bluuebunny/crossref_metadata_2025_split huggingface dataset:
Care management in the twenty‐first century
Authors: Stewart Ailsa , MacIntyre Gillian 
Published: April 2013

PurposeThe purpose of this paper is to examine the persistent challenges in implementing care management within the context of integration. In addition the appropriateness of the care management model will be considered within the current, personalization focused, health and social care policy landscape. The paper draws upon a recent evaluation of a care management and assessment pilot project within a health and social care partnership in Scotland.Design/methodology/approachA multi‐method approach was adopted, including interviews, vignettes and focus groups, in order to capture data around expectations in relation to the pilot as well as exploring processes and outcomes for those involved.FindingsThis paper argues that whilst progress has been made with regard to care management, specific and persistent challenges remain. Professional and organizational boundaries, communication and information sharing remain key challenges. Policy imperatives have shifted the emphasis in community care services towards self‐care, co‐production and personalization contributing to a lack of clarity over the place of care management within the broader integration agenda.Research limitations/implicationsThis research was undertaken in one partnership locality in Scotland and as such the findings are related to that particular area. However, the key messages arising from this paper resonate with the broader academic literature on care management and as such are likely to be of interest to a broader audience.Originality/valueThis paper brings together integrated working, care management and the developing policy framework of self‐care to consider the challenges for care management in this context.
Rotational vegetation burning effects on peatland stream ecosystems
Authors: Ramchunder Sorain J. , Brown Lee E. , Holden Joseph 
Published: April 2013

Summary

Rotational vegetation burning in peatlands is undertaken predominantly to increase habitat suitability and food availability for red grouse Lagopus lagopus (Linnaeus). Red grouse shooting contributes to the upland economy and is seen as a traditional leisure activity. However, there is concern that burning can have detrimental effects on peatland terrestrial and freshwater ecosystems.

This study examined spatial and seasonal dynamics of stream physicochemistry and benthic macroinvertebrates from peatland sites that are managed via rotational vegetation burning and compared these with intact sites with no recent history of burning.

Streams draining burned catchments were characterized by higher fine benthic particulate organic matter (FPOM), suspended sediment concentration (SSC), aluminium, iron and dissolved organic carbon than unburnt intact catchments. Anion concentrations were higher in intact catchments.

There were significant differences in benthic macroinvertebrate richness, diversity and dominance, and community composition and functional feeding groups between burned and intact catchments, suggesting that land management had an effect on aquatic ecosystems.

Higher SSC and FPOM in burned catchments were associated with lower abundance of some mayflies, stoneflies and caddis‐flies and elevated abundance of some Diptera (Chironomidae and Simuliidae) larvae.

Synthesis and applications. This study suggests that some aspects of peatland stream ecosystems are altered in catchments with rotational vegetation burning. Currently, there is much emphasis on the effects of rotational burning on peat carbon stores, but this study is the first to document the impacts on stream biota. Agencies with a remit covering upland freshwater ecosystem management might need to consider ways of reducing the extent of rotational vegetation burning to prevent effects on lotic ecosystems, and monitor whether macroinvertebrate assemblages subsequently shift back to a status similar to those in intact peatland streams. Fire occurs commonly on peatlands throughout the world, and our results suggest that trade‐offs are needed to satisfy both economic and ecological facets of the combined social–ecological systems in such areas, especially where fire is implemented as a management tool.
How many signal peptides are there in bacteria?
Authors: Ivankov Dmitry N. , Payne Samuel H. , Galperin Michael Y. , Bonissone Stefano , Pevzner Pavel A. , Frishman Dmitrij 
Published: April 2013

SummaryOver the last 5 years proteogenomics (using mass spectroscopy to identify proteins predicted from genomic sequences) has emerged as a promising approach to the high‐throughput identification of protein N‐termini, which remains a problem in genome annotation. Comparison of the experimentally determined N‐termini with those predicted by sequence analysis tools allows identification of the signal peptides and therefore conclusions on the cytoplasmic or extracytoplasmic (periplasmic or extracellular) localization of the respective proteins. We present here the results of a proteogenomic study of the signal peptides in Escherichia coli K‐12 and compare its results with the available experimental data and predictions by such software tools as SignalP and Phobius. A single proteogenomics experiment recovered more than a third of all signal peptides that had been experimentally determined during the past three decades and confirmed at least 31 additional signal peptides, mostly in the known exported proteins, which had been previously predicted but not validated. The filtering of putative signal peptides for the peptide length and the presence of an eight‐residue hydrophobic patch and a typical signal peptidase cleavage site proved sufficient to eliminate the false‐positive hits. Surprisingly, the results of this proteogenomics study, as well as a re‐analysis of the E. coli genome with the latest version of SignalP program, show that the fraction of proteins containing signal peptides is only about 10%, or half of previous estimates.
The Effect of Parity on Expenditures for Individuals with Severe Mental Illness
Authors: McConnell K. John 
Published: April 2013

ObjectiveTo determine whether comprehensive behavioral health parity leads to changes in expenditures for individuals with severe mental illness (SMI), who are likely to be in greatest need for services that could be outside of health plans' traditional limitations on behavioral health care.Data Sources/Study SettingWe studied the effects of a comprehensive parity law enacted by Oregon in 2007. Using claims data, we compared expenditures for individuals in four Oregon commercial plans from 2005 through 2008 to a group of commercially insured individuals in Oregon who were exempt from parity.Study DesignWe used difference‐in‐differences and difference‐in‐difference‐in‐differences analyses to estimate changes in spending, and quantile regression methods to assess changes in the distribution of expenditures associated with parity.Principal FindingsAmong 2,195 individuals with SMI, parity was associated with increased expenditures for behavioral health services of $333 (95 percent CI $67, $615), without corresponding increases in out‐of‐pocket spending. The increase in expenditures was primarily attributable to shifts in the right tail of the distribution.ConclusionsOregon's parity law led to higher average expenditures for individuals with SMI. Parity may allow individuals with high mental health needs to receive services that may have been limited without parity regulations.
Telephone Care Management's Effectiveness in Coordinating Care for Medicaid Beneficiaries in Managed Care: A Randomized Controlled Study
Authors: Kim Sue E. , Michalopoulos Charles , Kwong Richard M. , Warren Anne , Manno Michelle S. 
Published: April 2013

ObjectiveTo test the effectiveness of a telephone care management intervention to increase the use of primary and preventive care, reduce hospital admissions, and reduce emergency department visits for Medicaid beneficiaries with disabilities in a managed care setting.Data SourceFour years (2007–2011) of Medicaid claims data on blind and/or disabled beneficiaries, aged 20–64.Study DesignRandomized control trial with an intervention group (n = 3,540) that was enrolled in managed care with telephone care management and a control group (n = 1,524) who remained in fee‐for‐service system without care management services. Multi‐disciplinary care coordination teams provided telephone services to the intervention group to address patients' medical and social needs.Data Collection/ExtractionMedicaid claims and encounter data for all participants were obtained from the state and the managed care organization.Principal FindingsThere was no significant difference in use of primary care, specialist visits, hospital admissions, and emergency department between the intervention and the control group. Care managers experienced challenges in keeping members engaged in the intervention and maintaining contact by telephone.ConclusionsThe lack of success for Medicaid beneficiaries, along with other recent studies, suggests that more intensive and more targeted interventions may be more effective for the high‐needs population.
Enzymatic Properties of β‐1,3‐Glucanase from Streptomyces sp Mo.
Authors: Kurakake Masahiro , Yamanouchi Yuuki , Kinohara Kouta , Moriyama Shingo 
Published: April 2013

AbstractStreptomyces sp Mo endo‐β‐1,3‐glucanase was found to have hydrolyzing activity toward curdlan and released laminarioligosaccharides selectively. The molecular weight was estimated to be 36000 Da and its N‐terminal amino acid sequence was VTPPDISVTN. The optimal pH was 6 and the enzyme was found to be stable from pH 5 to 8. The optimal temperature was 60 °C and the activity was stable below 50 °C. The enzyme hydrolyzed selectively curdlan containing only β‐1,3 linkages. The enzyme had 89% relative activity toward Laminaria digitata laminarin, which contains a small amount of β‐1,6 linkages compared with curdlan, while Eisenia bicyclis laminarin with a higher amount of β‐1,6‐linkages, was not hydrolyzed. Mo enzyme adsorbed completely on curdlan powder. The enzymatic hydrolysis of curdlan powder resulted in the accumulation of laminaribiose (yield 81.7%). Trisaccharide was inevitably released from the hydrolysis of laminarioligosaccharides with 5 to 7 degrees of polymerization (DP). Although the enzyme cleaved off disaccharide (DP 2) from tetrasaccharide (DP 4), the reaction rate was lower than those of DP 5 to 7. The results indicated that the active site of Mo endo‐β‐1,3‐glucanase can efficiently recognize glucosyl residue chain of greater than DP 5 and hydrolyzes the β‐1,3 linkage between the 3rd and 4th glucosyl residue.
Impact of the spinal cord position uncertainty on the dose received during head and neck helical tomotherapy
Authors: Piotrowski Tomasz , Kaźmierska Joanna , Sokołowski Adam , Skórska Małgorzata , Jodda Agata , Ryczkowski Adam , Cholewiński Witold , Bąk Bartosz 
Published: April 2013

AbstractIntroductionThe study aims to establish the optimal planning risk volume (PRV) to the spinal cord (SC) for oropharyngeal cancer patients during adaptive radiation therapy with concurrent chemotherapy.MethodsGeometrical uncertainties of the SC were evaluated. Differences between planned and delivered maximum doses to each part of the SC were established for every fraction dose and for cumulative dose. Maximum doses were evaluated as a dose received in 0.5 and 1 cm3 of the analysed part of the SC defined as C1–C2, C3–C4, C5–C6 and C7–Th1 where Cn was a n‐th cervical vertebra (n = 1, … , 7) and Th1 was the first thoracic vertebra. Finally, relations between dose differences and geometrical uncertainties were analysed using a relative risk (RR) and the importance of the PRV dose gradient to establish an optimal PRV for the SC.ResultsProspective study based on the 875 observations from 25 oropharyngeal cancer patients was performed. The C1‐C2 part of the SC is most exposed to risk of overdosage during chemoradiation for patients with oropharyngeal cancer due to its proximity to the clinical target volume (CTV). Doses received by other parts of the SC are smaller, with the lowest dose delivered to C7–Th1. For the C1–C2, delivered dose was higher than planned dose by 11%, while for the C7–Th1, this difference was smaller than 7%. The lowest movement of individual parts of the SC were detected for the C1–C2 and the highest for the C7–Th1. The standard deviations of the mean shift ranged respectively from 0.9 to 1.4 mm and from 1.3 to 2.9 mm. For each part of the SC delivered dose was smaller than planned dose to the PRV (RR < 1).ConclusionOur study showed that for chemoradiation of oropharyngeal cancer, using daily image guidance and proper plan adaptation scheme, the current PRV margin for the SC could be reduced to 4 mm.
Assessment of intraoperative microaspiration: does a modified cuff shape improve sealing?
Authors: D'HAESE J. , DE KEUKELEIRE T. , REMORY I. , VAN ROMPAEY K. , UMBRAIN V. , POELAERT J. 
Published: April 2013

BackgroundIntra‐operative aspiration of oropharyngeal secretions is associated with post‐operative pneumonia. The use of endotracheal tubes (ETTs) with a modified cuff shape could be one preventive action. In this clinical, prospective, randomised controlled trial, we hypothesised that altering the cuff shape to a tapered shape could reduce the aspiration incidence. The primary outcome was aspiration of dye solution into the trachea.MethodsPatients scheduled for lumbar surgery were intubated with either an ETT with a barrel‐shaped polyvinylchloride cuff (control group, n = 30) or tapered‐shaped polyvinylchloride cuff (intervention group, n = 30). Subsequently, instillation with methylthioninium chloride was performed. At 10, 30, 60, 90, and 120 min after intubation, bronchoscopy was performed assessing the degree of dye descent along the cuff and digitally stored. Single blind review of the videoclips provided data on incidence of dye aspiration and depth of penetration along the cuff.ResultsThe traditional cuff showed descent of dye into the trachea in 20% of the patients. Although a tapered‐shaped polyvinylchloride cuff leaked up to the second third of the cuff, no dye leakage into the trachea was observed. The use of a tapered‐shaped cuff had a protective role against aspiration (T30: OR 3.0, CI 1.57‐5.75; P = 0.001).ConclusionsShort‐term use of tapered‐shaped polyvinylchloride cuffs in surgical patients results in more effective sealing of the tracheal lumen in comparison with a traditional barrel‐shaped polyvinylchloride cuffs. Further evaluation is needed to determine whether a reduction in post‐operative pneumonia can be demonstrated when these cuffs are used.
Refining the ‘pulse‐reserve’ model for arid central Australia: Seasonal rainfall, soil moisture and plant productivity in sand ridge and stony plain habitats of the Simpson Desert
Authors: Nano Catherine E. M. , Pavey Chris R. 
Published: April 2013

AbstractIn dry ecosystems, water supply is highly variable in time and space, occurring either as short pulses of shallow soil water or long phases of deep soil water. There may be correspondence between hierarchical soil water pulses and hierarchical biological responses, but this has not been directly tested for arid Australia. We compared plant community responses to an isolated short rain pulse (about 130 mm, November 2008) versus the start, mid and later stages of an extended high rainfall phase (about 540 mm, February 2010 to March 2011) at a site on the western edge of the Simpson Desert. We sampled across contrasting habitats: tall longitudinal sand ridges and adjacent stony clay plains (gibber). Thus, we compared responses to spatially variable soil moisture availability (sand vs. clay soil; run‐off/on relief) and temporally variable rainfall supply. Our results supported the hierarchical resource pulse‐biological response concept for dry ecosystems, with the short and long rainfall phases modulating distinct responses among functional types. Shallow‐rooted annual grasses showed an equivalent positive response to the isolated pulse as to the first pulse of the high rain phase; whereas short‐lived forbs, longer‐lived (2–3 years) grasses and persistent forbs had peak abundance during the high rainfall phase. Perennial grass and shrub productivity did not change over time, though there was a distinct trend towards heightened sexual reproduction at the mid‐late stages of the high rain phase. We also found that species seasonal growth tendencies were pronounced, and that spatial aspects of moisture availability resulted in different composition patterns at the habitat scale with the gibber and sand ridge sites showing strong and weak correspondence with temporal rainfall patterning respectively. Thus, we confirm that plant productivity models for this region should include the effects of rainfall connectivity and soil texture as well as species seasonal growth constraints and rooting attributes.
Restoration of retinal morphology and residual scarring after photocoagulation
Authors: Lavinsky Daniel , Cardillo Jose A. , Mandel Yossi , Huie Philip , Melo Luiz A. , Farah Michel E. , Belfort Rubens , Palanker Daniel 
Published: April 2013

Abstract.Purpose:  To study healing of retinal laser lesions in patients undergoing PRP using SD‐OCT.Methods:  Moderate, light and barely visible retinal burns were produced in patients with proliferative diabetic retinopathy scheduled for PRP using 100‐, 20‐ and 10‐ms pulses of 532‐nm laser, with retinal spot sizes of 100, 200 and 400 μm. Lesions were measured with OCT at 1 hr, 1 week, 1, 2, 4, 6, 9 and 12 months. OCT imaging was correlated with histology in a separate study in rabbits.Results:  Lesions produced by the standard 100‐ms exposures exhibited steady scarring, with the damage zone stabilized after 2 months. For 400‐ and 200‐μm spots and 100‐ms pulses, the residual scar area at 12 months was approximately 50% of the initial lesion size for moderate, light and barely visible burns. In contrast, lesions produced by shorter exposures demonstrated enhanced restoration of the photoreceptor layer, especially in smaller burns. With 20‐ms pulses, the damage zone decreased to 32%, 24% and 20% for moderate, light and barely visible burns of 400 μm, respectively, and down to 12% for barely visible burns of 200 μm. In the 100‐μm spots, the residual scar area of the moderate 100‐ms burns was 41% of the initial lesion, while barely visible 10‐ms burns contracted to 6% of the initial size. Histological observations in rabbits were useful for proper interpretation of the damage zone boundaries in OCT.Conclusions:  Traditional photocoagulation parameters (400 μm, 100 ms and moderate burn) result in a stable scar similar in size to the beam diameter. Restoration of the damaged photoreceptor layer in lighter lesions produced by shorter pulses should allow reducing the common side‐effects of photocoagulation such as scotomata and scarring.
Biomechanical diagnosis of keratoconus: evaluation of the keratoconus match index and the keratoconus match probability
Authors: Labiris Georgios , Gatzioufas Zisis , Sideroudi Haris , Giarmoukakis Athanassios , Kozobolis Vassilios , Seitz Berthold 
Published: April 2013

Abstract.Purpose:   To evaluate the diagnostic capacity of the Ocular Response Analyser’s keratoconus match index (KMI) and keratoconus match probability (KMP) classification in a sample of keratoconus (KC) patients.Methods:  Keratoconus match index and KMP from 114 KC eyes, randomly selected from 114 patients with bilateral keratoconus (KCG), were compared with the corresponding ones from 109 normal eyes (CG). Keratoconus match index’s predictive accuracy was assessed by receiver operating curves (ROC). Keratoconus match probability level of agreement was evaluated at the different KC stages of the Amsler–Krumeich classification. Correlations were estimated with topographic keratoconus classification (TKC), keratoconus index (KI), index of surface variance (ISV), vertical asymmetry (IVA), height asymmetry (IHA), height decentration (IHD), minimal radius (Rmin), central corneal thickness (CCT), thinnest corneal thickness (TCT) mean keratometry (Km) and intraocular pressure (IOPg).Results:  Mean KMI in KCG and CG was 0.20 ± 0.38 and 0.98 ± 0.25, respectively (p < 0.01). Significant KMI differences (p < 0.01) were detected in different KC groups [range: 0.62 ± 0.38 (KC 1), −0.62 ± 0.04 (KC 4)]. Significant correlation was detected between KC staging and KMI (r = −0.56, p < 0.0001). Keratoconus match probability identified 22.03% of the CG eyes as suspect. Moreover, KMP identified 7.01% and 23.68% of the KCG eyes as normal and suspect, respectively. Receiver operating curves analysis for KMI parameter indicated a predictive accuracy of 97.7% (cut‐off point: 0.512, sensitivity: 91.18%, specificity: 94.34%).Conclusions:  Keratoconus match index seems to be a reliable index in keratoconus diagnosis and staging. Keratoconus match probability identifies a significant percentage of topographically defined KC and CG eyes as suspect. Diagnostic capacity of these novel indexes needs to be further explored.
Transition to noncurative end‐of‐life care in paediatric oncology – a nationwide follow‐up in Sweden
Authors: Jalmsell Li , Forslund Martin , Hansson Mats G , Henter Jan‐Inge , Kreicbergs Ulrika , Frost Britt‐Marie 
Published: April 2013

AbstractAimTo estimate whether and when children dying from a malignancy are recognized as being beyond cure and to study patterns of care the last weeks of life.MethodsA nationwide retrospective medical record review was conducted. Medical records of 95 children (60% of eligible children) who died from a malignancy 2007–2009 in Sweden were studied.ResultsEighty‐three children (87%) were treated without curative intent at the time of death. Children with haematological malignancies were less likely to be recognized as being beyond cure than children with brain tumours [relative risks (RR) 0.7; 95% confidence interval (CI) 0.6–0.9] or solid tumours (RR 0.8; 0.6–1.0). The transition to noncurative care varied from the last day of life to over four years prior to death (median 60 days). Children with haematological malignancies were treated with a curative intent closer to death and were also given chemotherapy (RR 5.5; 1.3–22.9), transfusions (RR 2.0; 1.0–4.0) and antibiotics (RR 5.3; 1.8–15.5) more frequently than children with brain tumours the last weeks of life.ConclusionThe majority of children dying from a malignancy were treated with noncurative intent at the time of death. The timing of a transition in care varied with the diagnoses, being closer to death in children with haematological malignancies.
Pan‐BH3 Mimetic S1 Exhibits Broad‐Spectrum Antitumour Effects by Cooperation between Bax and Bak
Authors: Song Ting , Xue Zuguang , Zhang Zhichao , Shen Xiaoyun , Li Xiangqian 
Published: April 2013

AbstractSmall molecule S1 is a pan‐BH3 mimetic that can bind antiapoptotic Bcl‐2, Bcl‐xL and Mcl‐1 proteins. Herein, different Bcl‐2 member expression cancer cell lines (NCI‐H345, MCF‐7, SMMC‐7721 and Hela) and cells deficient in Bax and/or Bak by shRNA were used to unravel the cascade of events by which S1 promotes apoptosis compared with Bcl‐2/Bcl‐xL inhibitor ABT‐737. We identified that S1 exhibited broader antitumour spectrum than ABT‐737 through disruption of more Bcl‐2 interactions including Mcl‐1/Bak interaction. Moreover, the individual and combined roles of Bax and Bak in S1‐induced apoptosis were revealed. Our results showed that S1 induced a Bak‐mediated apoptosis. Bak played a predominant role in either S1 or ABT‐737‐induced apoptosis through the cooperation with Bax on the formation of large oligomers on mitochondrial membrane.