bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Fellowship Pay: What Is the Long-term Financial Impact of Subspecialty Training in Pediatrics?
Authors: Rochlin Jonathan M. , Simon Harold K. 
Published: January 2011

OBJECTIVES:
To (1) analyze the financial returns of fellowship training in pediatrics and to compare them with those generated from a career in general pediatrics and (2) evaluate the effects of including the newly enacted federal loan-repayment program and of changing the length of fellowship training.

BACKGROUND:
Although the choice to enter fellowship is based on many factors, economic considerations are important. We are not aware of any study that has focused on the financial impact of fellowship training in pediatrics.

METHODS:
Using standard financial techniques, we estimated the financial returns that a graduating pediatric resident might anticipate from additional fellowship training followed by a career as a pediatric subspecialist and compared them with the returns that might be expected from starting a career as a general pediatrician immediately after residency.

RESULTS:
The financial returns of pediatric fellowship training varied greatly depending on which subspecialty fellowship was chosen. Pursuing a fellowship in most pediatric subspecialties was a negative financial decision when compared with pursuing no fellowship at all and practicing as a general pediatrician. Incorporating the federal loan-repayment program targeted toward pediatric subspecialists and decreasing the length of fellowship training from 3 to 2 years would substantially increase the financial returns of the pediatric subspecialties.

CONCLUSIONS:
Pediatric subspecialization yielded variable financial returns. The results from this study can be helpful to current pediatric residents as they contemplate their career options. In addition, our study may be valuable to policy makers evaluating health care reform and pediatric workforce-allocation issues.
Current Referral Patterns and Means to Improve Accuracy in Diagnosis of Undescended Testis
Authors: Snodgrass Warren , Bush Nicol , Holzer Michael , Zhang Song 
Published: January 2011

OBJECTIVES:The goals were to determine current referral patterns for boys suspected of having undescended testis (UDT) and to identify factors to assist primary care providers in distinguishing retractile testes from UDTs on the basis of history, physical examination, or imaging findings.METHODS:By using a standardized history assessment, visual inspection of the scrotum for symmetry, physical examination, and review of previously obtained imaging findings, we performed a prospective observational study with consecutive patients referred to a pediatric urologist for evaluation of UDT.RESULTS:Of 118 boys, 51 (43%) had descended testes, 60 (51%) had UDTs, and 7 (6%) had initially indeterminate findings. Boys with UDT were referred at a median age of 43.3 months. Patients referred at &lt;1 year or &gt;10 years of age were significantly more likely to have UDT than were those referred at 1 to 10 years of age. History of UDT at birth, prematurity, and scrotal asymmetry strongly increased the risk of UDT. Genital ultrasonography had been performed for 25% of patients, incorrectly indicating UDT for 48%.CONCLUSIONS:Most boys were referred well beyond the recommended age of &lt;12 months for orchiopexy. Only one-half of the patients had UDT, with most errors in diagnosis being made for boys 1 to 10 years of age, which suggests difficulty distinguishing UDT from retractile testis. Positive birth history findings, prematurity, and scrotal asymmetry predicted UDT and can be used by primary care physicians in their assessment before referral. Genital ultrasonography did not distinguish UDTs from retractile testes.
Prospective Assessment of Practice Pattern Variations in the Treatment of Pediatric Gastroenteritis
Authors: Freedman Stephen B. , Gouin Serge , Bhatt Maala , Black Karen J. L. , Johnson David , Guimont Chantal , Joubert Gary , Porter Robert , Doan Quynh , van Wylick Richard , Schuh Suzanne , Atenafu Eshetu , Eltorky Mohamed , Cho Dennis , Plint Amy ,   for Pediatric Emergency Research Canada
Published: January 2011

OBJECTIVES:We aimed to determine whether significant variations in the use of intravenous rehydration existed among institutions, controlling for clinical variables, and to assess variations in the use of ancillary therapeutic and diagnostic modalities.METHODS:We conducted a prospective cohort study of children 3 to 48 months of age who presented to 11 emergency departments with acute gastroenteritis, using surveys, medical record reviews, and telephone follow-up evaluations.RESULTS:A total of 647 eligible children were enrolled and underwent chart review; 69% (446 of 647 children) participated in the survey, and 89% of survey participants (398 of 446 children) had complete follow-up data. Twenty-three percent (149 of 647 children) received intravenous rehydration (range: 6%–66%; P &lt; .001) and 13% (81 of 647 children) received ondansetron (range: 0%–38%; P &lt; .001). Children who received intravenous rehydration had lower Canadian Triage Acuity Scale scores at presentation (3.1 ± 0.5 vs 3.5 ± 0.5; P &lt; .0001). Regression analysis revealed that the greatest predictor of intravenous rehydration was institution location (odds ratio: 3.0 [95% confidence interval: 1.8–5.0]). Children who received intravenous rehydration at the index visit were more likely to have an unscheduled follow-up health care provider visit (29% vs 19%; P = .05) and to revisit an emergency department (20% vs 9%; P = .002).CONCLUSIONS:In this cohort, intravenous rehydration and ondansetron use varied dramatically. Use of intravenous rehydration at the index visit was significantly associated with the institution providing care and was not associated with a reduction in the need for follow-up care.
Low-Dose-Rate Definitive Brachytherapy for High-Grade Vaginal Intraepithelial Neoplasia
Authors: Blanchard Pierre , Monnier Laurie , Dumas Isabelle , Morice Philippe , Pautier Patricia , Duvillard Pierre , Azoury Fares , Mazeron Renaud , Haie-Meder Christine 
Published: January 2011

Abstract

Learning Objectives
After completing this course, the reader will be able to: Utilize data supporting the efficacy of low-dose definitive brachytherapy to inform clinical decisions about treating women with high-grade vaginal intraepithelial neoplasia.Implement methods for delivering low-dose definitive brachytherapy that minimize toxicity.Communicate to patients the type and incidence of toxic events associated with low-dose definitive brachytherapy.
CME This article is available for continuing medical education credit at CME.TheOncologist.com

Background.
Treatment of high-grade vaginal intraepithelial neoplasia (VAIN) is controversial and could include surgical excision, topical medication, brachytherapy, or other treatments. We report the results of low-dose-rate (LDR) vaginal brachytherapy for grade 3 VAIN (VAIN-3) over a 25-year period at Gustave Roussy Institute.

Patients and Methods.
We retrospectively reviewed the files of all patients treated at Gustave Roussy Institute for VAIN-3 since 1985. The treatment consisted of LDR brachytherapy using a personalized vaginal mold and delivered 60 Gy to 5 mm below the vaginal mucosa. All patients had at least an annual gynecological examination, including a vaginal smear.

Results.
Twenty-eight patients were eligible. The median follow-up was 41 months. Seven patients had a follow-up &lt;2 years, and the median follow-up for the remaining 21 patients was 79 months. The median age at brachytherapy was 63 years (range, 38–80 years). Twenty-six patients had a history of VAIN recurring after cervical intraepithelial neoplasia and 24 had a previous hysterectomy. The median brachytherapy duration was 4.5 days. Median doses to the International Commission of Radiation Units and Measurements rectum and bladder points were 68 Gy and 45 Gy, respectively. The median prescription volume (60 Gy) was 74 cm3. Only one “in field” recurrence occurred, corresponding to a 5- and 10-year local control rate of 93% (95% confidence interval, 70%–99%). The treatment was well tolerated, with no grade 3 or 4 late toxicity and only one grade 2 digestive toxicity. No second cancers were reported.

Conclusion.
LDR brachytherapy is an effective and safe treatment for vaginal intraepithelial neoplasia.
A new species of the genus Parasa Moore (Lepidoptera: Limacodidae) from Yemen
Authors: Solovyev Alexey V. , Saldaitis Aidas 
Published: January 2011

Abstract
A new species Parasa dusii Solovyev and Saldaitis from northern Yemen is described (holotype in Museum Witt, Munich; Germany). The species has tendency to lose the green pigment typical for other congeners. It is provisionally placed into the genus Parasa Moore, 1859 where it is closely related to P. divisa West, 1940, P. catori Bethune-Baker, 1911, P. marginata West, 1940, P. thamia Rungs, 1951, P. dentina Hering, 1932, P. ananii Karsch, 1896, and P. semiochracea Hering, 1933. The relationship of the new species to these African species suggests its secondary penetration into the Arabian Peninsula from an origin in tropical Africa. The problems of monophyly of the genus Parasa and several associated genera are briefly discussed. All important characters of the new species, and some related species, are illustrated.
Spirituality in Medical School Curricula: Findings from a National Survey
Authors: Koenig Harold G. , Hooten Elizabeth G. , Lindsay-Calkins Erin , Meador Keith G. 
Published: January 2011

Objective: No systematic information exists on what U.S. medical schools are teaching on spirituality and health or on the attitudes of faculty toward inclusion of this subject in the medical curriculum. We systematically surveyed U.S. medical school deans and assessed both attitudes about and the extent to which spirituality is addressed in medical school curricula. Methods: The responses to a questionnaire were solicited from deans representing 122 U.S. medical schools accredited by the Liaison Committee for Medical Education. Completed surveys were received from 85% ( n = 104), with 94% ( n = 115) responding to the primary question. Outcomes were proportion of medical schools with curricular content on spirituality and attitudes of deans toward such material. Results: Ninety percent (range 84%–90%) of medical schools have courses or content on spirituality and health (S&H), 73% with content in required courses addressing other topics and 7% with a required course dedicated to S&H. Although over 90% indicate that patients emphasize spirituality in their coping and health care, only 39% say that including S&H is important. When asked if their institution needs more S&H curricular content, 43% indicated they did; however, even if funding and training support were available, only 25% would open additional curricular time. National policy statements, established competencies, or methods to evaluate student competencies in S&H were generally considered unimportant. Conclusions: Most U.S. medical schools have curricular content on S&H, although this varies greatly in scope. Despite acknowledging its importance to patients, the majority of deans are uncertain about including spirituality and do not think more content is needed.
IFN-γ Reduction by Tricyclic Antidepressants
Authors: Himmerich Hubertus , Fulda Stephany , Sheldrick Abigail J. , Plümäkers Birgit , Rink Lothar 
Published: January 2011

Objective: A growing body of data indicates that an activation of proinflammatory cytokines such as interferon-gamma (IFN-γ) is involved in the pathophysiology of depression and that the suppression of pro-inflammatory cytokine production by antidepressants may lead to an improvement of depressive symptoms. However, the influence of the serotonin and noradrenalin reuptake inhibitor (SNRI) venlafaxine and its metabolite O-desmethylvenlafaxine on the stimulated blood cell secretion of IFN-γ has not been studied so far. Method: We measured IFN-γ levels in the stimulated blood of healthy female subjects in a whole blood assay using the toxic shock syndrome toxin TSST-1 as stimulant. Blood was either supplemented with antidepressants or not. Results: Mean IFN-γ concentrations differed between blood with and without antidepressant supplements ( p = 0.026). Planned contrasts revealed that compared to non-supplemented blood, four of the blood samples supplemented with the tricyclic antidepressants (TCAs) reduced IFN-γ levels: amitriptyline (adjusted p-value ( p = 0.004), nortriptyline ( p = 0.037), imipramine ( p = 0.021), and desipramine ( p = 0.048). There was no significant difference between the control condition and the venlafaxine or O-desmethylvenlafaxine condition. Conclusions: TCAs might, among other mechanisms, act as antidepressants by suppressing the production of pro-inflammatory cytokines, whereas no significant effect of venlafaxine and O-desmethylvenlafaxine on IFN-γ secretion could be demonstrated.
Coping as a Mediator in the Relationships of Spiritual Well-Being to Mental Health in Black Women with Type 2 Diabetes
Authors: Newlin Kelley , Melkus Gail D. , Peyrot Mark , Koenig Harold G. , Allard Emily , Chyun Deborah 
Published: January 2011

Objective: Examine coping as a mediator in the relationships of spiritual well-being to mental health in Black women with type 2 diabetes (T2DM). Methods: Using a cross-sectional design, data were collected from a convenience sample of 45 Black women with T2DM. Measures of coping strategies, spiritual well-being (religious and existential well-being), and mental health, as measured by diabetes-specific distress (DSED), were collected. Bivariate findings informed mediational, trivariate model development. Results: Religious well-being was significantly related to cognitive reframing (CR) coping strategies ( p = 0.026) but not DSED ( p = 0.751). Existential well-being was significantly related to CR (β = 0.575, p < 0.001), direct assistance (DA) coping (β = 0.368, p = 0.006) and DSED (β = −0.338, p = 0.023). Although CR (β = −0.305, p = 0.021) and DA (β = −0.262, p = 0.041) had significant bivariate associations with DSED, the relationships were not significant when existential well-being was controlled. However, the relationship of existential well-being to DSED was mediated by specific CR and DA strategies that were associated with DSED to varying degrees—“I came up with a couple different solutions to the problem” (β = −0.301, p = 0.049); “I came out of the experience better than I went in” (β = −0.308, p = 0.061); and “I talked to someone who could do something concrete about the problem” (β = −0.272, p = 0.078). Conclusion: Findings indicate that diabetes care address spiritual well-being, both its religious and existential components, in Black women with T2DM.
Exchange Rates and the Effectiveness of Actual and Oral Official Interventions: A Survey on Findings, Issues and Policy Implications
Authors: Cavusoglu Nevin 
Published: January 2011

Monetary authorities of many open economies have been regularly intervening in foreign exchange markets for years to limit volatility in exchange rates and/or push exchange rates back to some desired level. Such interventions have taken the form of actual and oral official interventions. Review of studies investigating the effectiveness of interventions reveals one major issue, related to the assumption that interventions are mostly sterilized. This assumption might lead to unreliable results when changes in interest rates and interventions are both used as explanatory variables for exchange rates. One major consistent finding is that intervention has a significant but short-lasting effect on exchange rates. Studies have reached this conclusion by investigating whether intervention has been effective in turning around the exchange rate over the few days, weeks or months following intervention(s). Only a few studies have investigated and provided evidence that intervention has been effective in limiting long swings in exchange rates. Studies testing for the effectiveness of interventions specifically through the signaling channel also provide evidence on the importance of macroeconomic variables for exchange rates. The significance of official intervention and official communication for exchange rate movements combined with the importance of macroeconomic variables for exchange rates provide a role for official intervention and parity announcement to influence exchange rate movements and limit the magnitude of exchange rate swings.
Diabetes and Risk of Prostate Cancer
Authors: Tseng Chin-Hsiao 
Published: January 2011

OBJECTIVE
The link between diabetes and prostate cancer is rarely studied in Asians.

RESEARCH DESIGN AND METHODS
The trend of age-standardized prostate cancer incidence in 1995–2006 in the Taiwanese general population was calculated. A random sample of 1,000,000 subjects covered by the National Health Insurance in 2005 was recruited. A total of 494,630 men for all ages and 204,741 men ≥40 years old and without prostate cancer at the beginning of 2003 were followed to the end of 2005. Cumulative incidence and risk ratio between diabetic and nondiabetic men were calculated. Logistic regression estimated the adjusted odds ratios for risk factors.

RESULTS
The trend of prostate cancer incidence increased significantly (P &lt; 0.0001). The cumulative incidence markedly increased with age in either the diabetic or nondiabetic men. The respective risk ratio (95% CI) for all ages and age 40–64, 65–74, and ≥75 years was 5.83 (5.10–6.66), 2.09 (1.60–2.74), 1.35 (1.07–1.71), and 1.39 (1.12–1.71). In logistic regression for all ages or for age ≥40 years, age, diabetes, nephropathy, ischemic heart disease, dyslipidemia, living region, and occupation were significantly associated with increased risk, but medications including insulin and oral antidiabetic agents were not.

CONCLUSIONS
Prostate cancer incidence is increasing in Taiwan. A positive link between diabetes and prostate cancer is observed, which is more remarkable in the youngest age of 40–64 years. The association between prostate cancer and comorbidities commonly seen in diabetic patients suggests a more complicated scenario in the link between prostate cancer and diabetes at different disease stages.
The effect of solvent extraction on antioxidant properties of apricot fruit
Authors: Leccese Annamaria , Viti Raffaella , Bartolini Susanna 
Published: January 2011

Abstract
Two solvent extraction procedures were used to investigate the extraction efficiency in terms of total antioxidant capacity and total phenols in apricot fruit. Samples were either sequentially extracted with aqueous ethanol (ethanol/water 80% v/v) and tetrahydrofuran or directly extracted with tetrahydrofuran. Each extract was analyzed for total antioxidant capacity by the Trolox Equivalent Antioxidant Capacity (TEAC) assay and total phenols by the Folin-Ciocalteu assay. The results showed that using sequential solvent extraction, the majority (85%) of the total antioxidant capacity and total phenols was due to hydrophilic compounds. In tetrahydrofuran direct extractions, the total antioxidant capacity and total phenols were higher than values obtained with aqueous ethanol and the sum of results obtained from sequential extracts for either total antioxidant capacity or total phenols was similar to the tetrahydrofuran-extract antioxidant values. A linear correlation between total antioxidant capacity and total phenols was found and was independent of the solvent extraction method. In conclusion, the choice of solvent is related to the antioxidant potential of fruit and depends on the food hydrophilic/lipophilic composition.
Potential role of FRAX analysis in postmenopausal women with osteopenia
Authors: Dimić Aleksandar , Sonja Stojanovic , Jovan Nedovic , Aleksandra Stankovic , Bojana Stamenkovic , Sasa Milenkovic , Valentina Mitic 
Published: January 2011

AbstractEarly diagnosis of osteoporosis and estimation of subjects that are at high risk for fracture, is neccesary for osteoporosis treatment. Dual-energy X-ray absorptometry (DXA) is a modern method for bone mineral density (BMD) evaluation. However, along BMD, clinical risk factors may significantly influence fracture development. Therefore, FRAX algorithm was designed for the assessment of a ten-year risk for serious osteoporotic fractures (SOF), as well as hip fractures. In the current study, we tried to evaluate the possible lumbal spine and hip BMD influence on ten year risk for SOF and hip fractures and potential role of FRAX in predicting the therapy in postmenopausal women with osteopenia. We performed the study on 385 postmenopausal women. According to the DXA measurements, at the lumbal (L) spine (L1–L4) and hip (femor neck), patients were then classified as normal, osteopenic, or osteoporotic. BMD evaluation included the L spine and the hip (subgroup 1), and only on the L spine (subgroup 2). By filling up the FRAX questionnaire, a ten-year risk for SOF fracture and hip fracture was calculated. BMD evaluation, in complete patient’s group and in subgroup 1, resulted in the highest number of osteoporosis (61.04%, 48.08%, retrospectively), while ospeopenia was a main finding in subgroup 2. In the subgroup 1, a high risk for SOF and hip fracture was detected in 16.45% and with high risk for hip fracture in 11.38% subjects. In subgroup 2, only high risk for hip fracture was observed in 3.16% subjects, indicating the active medicament treatment. Simultaneously, correlation of BMD results with FRAX values for SOF and hip fracture, showed significant negative correlation (p<0.001). Obtained results showed significant role of femur neck BMD evaluation in predicting the future factors, which may, together with FRAX analysis, improve the therapy approach in postmenopausal women with ospeopenia.
The effect of the physical properties of the liquid phase on the gas-liquid mass transfer coefficient in two- and three-phase agitated systems
Authors: Kiełbus-Rąpała Anna , Karcz Joanna , Cudak Magdalena 
Published: January 2011

AbstractThe results of studies concerning two- and three-phase systems in an agitated vessel are presented. The aim of our research was to investigate the effect of the physical properties of the liquid phase on the value of the volumetric gas-liquid mass transfer coefficient in mechanically agitated gas-liquid and gas-solid-liquid systems. Our experimental studies were conducted in a vessel with an internal diameter of 0.288 m. The flat bottom vessel, equipped with four baffles, was filled with liquid up to a height equal to the inner diameter. The liquid volume was 0.02 m3. Three high-speed impellers of a diameter equal to 0.33 of the vessel diameter were used: Rushton turbine (RT), Smith turbine (CD 6), or A 315 impeller. The measurements were carried out in coalescing and non-coalescing systems. Distilled water and aqueous solutions of an electrolyte (sodium chloride) of two different concentrations were used as the liquid phase. The gas phase was air. In the three-phase system, particles of sea sand were used as solid phase. The measurements were conducted at five different gas-flow rates and three particle loadings. Volumetric gas-liquid mass transfer coefficients were measured using the dynamic method. The presence and concentration of an electrolyte strongly affected the value of the gas-liquid mass transfer coefficient in both two- and three-phase systems. For all agitators used, significantly higher k l a coefficient values were obtained in the 0.4 kmol m−3 and 0.8 kmol m−3 aqueous NaCl solutions compared with the data for a coalescing system (with distilled water as the liquid phase). The k l a coefficient did not exhibit a linear relationship with the electrolyte concentration. An increase in the sodium chloride concentration from 0.4 kmol m−3 to 0.8 kmol m−3 caused a considerable decrease in the volumetric mass transfer coefficient in both the two-phase and three-phase systems. It was concluded that the mass transfer processes improved at a certain concentration of ions; however, above this concentration no further increase in k l a could be achieved.