bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leadership and management in the undergraduate medical curriculum: a qualitative study of students’ attitudes and opinions at one UK medical school
Authors: Quince Thelma , Abbas Mark , Murugesu Sughashini , Crawley Francesca , Hyde Sarah , Wood Diana , Benson John 
Published: June 2014

ObjectiveTo explore undergraduate medical students’ attitudes towards and opinions about leadership and management education.DesignBetween 2009 and 2012 we conducted a qualitative study comprising five focus group discussions, each devoted to one of the five domains in the Medical Leadership Competency Framework, (Personal Qualities, Working with Others, Managing Services, Improving Services and Setting Direction). Each discussion examined what should be learnt, when should learning occur, what methods should be used, how should learning be assessed, what are the barriers to such education.Participants28 students from all three clinical years (4–6) of whom 10 were women.Results2 inter-related themes emerged: understanding the broad perspective of patients and other stakeholders involved in healthcare provision and the need to make leadership and management education relevant in the clinical context. Topics suggested by students included structure of the National Health Service (NHS), team working skills, decision-making and negotiating skills. Patient safety was seen as particularly important. Students preferred experiential learning, with placements seen as providing teaching opportunities. Structured observation, reflection, critical appraisal and analysis of mistakes at all levels were mentioned as existing opportunities for integrating leadership and management education. Students’ views about assessment and timing of such education were mixed. Student feedback figured prominently as a method of delivery and a means of assessment, while attitudes of medical professionals, students and of society in general were seen as barriers.ConclusionsMedical students may be more open to leadership and management education than thought hitherto. These findings offer insights into how students view possible developments in leadership and management education and stress the importance of developing broad perspectives and clinical relevance in this context.
A health economic model for the development and evaluation of innovations in aged care: an application to consumer-directed care—study protocol
Authors: Ratcliffe Julie , Lancsar Emily , Luszcz Mary , Crotty Maria , Gray Len , Paterson Jan , Cameron Ian D 
Published: June 2014

IntroductionConsumer-directed care is currently being embraced within Australia and internationally as a means of promoting autonomy and choice in the delivery of health and aged care services. Despite its wide proliferation little research has been conducted to date to assess the views and preferences of older people for consumer-directed care or to assess the costs and benefits of such an approach relative to existing models of service delivery.Methods and analysisA comprehensive health economic model will be developed and applied to the evolution, implementation and evaluation of consumer-directed care in an Australian community aged care setting. A mixed methods approach comprising qualitative interviews and a discrete choice experiment will determine the attitudes and preferences of older people and their informal carers for consumer-directed care. The results of the qualitative interviews and the discrete choice experiment will inform the introduction of a new consumer-directed care innovation in service delivery. The cost-effectiveness of consumer-directed care will be evaluated by comparing incremental changes in resource use, costs and health and quality of life outcomes relative to traditional services. The discrete choice experiment will be repeated at the end of the implementation period to determine the extent to which attitudes and preferences change as a consequence of experience of consumer-directed care. The proposed framework will have wide applicability in the future development and economic evaluation of new innovations across the health and aged care sectors.Ethics and disseminationThe study is approved by Flinders University Social and Behavioural Research Ethics Committee (Project No. 6114/SBREC). Findings from the qualitative interviews, discrete choice experiments and the economic evaluation will be reported at a workshop of stakeholders to be held in 2015 and will be documented in reports and in peer reviewed journal articles.
Customising turnaround time indicators to requesting clinician: a 10-year study through balanced scorecard indicators
Authors: Salinas Maria , López-Garrigós Maite , Santo-Quiles Ana , Gutierrez Mercedes , Lugo Javier , Lillo Rosa , Leiva-Salinas Carlos 
Published: June 2014

AimThe purpose of this study is, first to present a 10-year monitoring of postanalytical turnaround time (TAT) adapted to different clinicians and patient situations, second to evaluate and analyse the indicators results during that period of time, and finally to show a synthetic appropriate indicator to be included in the balanced scorecard management system.MethodsTAT indicator for routine samples was devised as the percentage of certain key tests that were verified before a specific time on the phlebotomy day. A weighted mean synthetic indicator was also designed. They were calculated for inpatients at 15:00 and 12:00 and for primary care patients only at 15:00. The troponin TAT of emergency department patients, calculated as the difference between the troponin verification and registration time, was selected as the stat laboratory TAT indicator.ResultsThe routine and stat TAT improved along the 10-year study period. The synthetic indicator showed the same trend.ConclusionsThe implementation of systematic and continuous monitoring over years, promoted a continuous improvement in TAT which will probably benefit patient outcome and safety.
Imaging of degenerative lumbar intervertebral discs; linking anatomy, pathology and imaging
Authors: Adams Ashok , Roche Oran , Mazumder Asif , Davagnanam Indran , Mankad Kshitij 
Published: June 2014

Abstract
Low back pain is a common medical condition that has significant implications for healthcare providers and the UK economy. Low back pain can be classified as ‘specific’ in which an underlying pathophysiological mechanism is identified (eg, herniated intervertebral disc). Advanced imaging should be performed in this situation and in those patients in whom systemic disease is strongly suspected. In the majority (approximately 90%), low back pain in ‘non specific’ and there is a weak correlation with imaging abnormalities. This is an area of ongoing research and remains controversial in terms of imaging approach and treatment (eg, theory of discogenic pain, interpretation and treatment of endplate changes). With regards Modic endplate changes, current research suggests that an infective component may be involved that may identify novel potential treatments in patients with chronic low back pain refractory to other treatment modalities. MRI is the imaging modality of choice for the assessment of degenerative changes in intervertebral discs. MRI has superior soft tissue contrast resolution when compared to other imaging modalities (eg, plain radiography, CT). An understanding of normal anatomy and MR appearances of intervertebral discs, particularly with regards to how these appearances change with advancing age, is required to aid image interpretation. Knowledge of the spectrum of degenerative processes that may occur in the intervertebral discs is required in order to identify and explain abnormal MRI appearances. As the communication of MRI findings may guide therapeutic decision making and surgical intervention, the terminology used by radiologists must be accurate and consistent. Therefore, description of degenerative disc changes in the current paper is based on the most up-to-date recommendations, the aim being to aid reporting by radiologists and interpretation of reports by referring clinicians.
Coastal structure, sea-level changes and vertical motion of the land in the Mediterranean
Authors: Anzidei Marco , Lambeck Kurt , Antonioli Fabrizio , Furlani Stefano , Mastronuzzi Giuseppe , Serpelloni Enrico , Vannucci Gianfranco 
Published: June 2014

Abstract
The Mediterranean basin is an important area of the Earth for studying the interplay between geodynamic processes and landscape evolution affected by tectonic, glacio-hydro-isostatic and eustatic factors. We focus on determining vertical deformations and relative sea-level change of the coastal zone utilizing geological, archaeological, historical and instrumental data, and modelling. For deformation determinations on recent decadal to centennial time scales, seismic strain analysis based on about 6000 focal mechanisms, surface deformation analysis based on some 850 continuous GPS stations, and 57 tide gauge records were used. Utilizing data from tectonically stable areas, reference surfaces were established to separate tectonic and climate (eustatic) signals throughout the basin for the last 20 000 years. Predominant Holocene subsidence (west coast of Italy, northern Adriatic sea, most of Greece and Turkey are areas at risk of flooding owing to relative sea-level rise), uplift (local areas in southwestern Italy and southern Greece) or stability (northwestern and central western Mediterranean and Levant area) were determined. Superimposed on the long trends, the coasts are also impacted by sudden extreme events such as recurring large storms and numerous, but unpredictable tsunamis caused by the high seismicity of parts of the basins.

Supplementary material:

A table of locations and timings of the largest tsunamis in the Mediterranean during the last 5660 years BP is available at
http://www.geolsoc.org.uk/SUP18757
.
Phase II Study of Single-Agent Orteronel (TAK-700) in Patients with Nonmetastatic Castration-Resistant Prostate Cancer and Rising Prostate-Specific Antigen
Authors: Hussain Maha , Corn Paul G. , Michaelson M. Dror , Hammers Hans J. , Alumkal Joshi J. , Ryan Charles J. , Bruce Justine Y. , Moran Susan , Lee Shih-Yuan , Lin H. Mark , George Daniel J. ,   for the Prostate Cancer Clinical Trials Consortium, a program of the Department of Defense Prostate Cancer Research Program and the Prostate Cancer Foundation
Published: June 2014

Abstract
Purpose: Orteronel (TAK-700) is an investigational, nonsteroidal, oral, inhibitor of androgen synthesis with greater specificity for 17,20-lyase than for 17α-hydroxylase. We investigated orteronel without steroids in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC; M0).
Experimental Design: Patients with nmCRPC and rising prostate-specific antigen (PSA) received orteronel 300 mg twice daily until PSA progression, metastases, or unacceptable toxicity. The primary endpoint was percentage of patients achieving PSA ≤0.2 ng/mL (undetectable levels) at 3 months. Secondary endpoints included safety, PSA response, time to metastases, and correlated endpoints.
Results: Thirty-nine patients with a median baseline PSA doubling time of 2.4 months (range, 0.9–9.2) received a median of fourteen 28-day treatment cycles. PSA decreased &gt;30% in 35 patients and 6 (16%) achieved PSA ≤ 0.2 ng/mL at 3 months. Median times to PSA progression and metastasis were 13.8 and 25.4 months, respectively. Kaplan–Meier estimates of freedom from PSA progression were 57% and 42% at 12 and 24 months, and of freedom from metastasis were 94% and 62% at 12 and 24 months, respectively. At 3 months, median testosterone declined by 89% from baseline. Adverse events led to therapy discontinuation in 12 patients and grade ≥3/4 adverse events occurred in 22 patients. Most frequent all-cause adverse events included fatigue (64%), hypertension (44%), diarrhea (38%), and nausea (33%), which were primarily grade 1/2.
Conclusions: Single-agent orteronel produced marked and durable declines in PSA in patients with nmCRPC. Orteronel has moderate but manageable toxicities and its chronic administration without steroids appears feasible. Clin Cancer Res; 20(16); 4218–27. ©2014 AACR.
Association between chronic osteomyelitis and deep-vein thrombosis
Authors: Lin Te-Yu , Chen Yu-Guang , Huang Wen-Yen , Lin Cheng-Li , Peng Chiao-Ling , Sung Fung-Chang , Kao Chia-Hung 
Published: June 2014

SummaryStudies on the association between chronic osteomyelitis and deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) are scarce. The aim of this study was to analyse a nationwide population-based database for association between DVT or PE after a diagnosis of chronic osteomyelitis. This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Database from 1998 to 2008, with a follow-up period extending to the end of 2010. We identified patients with chronic osteomyelitis using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The patients with chronic osteomyelitis and comparison controls were selected by 1:1 matching on a propensity score. The propensity score was calculated by a logistic regression to estimate the probability of the treatment assignment given the baseline variables including age, sex, and Charlson comorbidity index score. We analysed the risks of DVT and PE by using Cox proportional hazards regression models, including sex, age, and comorbidities. In total, 24,335 chronic osteomyelitis patients and 24,335 controls were enrolled in the study. The risk of developing DVT was 2.49-fold in patients with chronic osteomyelitis compared with the comparison cohort, after adjusting for age, sex, and comorbidities. The multiplicative increased risks of DVT were also significant in patients with chronic osteomyelitis with any comorbidity. In conclusion, physicians should consider chronic osteomyelitis in their evaluation of risk factors for DVT.
The effect of fibrin(ogen) on thrombin generation and decay
Authors: Wagenvoord Rob , Hemker H. Coenraad , Kremers Romy 
Published: June 2014

SummaryDefibrination causes a ~30% decrease of thrombin generation (TG) which can be restored by adding native fibrinogen in its original concentration (3 mg/ml). The fibrinogen variant γA/γ′, which binds thrombin with high affinity, is over four times more efficient in this respect than the more common γA/γA form. By using high tissue factor concentrations we accelerated prothrombin conversion so as to obtain a descending part of the TG curve that was governed by thrombin decay only. From that part we calculated the antithrombin (AT)- and α2-macroglobulin- dependent decay constants at a series of concentrations of native, γA/γA and γA/γ′ fibrinogen. We found that the increase of TG in the presence of fibrinogen is primarily due to a dose-dependent decrease of thrombin inactivation by α2-macroglobulin, where the γA/γ′ form is much more active than the γA/γA form. AT-dependent decay is somewhat decreased by γA/γ′ fibrinogen but hardly by the γA/γA form. We assume that binding of thrombin to fibrin(ogen) interferes with its binding to inhibitors. Attenuation of decay only in part explains the stimulating effect of fibrinogen on TG, as fibrinogen stimulates prothrombin conversion, regardless of the fibrinogen variant.Note: Part of this work was presented at the ISTH meeting in 2013.
Alcohol Consumption, Specific Alcoholic Beverages, and Abdominal Aortic Aneurysm
Authors: Stackelberg Otto , Björck Martin , Larsson Susanna C. , Orsini Nicola , Wolk Alicja 
Published: June 2014

Background—
Studies investigating the role of alcohol consumption in the development of abdominal aortic aneurysm (AAA) are scarce. We aimed to examine associations between total alcohol consumption and specific alcoholic beverages and the hazard of AAA.

Methods and Results—
The study population was made up of 44 715 men from the Cohort of Swedish Men and 35 569 women from the Swedish Mammography Cohort who were 46 to 84 years of age at baseline in 1998. Cox proportional hazards models were used to estimate hazard ratios with 95% confidence intervals for the associations between alcohol consumption, assessed through a food frequency questionnaire, and AAA, identified by means of linkage to the Swedish Inpatient Register and the Swedish Vascular Registry (Swedvasc). Over the 14-year follow-up until December 2011 (1 019 954 person-years), AAAs occurred in 1020 men and 194 women. Compared with the consumption of 1 glass of alcohol per week (12 g of ethanol), the hazard ratio of AAA among men who consumed 10 glasses per week was 0.80 (95% confidence interval, 0.68–0.94). The corresponding hazard ratio among women who consumed 5 glasses per week was 0.57 (95% confidence interval, 0.40–0.82). Among participants free from cardiovascular disease, total alcohol consumption did not seem to be associated with hazard of the disease. The most commonly consumed alcoholic beverages, beer among men and wine among women, were inversely associated, whereas no association was observed for liquor.

Conclusions—
Moderate alcohol consumption, specifically wine and beer, was associated with a lower hazard of abdominal aortic aneurysm. The associations between higher doses of alcohol and risk of the disease remain unknown.
Vasculogenic Conditioning of Peripheral Blood Mononuclear Cells Promotes Endothelial Progenitor Cell Expansion and Phenotype Transition of Anti‐Inflammatory Macrophage and T Lymphocyte to Cells With Regenerative Potential
Authors: Masuda Haruchika , Tanaka Rica , Fujimura Satoshi , Ishikawa Masakazu , Akimaru Hiroshi , Shizuno Tomoko , Sato Atsuko , Okada Yoshinori , Iida Yumi , Itoh Jobu , Itoh Yoshiko , Kamiguchi Hiroshi , Kawamoto Atsuhiko , Asahara Takayuki 
Published: June 2014

Background

Cell‐based therapies involving mononuclear cells (
MNC
s) have been developed for vascular regeneration to treat ischemic diseases; however, quality control of therapeutic
MNC
s has not been evaluated. We investigated the therapeutic potential of peripheral blood (
PB
)
MNC
s, operated by recently developed quality and quantity (
QQ
) culture of endothelial progenitor cells (
EPC
s).

Methods and Results

PBs were collected from healthy volunteers; peripheral blood mononuclear cells (
PBMNC
s) isolated from these
PB
s were subjected to
QQ
culture for 7 days with medium containing stem cell factor, thrombopoietin, Flt‐3 ligand, vascular endothelial growth factor, and interleukin‐6. The resulting cells (
QQMNC
s) in
EPC
colony‐forming assay generated significantly more definitive
EPC
colonies than
PBMNC
s. In flow cytometry, macrophages and helper T lymphocytes of
QQMNC
s became phenotypically polarized into angiogenic, anti‐inflammatory, and regenerative subsets: classical M1 to alternative M2; T helper (Th)1 to Th2; angiogenic or regulatory T‐cell expansion. Quantitative real‐time polymerase chain reaction (
qRT
‐
PCR
) assay revealed the predominant proangiogenic gene expressions in
QQMNC
s versus
PBMNC
s. Using murine ischemic hindlimb models, the efficacy of
QQMNC
intramuscular transplantation (Tx) was compared to that of
PBMNCTx
, cultured “early
EPC
” Tx (
eEPCTx
), and granulocyte colony‐stimulating factor mobilized CD34
+
cell Tx (GmCD34Tx). Laser Doppler imaging revealed the blood perfusion recovery in ischemic hindlimbs after
QQMNCTx
superior to after
PBMNCTx
and
eEPCT
x, but also earlier than after GmCD34Tx. Histological evaluations and q
RT
‐
PCR
assays in ischemic hindlimbs demonstrated that
QQMNCTx
, similarly to GmCD34Tx, enhanced angiovasculogenesis and myogenesis, whereas it preponderantly inhibited inflammation and fibrosis versus
PBMNCTx
and
eEPCTx
.

Conclusions

QQ
culture potentiates the ability of
PBMNC
s to promote regeneration of injured tissue; considering the feasible cell preparation,
QQ
culture‐treated
PBMNC
s may provide a promising therapeutic option for ischemic diseases.

Clinical Trial Registration

URL
:
irb.med.u-tokai.ac.jp/d/2/monthly/2010.html
;
IRB
No.: 10R‐020.

URL
:
irb.med.u-tokai.ac.jp/d/2/monthly/201312.html
;
IRB
No.: 13R228.
Increasing Muscle Mass Improves Vascular Function in Obese (
db/db
) Mice
Authors: Qiu Shuiqing , Mintz James D. , Salet Christina D. , Han Weihong , Giannis Athanassios , Chen Feng , Yu Yanfang , Su Yunchao , Fulton David J. , Stepp David W. 
Published: June 2014

Background

A sedentary lifestyle is an independent risk factor for cardiovascular disease and exercise has been shown to ameliorate this risk. Inactivity is associated with a loss of muscle mass, which is also reversed with isometric exercise training. The relationship between muscle mass and vascular function is poorly defined. The aims of the current study were to determine whether increasing muscle mass by genetic deletion of myostatin, a negative regulator of muscle growth, can influence vascular function in mesenteric arteries from obese
db/db
mice.

Methods and Results

Myostatin expression was elevated in skeletal muscle of obese mice and associated with reduced muscle mass (30% to 50%). Myostatin deletion increased muscle mass in lean (40% to 60%) and obese (80% to 115%) mice through increased muscle fiber size (
P
<0.05). Myostatin deletion decreased adipose tissue in lean mice, but not obese mice. Markers of insulin resistance and glucose tolerance were improved in obese myostatin knockout mice. Obese mice demonstrated an impaired endothelial vasodilation, compared to lean mice. This impairment was improved by superoxide dismutase mimic Tempol. Deletion of myostatin improved endothelial vasodilation in mesenteric arteries in obese, but not in lean, mice. This improvement was blunted by nitric oxide (
NO
) synthase inhibitor
l
‐
NG
‐nitroarginine methyl ester (
l
‐
NAME)
. Prostacyclin (
PGI
2
)‐ and endothelium‐derived hyperpolarizing factor (
EDHF)‐
mediated vasodilation were preserved in obese mice and unaffected by myostatin deletion. Reactive oxygen species) was elevated in the mesenteric endothelium of obese mice and down‐regulated by deletion of myostatin in obese mice. Impaired vasodilation in obese mice was improved by
NADPH
oxidase inhibitor (
GKT
136901). Treatment with sepiapterin, which increases levels of tetrahydrobiopterin, improved vasodilation in obese mice, an improvement blocked by
l
‐
NAME
.

Conclusions

Increasing muscle mass by genetic deletion of myostatin improves
NO‐
, but not
PGI
2
‐ or
EDHF‐
mediated vasodilation in obese mice; this vasodilation improvement is mediated by down‐regulation of superoxide.
The discretionary use of performance information by different local government actors – analysing and comparing the predictive power of three factor sets
Authors: Saliterer Iris , Korac Sanja 
Published: June 2014

In recent years, empirical research on performance information use has gained momentum, but quantitative studies, which include different actor groups, are less widespread. Building on prior research within this field, our study offers insights into various antecedents for performance information use – including individual, performance-measurement-specific, and organizational context factors. By applying a quantitative survey of different actor groups at the local government level in Austria, we draw a picture of different user profiles for mayors with administrative authority, chief officials and chief financial officials. Hence, we are able to confirm findings from former studies with other national backgrounds and contribute to a better understanding regarding some new individual aspects influencing discretionary performance information use in a strategy formulation context. Points for practitioners It is important to gather insights on the factors driving performance information use, as the latter is a crucial indicator for whether the introduction of performance measurement is worth the effort. Moreover, the results show that the performance information use intensity of mayors, chief officials and chief financial officials is driven by different factors. The study not only contributes to a better understanding of performance measurement utilization in general, but also points to the existence of different user profiles, therefore offering implications for the development of performance management implementation strategies.