bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dilating the vagina to prevent damage from radiotherapy: systematic review of the literature
Authors: Johnson N , Miles TP , Cornes P 
Published: February 2010

Please cite this paper as: Johnson N, Miles T, Cornes P. Dilating the vagina to prevent damage from radiotherapy: systematic review of the literature. BJOG 2010;117:522–531.Background  UK guidelines recommend routine vaginal dilation during and after pelvic radiotherapy to prevent stenosis.Objective  To examine critically the evidence behind this guideline.Search strategy  Cochrane‐style systematic review of the data and literature relevant to vaginal dilation and stenosis attributable to radiotherapy.Selection criteria  Any and every measure of vaginal or sexual function after radiotherapy.Data collection and analysis  Numerous papers gave recommendations on dilation during or immediately after radiotherapy, but only seven contained relevant data. Case reports describe vaginal fistulas or psychological morbidity. Two trials showed that encouraging dilation increased compliance, but the first trial found no difference in sexual function scores. One comparative unmatched trial showed no advantage from inserting mitomycin C. A report of five women implied that stenosis can be treated by dilation many years after radiotherapy. One uncontrolled observational report involving 89 women showed that the median vaginal length 6–10 weeks after therapy was measured at 6 cm, but women tolerated a 9‐cm measurer after 4 months of dilation experience. One retrospective report implied that dilation lowered stenosis rates, but the control group is not comparable.Main results  Dilation during or immediately after radiotherapy can cause damage, and there is no evidence that it prevents stenosis. Dilation might stretch the vagina if commenced after the inflammatory phase.Author’s conclusions  Dilation might help treat the late effects of radiotherapy, but it must not be assumed that this applies to the acute toxicity phase. Routine dilation during treatment is not supported by good evidence.
Characteristics and Outcomes of Injured Older Adults After Hospital Admission
Authors: Aitken Leanne M. , Burmeister Elizabeth , Lang Jacelle , Chaboyer Wendy , Richmond Therese S. 
Published: February 2010

OBJECTIVES: To describe the seriously injured adult population aged 65 and older; compare the differences in injury characteristics and outcomes in three subgroups aged 65 to 74, 75 to 84, and 85 and older; and identify predictors of death, complications, and hospital discharge destination.DESIGN: Retrospective secondary analysis of data from the Queensland Trauma Registry (QTR) using all patients aged 65 and older admitted from 2003 through 2006.SETTING: Data from 15 regional and tertiary hospitals throughout Queensland, Australia.PARTICIPANTS: Six thousand sixty‐nine patients: 2,291 (37.7%) aged 65 to 74, 2,265 (37.3%) aged 75 to 84, and 1,513 (24.9%) aged 85 and older.MEASUREMENTS: Outcome variables included mortality, complications, and discharge destination (usual residence, rehabilitation, nursing home, convalescence). Predictive factors incorporated demographic details, injury characteristics, and acute care factors.RESULTS: Hospital survival was 95.0%, with a median length of hospital stay of 8 days (interquartile range 5–15), and 33.8% of cases with a major injury developed a complication. Predictors of death included older age, male sex, admission to the intensive care unit (ICU), greater Injury Severity Score (ISS), injury caused by a fall, and two or more injuries; those who had surgery were less likely to die. Predictors of complications included ICU admission, older age, longer hospital stay, and two or more injuries. Predictors of discharge to a nursing home included older age, greater ISS, longer hospital stay, and injury caused by a fall, among others.CONCLUSION: Older adults with severe injuries are at risk of poor outcomes. These findings suggest opportunities for improving geriatric trauma care that could lead to better outcomes.
Oncologist’s/haematologist’s view on the roles of pathologists for molecular targeted cancer therapy
Authors: Keller Ulrich , Von Bubnoff Nikolas , Peschel Christian , Duyster Justus 
Published: February 2010

AbstractIntroductionTechniques used for diagnosis and monitoring of malignant diseases treated with targeted therapiesChronic myelogenous leukaemia: the poster child of targeted therapyTreating cancer with EGFR targeting therapyDiagnostic use of gene expression analysis: carcinoma of unknown primaryPrognostic relevance of gene expression analysis: diffuse large B‐cell lymphomaThe role of biomarker analysis within clinical trials – involvement of pathologistsSummaryIn the past two decades there has been a tremendous increase in the understanding of the molecular basis of human malignancies. In a variety of neoplasms, specific molecular markers became part of disease classifications and are now routinely used to define specific entities. Molecular analyses discriminate prognostic groups, guide differential treatment strategies and identify targets for molecular defined cancer therapy. A battery of new drugs has been developed to specifically inhibit oncogenic pathways. For an increasing number of solid and haematological malignancies, the availability of molecular targeted drugs has fundamentally changed treatment algorithms. However, the diagnostic, prognostic and therapeutic impact of selected molecular markers is still limited in many cases. After all, the success of a molecular targeted therapy is clearly determined by the significance of the targeted structure for the biology of cancer and the ability of the malignant cell to evade specific inhibition.
Detection of new respiratory viruses in hospitalized infants with bronchiolitis: a three‐year prospective study
Authors: Calvo C , Pozo F , García‐García ML , Sanchez M , Lopez‐Valero M , Pérez‐Breña P , Casas I 
Published: February 2010

AbstractAim:  We have designed a study with the objective of describing the clinical impact of other viruses different from the respiratory syncytial virus (RSV) in hospitalized infants with bronchiolitis.Methods:  A 3 year prospective study was conducted on infants admitted to the Paediatrics Department of the Severo Ochoa Hospital (Spain). We studied the frequency of 16 respiratory viruses. Clinical characteristics of RSV‐only infections were compared with other single agent viral infections.Results:  Positive results were confirmed in 275 (86.5%) of the 318 children studied. A single virus was detected in 196 patients and 79 were dual or multiple viral infections. RSV was detected in 61.3% of total bronchiolitis. Rhinovirus (RV) was 17.4% of the identified virus, followed by human bocavirus (HBoV), adenovirus and metapneumovirus (hMPV). Only RV, HBoV and hMPV were significant as single infections. RSV patients were younger than HBoV (p > 0.0001) and hMPV (p = 0.025). Seasonality was clearly different between them. Children with RSV infection needed treatment in the intensive care unit more frequently than others.Conclusions:  In hospitalized infants, RSV was the most frequent agent in bronchiolitis in winter, but other viruses were present in 47% of the patients. RV, HBoV and hMPV had a significant proportion of single infections. Clinical characteristics were similar amongst them, but seasonality was clearly different.
Intra- to Multidecadal Variations of Snowpack and Streamflow Records in the Andes of Chile and Argentina between 30° and 37°S
Authors: Masiokas Mariano H. , Villalba Ricardo , Luckman Brian H. , Mauget Steven 
Published: February 2010

Abstract
In a recent study the authors developed the first regionally averaged, transnational records of snowpack and streamflow for the Andes between 30° and 37°S using Chilean and Argentinean data. That study was mainly intended to evaluate the relationships between the interannual variations in the regional snowpack record and large-scale atmospheric variables and indices. Here the focus is on the main intra- to multidecadal variations in updated records of winter snowpack and mean annual river flows. River discharges show similar temporal variations on both sides of the Andes with extreme dry conditions concentrated between the mid-1940s and 1976/77 and extreme wet conditions peaking between the late 1970s and the 1980s. A regional streamflow composite (1906–2007) has a nonsignificant negative trend but significant regime shifts in 1945, when mean levels dropped 31%, and in 1977 when they increased 28%. These events coincide almost exactly with well-known shifts in the Pacific decadal oscillation (PDO). The analyses are preliminary but suggest a PDO influence on the low-frequency modes of hydroclimatic variability in the study area. Analyses of the magnitude of 5–20-yr moving windows in the regional streamflow composite indicate that the most significant concentration of high (low) discharges occurred between 1977 and 1987 (1954 and 1971). Snowpack series show a more heterogeneous pattern of variations on a local basis but when aggregated into a regional series (1951–2008) they share remarkable similarities with river flows. However, the snowpack composite has a stronger year-to-year variability, a slight positive trend, and no significant regime shifts.
Randomized control of extracorporeal shock wave therapy versus placebo for chronic decubitus ulceration
Authors: Larking Anna M , Duport Sophie , Clinton Michael , Hardy Mary , Andrews Keith 
Published: February 2010

Objective: To assess whether extracorporeal shock wave therapy increases the rate of healing in chronic decubitus ulceration. Design: Double-blind randomized cross-over study. Setting: A large, long-stay hospital specializing in the management of people with complex neurological disabilities. Subjects: The total population of available patients with chronic neurological conditions and chronic decubitus ulceration who met the inclusion criteria. Interventions: Ulcers were randomized into receiving either the extracorporeal shock wave therapy or the placebo for a four-week period, followed by a two-week ‘washout’ period followed by a four-week period of the cross-over treatment/ placebo. Main measures: Measurement of the area of the ulceration. For each observation the average of three measurements were taken. Results: Nine ulcers (in eight patients) were included in the study: five on the buttocks/sacrum/trochanter and four on the feet/ankles. All those with static chronic ulcers showed improved healing starting 6—8 weeks after the start of extracorporeal shock wave therapy, whether treated first with the placebo or the therapy. Conclusions: Extracorporeal shock wave therapy has a potential part to play in the treatment of chronic skin ulceration.
Comparison of two accelerated clinical pathways - after total knee replacement how fast can we really go?
Authors: Renkawitz T. , Rieder T. , Handel M. , Koller M. , Drescher J. , Bonnlaender G. , Grifka J. 
Published: February 2010

Objective: To evaluate whether a further optimization of an existing accelerated clinical pathway protocol after total knee replacement is feasible and improves postoperative outcome. Design: Prospective, parallel group design. Setting: Orthopaedic University Medical Centre. Patients: A total of 143 patients, scheduled for unilateral primary total knee replacement under perioperative regional analgesia. Intervention: Sixty-seven patients received an optimized accelerated clinical pathway including patient-controlled regional analgesia pumps, ultra-early/doubled physiotherapy and motor-driven continuous passive motion machine units. Seventy-six patients received a standard accelerated clinical pathway. Main measures: Feasibility was defined as the proportion of patients successfully completing the assigned pathway. Early postoperative pain on a visual analogue scale, consumption of regional anaesthetics, knee range of motion, time out of bed, non-stop walking distance/stair climbing, circumference measurement and Knee Society Score on the operated leg. Possible discharge according to an own discharge checklist. Results: All patients assigned to both groups successfully completed this pathway. Patients in the optimized pathway showed significant benefits regarding stair climbing/walking distance/time out of bed/circumference measurements of the thigh/Knee Society function score on the fifth postoperative day and stair climbing/ circumference measurements of the thigh on the eighth postoperative day, and reduction of the consumption of regional anaesthetics. No significant reduction in length of stay was observed. Conclusions: Early postoperative functional process indicators tended to be higher within the optimized pathway group, but the main effects flattened over the course of the first eight postoperative days.
The Factorial Mirror (FAM) Concept of Small and Medium-sized Enterprises (SMEs) and the Firm Impact Sphere (FIP)
Authors: Abouzeedan Adli 
Published: February 2010

E-globalization is a terminology of high significance when focusing on smaller firm mechanisms of survival and growth in the new IT-based economy. One of the new approaches to understanding the interaction between the firms’ activities and their environments is the concept of the ‘Firm Impact Sphere’. The ‘Firm Impact Sphere’ (or FIP) concept was initially proposed by Abouzeedan and Busler (2002a, 2006a). The FIP concept facilitates better perception of the business environment of today. In relation to that, it is worth recalling that scholars made an effort to categorize a firm’s performance factors related to internal environments versus the ones related to the external environment of the firm, by arranging the various factors of impact into individual groups, such as the SPF classification system (see Abouzeedan 2002). In that paper, the equivalency between the sub-groups within the SPF-classification system was established. That work was developed further by a later paper by Abouzeedan (2003), where the author discussed how to relate equivalent groups of parameters. To do this, he introduced the concept of the mirror effect using the ‘Factorial Mirror’ concept (see Abouzeedan 2003). In this article, I try to illustrate how the ‘Factorial Mirror’ (or FAM) concept can be utilized to understand the relationship between the external and internal parameters incorporated in the firm performance models and relate that concept to the Firm Impact Sphere (FIP) framework of analysis. I then proceed to connect that analysis to bridging tactics and alliances’ formation. In the context of this discussion, I introduce the BFF Triangle as an abstract presentation to the said. By understanding how manipulating parameters of the external environment would alter the internal environment of the firm, scholars should be able to build a better perception of the dynamism behind the ability of firm bridging tactics to transfer themselves into workable alliances.
Safeguarding children and public health: Midwives’ responsibilities
Authors: Lazenbatt Anne 
Published: February 2010

Aim: Using a healthy settings framework, this study aims to compare and contrast how midwives working in either hospital or community settings are currently responding to the co-occurrence of domestic and child abuse; their perceived role and willingness to identify abuse; record keeping; reporting of suspected or definite cases of child abuse; and training received. Methods: A survey questionnaire was sent to 861 hospital and community midwives throughout Northern Ireland, which resulted in 488 midwives completing the questionnaire, a 57% response rate. Comparisons were made using descriptive statistics and cross-tabulation and the questionnaire was validated using exploratory factor analysis. Results: Community midwives reported receiving more training on domestic and child abuse. Although a high percentage of both hospital and community midwives acknowledged a link between domestic and child abuse, it was the community midwives who encountered more suspected and definite ( p < 0.001) cases of child abuse. More community midwives reported being aware of the mechanisms for reporting child abuse. However, an important finding is that although 12% of community midwives encountered a ‘definite’ case of child abuse, only 2% reported the abuse, leaving a 10% gap between reporting and identifying definite cases of child abuse. Findings suggest that lack of education and training was a problem as only a quarter of hospital midwives reported to have received training on domestic violence and 40% on child abuse. This was significantly less than that received by community midwives, where the figures were 57% and 62%, respectively. Conclusion: Midwives need training on how to interact with abused mothers using non-coercive, supportive and empowering mechanisms. Many women may not spontaneously disclose the issues of child or domestic abuse in their lives, but often respond honestly to a sensitively asked question. This issue is important as only 13% of the sample actually asked a woman a direct question about domestic violence.
The genetic diversity and evolution of field pea (Pisum) studied by high throughput retrotransposon based insertion polymorphism (RBIP) marker analysis
Authors: Jing Runchun , Vershinin Alexander , Grzebyta Jacek , Shaw Paul , Smýkal Petr , Marshall David , Ambrose Michael J , Ellis TH Noel , Flavell Andrew J 
Published: February 2010

Abstract

Background
The genetic diversity of crop species is the result of natural selection on the wild progenitor and human intervention by ancient and modern farmers and breeders. The genomes of modern cultivars, old cultivated landraces, ecotypes and wild relatives reflect the effects of these forces and provide insights into germplasm structural diversity, the geographical dimension to species diversity and the process of domestication of wild organisms. This issue is also of great practical importance for crop improvement because wild germplasm represents a rich potential source of useful under-exploited alleles or allele combinations. The aim of the present study was to analyse a major Pisum germplasm collection to gain a broad understanding of the diversity and evolution of Pisum and provide a new rational framework for designing germplasm core collections of the genus.

Results
3020 Pisum germplasm samples from the John Innes Pisum germplasm collection were genotyped for 45 retrotransposon based insertion polymorphism (RBIP) markers by the Tagged Array Marker (TAM) method. The data set was stored in a purpose-built Germinate relational database and analysed by both principal coordinate analysis and a nested application of the Structure program which yielded substantially similar but complementary views of the diversity of the genus Pisum. Structure revealed three Groups (1-3) corresponding approximately to landrace, cultivar and wild Pisum respectively, which were resolved by nested Structure analysis into 14 Sub-Groups, many of which correlate with taxonomic sub-divisions of Pisum, domestication related phenotypic traits and/or restricted geographical locations. Genetic distances calculated between these Sub-Groups are broadly supported by principal coordinate analysis and these, together with the trait and geographical data, were used to infer a detailed model for the domestication of Pisum.

Conclusions
These data provide a clear picture of the major distinct gene pools into which the genus Pisum is partitioned and their geographical distribution. The data strongly support the model of independent domestications for P. sativum ssp abyssinicum and P. sativum. The relationships between these two cultivated germplasms and the various sub-divisions of wild Pisum have been clarified and the most likely ancestral wild gene pools for domesticated P. sativum identified. Lastly, this study provides a framework for defining global Pisum germplasm which will be useful for designing core collections.
Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients
Authors: Kilmartin Timothy E , O'Kane Claire 
Published: February 2010

AbstractBackgroundThe Cochrane review of hallux valgus surgery has disputed the scientific validity of hallux valgus research. Scoring systems and surrogate measures such as x‐ray angles are commonly reported at just one year post operatively but these are of dubious relevance to the patient. In this study we extended the follow up to a minimum of 8 years and sought to address patient specific concerns with hallux valgus surgery. The long term follow up also allowed a comprehensive review of the complications associated with the combined rotation scarf and Akin osteotomies.MethodsBetween 1996 and 1999, 101 patients underwent rotation scarf and Akin osteotomies for the treatment of hallux valgus. All patients were contacted and asked to participate in this study. 50 female participants were available allowing review of 73 procedures. The average follow up was over 9 years and the average age at the time of surgery was 57. The participants were physically examined and interviewed.ResultsPost‐operatively, in 86% of the participants there were no footwear restrictions. Stiffness of the first metatarsophalangeal joint was reported in 8% (6 feet); 10% were unhappy with the cosmetic appearance of their feet, 3 feet had hallux varus, and 2 feet had recurrent hallux valgus. There were no foot‐related activity restrictions in 92% of the group. Metatarsalgia occurred in 4% (3 feet). 96% were better than before surgery and 88% were completely satisfied with their post‐operative result. Hallux varus was the greatest single cause of dissatisfaction. The most common adverse event in the study was internal fixation irritation. Hallux valgus surgery is not without risk and these findings could be useful in the informed consent process.ConclusionsWhen combined the rotation scarf and Akin osteotomies are an effective treatment for hallux valgus that achieves good long‐term correction with a low incidence of recurrence, footwear restriction or metatarsalgia. The nature of the osteotomies allows early return to normal shoes and activity without the need for postoperative immobilisation in a plaster cast.
Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: a randomized, controlled trial
Authors: Mayer Jochen , Boldt Joachim , Mengistu Andinet M , Röhm Kerstin D , Suttner Stefan 
Published: February 2010

Abstract
Introduction
Several studies have shown that goal-directed hemodynamic and fluid optimization may result in improved outcome. However, the methods used were either invasive or had other limitations. The aim of this study was to perform intraoperative goal-directed therapy with a minimally invasive, easy to use device (FloTrac/Vigileo), and to evaluate possible improvements in patient outcome determined by the duration of hospital stay and the incidence of complications compared to a standard management protocol.

Methods
In this randomized, controlled trial 60 high-risk patients scheduled for major abdominal surgery were included. Patients were allocated into either an enhanced hemodynamic monitoring group using a cardiac index based intraoperative optimization protocol (FloTrac/Vigileo device, GDT-group, n = 30) or a standard management group (Control-group, n = 30), based on standard monitoring data.

Results
The median duration of hospital stay was significantly reduced in the GDT-group with 15 (12 - 17.75) days versus 19 (14 - 23.5) days (P = 0.006) and fewer patients developed complications than in the Control-group [6 patients (20%) versus 15 patients (50%), P = 0.03]. The total number of complications was reduced in the GDT-group (17 versus 49 complications, P = 0.001).

Conclusions
In high-risk patients undergoing major abdominal surgery, implementation of an intraoperative goal-directed hemodynamic optimization protocol using the FloTrac/Vigileo device was associated with a reduced length of hospital stay and a lower incidence of complications compared to a standard management protocol.

Trial Registration
Clinical trial registration information: Unique identifier: NCT00549419