bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of antiretroviral therapy adherence interventions: a realist synthesis of evidence
Authors: Leeman Jennifer , Chang Yun Kyung , Lee Eun Jeong , Voils Corrine I. , Crandell Jamie , Sandelowski Margarete 
Published: October 2015

leeman j., chang y.k., lee e.j., voils c.i., crandell j. & sandelowski m. (2010)
Implementation of antiretroviral therapy adherence interventions: a realist synthesis of evidence. Journal of Advanced Nursing 66(9), 1915–1930.AbstractAim.  This paper is a report of a synthesis of evidence on implementation of interventions to improve adherence to antiretroviral therapy.Background.  Evidence on efficacy must be supplemented with evidence on how interventions were implemented in practice and on how that implementation varied across populations and settings.Data sources.  Sixty‐one reports were reviewed of studies conducted in the United States of America in the period 2001 to December 2008. Fifty‐two reports were included in the final analysis: 37 reporting the effects of interventions and 15 reporting intervention feasibility, acceptability, or fidelity.Review methods.  An adaptation of Pawson’s realist synthesis method was used, whereby a provisional explanatory model and associated list of propositions are developed from an initial review of literature. This model is successively refined to the point at which it best explains empirical findings from the reports reviewed.Results.  The final explanatory model suggests that individuals with HIV will be more likely to enrol in interventions that protect their confidentiality, to attend when scheduling is responsive to their needs, and both to attend and continue with an intervention when they develop a strong, one‐to‐one relationship with the intervener. Participants who have limited prior experience with antiretroviral therapy will be more likely to continue with an intervention than those who are more experienced. Dropout rates are likely to be higher when interventions are integrated into existing delivery systems than when offered as stand‐alone interventions.Conclusion.  The explanatory model developed in this study is intended to provide guidance to clinicians and researchers on the points in the implementation chain that require strengthening.
W(h)ither complexity? The emperor's new toolkit? Or elucidating the evolution of health systems knowledge?
Authors: Martin Carmel M. , Félix‐Bortolotti Margot 
Published: October 2015

AbstractRationale The outputs from vastly expanding health research and knowledge industry with a broadening range of approaches to the synthesis of knowledge provide an impetus to develop complex science and theory‐informed knowledge management in health care.Aims To stimulate debate in order to assist health care decision makers to move beyond framing certainty and evidence in purely reductionist terms.Objectives To locate health, health care and health knowledge systems research using a complex adaptive systems theory framework.Methods An conceptual analysis of pervading methodologies and ways of knowing in health systems research to elucidate a framework in order to inform health care decision making.Findings A living Tree of (Research) Knowledge is proposed, with theoretic and operational frameworks. Branches of the tree are linked to differing evolutionary and developmental processes in order to assist researchers in the ongoing self‐organizing of taxonomies, multiple methods and types of knowledge, recognizing the ‘lived’, developing and adaptive nature of our understandings.Conclusions It is challenging to determine whither the directions ‘knowledge’ creation and management should take in complex health systems, beyond a total reliance on reductionism. Yet quality will wither, if knowledge does not pertain to real world contexts.
Power law relationships between health care utilization and symptom assessment among people with panic attacks
Authors: Katerndahl David 
Published: October 2015

AbstractRationale  Although people with panic attacks are high utilizers of health care, the role of symptom assessment in care‐seeking is unclear. Previous studies suggest that symptom perceptions are linearly related to utilization but panic appraisal is not. The purpose of this study was to determine whether the relationships between symptom assessment and utilization are non‐linear, displaying power law distributions.Methods  This community‐based study of 97 subjects with panic attacks assessed utilization of family doctor offices, total ambulatory utilization, and hospitalizations as well as symptom perceptions and panic appraisals. Matrices of symptom assessment versus utilization were created, and log–log plots were constructed. To minimize the risk of overestimation of power law distributions, linear, quadratic and cubic regression models were computed.Results  None of the utilization versus symptom perceptions displayed power law distributions. However, all three measures of utilization showed power law relationships with panic appraisals, but in unique patterns.Conclusions  Although power law relationships were not found between symptom perceptions and utilization, unique patterns of power laws were identified between panic appraisals and all three measures of utilization.
Medical education accreditation in Mexico and the Philippines: impact on student outcomes
Authors: van Zanten Marta , McKinley Danette , Durante Montiel Irene , Pijano Concepcion V 
Published: October 2015

Medical Education 2012: 46:586–592Context  Accreditation of medical education programmes is becoming increasingly prevalent worldwide, but beyond the face validity of these quality assurance methods, data linking accreditation to improved student outcomes are limited. Mexico and the Philippines both have voluntary systems of medical education accreditation and large numbers of students who voluntarily take components of the United States Medical Licensing Examination (USMLE). We investigated the examination performance of Mexican and Philippine citizens who attended medical schools in their home countries by medical school accreditation status.Methods  The sample included 5045 individuals (1238 from Mexico, 3807 from the Philippines) who took at least one of the three USMLE components required for Educational Commission for Foreign Medical Graduates (ECFMG) certification. We also separately studied 2702 individuals who took all three examinations (589 from Mexico, 2113 from the Philippines). The chi‐squared statistic was used to determine whether the associations between outcomes (first attempt pass rate on USMLE components and rate of ECFMG certification) and medical school accreditation (yes/no) were statistically significant.Results  For the sample of registrants who took at least one USMLE component, first attempt pass rates on all USMLE components were higher for individuals attending accredited schools, although there were differences in pass rates among the components and between the two countries. The distinction was greatest for USMLE Step 1, for which attending an accredited school was associated with increases in first attempt pass rates of 15.9% for Mexican citizens and 29.2% for Philippine citizens. In registrants from the Philippines who took all three examinations, attending an accredited medical school was also associated with increased success in obtaining ECFMG certification.Conclusions  These findings support the value and usefulness of accreditation in Mexico and the Philippines by linking accreditation to improved student outcomes.
The process of feedback in workplace‐based assessment: organisation, delivery, continuity
Authors: Pelgrim Elisabeth A M , Kramer Anneke W M , Mokkink Henk G A , van der Vleuten Cees P M 
Published: October 2015

Medical Education 2012: 46:604–612Objectives  Feedback in workplace‐based clinical settings often relies on expert trainers’ judgements of directly observed trainee performance. There is ample literature on effective feedback, but in practice trainees in workplace‐based training are not regularly observed. We aimed to examine external conditions that impact feedback in observational workplace‐based assessment (WBA).Methods  Interviews were conducted and the resulting data analysed using a qualitative, phenomenological approach. Between October 2009 and January 2010, we interviewed 22 postgraduate general practice trainees at two institutions in the Netherlands. Three researchers analysed the transcripts of the interviews.Results  A three‐step scheme emerged from the data. Feedback as part of WBA is of greater benefit to trainees if: (i) observation and feedback are planned by the trainee and trainer; (ii) the content and delivery of the feedback are adequate, and (iii) the trainee uses the feedback to guide his or her learning by linking it to learning goals. Negative emotions reported by almost all trainees in relation to observation and feedback led to different responses. Some trainees avoided observation, whereas others overcame their apprehension and actively sought observation and feedback. Active trainers were able to help trainees overcome their fears. Four types of trainer–trainee pairs were distinguished according to their engagement in observation and feedback. External requirements set by training institutions may stimulate inactive trainers and trainees.Conclusions  In line with the literature, our results emphasise the importance of the content of feedback and the way it is provided, as well as the importance of its incorporation in trainees’ learning. Moreover, we highlight the step before the actual feedback itself. The way arrangements for feedback are made appears to be important to feedback in formative WBA. Finally, we outline several factors that influence the success or failure of feedback but precede the process of observation and feedback.
Skin diseases in the Peruvian Amazonia
Authors: Gutierrez Ericson L. , Galarza Carlos , Ramos Willy , Tello Mercedes , Jiménez Gerardo , Ronceros Gerardo , Chía Humberto , Hurtado Jorge , Ortega‐Loayza Alex G. 
Published: October 2015

AbstractBackground  Dermatologic diseases vary widely as a result of geographic location and may be influenced by environmental factors.Aim  To determine the epidemiology of dermatological diseases in the Peruvian Amazonia.Methods  Transversal and multicentric study, which were carried out during February of 2006, 2007, and 2008 in three regional hospitals in the Peruvian Amazonia. All new patients who were looking for dermatological consultation were included. Univariate/bivariate analysis, chi square, and multinomial logistic regression were used with a confidence level of 95%.Results  A total of 1602 patients were included. The infectious and parasitic dermatoses were the most prevalent (31.5%). There was a statiscally significant association between infections of the skin and subcutaneous tissue in children (P < 0.001). The parasitic dermatoses such as scabiosis, pediculosis, and myiasis were associated with an altitude less than 700 meters above sea level (m.a.s.l.) (P = 0.003, OR = 3.1, CI: 1.5–6.7). On the other hand, radiation‐related disorders of the skin and subcutaneous tissue were associated with more than 700 m.a.s.l. (P < 0.01, OR = 2.9, CI: 1.7–4.9).Conclusions  Infectious dermatological diseases were the most common diagnoses in the Peruvian Amazonia. In addition, radiation‐related disorders of the skin should be addressed for people living/traveling in the rainforest area. These findings may assist in the training of general doctors in diagnosis and treatment of the most common dermatoses in tropical areas. Moreover, this study would be helpful for physicians from developed countries when giving medical advice/attention to travelers or immigrants of tropical areas.
Proteasome inhibitor therapy for antibody‐mediated rejection
Authors: Woodle E. S. , Walsh R. C. , Alloway R. R. , Girnita A. , Brailey P. 
Published: October 2015

Woodle ES, Walsh RC, Alloway RR, Girnita A, Brailey P. Proteasome inhibitor therapy for antibody‐mediated rejection. Pediatr Transplantation 2011: 15: 548–556. © 2011 John Wiley & Sons A/S.Abstract:  AMR is being recognized with increasing efficiency, but continues to present a significant threat to renal allograft survival. Traditional therapies for AMR (IVIG, plasmapheresis, rituximab, and antilymphocyte preparations) in general have provided inconsistent results and do not deplete the source of antibody production, viz., the mature plasma cell. Recently, the first plasma cell–targeted therapy in humans has been developed using bortezomib (a first in class PI) for AMR treatment in kidney transplant recipients. Initial experience with bortezomib involved treatment of refractory AMR. Subsequently, the efficacy of bortezomib in primary therapy for AMR was demonstrated. In a multicenter collaborative effort, the initial results with bortezomib in AMR have been confirmed and expanded to pediatric and adult heart transplant recipients. More recently, results from a prospective, staged desensitization trial has shown that bortezomib alone can substantially reduce anti‐HLA antibody levels. These results demonstrate the significant potential of proteasome inhibition in addressing humoral barriers. However, the major advantage of proteasome inhibition lies in the numerous potential strategies for achieving synergy.
Volume kinetics of acetated Ringer's solution during experimental spinal anaesthesia
Authors: HAHN R. G. , LINDAHL C. C. , DROBIN D. 
Published: October 2015

BackgroundGeneral anaesthesia lowers the clearance of crystalloid fluid, but the volume kinetics of such fluid throughout the duration of spinal anaesthesia has not been studied.MethodsTen female volunteers (mean age 29 years) received an intravenous infusion of 25 ml/kg of acetated Ringer's solution with and without spinal anaesthesia. A volume kinetic model was fitted to serial measurements of the haemoglobin concentration over 240 min based on arterial, cubital vein, and femoral vein blood. The measured urine flow was compared to the model‐predicted elimination.ResultsThe arterial pressure remained stable, although the block reached to Th3‐Th5 in half of the volunteers. There were no differences in fluid kinetics between the spinal anaesthesia and the control experiments. The administered volume was well confined to the kinetic system, which consisted of two communicating fluid spaces that were 2.8 l and approximately 7 l in size at baseline. The arteriovenous difference in plasma dilution remained positive for 30 min post‐infusion in those having analgesia reaching to Th3‐Th5, which differed significantly from low‐level analgesia (Th12‐L2, P < 0.03) when venous plasma was sampled from the leg. The urinary excretion averaged 1.13 l and 1.01 l for the spinal and control experiments, respectively. Volume kinetics predicted the urinary excretion at 5‐ to 10‐min intervals with an overall bias of 52 ml.ConclusionAcetated Ringer's solution showed the same kinetics during experimental spinal anaesthesia as when the fluid was infused alone. Hence, spinal anaesthesia is not associated with the reduced fluid clearance reported for general anaesthesia.
Enzymatic interactions between Gremmeniella abietina var. abietina, European race, and two resistant hosts, Pinus banksiana and P. contorta
Authors: Simard M. , Laflamme G. , Rioux D. 
Published: October 2015

SummaryUltrastructural observations showed that the European race of Gremmeniella abietina var. abietina can secrete several cell wall–degrading enzymes that help the invasion of Pinus banksiana and P. contorta shoot tip tissues. Alterations in the content or distribution of cellulose were obvious, indicating that colonization might be achieved primarily through the action of glucanases. Polygalacturonases seemed more abundant in the cortex and the phloem of the stem, suggesting they are among the first enzymes secreted by the pathogen during infection. Production of laccases and peroxidases was also revealed but always close to fungal cells or in areas where host wall degradation was obvious. In places where there was an accumulation of phenolic compounds in the infected zones of the shoot, particularly in or near the transition zone, immunolocalization of both enzymes was limited or absent. Laccases and polygalacturonases were regularly detected over the extracellular sheath of G. abietina, and this indicates that the sheath could play a significant role during host wall degradation. Finally, examination of G. abietina wall constituents, such as chitin and β‐1,3‐glucans, suggests that the composition of the pathogen wall changes during the infection process. This change may be associated with the secretion of fungal enzymes but could also be linked to host reactions altering the integrity of pathogen cell walls.
Palliative care for patients with chronic obstructive pulmonary disease: exploring the landscape
Authors: Philip J. , Lowe A. , Gold M. , Brand C. , Miller B. , Douglass J. , Sundararajan V. 
Published: October 2015

AbstractPatients with chronic obstructive pulmonary disease experience a substantial symptom burden, high levels of psychosocial need and significant mortality. This epidemiological study reveals that the majority of patients are cared for in the public hospital system (64%) and generally die in hospital (72%) with a number of identifiable predictors of 6‐month mortality. Our results suggest that palliative care services need to be redirected from a community‐based admission focus to a model that is responsive to emergency and acute care hospital systems.
Referral to specialist palliative care
Authors: Broom A. , Kirby E. , Good P. 
Published: October 2015

AbstractRecent literature has suggested that earlier referral to palliative care can improve quality of life and prognosis. The decision to refer to palliative care is a complex process that can involve an interplay of interpersonal, subjective and institutional factors. Negotiating this referral process can be challenging to a medical specialist from a professional and personal viewpoint. What remains unknown is what actually influences the individual clinician to refer a patient to palliative care.
A Web of Learning Opportunities
Authors: ANDERSEN BRITT , REE GUNNAR , SANDAKER INGUNN 
Published: October 2015

For at least two decades, politicians, academics and other stakeholders have advocated cooperation across sectors, administrative layers and other institutionalised boundaries to achieve objectives of what are called ‘learning regions’ and the ‘lifelong learning perspective’. Boundaries between geographical, institutional and sectors are becoming more porous. Regions and cities may be seen as complex adaptive systems (CAS), and hence do not necessarily follow the logic of formal institutions. While formal institutions have innate interests in regulating interaction and communication between their members, networks develop according to evolutionary or selectionist dynamics, in that the processes of change can be seen as analogous to natural (Darwinian) selection.Networks may be seen as the architecture of complex systems. Research on networks has been relatively extensive in the last 20 to 30 years in mathematics, sociology, anthropology, and biology. There is an emerging science of networks that studies the structure and function of systems. There is also substantial research on the features in the interconnectedness or interdependencies within the system that contribute to explaining the functionality of that system. In this perspective, we may view a learning region as a web of learning opportunities.
Quality and Quality Assurance in Vocational Education and Training in the Mediterranean Countries: lessons from the European approach
Authors: MASSON JEAN‐RAYMOND , BAATI MOUNIR , SEYFRIED ERWIN 
Published: October 2015

This article reflects on the development of the European approach towards quality and quality assurance in vocational education and training (VET) and its relevance for VET reforms in the European Training Foundation (ETF) partner countries. The analysis is based on an ETF project conducted in 2007‐2008 in the Mediterranean partner countries to promote exchanges of information and experience between the decision makers and experts of the countries concerned and within the EU. More precisely, it aims to analyse how quality assurance (QA) initiatives could promote the quality of systems and support best practices already established in the EU and in the Mediterranean region in order to lay the foundations for specific actions at national and regional level.The authors of the article found out that: the tools developed by the EU to quality assure VET systems are relevant for the Mediterranean region. They can serve as a guideline for identifying strategic priorities. However, they do not provide a well‐delimited concept to be implemented in the short term. Moreover, these EU tools reflect a new model of governance based on decentralization of responsibilities, autonomy of providers and accountability that may be difficult to implement in Mediterranean countries where VET systems remain very centralised and compartimentalised.
Exchange Rate Policy and Sovereign Spreads in Emerging Market Economies
Authors: Gumus Inci 
Published: October 2015

AbstractThis paper empirically analyzes the relationship between exchange rate policy and sovereign risk premia in emerging market economies, considering both officially declared regimes and actual exchange rate behavior. The results show that countries that announce a fixed exchange rate regime face lower spreads than countries that announce a floating regime or intermediate flexibility. When the actual exchange rate behavior is considered, this relationship persists between intermediate flexibility and pegs but countries that allow their exchange rates to freely float do not face higher spreads. The difference between the results is due to the fact that many countries deviate from their declared exchange rate policy. The countries that announce a floating regime do not face higher spreads than pegs when they actually allow a high degree of flexibility as they announced. However, intermediate flexibility leads to higher spreads independently of whether this is the announced policy or the actual behavior.
International Outsourcing and Unemployment in a Minimum‐wage Economy
Authors: Zhang Ting 
Published: October 2015

AbstractTo explore the impact of international outsourcing on unemployment and social welfare, the conventional trade model is extended by including both economies of scale and a minimum‐wage constraint in the unskilled‐labor market. In the paper, the scale economies are linked with the production of the most skill‐intensive good. It is shown that within such a framework, there is a trade‐off between a more socially desirable endowment allocation and a greater level of employment. Therefore, even though outsourcing could raise aggregate employment, this benefit is at the cost of further exacerbating the resource misallocation. In this way, the extensions to the traditional framework explored in the paper generate new insights as to why outsourcing may cause a net welfare loss to the home country.
Are Lone Mothers Responsive to Policy Changes? Evidence from a Workfare Reform in a Generous Welfare State*
Authors: Mogstad Magne , Pronzato Chiara 
Published: October 2015

AbstractThere is a heated debate in many developed countries about how to design a welfare system that moves lone mothers off welfare and into work. We analyze the consequences of a major Norwegian workfare reform of the generous welfare system for lone mothers. The reform imposed work requirements and time limits on welfare receipt, while raising in‐work benefits. Our difference‐in‐differences estimates show that the reform was successful in improving labor‐market participation and in increasing the earnings of lone mothers. However, the reform was associated with income loss and increased poverty among a sizeable subgroup of lone mothers, who were unable to offset the loss of out‐of‐work benefits with gains in earnings.