bluuebunny/crossref_metadata_2025_split huggingface dataset:
Environmental sustainability in hospitals – a systematic review and research agenda
Authors: McGain Forbes , Naylor Chris 
Published: May 2014

Objectives Hospitals are significant contributors to natural resource depletion and environmental change. Our objective was to establish the extent to which hospital environmental sustainability has been studied and the key issues that emerge for policy, practice and research. Methods The PubMed, Engineering Village, Cochrane and King's Fund databases were searched for articles relating to hospital environmental sustainability published in English between 1 January 1990 and 1 October 2013. Further studies were found by review of reference lists. One hundred ninety-three relevant articles were found and 76 were selected for inclusion in the review. Results Common research themes were identified: hospital design, direct energy consumption, water, procurement, waste, travel and psychology and behaviour. Some countries (particularly the United Kingdom) have begun to invest systematically in understanding the environmental effects of hospitals. We found large variability in the extent of the evidence base according to topic. Research regarding the architectural fabric of hospital buildings is at a relatively mature stage. Similarly, there is a developed research base regarding devices and technologies used within hospitals to reduce the environmental effects of direct hospital energy and water use. Less is known about the clinical, psychological and social factors that influence how health care professionals use resources, travel to/from hospital, and interact with the buildings and technologies available. A significant part of the environmental footprint of hospitals relates to clinical practice, e.g. decisions regarding the use of pharmaceuticals and medical devices. Medical ‘cradle to grave’ life cycle assessment studies have been published to understand the full financial and environmental costs of hospital activities. The effects of preventive or demand management measures which avoid unnecessary hospital procedures are likely to be much greater than incremental changes to how hospital procedures are performed. Conclusions There remain significant gaps in the evidence base on hospital sustainability. Assessments of environmental impacts and natural resource use are beginning to be produced, both at the level of individual hospitals and at the health system level. These are an important start, but in many areas do not yet provide sufficiently detailed information to guide decision-making. There are many areas where the interests of patients and the environment coincide, but others where tensions exist. Rising resource costs and climate change mitigation measures are likely to create an increasing stimulus for research on hospital sustainability. Such research will benefit from inter-disciplinary coordination across research funders and countries.
Life Span Exercise Among Elite Intercollegiate Student Athletes
Authors: Sorenson Shawn C. , Romano Russell , Azen Stanley P. , Schroeder E. Todd , Salem George J. 
Published: May 2014

Background: Despite prominent public attention, data on life span health and exercise outcomes among elite, competitive athletes are sparse and do not reflect the diversity of modern athletes. Hypothesis: Life span exercise behavior differs between National Collegiate Athletic Association (NCAA) student athletes and a nonathlete control group. Sustained exercise is associated with improved cardiopulmonary health outcomes. Study Design: Cross-sectional, descriptive epidemiology study. Level of Evidence: Level 3. Methods: A total of 496 students and alumni (age range, 17-84 year) at a large, NCAA Division I university, including student athletes and an age- and sex-matched nonathlete control group, completed anonymous, self-report health and exercise questionnaires. Age-stratified, cross-sectional analysis evaluated previous week’s total exercise volume (ExVol), self-rated exercise importance (ExImp), and compliance with American College of Sports Medicine (ACSM) exercise guidelines for healthy adults. The association of ACSM guideline compliance with lifetime cardiopulmonary health outcomes was also assessed. Results: Current student athletes reported significantly greater ExVol ( P < 0.001. Cohen d = 0.99, probability of clinically important difference [pCID] >99.5%), ExImp ( P < 0.001, d = 1.96, pCID = 96%), and likelihood of compliance with ACSM guidelines (odds ratio [OR], 95% confidence interval [CI] = 30.6, 11.0-84.6) compared with nonathletes. No significant differences were found between alumni student athletes and nonathletes. Alumni student athletes demonstrated substantially lower ExVol ( P < 0.001, d = –0.94, pCID >99.5%) and guideline compliance (OR = 0.09, 95% CI = 0.05-0.19) compared with current student athletes, whereas nonathletes had similar exercise behavior across the life span. Among alumni, ACSM guideline compliance was associated with significant attenuation of cardiopulmonary health concerns ( P = 0.02, d = –0.50, pCID = 14%) independent of intercollegiate athletic participation. Conclusion: Although current NCAA Division I student athletes demonstrated significant, clinically important differences in exercise behavior compared with nonathletes, no group differences were evident later in life. Irrespective of collegiate athletic status, healthy exercise behavior among alumni was associated with cardiopulmonary health benefits. Clinical Relevance: To realize life span health benefits, it is imperative that student athletes maintain consistent patterns of healthy exercise beyond retirement from competitive sports.
Long-term post-marketing surveillance of mizoribine for the treatment of lupus nephritis: Safety and efficacy during a 3-year follow-up
Authors: Yagi Nobuyuki , Okada Kenya , Sudo Yohei , Itoh Hiromichi , Yoshida Hisao , Kuroda Tatsuhiko 
Published: May 2014

Objective: To determine the safety and efficacy of long-term use of mizoribine by undertaking a 3-year post-marketing surveillance study. Methods: Subjects were all lupus nephritis patients newly treated with mizoribine between 1 October 2003 and 30 September 2005 at contracted study sites. Results: Mizoribine was administered to 881 lupus nephritis patients in the safety analysis set consisting of 946 patients recruited from 281 contracted study sites after satisfying the eligibility criteria. There were 301 events of adverse drug reactions that were observed in 196 (20.7%) of the 946 subjects. There were 34 events of serious adverse drug reactions in 31 patients (3.2%). No deterioration in hematological and biochemical test values was observed, but immunological testing showed significant improvements in C3, CH50, and anti-DNA antibody titers. The negative rate of proteinuria also increased over time. The median steroid dosage was 15 mg/day at the commencement of treatment, but was reduced to 10 mg/day at 12 months and 8 mg/day at 36 months. Conclusion: The findings of the 3-year long-term drug use surveillance study indicated that mizoribine can be used over the long term with relatively few adverse drug reactions, suggesting its suitability for use in maintenance drug therapy.
Serum activin A and B, and follistatin in critically ill patients with influenza A(H1N1) infection
Authors: Linko Rita , Hedger Mark P , Pettilä Ville , Ruokonen Esko , Ala-Kokko Tero , Ludlow Helen , de Kretser David M 
Published: May 2014

Abstract

Background
Activin A and its binding protein follistatin (FS) are increased in inflammatory disorders and sepsis. Overexpression of activin A in the lung causes similar histopathological changes as acute respiratory distress syndrome (ARDS). ARDS and severe respiratory failure are complications of influenza A(H1N1) infection. Interleukin 6 (IL-6), which in experimental studies increases after activin A release, is known to be related to the severity of H1N1 infection. Our aim was to evaluate the levels of activin A, activin B, FS, IL-6 and IL-10 and their association with the severity of respiratory failure in critically ill H1N1 patients.

Methods
A substudy of a prospective, observational cohort of H1N1 patients in Finnish intensive care units (ICU). Clinical information was recorded during ICU treatment, and serum activin A, activin B, FS, IL-6 and IL-10 were measured at admission to ICU and on days 2 and 7.

Results
Blood samples from 29 patients were analysed. At the time of admission to intensive care unit, elevated serum levels above the normal range for respective age group and sex were observed in 44% for activin A, 57% for activin B, and 39% for FS. In 13 of the 29 patients, serial samples at all time points were available and in these the highest activin A, activin B and FS were above the normal range in 85%, 100% and 46% of the patients, respectively. No difference in baseline or highest activin A or activin B was found in patients with or without acute lung injury (ALI) or ARDS (P > 0.05 for all). Peak levels of IL-6 were significantly elevated in ALI/ARDS patients. Peak activin A and activin A/FS were associated with ventilatory support free-days, severity of acute illness and length of ICU stay (P < 0.05 for all).

Conclusions
Higher than normal values of these proteins were common in patients with H1N1 infection but we found no association with the severity of their respiratory failure.
Evaluation of the normal-to-diseased apparent diffusion coefficient ratio as an indicator of prostate cancer aggressiveness
Authors: Lebovici Andrei , Sfrangeu Silviu A , Feier Diana , Caraiani Cosmin , Lucan Ciprian , Suciu Mihai , Elec Florin , Iacob Gheorghita , Buruian Mircea 
Published: May 2014

Abstract

Background
We tested the feasibility of a simple method for assessment of prostate cancer (PCa) aggressiveness using diffusion-weighted magnetic resonance imaging (MRI) to calculate apparent diffusion coefficient (ADC) ratios between prostate cancer and healthy prostatic tissue.

Methods
The requirement for institutional review board approval was waived. A set of 20 standardized core transperineal saturation biopsy specimens served as the reference standard for placement of regions of interest on ADC maps in tumorous and normal prostatic tissue of 22 men with PCa (median Gleason score: 7; range, 6–9). A total of 128 positive sectors were included for evaluation. Two diagnostic ratios were computed between tumor ADCs and normal sector ADCs: the ADC peripheral ratio (the ratio between tumor ADC and normal peripheral zone tissue, ADC-PR), and the ADC central ratio (the ratio between tumor ADC and normal central zone tissue, ADC-CR). The performance of the two ratios in detecting high-risk tumor foci (Gleason 8 and 9) was assessed using the area under the receiver operating characteristic curve (AUC).

Results
Both ADC ratios presented significantly lower values in high-risk tumors (0.48 ± 0.13 for ADC-CR and 0.40 ± 0.09 for ADC-PR) compared with low-risk tumors (0.66 ± 0.17 for ADC-CR and 0.54 ± 0.09 for ADC-PR) (p < 0.001) and had better diagnostic performance (ADC-CR AUC = 0.77, sensitivity = 82.2%, specificity = 66.7% and ADC-PR AUC = 0.90, sensitivity = 93.7%, specificity = 80%) than stand-alone tumor ADCs (AUC of 0.75, sensitivity = 72.7%, specificity = 70.6%) for identifying high-risk lesions.

Conclusions
The ADC ratio as an intrapatient-normalized diagnostic tool may be better in detecting high-grade lesions compared with analysis based on tumor ADCs alone, and may reduce the rate of biopsies.
Hydrocortisone concentration influences time to clinically significant healing of acute inflammation of the ocular surface and adnexa – results from a double-blind randomized controlled trial
Authors: Sergiyenko Nikolay , Sukhina Ludmila , Bezdetko Pavel , Kovalenko Yuriy , Nikitin Nikolai , Merzbacher Matthias , Groß Dorothea , Kohnen Ralf 
Published: May 2014

Abstract

Background
The efficacy of topical ophthalmic corticosteroids depends upon small modifications in preparations, such as drug concentration.
The aim of this study was to confirm that hydrocortisone acetate (HC-ac) ophthalmic ointments of 2.5% and 1% are more effective than a 0.5% eye ointment.

Methods
In this randomized, double-blind, placebo-controlled, parallel-group clinical study, the change of signs and symptoms of acute inflammation of the ocular surface and adnexa was evaluated in 411 subjects.

Results
Median time to clinically relevant response as estimated by 50% reduction in clinical signs and symptoms (CSS) total score over the entire trial was similar for subjects treated with HC-ac 2.5% (73.5 h) and for subjects treated with HC-ac 1.0% (67.7 h) and was considerably and significantly longer for subjects treated with HC-ac 0.5% (111.8 h) [p < 0.001 for both dosages]. All trial medications were safe and well tolerated.

Conclusion
Hydrocortisone acetate 2.5% and Hydrocortisone acetate 1% eye ointments are efficacious and safe treatments for acute inflammations of the ocular surface or adnexa, and showed significantly better efficacy than a control group treated with Hydrocortisone acetate 0.5% therapy.

Trial registration
Current Controlled Trials ISRCTN15464650.
A stakeholder analysis of the perceived outcomes of developing and implementing England’s obesity strategy 2008–2011
Authors: Hawkes Corinna , Ahern Amy L , Jebb Susan A 
Published: May 2014

Abstract

Background
International recommendations urge governments to implement population-based strategies to reduce the burden of obesity. This study assesses the development and implementation of the obesity strategy in England 2008–2011, Healthy Weight, Healthy Lives (HWHL). The aim was to identify if stakeholders perceived HWHL to have made any difference to the action to address obesity in England, with the ultimate objective of identifying insights that could inform the development and implementation of future obesity strategies in England and elsewhere.

Methods
Qualitative study using semi-structured interviews and thematic framework analysis. 40 stakeholders involved in the development and implementation of the obesity strategy were interviewed.

Results
Evidence from this study suggests that HWHL was perceived to have made a positive difference to efforts to address obesity in England. It was credited with creating political buy-in, engaging more stakeholders, stimulating and facilitating action, enhancing knowledge and changing attitudes. But it was reported to have failed to fully catalyse action across all government departments and sectors, or to develop adequate mechanisms for learning about the effectiveness of the different elements and actions in the Strategy. Key elements of the Strategy contributing towards to the perceived positive differences included its multi-faceted, inclusive nature; governance structures; monitoring programme to assess progress against national and local targets; child-focus; and funding. The development of the Strategy was said to be stimulated and aided by the prior synthesis of a critical mass of scientific evidence.

Conclusions
The English experience of HWHL lends support to the recommendations to develop population-based obesity strategies. It indicates that in order to stimulate comprehensive, inter-sectoral action, obesity strategies need to take a population-based, multi-faceted approach, be implemented through a clear governance structure, follow a systematic process of aligning goals, objectives and agendas between government departments and sectors with a stake in obesity, and have a clear system of reporting changes in obesity rates against a target. In order to design effective policies and to build the case for continued investment, obesity strategies also need to incorporate a national framework for learning and evaluation from the outset.
Effects of long-term low-level radiation exposure after the Chernobyl catastrophe on immunoglobulins in children residing in contaminated areas: prospective and cross-sectional studies
Authors: McMahon Daria M , Vdovenko Vitaliy Y , Karmaus Wilfried , Kondrashova Valentina , Svendsen Erik , Litvinetz Oksana M , Stepanova Yevgenia I 
Published: May 2014

AbstractBackgroundAfter the Chernobyl nuclear incident in 1986, children in the Narodichesky region, located 80 km west of the Chernobyl Power Plant, were exposed to137Cesium (137Cs). Little is known about the effects of chronic low-level radiation on humoral immune responses in children residing in contaminated areas.MethodsIn four different approaches we investigated the effect of residential137Cs exposure on immunoglobulins A, G, M, and specific immunoglobulin E in children. In a dynamic cohort (1993–1998) we included 617 children providing 2,407 repeated measurements; 421 and 523 children in two cross-sectional samples (1997–1998 and 2008–2010, respectively); and 25 participants in a small longitudinal cohort (1997–2010). All medical exams, blood collections, and analyses were conducted by the same team. We used mixed linear models to analyze repeated measurements in cohorts and general linear regression models for cross-sectional studies.ResultsResidential soil contamination in 2008 was highly correlated with the individual body burden of137Cs. Serum IgG and IgM concentrations increased between 1993 and 1998. Children with higher137Cs soil exposure had lower serum IgG levels, which, however, increased in the small cohort assessed between 1997 and 2010. Children within the fourth quintile of137Cs soil exposure (266–310 kBq/m2) had higher IgM serum concentrations between 1993 and 1998 but these declined between 1997 and 2010. IgA remained stable with median137Cs exposures related to higher IgA levels, which was corroborated in the cross-sectional study of 2008–2010. Specific IgE against indoor allergens was detected less often in children with higher137Cs exposure.ConclusionsOur findings show radiation-related alterations of immunoglobulins which by themselves do not constitute adverse health effects. Further investigations are necessary to understand how these changes affect health status.
Pedestrian dead reckoning for MARG navigation using a smartphone
Authors: Tian Zengshan , Zhang Yuan , Zhou Mu , Liu Yu 
Published: May 2014

Abstract
The demand for navigating pedestrian by using a hand-held mobile device increased remarkably over the past few years, especially in GPS-denied scenario. We propose a new pedestrian dead reckoning (PDR)-based navigation algorithm by using magnetic, angular rate, and gravity (MARG) sensors which are equipped in existing commercial smartphone. Our proposed navigation algorithm consists of step detection, stride length estimation, and heading estimation. To eliminate the gauge step errors of the random bouncing motions, we designed a reliable algorithm for step detection. We developed a BP neural network-based stride length estimation algorithm to apply to different users. In response to the challenge of magnetic disturbance, a quaternion-based extended Kalman filter (EKF) is introduced to determine the user's heading direction for each step. The performance of our proposed pedestrian navigation algorithm is verified by using a smartphone in providing accurate, reliable, and continuous location tracking services.
Detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial
Authors: Blankman Paul , Hasan Djo , Erik Groot Jebbink , Gommers Diederik 
Published: May 2014

Abstract
Introduction
This study compares different parameters derived from electrical impedance tomography (EIT) data to define ‘best’ positive end-expiratory pressure (PEEP) during a decremental PEEP trial in mechanically-ventilated patients. ‘Best’ PEEP is regarded as minimal lung collapse and overdistention in order to prevent ventilator-induced lung injury.

Methods
A decremental PEEP trial (from 15 to 0 cm H2O PEEP in 4 steps) was performed in 12 post-cardiac surgery patients on the ICU. At each PEEP step, EIT measurements were performed and from this data the following were calculated: tidal impedance variation (TIV), regional compliance, ventilation surface area (VSA), center of ventilation (COV), regional ventilation delay (RVD index), global inhomogeneity (GI index), and intratidal gas distribution. From the latter parameter we developed the ITV index as a new homogeneity parameter. The EIT parameters were compared with dynamic compliance and the PaO2/FiO2 ratio.

Results
Dynamic compliance and the PaO2/FiO2 ratio had the highest value at 10 and 15 cm H2O PEEP, respectively. TIV, regional compliance and VSA had a maximum value at 5 cm H2O PEEP for the non-dependent lung region and a maximal value at 15 cm H2O PEEP for the dependent lung region. GI index showed the lowest value at 10 cm H2O PEEP, whereas for COV and the RVD index this was at 15 cm H2O PEEP. The intratidal gas distribution showed an equal contribution of both lung regions at a specific PEEP level in each patient.

Conclusion
In post-cardiac surgery patients, the ITV index was comparable with dynamic compliance to indicate ‘best’ PEEP. The ITV index can visualize the PEEP level at which ventilation of the non-dependent region is diminished, indicating overdistention. Additional studies should test whether application of this specific PEEP level leads to better outcome and also confirm these results in patients with acute respiratory distress syndrome.
Pupil dilation prediction of random events
Authors: Tressoldi Patrizio E , Martinelli Massimiliano , Semenzato Luca 
Published: May 2014

We report the results of a conceptual replication of a study that reported that pupil dilation can predict potentially threatening random events above chance level. In this study, participants’ pupil dilation was used to predict the appearance of a threatening or a neutral stimulus, presented randomly in a double sequence of ten trials with replacement, i.e. replacing the chosen trial for the future extractions.In the first experiment, with a sample of 100 participants, the average correct prediction was 55.9%, with a small difference between the two stimuli.This effect was further tested in an exact pre-registered study where the average correct prediction was 58.7%. The reliability of these findings was checked utilizing both a frequentist and a Bayesian statistical parameters estimate approach.These findings collectively support the hypothesis that pupil dilation can be used to anticipate random and therefore theoretically “unpredictable” events in an implicit unconscious way that is without a conscious awareness, and that this ability is another characteristic of the powerful anticipatory adaptive systems of our psychophysiological system.
The coverage of the Catalan conflict and nationalism in the Danish newspaper Politiken
Authors: Høeberg Helle Kettner 
Published: May 2014

Abstract
The aim of this article is to analyse the coverage of Catalan issues such as nationalism and secessionism and of the relationship and conflict between Catalonia and Spain in the Danish daily newspaper Politiken. The article focuses on what is published about Catalan identity, Catalan nationalism and its conflict with Spain, how it is published and, finally, why it is published in a Danish quality newspaper over a time period of five years (January 2008–December 2012). The analysis of the newspaper articles is complemented with in-depth interviews with four journalists at Politiken. The main conclusion of this research is that the contents relating to Catalan issues are dealt with in in-depth articles and reports providing context to their readers from a point of view neither predominantly Spanish nor Catalan.