bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Urban‐Rural Disparity in Nursing Home Quality Indicators: The Case of Facility‐Acquired Contractures
Authors: Bowblis John R. , Meng Hongdao , Hyer Kathryn 
Published: June 2012

ObjectiveTo identify and quantify the sources of the urban‐rural disparity in facility‐acquired contracture rates in nursing homes.Data SourcesSurvey inspection data of U.S. nursing homes from 1999 to 2008 and standardized national rural definition file from the Rural‐Urban Commuting Area Codes.Study DesignWe estimated regressions of facility‐level contracture rate as a function of urban‐rural categories (urban, micropolitan, small rural town, and isolated small rural town) and other related facility characteristics to identify size of the urban‐rural disparity. We used Blinder–Oaxaca decomposition techniques to determine the extent to which the disparity is attributable to the differences in facility and aggregate resident characteristics.Principal FindingsRural nursing homes have higher contracture rates than urban nursing homes. About half of the urban‐rural disparity is explained by differences in observable characteristics among urban and rural nursing homes. Differences in staffing levels explain less than 5 percent of the disparity, case‐mix explains 6–8 percent, and structure and operational characteristics account for 10–22 percent of the disparity.ConclusionWhile a lower level and quality of staffing are a concern for rural nursing homes, facility structure and funding sources explain a larger proportion of the urban‐rural disparity in the quality of care.
The Cost of an Additional Disability‐Free Life Year for Older Americans: 1992–2005
Authors: Cai Liming 
Published: June 2012

ObjectiveTo estimate the cost of an additional disability‐free life year for older Americans in 1992–2005.Data SourceThis study used 1992–2005 Medicare Current Beneficiary Survey, a longitudinal survey of Medicare beneficiaries with a rotating panel design.Study DesignThis analysis used multistate life table model to estimate probabilities of transition among a discrete set of health states (nondisabled, disabled, and dead) for two panels of older Americans in 1992 and 2002. Health spending incurred between annual health interviews was estimated by a generalized linear mixed model. Health status, including death, was simulated for each member of the panel using these transition probabilities; the associated health spending was cross‐walked to the simulated health changes.Principal FindingsDisability‐free life expectancy (DFLE) increased significantly more than life expectancy during the study period. Assuming that 50 percent of the gains in DFLE between 1992 and 2005 were attributable to increases in spending, the average discounted cost per additional disability‐free life year was $71,000. There were small differences between gender and racial/ethnic groups.ConclusionsThe cost of an additional disability‐free life year was substantially below previous estimates based on mortality trends alone.
RECOVERevidence and knowledge gap analysis on veterinaryCPR. Part 2: Preparedness and prevention
Authors: McMichael Maureen , Herring Jennifer , Fletcher Daniel J. , Boller Manuel ,   the RECOVER Preparedness and Prevention Domain Worksheet Authors
Published: June 2012

AbstractObjectiveTo systematically examine the evidence on the effect of prevention and preparedness measures on outcomes in veterinary cardiopulmonary resuscitation and to determine knowledge gaps.DesignStandardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Relevant questions were answered on a worksheet template and reviewed by theReassessmentCampaign onVeterinaryResuscitation (RECOVER) prevention and preparedness domain members, by theRECOVERcommittee, and opened for comments by veterinary professionals for 3 months.SettingAcademia, referral practice, and general practice.ResultsNine worksheets were prepared to determine the extent to which preparation of the environment (charts, visual aids, etc) and personnel (training, debriefing, etc) are beneficial in improving return of spontaneous circulation.ConclusionsOf the questions evaluated, only the association between anesthesia‐related cardiopulmonary arrest and better outcomes was supported by strong evidence. There is some evidence from the human literature that the use of cognitive aids, standardized didactic, and hands‐on training with high‐fidelity simulators, team and leadership training, and post‐cardiac arrest debriefing improve adherence to cardiopulmonary resuscitation guidelines and, in some cases, patient outcomes. Veterinary studies investigating these issues are lacking, and development of initial guidelines is a crucial first step.
RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support
Authors: Rozanski Elizabeth A. , Rush John E. , Buckley Gareth J. , Fletcher Daniel J. , Boller Manuel ,   the RECOVER Advanced Life Support Domain Worksheet Authors
Published: June 2012

AbstractObjectiveTo systematically evaluate the evidence of the effect of advanced life support techniques on outcome in veterinary cardiopulmonary resuscitation (CPR) and to outline knowledge gaps.DesignStandardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice.SettingAcademia, referral practice, and general practiceResultsSixteen population, intervention, control group, outcome questions were evaluated to determine if recommendations could be made concerning drug therapy, including vasopressors, vagolytics, corticosteroids, reversal agents, buffer therapy, and correction of electrolyte disturbances. Electrical defibrillation strategies as well as other advanced interventions such as open‐chest CPR, impedance threshold devices, and special considerations regarding anesthesia‐related cardiopulmonary arrest (CPA) were also investigated.ConclusionsThere is strong evidence supporting the use of standard‐dose (0.01 mg/kg) epinephrine in CPR, as well as early electrical defibrillation for animals experiencing CPA due to ventricular fibrillation or pulseless ventricular tachycardia, preferentially using a biphasic defibrillator. For CPA due to certain causes and with the availability of advanced postcardiac arrest support, open chest CPR is preferred. Many knowledge gaps regarding other pharmacologic and advanced therapies were identified, and further studies are recommended to better systematically address these questions.
RECOVERevidence and knowledge gap analysis on veterinaryCPR. Part 1: Evidence analysis and consensus process: collaborative path toward small animalCPRguidelines
Authors: Boller Manuel , Fletcher Daniel J. 
Published: June 2012

AbstractObjectiveTo describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to evaluate the scientific evidence relevant to small animalCPRand to compose consensus‐based clinicalCPRguidelines for dogs and cats.DesignThis report is part of a series of 7 articles on theRECOVERevidence and knowledge gap analysis and consensus‐based small animalCPRguidelines. It describes the organizational structure ofRECOVER, the evaluation process employed, consisting of standardized literature searches, the analysis of relevant articles according to study design, species and predefined quality markers, and the drafting of clinicalCPRguidelines based on these data. Therefore, this article serves as the methodology section for the subsequent 6RECOVERarticles.SettingAcademia, referral practice.ResultsRECOVERis a collaborative initiative that systematically evaluated the evidence on 74 topics relevant to small animalCPRand generated 101 clinicalCPRguidelines from this analysis. All primary contributors were veterinary specialists, approximately evenly split between academic institutions and private referral practices. The evidence evaluation and guideline drafting processes were conducted according to a predefined sequence of steps designed to reduce bias and increase the repeatability of the findings, including multiple levels of review, culminating in a consensus process. Many knowledge gaps were identified that will allow prioritization of research efforts in veterinaryCPR.ConclusionsCollaborative systematic evidence review is organizationally challenging but feasible and effective in veterinary medicine. More experience is needed to refine the process.
TNF‐α neutralization improves experimental hepatopulmonary syndrome in rats
Authors: Liu Li , Liu Nan , Zhao Zhi , Liu Jiabao , Feng Yingmei , Jiang Huiqing , Han Delan 
Published: June 2012

Background/AimTNF‐α is increased in hepatopulmonary syndrome (HPS). Pentoxifylline (PTX) mitigated experimental HPS through the inhibition of TNF‐α. However, PTX has pleiotropic effects besides the inhibition of TNF‐α. This study is to neutralize TNF‐α with specific monoclonal antibody to TNF‐α (TNF‐α McAb) to investigate the effect of TNF‐α on HPS.Materials and methodsHepatopulmonary syndrome was induced by common bile duct ligation (CBDL); controls were sham operated. The endpoints were 1, 2, 3, 4 and 5 weeks after surgery. 99mTechnetium‐macroaggregated albumin (Tc‐MAA) was to evaluate intrapulmonary arteriovenous shunts; Portal venous pressure, cardiac output and mean blood pressure (MAP) were also measured. Serum was for Alanine transaminase (ALT), endotoxin, TNF‐α and nitric oxide (NO) measurements, liver for histology, lung for histology and iNOS, PI3K/Akt expression assay.ResultsPortal vein pressure was significantly elevated and MAP decreased in CBDL rats. Tc‐MAA was mainly located in lung and very weak in brain in sham group and mainly in brain of CBDL rats. TNF‐α McAb significantly decreased the radioactivity in the brain, reduced cardiac output, increased MAP and systemic vascular resistance (SVR) in CBDL animals. Serum ALT, endotoxin, TNF‐α and NO were significantly increased. TNF‐α McAb significantly decreased these serum indices in CBDL rats. TNF‐α McAb significantly alleviated liver damage, decreased alveolar‐arterial gradient and inhibited iNOS, PI3K/Akt and p‐Akt expression in lung tissue. Furthermore, TNF‐α McAb significantly attenuated the inflammatory response in lung.ConclusionTNF‐α McAb improves HPS in cirrhotic rats; this effect is likely mediated through the inhibition of TNF‐α PI3K/Akt‐NO pathway.
The use of a rigid disc to protect exposed structures in wounds treated with negative pressure wound therapy: Effects on wound bed pressure and microvascular blood flow
Authors: Anesäter Erik , Borgquist Ola , Torbrand Christian , Roupé K. Markus , Ingemansson Richard , Lindstedt Sandra , Malmsjö Malin 
Published: June 2012

AbstractThere are increasing reports of deaths and serious complications associated with the use of negative pressure wound therapy (NPWT). Bleeding may occur in patients when NPWT is applied to a wound with exposed blood vessels or vascular grafts, possibly due to mechanical deformation and hypoperfusion of the vessel walls. Recent evidence suggests that using a rigid barrier disc to protect underlying tissue can prevent this mechanical deformation. The aim of this study was to examine the effect of rigid discs on the tissue exposed to negative pressure with regard to tissue pressure and microvascular blood flow. Peripheral wounds were created on the backs of eight pigs. The pressure and microvascular blood flow in the wound bed were measured when NPWT was applied. The wound was filled with foam, and rigid discs of different designs were inserted between the wound bed and the foam. The discs were created with or without channels (to accommodate exposed sensitive structures such as blood vessels and nerves), perforations, or a porous dressing that covered the underside of the discs (to facilitate pressure transduction and fluid evacuation). When comparing the results for pressure transduction to the wound bed, no significant differences were found using different discs covered with dressing, whereas pressure transduction was lower with bare discs. Microvascular blood flow in the wound bed decreased by 49 ± 7% when NPWT was applied to control wounds. The reduction in blood flow was less in the presence of a protective disc (e.g., −6 ± 5% for a dressing‐covered, perforated disc, p = 0.006). In conclusion, NPWT causes hypoperfusion of superficial tissue in the wound bed. The insertion of a rigid barrier counteracts this effect. The placement of a rigid disc over exposed blood vessels or nerves may protect these structures from rupture and damage.
Assessment of replication rates of human keratinocytes in engineered skin substitutes grafted to athymic mice
Authors: Boyce Steven T. , Rice Rachel K. , Lynch Kaari A. , Supp Andrew P. , Swope Viki B. , Kagan Richard J. , Supp Dorothy M. 
Published: June 2012

AbstractStable closure of skin wounds with engineered skin substitutes (ESS) requires indefinite mitotic capacity to generate the epidermis. To evaluate whether keratinocytes in ESS exhibit the stem cell phenotype of label retention, ESS (n = 6–9/group) were pulsed with 5‐bromo‐2'‐deoxyuridine (BrdU) in vitro, and after grafting to athymic mice (n = 3–6/group). Pulse and immediate chase in vitro labeled virtually all basal keratinocytes at day 8, with label uptake decreasing until day 22. Label retention in serial chase decreased more rapidly from day 8 to day 22, with a reorganization of BrdU‐positive cells into clusters. Similarly, serial chase of labeled basal keratinocytes in vivo decreased sharply from day 20 to day 48 after grafting. Label uptake was assessed by immediate chases of basal keratinocytes, and decreased gradually to day 126, while total labeled cells remained relatively unchanged. These results demonstrate differential rates of label uptake and retention in basal keratinocytes of ESS in vitro and in vivo, and a proliferative phenotype with potential for long‐term replication in the absence of hair follicles. Regulation of a proliferative phenotype in keratinocytes of ESS may improve the biological homology of tissue‐engineered skin to natural skin, and contribute to more rapid and stable wound healing.
Increasing the presence of biofilm and healing delay in a porcine model of MRSA‐infected wounds
Authors: Roche Eric D. , Renick Paul J. , Tetens Shannon P. , Ramsay Sarah J. , Daniels Egeenee Q. , Carson Dennis L. 
Published: June 2012

AbstractData supporting the concept that microbial biofilms are a major cause of non‐healing ulcers remain limited. A porcine model was established where delayed healing resulted from methicillin‐resistant Staphylococcus aureus (MRSA) infection in full‐thickness wounds. At the end of one study a wound remaining open was sampled and a MRSA strain was isolated. This pig‐passaged strain was used as the inoculating strain in several subsequent studies. The resulting MRSA wound infections exhibited a greater, more stable tissue bioburden than seen in studies using the parent strain. Furthermore, wounds infected with the passaged strain experienced a greater delay in healing. To understand whether these changes corresponded to an increased biofilm character of the wound infection, wound biopsy samples from studies using either the parent or passaged MRSA strains were examined microscopically. Evidence of biofilm was observed for both strains, as most samples at a minimum had multiple isolated, dense microcolonies of bacteria. However, the passaged MRSA resulted in bacterial colonies of greater frequency and size that occurred more often in concatenated fashion to generate extended sections of biofilm. These results provide a model case in which increasing biofilm character of a wound infection corresponded with a greater delay in wound healing.
Absence of P300 Reduction in South African Treatment‐Naïve Adolescents with Alcohol Dependence
Authors: Cuzen Natalie L. , Andrew Colin , Thomas Kevin G. F. , Stein Dan J. , Fein George 
Published: June 2012

BackgroundEvent‐related potential studies show reduced P300 amplitudes in alcohol use disorders (AUDs). Alcohol exposure, genetic vulnerability to alcoholism, and comorbid psychopathology may contribute to this reduction. Most previous research has studied treated adult AUD samples, which have more severe alcoholism, a greater family history of AUDs, and more comorbidity than untreated samples. Untreated AUD samples tend to have little or no P300 amplitude reduction. We compared P300 between treatment‐naïve alcohol‐dependent (TNAD) adolescents with no diagnosable substance abuse or psychiatric comorbidity and nonsubstance‐abusing control (NSAC) adolescents.MethodsIndividuals between the ages of 13 and 18 years were recruited into either TNAD (n = 45) or NSAC (n = 64) groups. Alcohol use variables, family history density of alcohol problems, and psychiatric symptom counts were assessed in a clinician‐administered evaluation. EEGs were recorded during performance of a 3‐condition visual target detection task.ResultsP300 amplitudes were of comparable size in TNAD adolescents and NSAC adolescents. Boys demonstrated larger P3a and P3b amplitudes than girls. Within TNAD, P3b amplitude was reduced in those who drank more frequently, and P3a latency was more prolonged in subjects with higher internalizing symptom counts.ConclusionsThe P300 deficit was not present in TNAD adolescents without comorbidities. In comparison to results of reduced P300 in treated adolescent AUD samples, this finding likely reflects moderate alcohol exposure, lower genetic vulnerability to alcoholism, and lack of comorbidity in our sample. Further work is needed to determine the relative contributions of these factors to changes in the P300.
International Comparison and Suggestions for Capacity Development in Industrializing Countries
Authors: Aoki‐Suzuki Chika , Bengtsson Magnus , Hotta Yasuhiko 
Published: June 2012

SummaryThe global consumption of natural resources is soaring, especially in rapidly industrializing economies. This increasing demand is depleting resource stocks and is a major driver of other environmental problems, including climate change and waste. With rising prices and growing concerns about resource access, these trends are increasingly attracting policy makers’ attention. Some developed countries have devised indicator systems, based on economy‐wide material flow analysis/accounting (EW‐MFA), to monitor resource consumption. This article consists of two separate but related parts: (1) a study of how EW‐MFA indicators are used in a number of developed countries, including analysis of the commonalities between countries that are actively using these indicators in policy, and (2) a survey of the current capacity for EW‐MFA in developing countries, including data availability and policy uptake. This study found that countries in which policy makers show a great interest in EW‐MFA indicators are characterized by large resource imports and large net export of manufactured goods. Many rapidly industrializing countries demonstrate similar characteristics. The study of developing countries found that many of the data for EW‐MFA exist, but collection is fragmented and access is limited. This article recommends that capacity development of EW‐MFA in rapidly industrializing economies should first coordinate a national focal point and then raise awareness among government officials, strengthen institutions collecting EW‐MFA data, and train researchers and experts in EW‐MFA techniques and effective policy interaction.
A randomized controlled trial evaluating recovery and survival of 6% dimethyl sulfoxide–frozen autologous platelets in healthy volunteers
Authors: Dumont Larry J. , Cancelas Jose A. , Dumont Deborah F. , Siegel Alan H. , Szczepiorkowski Zbigniew M. , Rugg Neeta , Pratt P. Gayle , Worsham D. Nicole , Hartman Elizabeth L. , Dunn Susan K. , O'Leary Margaret , Ransom Janet H. , Michael Rodney A. , Macdonald Victor W. 
Published: June 2012

BACKGROUND: Availability of platelets (PLTs) is severely limited by shelf life in some settings. Our objective was to determine and compare to Food and Drug Administration (FDA) criteria the PLT recovery and survival of autologous PLTs cryopreserved at −65°C or less in 6% dimethyl sulfoxide (DMSO) reconstituted with a no‐wash method (cryopreserved PLTs [CPPs]) compared to autologous fresh PLTs.STUDY DESIGN AND METHODS: This was a randomized, Phase I study analyzing PLT viability and in vitro function in consenting healthy subjects. Apheresis PLTs (APs) were collected in plasma. APs were suspended in 6% DMSO, concentrated, and placed at not more than −65°C for 7 to 13 days. Frozen CPPs were thawed at 37°C and resuspended into 25 mL of 0.9% NaCl. Control PLTs (fresh autologous) and CPPs were labeled with 111In or 51Cr, and recovery and survival after reinfusion were determined using standard methods. A panel of in vitro assays was completed on APs and CPPs.RESULTS: After frozen storage, CPPs retained 82% of AP yield and showed increased PLT associated P‐selectin and reduced responses to agonists. CPP 24‐hour recovery (41.6 ± 9.7%) was lower than for fresh PLTs (68.4 ± 8.2%; p < 0.0001) and did not meet the current FDA criterion. CPPs had diminished survival compared to fresh PLTs (7.0 ± 2.1 days vs. 8.4 ± 1.2 days, respectively; p = 0.018), but did meet and exceed the FDA criterion for survival.CONCLUSION: While 24‐hour recovery does not meet FDA criteria for liquid‐stored PLTs, the CPP survival of circulating PLTs was surprisingly high and exceeded the FDA criteria. These data support proceeding with additional studies to evaluate the clinical effectiveness of CPPs.
Two cases of transfusion‐transmitted hepatitis B virus (HBV) infection in a low‐endemic country before implementation of HBV nucleic acid testing
Authors: Servant‐Delmas Annabelle , Chuteau Claude , Lefort Caroline , Piquet Yves , Chevaleyre Sylvie , Betbeze Véronique , Delhoume Martine , Hantz Sébastien , Alain Sophie , Laperche Syria 
Published: June 2012

BACKGROUND: The risk of hepatitis B virus (HBV) transmission by transfusion is higher than that of other blood‐borne viruses. In France, before the introduction of HBV nucleic acid testing (NAT) in 2010, blood donations were tested for hepatitis B surface antigen (HBsAg) and antibodies against hepatitis B core antigen, and the residual risk of HBV transfusion related to preseroconversion acute phase was estimated at 0.54 per million donations. The additional value of the implementation of a highly sensitive HBV NAT to prevent such transmissions is discussed.STUDY DESIGN AND METHODS: Two lookback investigations based on HBV seroconversion of repeat donors were performed. Donors and recipients were followed up in multiple samples that were tested for HBV serologic and molecular markers.RESULTS: The recipients have shown posttransfusion HBsAg seroconversion. The archived samples from the implicated donations were positive for HBV DNA at extremely low viral load in both cases. HBV isolates from donors and recipients of each case were organized in the same cluster with 100% identities into Genotypes A2 and B4, respectively. One recipient spontaneously recovered from infection while the second was successfully treated.CONCLUSION: The present cases highlight the importance of introducing highly sensitive HBV NAT to prevent transmission. Moreover, the lookback studies based on appropriate molecular and serologic investigations of patients transfused with previous donations from newly identified HBV‐infected repeat donors offer the opportunity to treat a recently infected recipient.