bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paying for hospital care: the experience with implementing activity-based funding in five European countries
Authors: O'Reilly Jacqueline , Busse Reinhard , Häkkinen Unto , Or Zeynep , Street Andrew , Wiley Miriam 
Published: January 2012

AbstractFollowing the US experience, activity-based funding has become the most common mechanism for reimbursing hospitals in Europe. Focusing on five European countries (England, Finland, France, Germany and Ireland), this paper reviews the motivation for introducing activity-based funding, together with the empirical evidence available to assess the impact of implementation. Despite differences in the prevailing approaches to reimbursement, the five countries shared several common objectives, albeit with different emphasis, in moving to activity-based funding during the 1990s and 2000s. These include increasing efficiency, improving quality of care and enhancing transparency. There is substantial cross-country variation in how activity-based funding has been implemented and developed. In Finland and Ireland, for instance, activity-based funding is principally used to determine hospital budgets, whereas the models adopted in the other three countries are more similar to the US approach. Assessing the impact of activity-based funding is complicated by a shortage of rigorous empirical evaluations. What evidence is currently available, though, suggests that the introduction of activity-based funding has been associated with an increase in activity, a decline in length of stay and/or a reduction in the rate of growth in hospital expenditure in most of the countries under consideration.
HOx budgets during HOxComp: A case study of HOx chemistry under NOx‐limited conditions
Authors: Elshorbany Y. F. , Kleffmann J. , Hofzumahaus A. , Kurtenbach R. , Wiesen P. , Brauers T. , Bohn B. , Dorn H.‐P. , Fuchs H. , Holland F. , Rohrer F. , Tillmann R. , Wegener R. , Wahner A. , Kanaya Y. , Yoshino A. , Nishida S. , Kajii Y. , Martinez M. , Kubistin D. , Harder H. , Lelieveld J. , Elste T. , Plass‐Dülmer C. , Stange G. , Berresheim H. , Schurath U. 
Published: January 2012

Recent studies have shown that measured OH under NOx‐limited, high‐isoprene conditions are many times higher than modeled OH. In this study, a detailed analysis of the HOx radical budgets under low‐NOx, rural conditions was performed employing a box model based on the Master Chemical Mechanism (MCMv3.2). The model results were compared with HOx radical measurements performed during the international HOxComp campaign carried out in Jülich, Germany, during summer 2005. Two different air masses influenced the measurement site denoted as high‐NOx (NO, 1–3 ppbv) and low‐NOx (NO, < 1 ppbv) periods. Both modeled OH and HO2 diurnal profiles lay within the measurement range of all HOx measurement techniques, with correlation slopes between measured and modeled OH and HO2 around unity. Recently discovered interference in HO2 measurements caused by RO2 cross sensitivity was found to cause a 30% increase in measured HO2 during daytime on average. After correction of the measured HO2 data, the model HO2 is still in good agreement with the observations at high NOx but overpredicts HO2 by a factor of 1.3 to 1.8 at low NOx. In addition, for two different set of measurements, a missing OH source of 3.6 ± 1.6 and 4.9 ± 2.2 ppb h−1 was estimated from the experimental OH budget during the low‐NOx period using the corrected HO2 data. The measured diurnal profile of the HO2/OH ratio, calculated using the corrected HO2, is well reproduced by the MCM at high NOx but is significantly overestimated at low NOx. Thus, the cycling between OH and HO2 is better described by the model at high NOx than at low NOx. Therefore, similar comprehensive field measurements accompanied by model studies are urgently needed to investigate HOx recycling under low‐NOx conditions.
Infection Prevention Promotion Program Based on the PRECEDE Model: Improving Hand Hygiene Behaviors among Healthcare Personnel
Authors: Aboumatar Hanan , Ristaino Polly , Davis Richard O. , Thompson Carol B. , Maragakis Lisa , Cosgrove Sara , Rosenstein Beryl , Perl Trish M. 
Published: January 2012

Background.Healthcare-associated infections (HAIs) result in significant morbidity and mortality. Hand hygiene remains a cornerstone intervention for preventing HAIs. Unfortunately, adherence to hand hygiene guidelines among healthcare personnel is poor.Objective.To assess short- and long-term effects of an infection prevention promotion program on healthcare personnel hand hygiene behaviors.Design.Time series design.SettingOur study was conducted at a tertiary care academic center.Participants.Hospital healthcare personnel.Methods.We developed a multimodal program that included a multimedia communications campaign, education, leadership engagement, environment modification, team performance measurement, and feedback. Healthcare personnel hand hygiene practices were measured via direct observations over a 3-year period by “undercover” observers.Results.Overall hand hygiene compliance increased by 2-fold after full program implementation (P<.001), and this increase was sustained over a 20-month follow-up period (P< .001). The odds for compliance with hand hygiene increased by 3.8-fold in the 6 months after full program implementation (95% confidence interval, 3.53–4.23; P< .001), and this increase was sustained. There was even a modest increase at 20 months of follow up. Hand hygiene compliance increased among all disciplines and hospital units. Hand hygiene compliance increased from 35% in the first 6 months after program initiation to 77% in the last 6 months of the study period among nursing providers (P<.001), from 38% to 62% among medical providers (P<.001), and from 27% to 75% among environmental services staff (P<.001).Conclusions.Implementation of the infection prevention promotion program was associated with a significant and sustained increase in hand hygiene practices among healthcare personnel of various disciplines.Infect Control Hosp Epidemiol 2012;33(2):144-151
Leadership and transitions: maintaining the science in complexity and complex systems
Authors: Sturmberg Joachim P. , Martin Carmel M. 
Published: January 2012

AbstractIt is the ‘moral compass’, however subtle, that underpins leadership. Leadership, meaning showing the way, demands as much conviction as gentile diplomacy in the discourse with supporters and detractors. In particular, leadership defends the goal by safeguarding its principles from its detractors. The authors writing in the Forum on Complexity in Medicine and Healthcare since its inception are leaders in an intellectual transition to complex systems thinking in medicine and health.
Understanding health system reform – a complex adaptive systems perspective
Authors: Sturmberg Joachim P. , O'Halloran Di M. , Martin Carmel M. 
Published: January 2012

AbstractBackground Everyone wants a sustainable well‐functioning health system. However, this notion has different meaning to policy makers and funders compared to clinicians and patients. The former perceive public policy and economic constraints, the latter clinical or patient‐centred strategies as the means to achieving a desired outcome.Design Theoretical development and critical analysis of a complex health system model.Results and conclusions We introduce the concept of the health care vortex as a metaphor by which to understand the complex adaptive nature of health systems, and the degree to which their behaviour is predetermined by their ‘shared values’ or attractors. We contrast the likely functions and outcomes of a health system with a people‐centred attractor and one with a financial attractor. This analysis suggests a shift in the system's attractor is fundamental to progress health reform thinking.
Armillaria ostoyae associated with dying 60‐year‐old Scots pines in northern Turkey
Authors: Lehtijärvi A. , Doğmuş ‐Lehtijärvi H. T. , Aday A. G. 
Published: January 2012

SummaryWe investigated an Armillaria root disease centre in a 60‐year‐old, naturally regenerated Pinus sylvestris stand located at 1250 m altitude in Sinop province in northern Turkey. Based on sequence analysis of the internal transcribed spacer region of the rDNA, the mycelial fans sampled from the infected trees were Armillaria ostoyae. Multilocus genotyping indicated that the fans belonged to a single genet, at least 0.2 ha in size. Drought as a predisposing factor is discussed. The study area received 50–70 and 25–50% of the normal precipitation in May, June and August in 2009 and in August and September in 2010, respectively. Moreover, earlier excavation work to prepare a forest road had probably disrupted the water table in the affected stand.
Tree chitinases – stress‐ and developmental‐driven gene regulation
Authors: Veluthakkal R. , Sundari B. Karpaga Raja , Dasgupta M. Ghosh 
Published: January 2012

SummaryIn recent years, a considerable number of studies have harnessed the power of genomics to decipher the role of pathogenesis‐related (PR) proteins in plant defence against various biotic and abiotic stresses. Chitinases are PR antifungal proteins expressed constitutively at low levels in plants and induced during biotic pressures and are demonstrated to be involved in the plant defence responses. Remarkable induction of chitinase enzymes by various abiotic agents (salicylic acid, jasmonic acid, ethylene and ozone) and biotic components (pathogens, insect pest, fungal cell wall components and oligosaccharides) is well demonstrated in plants. Several reviews on plant chitinase expression during host–pathogen interaction are available for annual species, whilst reports of their expression in tree species are limited to a few woody perennials: Populus, Pinus, Picea, Eucalyptus, Castanea and Pseudotsuga. The aim of this paper is to review the induction of chitinase during various stresses and developmental processes in forest tree species.
Paraneoplastic neurological and hematological syndromes associated with prostate cancer
Authors: Gakiya Munehisa , Naka Hidekatsu , Saito Seiichi 
Published: January 2012

AbstractParaneoplastic neurological syndromes are defined as the remote effects of cancer on the nervous system. Here we report a 68‐year‐old man who initially presented with worsening paresthesia in the lower extremities. Although the culprit lesion remained to be identified, he coincidentally had diagnosis of prostate cancer by an annual prostate‐specific antigen examination. Leukocytosis and elevated granulocyte colony‐stimulating factor in serum were also detected. Neurological symptoms and leukocytosis improved after initiation of androgen‐deprivation therapy followed by external beam radiotherapy. A total of 9 months after treatment, the patient showed no evidence of cancer recurrence or neurological signs. Paraneoplastic neurological syndromes are rare in prostate cancer and therefore have received little attention. We should be aware that when paraneoplastic neurological syndromes occur, they usually occur as the first sign of or during progression of prostate cancer. Furthermore, we should take into account the existence of malignancy when the cause of neurological symptoms cannot be specified.
Pheochromocytoma crisis caused by Campylobacter fetus
Authors: Abe Ichiro , Nomura Masatoshi , Watanabe Makiko , Shimada Shingo , Kohno Michiko , Matsuda Yayoi , Adachi Masahiro , Kawate Hisaya , Ohnaka Keizo , Takayanagi Ryoichi 
Published: January 2012

AbstractPheochromocytoma crisis is a life‐threatening endocrine emergency associated with symptoms of excess release of catecholamines. It might present spontaneously or be unmasked by triggers including trauma, surgery and certain medications that provoke catecholamine release by tumors. Here we report a case of pheochromocytoma crisis associated with abscess formation in the tumor and bacteremia of Campylobacter fetus, which was successfully treated with antibiotics and a surgical resection. This case appears to be the first reported case in the literature of abscess formation by C. fetus in pheochromocytoma, leading to catecholamine crisis.
Prospective trial comparing transrectal ultrasonography and transurethral seminal vesiculoscopy for persistent hematospermia
Authors: Xing Changyong , Zhou Xiaomei , Xin Lei , Hu Hongzhen , Li Liping , Fang Jingchuan , Liu Zhiyong 
Published: January 2012

Objective:  To compare the diagnostic yield of transrectal ultrasonography and transurethral seminal vesiculoscopy in patients with persistent hematospermia, and to determine the advantages and disadvantages of both modalities.Methods:  We prospectively enrolled 106 patients with persistent hematospermia of mean duration 20.5 months. All patients were evaluated by both transrectal ultrasonography and transurethral seminal vesiculoscopy after excluding definite etiological lesions beyond the reproductive duct system. The diagnostic yield and other technical parameters of both modalities were compared.Results:  Final diagnoses were made in 93 patients (87.7%), with transrectal ultrasonography and transurethral seminal vesiculoscopy showing overall diagnostic yields of 45.3% and 74.5%, respectively (P < 0.001). The diagnostic yield of combining transrectal ultrasonography and transurethral seminal vesiculoscopy was significantly higher than that of each modality alone (both P < 0.001). Of the 114 findings of diagnostic value, the most frequent was calculus (47.4%, n = 54), followed by obstruction/stricture (37.7%, n = 43), cyst (8.8%, n = 10), dysplasia (3.5%, n = 4), polyp (1.8%, n = 2) and benign mass (0.9%, n = 1). Transurethral seminal vesiculoscopy showed significant superiority in detecting calculi and obstruction/stricture. Hematospermia disappeared in 95.3% (101/106) of all patients and in 97.6% (83/85) of patients receiving transurethral seminal vesiculoscopy therapy during follow up. No major adverse effects occurred during and after examination.Conclusions:  The diagnostic yield of transurethral seminal vesiculoscopy for persistent hematospermia was significantly superior to that of transrectal ultrasonography, especially in lesions diagnosed with calculi and obstruction/stricture. Combining both modalities might provide extra benefits for patients with persistent hematospermia.
Effect of distigmine combined with propiverine on bladder activity in rats with spinal cord injury
Authors: Sugaya Kimio , Nishijima Saori , Kadekawa Katsumi , Ashitomi Katsuhiro , Yamamoto Hideyuki 
Published: January 2012

AbstractIt is not uncommon for patients with spinal cord injury to have both detrusor overactivity during the storage phase and detrusor underactivity during the voiding phase. However, there has been no information about the efficacy of combined treatment with cholinesterase inhibitors and anti‐muscarinic agents for this condition. Therefore, the effect of co‐administration of distigmine bromide (a cholinesterase inhibitor) and propiverine hydrochloride (an anti‐muscarinic agent) on bladder activity was examined in rats with spinal cord injury. Rats were anesthetized with isoflurane and the lower thoracic spinal cord was transected. The bladder was emptied by abdominal compression twice a day for 14 days after surgery. A total of 4 weeks after surgery, the animals were anesthetized with urethane, and the effect of intravenous injection of distigmine (0.01–1 mg/kg) followed by propiverine (1 mg/kg) on continuous cystometry parameters was examined. After injection of distigmine (0.1 and 1 mg/kg), the maximum bladder contraction pressure was significantly increased, and the duration of bladder contraction and the interval between bladder contractions were significantly prolonged. The baseline bladder pressure was not changed by injection of distigmine. After the addition of propiverine, the interval between bladder contractions was significantly further prolonged without any change of the maximum contraction pressure, baseline pressure or duration of bladder contraction. The residual volume after voiding bladder contraction was less than 0.1 mL in all animals. In conclusion, co‐administration of distigmine with propiverine might improve both bladder underactivity during the voiding phase and bladder overactivity during the storage phase.
Pregnancy rate after vasectomy reversal in a contemporary series: influence of smoking, semen quality and post‐surgical use of assisted reproductive techniques
Authors: van Dongen Joyce , Tekle Fetene B. , van Roijen J. Herman 
Published: January 2012

Study Type – Outcomes (cohort series)Level of Evidence 2bWhat's known on the subject? and What does the study add?Microsurgical vasectomy reversal is an effective and cost‐effective method of reinstating fertility in a man who has previously had a vasectomy. The current literature indicates that the success rate (i.e. potency and pregnancy rates) are dependent primarily on the time elapsed since vasectomy and the age of the female partner.Using a multivariate Cox regression model, evaluation of the influence of preoperative data (including smoking) and semen parameters indicates a significant influence of post‐surgical sperm motility only, on time to first pregnancy. The use of assisted reproductive techniques, when natural pregnancy failed, was successful in ≈50% of couples who attempted this procedure and accounted for an absolute increase in pregnancy rate of 14%.OBJECTIVE
To determine the influence of smoking, postoperative semen characteristics and the use of an assisted reproductive technique (ART) on pregnancy rate in a contemporary series of men undergoing vasectomy reversal.
PATIENTS AND METHODS
Between January 2002 and January 2009, 186 vasectomy reversals were performed. Of the 171 patients who could be contacted for follow‐up, 162 attempted pregnancy and constitute the study group.
Semen analysis was performed 3 months after the procedure and at subsequent 3‐monthly intervals.
Patient characteristics and surgical information were obtained from a computerized database, and follow‐up data were collected by telephone interview.
A multivariate Cox regression model was used to discern possible prognosticators with respect to pregnancy outcome.
RESULTS
The overall patency rate was 91.4%, with a natural pregnancy rate of 44.4% and a subsequent 14.2% of patients conceiving using a ARTs resulting in a total pregnancy rate of 58.6%. Multiple pregnancies were obtained by 20.4% of couples.
Smoking of the male or female partner did not influence the probability of conception.
In a multivariate model that included, among other factors, time since vasectomy, female age and semen characteristics, only sperm motility was significantly related to natural pregnancy outcome.
The probability of obtaining a natural pregnancy within 2 years after surgery is 53% for men with sperm motility >20% (WHO a+b) compared to 19% for men with sperm motility <5% (P= 0.003).
CONCLUSIONS
A clear and significant association between sperm motility and the probability of conception was found, whereas smoking, female age and time since vasectomy appeared to have no influence on pregnancy outcome in this patient cohort.
The use of ARTs accounted for an absolute increase in pregnancy rate of 14.2%.
Impact of pathological tumour characteristics in patients with sarcomatoid renal cell carcinoma
Authors: Shuch Brian , Bratslavsky Gennady , Shih Joanna , Vourganti Srinivas , Finley David , Castor Brandon , Treat Eric , Linehan W. Marston , Pantuck Allan J. , Said Jonathan W. , Belldegrun Arie S. 
Published: January 2012

Study Type – Prognosis (case series)Level of Evidence 4What's known on the subject? and What does the study add?Sarcomatoid renal cell carcinoma can occur in the setting of all histological subtypes of kidney cancer. These tumours are very aggressive and many patients present with disseminated disease. Long‐term survival is poor and the durable responses to systemic therapy are infrequent.Our large cohort analyses the influence of pathological tumour characteristics in determining prognosis for patients with sarcomatoid renal cell carcinoma undergoing surgical resection. This series helps define the prognostic influence of histological subtype, type of sarcomatoid morphology, the percentage necrosis and sarcomatoid features, and the presence of microvascular invasion.OBJECTIVES
To examine the influence of pathological tumour characteristics on survival to aid prognostication and clinical trial design.
Patients with sarcomatoid renal cell carcinoma (sRCC) are known to have poor prognosis and response to systemic therapy.
PATIENTS AND METHODS
A single‐centre database was reviewed to identify all patients with sRCC.
Clinical variables and pathological information, including histology, necrosis, percentage of sarcomatoid features (PSF) and microvascular invasion (MVI), were recorded and correlated to outcome.
RESULTS
Analyses of 104 patients with sRCC found that the median (range) size of tumours was 9.5 cm (2.5–30), 65% of patients had areas of clear cell histology, and 69.2% had metastatic disease at presentation.
The PSF did not influence tumour size, stage, necrosis, MVI, nodes or metastasis.
A total of 85 patients (81.7%) died during the follow‐up period with a median (95% confidence interval [CI]) survival of 5.9 months (4.7–8.9).
In the overall cohort, Eastern Cooperative Group performance status (ECOGPS), tumour size and metastatic disease were independent predictors of poor survival. MVI, PSF and percentage necrosis were strongly associated with outcome but were not independent predictors of outcome.
A multivariate risk model was established that incorporated six covariates (tumour size, MVI, ECOGPS, PSF, necrosis, and metastatic disease) to produce a predictive tool.
CONCLUSIONS
Both patients with localized and metastatic sRCC have very poor survival outcomes.
Pathological features MVI, PSF and necrosis are important predictors of survival and could be used in a prognostic model while grade and histology do not influence prognosis.
A prognostic model, if validated, could aid in patient counselling and/or clinical trial design.