenital Heart Disease
Authors: Romley John A. , Chen Alex Y. , Goldman Dana P. , Williams Roberta 
Published: October 2013

ObjectiveTo determine the association between hospital costs and risk‐adjusted inpatient mortality among children undergoing surgery for congenital heart disease (CHD) in U.S. acute‐care hospitals.Data Sources/Study SettingsRetrospective cohort study of 35,446 children in 2003, 2006, and 2009 Kids' Inpatient Database (KID).Study DesignCross‐sectional logistic regression of risk‐adjusted inpatient mortality and hospital costs, adjusting for a variety of patient‐, hospital‐, and community‐level confounders.Data Collection/Extraction MethodsWe identified relevant discharges in the KID using the AHRQ Pediatric Quality Indicator for pediatric heart surgery mortality, and linked these records to hospital characteristics from American Hospital Association Surveys and community characteristics from the Census.Principal FindingsChildren undergoing CHD surgery in higher cost hospitals had lower risk‐adjusted inpatient mortality (p = .002). An increase from the 25th percentile of treatment costs to the 75th percentile was associated with a 13.6 percent reduction in risk‐adjusted mortality.ConclusionsGreater hospital costs are associated with lower risk‐adjusted inpatient mortality for children undergoing CHD surgery. The specific mechanisms by which greater costs improve mortality merit further exploration.
Increasing the number of discrete character states for continuous characters generates well‐resolved trees that do not reflect phylogeny
Authors: BARDIN Jérémie , ROUGET Isabelle , YACOBUCCI Margaret Mary , CECCA Fabrizio 
Published: October 2013

AbstractSince the introduction of the cladistic method in systematics, continuous characters have been integrated into analyses but no methods for their treatment have received unanimous support. Some methods require a large number of character states to discretise continuous characters in order to keep the maximum level of information about taxa differences within the coding scheme. Our objective was to assess the impact of increasing the character state number on the outcomes of phylogenetic analyses. Analysis of a variety of simulated datasets shows that these methods for coding continuous characters can lead to the generation of well‐resolved trees that do not reflect a phylogenetic signal. We call this phenomenon the flattening of the tree‐length distribution; it is influenced by both the relative quantity of continuous characters in relation to discrete characters, and the number of characters in relation to the number of taxa. Bootstrap tests provide a method to avoid this potential bias.
Preliminary analyses of the frozen mummies of mammoth (Mammuthus primigenius), bison (Bison priscus) and horse (Equus sp.) from the Yana‐Indigirka Lowland, Yakutia, Russia
Authors: BOESKOROV Gennady G. , POTAPOVA Olga R. , MASHCHENKO Eugeny N. , PROTOPOPOV Albert V. , KUZNETSOVA Tatyana V. , AGENBROAD Larry , TIKHONOV Alexey N. 
Published: October 2013

AbstractThe frozen bodies of a young woolly mammoth (Mammuthus primigenius), a wild horse (Equus sp.) and a steppe bison (Bison priscus) were recently found in the northern Yakutia (northeastern Siberia). All specimens have preserved bones, skin and soft tissues. Whereas the woolly mammoth and the Pleistocene horse were represented by partial frozen bodies, the steppe bison body was recovered in an absolutely complete state. All specimens were found frozen in the permafrost, with some of the tissues mummified. The wild horse and steppe bison are of Holocene age, and the mammoth is of Late Pleistocene age.
Doubling time calculations for lung cancer by three‐dimensional computer‐aided volumetry: Effects of inter‐observer differences and nodule characteristics
Authors: Koike Wataru , Iwano Shingo , Matsuo Keiji , Kitano Mariko , Kawakami Kenichi , Naganawa Shinji 
Published: October 2013

AbstractIntroductionThe purpose of this study was to investigate doubling time (DT) differences among solid, part‐solid (PS) and non‐solid (NS) types of lung cancers. We also compared inter‐observer differences in size measurements between diameter and three‐dimensional (3D) volume measurements of lung cancers, including PS‐ and NS‐type nodules, using 3D computer‐aided volumetry (3D‐CAV).MethodsThe long‐axis diameters and 3D volumes of lung tumours were measured using CAV by two chest radiologists for 71 consecutive patients with peripheral lung cancer who underwent at least two CT examinations before surgical resection. We evaluated the inter‐observer variability for the ratio of diameter change (RCdiameter) and volume change (RCvolume), which were based on two CT images obtained at different times prior to resection. Inter‐observer agreement was evaluated by Bland–Altman plots. Based on the volumes obtained from 3D‐CAV, we calculated the DTs and compared DT differences between solid, PS and NS types of lung tumours.ResultsThe inter‐observer Spearman's rank correlation coefficients were 0.87 for RCvolume and 0.64 for RCdiameter (p < 0.001). For all internal appearance types, the rs values for RCvolume were greater than those for RCdiameter. The median DT values for solid, PS and NS were 278, 347 and 584 days, respectively. NS‐ and PS‐type tumours had significantly longer DTs (p = 0.024; by Spearman's rank correlation coefficient).ConclusionsDT determinations using 3D‐CAV had good correlations with the internal appearances of lung cancers. Lung tumour volume measurements by 3D‐CAV exhibited better inter‐observer correlations than did diameter measurements.
Seed dispersal kernels estimated from genotypes of established seedlings: does density‐dependent mortality matter?
Authors: Klein Etienne K. , Bontemps Aurore , Oddou‐Muratorio Sylvie 
Published: October 2013

Summary

The seed dispersal kernel is a major determinant of spatial population dynamics and spatial distribution of genetic diversity. Among the main methods to estimate it, inverse modelling (IM) and gene shadow model (GSM) rely on seed counts in traps, whereas competing source model (CSM) and spatially explicit mating models (SEMMs) rely on compositions of seed pools. Moreover, GSM, CSM and SEMM exploit genetic information from molecular markers, whereas IM only exploits seed counts ignoring seed origins. These methods were also applied to established seedlings.

In the presence of post‐dispersal density‐dependent mortality (DDM), the effective dispersal kernel, describing the spatial distribution of established seedlings relatively to the seed source, is notoriously different from the basic dispersal kernel, describing the spatial distribution of seed deposition sites relatively to the source. Using simulated data sets, we investigated whether IM, GSM, CSM and SEMM applied to established seedlings estimate the basic or the effective dispersal kernel. In our simulations, DDM resulted in a shift of the mean basic dispersal distance (10 m) towards substantially higher effective mean dispersal distances (15 m and 20·8 m).

We demonstrated that CSM and SEMM estimate the basic seed dispersal kernel, independently from the presence of post‐dispersal mortality. By contrast, GSM estimates the effective dispersal kernel. IM failed to provide satisfactory estimates in the presence of DDM in our sampling design. Besides, for all methods, seed migration was inflated in the presence of DDM, due to lower mortality among randomly distributed immigrants relatively to local seedlings.

It could seem intuitive that estimates based on seedlings or seeds provide effective or basic dispersal kernels respectively. Our results showed that it is not true for estimates obtained with CSM or SEMM because they rely on the composition of seed/seedling pools and not seed/seedling counts such as IM or GSM. This has important consequences for life stage studies where the discordance of dispersal kernels estimated from different cohorts is used to investigate post‐dispersal density‐dependent mortality.