bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methicillin-resistant Staphylococcus aureus in surgical patients: identification of high-risk populations for the development of targeted screening programmes
Authors: Fraser Stephanie , Brady Richard R , Graham Catriona , Paterson-Brown Simon , Gibb Alan P 
Published: April 2010

INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA)-related hospital-acquired infection (HAI) in surgical patients is associated with high morbidity, mortality and financial cost. The identification and characterisation of populations of patients who are at high risk of developing MRSA infection or colonisation could inform the design of more effective strategies to prevent HAIs and reduce transmission of MRSA. PATIENTS AND METHODS An analysis of historical discharge data for the whole of 2005 (7145 surgical in-patients) was performed, for all patients admitted to general surgery at the Royal Infirmary of Edinburgh. Analysis specifically focused on MRSA laboratory data and coding data for patient demographics, medical co-morbidities, and progress of in-patient stay. RESULTS A total of 134 (1.88%) individual patients with colonisation or infection by MRSA were identified from indicated laboratory testing. Univariate analysis identified a significant association of concurrent MRSA-positive status with patients aged over 60 years (P < 0.01), a duration of inpatient stay > 7 days (P < 0.01), presence of a malignant neoplasm (P < 0.01), circulatory disease (P < 0.01), respiratory disease (P < 0.01), central nervous system disease (P < 0.01), renal failure (P < 0.01), and concurrent admission to ITU/HDU (P < 0.01). Multivariate analysis suggested MRSA colonisation or infection was strongest in those with co-morbid malignancy (P < 0.0001) or admission to ITU/HDU (P < 0.0001). CONCLUSIONS This large observational study has identified cancer patients as a UK surgical patient subpopulation which is at significantly higher risk of colonisation by MRSA. These data could inform the development of focused hospital in-patient screening protocols and provide a means to stratify patient risk.
Low ninety-day re-admission rates after emergency and elective laparoscopic cholecystectomy in a district general hospital
Authors: Down Sue K , Nicolic Marko , Abdulkarim Hibba , Skelton Nick , Harris Adrian H , Koak Yashwant 
Published: April 2010

INTRODUCTION Re-admission rate following laparoscopic cholecystectomy is currently defined as within 30 days of the initial operation. This may underestimate the true incidence and financial cost of postoperative morbidity. This study aimed to analyse re-admissions within 90 days of elective and emergency laparoscopic cholecystectomy at a district general hospital, and to compare outcomes to larger teaching centres. PATIENTS AND METHODS We undertook a retrospective analysis of all patients re-admitted within 90 days of laparoscopic cholecystectomy during an 18-month period (June 2006 to December 2007). Patient characteristics, details of the primary operation, and reasons for re-admission were identified, and a comparison of re-admissions following elective versus emergency procedures was performed. RESULTS A total of 326 laparoscopic cholecystectomies were performed during the 18-month period (246 elective, 80 emergency). No operations required conversion to an open procedure. Twenty-five patients were re-admitted within 90 days of their operation, of whom only 14 had complications directly related to their surgery (overall re-admission rate 4.3%). There was no statistical difference in re-admission rate or cause of re-admission between elective and emergency procedures. However, the mean time to re-admission following elective procedures was significantly longer (36 days; P = 0.0003). CONCLUSIONS Re-admission rates at our district general hospital are comparable to those reported by larger teaching centres. Current 30-day re-admission data may significantly underestimate morbidity rates and socio-economic cost following elective laparoscopic cholecystectomy.
Five-year retrograde transpopliteal angioplasty results compared with antegrade angioplasty
Authors: Evans C , Peter N , Gibson M , Torrie EPH , Galland RB , Magee TR 
Published: April 2010

INTRODUCTION Retrograde transpopliteal angioplasty (PA) is a potentially useful alternative technique for endovascular treatment of infra-inguinal arterial disease when antegrade transfemoral puncture (FA) is technically not possible or appropriate. This study aimed to investigate the outcomes of PA compared with FA during a 5-year period. PATIENTS AND METHODS A retrospective study was performed to assess 88 PA and 275 FA performed between January 2003 and January 2008. Assessments of patients, indication for procedure, disease site, stenosis severity, procedure outcomes and time to further intervention were recorded. RESULTS FA was used to treat more patients with critical ischaemia (42.2% vs 30.7%; P = 0.014)). PA was used to treat more proximal superficial femoral lesions (P < 0.001) and occlusive lesions (P = 0.001). Overall, 84.1% of PA and 82.5 % of FA were technically successful. There was no difference in local puncture site complication rates. Significantly more FA resulted in distal thrombus/embolism (8.4% vs 3.4%; P = 0.044). Further intervention was required in 27.3% of PA and 36.0% of FA. The time interval to re-intervention was not different between the groups. CONCLUSIONS PA is safe with comparable success rates and long-term outcomes to an FA. PA is a useful alternative approach or treating occlusive, proximal disease.
Medicolegal claims following laparoscopic cholecystectomy in the UK and Ireland
Authors: Scurr James RH , Brigstocke Julian R , Shields David A , Scurr John H 
Published: April 2010

INTRODUCTION The causes and outcomes of medicolegal claims following laparoscopic cholecystectomy were evaluated. SUBJECTS AND METHODS A retrospective analysis of the experience of a consultant surgeon acting as an expert witness within the UK and Ireland (1990–2007). RESULTS A total of 151 claims were referred for an opinion. Sixty-three related to bile duct injuries and four followed major vascular injury. Bowel injury resulted in 17 claims. A postoperative biliary leak not associated with a bile duct injury was responsible for 25 claims. Other reasons for claims included spilled gallstones, port-site herniae, haemorrhage and other recognised complications associated with laparoscopic cholecystectomy. Twelve of the claims are on-going, two went to trial, 79 (52%) were settled out of court and 58 (38%) were discontinued after the claimants were advised that they were unlikely to win their case. Disclosed settlement amounts are reported. CONCLUSIONS Bile duct and major vascular injuries are almost indefensible. The delay in diagnosis and (mis)management of other recognised complications following laparoscopic cholecystectomy have also led to a significant number of successful medicolegal claims.
Which mesh for hernia repair?
Authors: Brown CN , Finch JG 
Published: April 2010

INTRODUCTION The concept of using a mesh to repair hernias was introduced over 50 years ago. Mesh repair is now standard in most countries and widely accepted as superior to primary suture repair. As a result, there has been a rapid growth in the variety of meshes available and choosing the appropriate one can be difficult. This article outlines the general properties of meshes and factors to be considered when selecting one. MATERIALS AND METHODS We performed a search of the medical literature from 1950 to 1 May 2009, as indexed by Medline, using the PubMed search engine (< http://www.pubmed.gov >). To capture all potentially relevant articles with the highest degree of sensitivity, the search terms were intentionally broad. We used the following terms: ‘mesh, pore size, strength, recurrence, complications, lightweight, properties’. We also hand-searched the bibliographies of relevant articles and product literature to identify additional pertinent reports. RESULTS AND CONCLUSIONS The most important properties of meshes were found to be the type of filament, tensile strength and porosity. These determine the weight of the mesh and its biocompatibility. The tensile strength required is much less than originally presumed and light-weight meshes are thought to be superior due to their increased flexibility and reduction in discomfort. Large pores are also associated with a reduced risk of infection and shrinkage. For meshes placed in the peritoneal cavity, consideration should also be given to the risk of adhesion formation. A variety of composite meshes have been promoted to address this, but none appears superior to the others. Finally, biomaterials such as acellular dermis have a place for use in infected fields but have yet to prove their worth in routine hernia repair.
Small Dense LDL Cholesterol and Coronary Heart Disease: Results from the Framingham Offspring Study
Authors: Ai Masumi , Otokozawa Seiko , Asztalos Bela F , Ito Yasuki , Nakajima Katsuyuki , White Charles C , Cupples L Adrienne , Wilson Peter W , Schaefer Ernst J 
Published: April 2010

AbstractObjective: We sought to establish reference values for a new direct assay for small dense LDL cholesterol (sdLDL-C) and to measure sdLDL-C concentrations in patients with established coronary heart disease (CHD) vs controls.Methods: Direct LDL-C and sdLDL-C were measured in samples from 3188 male and female participants of the Framingham Offspring Study, including 173 men and 74 women with CHD.Results: Postmenopausal status and male sex were associated with higher sdLDL-C concentrations (P &lt; 0.0001). Cholesterol-lowering medication use was more frequent (P &lt; 0.0001) in CHD patients than in controls (46.8% vs 11.4% in men; 35.1% vs 8.8% in women). In men, mean LDL-C was lower in CHD than in controls (3.22 vs 3.51 mmol/L, P &lt; 0.0001), whereas mean sdLDL-C concentrations were similar (0.83 vs 0.84 mmol/L, P = 0.609). In women, mean LDL-C was similar in CHD and controls (3.53 vs 3.46 mmol/L, P = 0.543), but mean sdLDL-C was higher (0.83 vs 0.68 mmol/L, P = 0.0015). The mean percentage of LDL-C as sdLDL-C was higher in both men and women with CHD than controls (P &lt; 0.01). Increased LDL-C and sdLDL-C were found in 10.4% and 22.0% of men and in 24.3% and 27.8% of women with CHD, respectively.Conclusions: Despite 4-fold greater cholesterol-lowering therapy use, CHD patients had mean LDL-C concentrations above the LDL-C goal of &lt;2.6 mmol/L (&lt;100 mg/dL). Although women with CHD had higher sdLDL-C concentrations than controls, this difference was not seen in men. These findings may explain some of the high residual risk of future CHD events in CHD patients.
The Silencing of MicroRNA 148a Production by DNA Hypermethylation Is an Early Event in Pancreatic Carcinogenesis
Authors: Hanoun Naïma , Delpu Yannick , Suriawinata Arief A , Bournet Barbara , Bureau Christophe , Selves Janick , Tsongalis Gregory J , Dufresne Marlène , Buscail Louis , Cordelier Pierre , Torrisani Jérôme 
Published: April 2010

AbstractBackground: The poor prognosis of pancreatic ductal adenocarcinoma (PDAC) is accounted for by the absence of early diagnostic markers and effective treatments. MicroRNAs inhibit the translation of their target mRNAs. The production of microRNAs is strongly altered in cancers, but the causes of these alterations are only partially known. DNA hypermethylation is a major cause of gene inactivation in cancer. Our aims were to identify microRNAs whose gene expression is inactivated by hypermethylation in PDAC and to determine whether this hypermethylation-mediated repression is an early event during pancreatic carcinogenesis. We also sought to investigate whether these differentially methylated regions can serve as a diagnostic marker for PDAC.Methods: MicroRNA production was measured by microarray hybridization and reverse-transcription quantitative PCR. The level of DNA methylation was measured by bisulfite mapping and semiquantitative methylation-specific PCR.Results: We identified 29 microRNAs encoded by genes whose expression is potentially inactivated by DNA hypermethylation. We focused our study on microRNA 148a (miR-148a) and found its production to be repressed, not only in PDAC samples but also in preneoplastic pancreatic intraepithelial neoplasia (PanIN) lesions. More importantly, we found that hypermethylation of the DNA region encoding miR-148a is responsible for its repression, which occurs in PanIN preneoplastic lesions. Finally, we show that the hypermethylated DNA region encoding miR-148a can serve as an ancillary marker for the differential diagnosis of PDAC and chronic pancreatitis (CP).Conclusions: We show that the hypermethylation of the DNA region encoding miR-148a is responsible for its repression in PDAC precursor lesions and can be a useful tool for the differential diagnosis of PDAC and CP.
Effect of Cladding on Biaxially Loaded Underclad Part-Through Cracks
Authors: Scibetta M. , Lucon E. , Houben T. 
Published: April 2010

Abstract
Fracture toughness testing on standard specimens in the ductile to brittle transition regime is well established and standardized by the ASTM since 1997. However, its applicability to structural components and its potential conservatism remain a subject of concern. In structural integrity assessment of reactor pressure vessels submitted to an accidental loading condition called pressurized thermal shock, the cladding is generally considered not to play any role and is neglected. However, cladding has the ability to restrain the crack from opening due to its good ductility. To investigate the potential safety margin, a semielliptical crack introduced by fatigue is covered by a stainless steel cladding and specimens are tested under biaxial conditions in the ductile to brittle transition regime. Test results shows that cladding plays a significant role and contributes to an additional safety margin. In addition, cladding increases the potential for crack arrest.
A Brief Survey of the Russian Historiography of Russian America of Recent Years
Authors: Grinëv Andrei. V. , Bland Richard L. 
Published: April 2010

Many people have written about the history of the Russian-American Company (RAC), some for scholars, others for a lay audience. Numerous writers have been Americans and Europeans who have had access to the records of the RAC that are held in the U.S. National Archives. But more records-preserved in Russia-were rarely accessible to Western scholars until the end of the Cold War. Dr. Andrei V. Grinëv is one of the leading authorities on the history of Russian America. In the past two decades he has published two monographs, ten chapters in the three-volume Istoriya Russkoi Ameriki [The History of Russian America], and seventy-five articles in Russian, English, and Japanese. He writes not just about the Europeans who settled in Russia's transoceanic territories but also about Native Americans. Many of his works are unique in that he draws on both the ethnography and history of Native Americans. With regard to Russian America, he deals not only with the policies of governments and companies but with individuals as well. In pursuit of this task, Grinëv has now written a book about everyone who had connections with Russian America. It contains more than 5,800 biographical sketches and was published in 2009. In the work below, he analyzes the writings of scholars who have tried to unravel historical details about individuals, companies, and governments that related to the Russian-American Company.
This article was translated from Russian. Since a great deal of Russian literature is cited, it is important to understand the form of transliteration used with these titles. For a detailed description of the transliteration, please see the Translator's Note in the appendix.
Safety and Immunogenicity of a 13-Valent Pneumococcal Conjugate Vaccine
Authors: Bryant Kristina A. , Block Stan L. , Baker Sherryl A. , Gruber William C. , Scott Daniel A. ,   for the PCV13 Infant Study Group
Published: April 2010

OBJECTIVE:
Invasive pneumococcal disease rates have declined since immunization with 7-valent pneumococcal conjugate vaccine (PCV7) (Prevenar/Prevnar [Wyeth Pharmaceuticals, Philadelphia, PA]) became routine. Certain nonvaccine Streptococcus pneumoniae serotypes (1, 3, 5, 6A, 7F, and 19A) still cause significant morbidity and mortality. The safety and immunogenicity of PCV7 were compared with those of 13-valent PCV (PCV13), which contains saccharides from serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F conjugated to CRM197.

PATIENTS AND METHODS:
Infants were randomly assigned to receive PCV13 or PCV7 at ages 2, 4, and 6 months with other vaccines. Post–third-dose antibodies to each pneumococcal polysaccharide were measured by immunoglobulin G enzyme-linked immunosorbent assay. Antibacterial functional antibodies were measured by opsonophagocytic assay (OPA).

RESULTS:
Subjects received PCV13 (n = 122) or PCV7 (n = 127). All PCV13 serotypes were immunogenic, with 88% to 98% of infants achieving antibody concentrations of ≥0.35 μg/mL to shared PCV7 serotypes. For the 6 additional serotypes, 97% to 100% of PCV13-vaccinated infants achieved antibody concentrations of ≥0.35 μg/mL. Geometric mean antibody concentration for PCV13 recipients ranged from 1.32 μg/mL (serotype 23F) to 4.26 μg/mL (serotype 14). The ratio of OPA geometric mean titers for the 7 shared serotypes (PCV13:PCV7) ranged from 0.6 to 1.4, suggesting no clinically meaningful differences. For PCV13-only serotypes, OPA geometric mean titers were significantly higher in the PCV13 group than in the PCV7 group. Local reactions and systemic events were similar between groups.

CONCLUSIONS:
PCV13 was well tolerated and immunogenic, with most infants developing antipolysaccharide antibody concentrations of ≥0.35 μg/mL, as well as OPA responses, to each of the 13 serotypes.
Psychometric Properties of a Peer-Assessment Program to Assess Continuing Competence in Physical Therapy
Authors: Miller Patricia A. , Nayer Marla , Eva Kevin W. 
Published: April 2010

BackgroundThe College of Physiotherapists of Ontario implemented an Onsite Assessment to evaluate the continuing competence of physical therapists.ObjectiveThis study was undertaken to examine the reliability of the various tools used in the Onsite Assessment and to consider the relationship between the final decision and demographic factors.DesignThis was a psychometric study.MethodsTrained peer assessors (n=63) visited randomly selected physical therapists (n=106) in their workplace. Fifty-three physical therapists were examined by 2 assessors simultaneously. The assessment included a review of practice issues, record keeping, billing practices, the physical therapist's professional portfolio, and a chart-stimulated recall process. The Quality Management Committee made the final decision regarding the physical therapist's performance using the assessor's summary report. Generalizability theory was used to examine the interrater reliability of the tools. Correlation coefficients and regression analyses were used to examine the relationships between demographic factors and performance.ResultsThe majority of the physical therapists (88%) completed the program successfully, 11% required remediation, and 1% required further assessment. The interrater reliability of the components was above .70 for 2 raters’ evaluations, with the exception of billing practices. There was no relationship between the final decision and age or years since graduation (r&lt;.05).LimitationsLimitations include a small sample and a lack of data on system-related factors that might influence performance.ConclusionsThe vast majority of the physical therapists met the College of Physiotherapists of Ontario's professional standards. Reliability analysis indicated that the number of charts reviewed could be reduced. Strategies to improve the reliability of the various components must take into account feasibility issues related to financial and human resources. Further research to examine factors associated with failure to adhere to professional standards should be considered. These results can provide valuable information to regulatory agencies or managers considering similar continuing competence assessment programs.
Trunk and Hip Muscle Activation Patterns Are Different During Walking in Young Children With and Without Cerebral Palsy
Authors: Prosser Laura A. , Lee Samuel C.K. , VanSant Ann F. , Barbe Mary F. , Lauer Richard T. 
Published: April 2010

Background
Poor control of postural muscles is a primary impairment in people with cerebral palsy (CP).

Objective
The purpose of this study was to investigate differences in the timing characteristics of trunk and hip muscle activity during walking in young children with CP compared with children with typical development (TD).

Methods
Thirty-one children (16 with TD, 15 with CP) with an average of 28.5 months of walking experience participated in this observational study. Electromyographic data were collected from 16 trunk and hip muscles as participants walked at a self-selected pace. A custom-written computer program determined onset and offset of activity. Activation and coactivation data were analyzed for group differences.

Results
The children with CP had greater total activation and coactivation for all muscles except the external oblique muscle and differences in the timing of activation for all muscles compared with the TD group. The implications of the observed muscle activation patterns are discussed in reference to existing postural control literature.

Limitations
The potential influence of recording activity from adjacent deep trunk muscles is discussed, as well as the influence of the use of an assistive device by some children with CP.

Conclusions
Young children with CP demonstrate excessive, nonreciprocal trunk and hip muscle activation during walking compared with children with TD. Future studies should investigate the efficacy of treatments to reduce excessive muscle activity and improve coordination of postural muscles in CP.
Facilitating Early Intervention: Experiences of Young People and Implications for the Shaping of Headspace Services
Authors: Medlow Sharon , Kelk Norm , Cohen Anjalee , Hickie Ian 
Published: April 2010

Objective: The aim of this study was to gain an understanding of the factors that facilitate entry of young people into the Australian mental health care system with a view to developing headspace service delivery in youth-friendly directions. Method: Fifteen semi-structured interviews were conducted with experienced mental health help-seekers in early adulthood. Results: Social factors involving families, friends and professionals dominated discussions about the initiation and voluntary continuation of mental health care. Conclusions: A range of social interactions combine to facilitate the entry of young people into care. The actions of families and friends are very important for the initiation of care while the clinicians’ modes of communicating with young people are critical in making the experience of care comfortable and worth the perseverance. If genuine service delivery reform is to be achieved, taking account of the views of young people who have overcome the well-documented obstacles to care is invaluable for the ongoing development of youth-friendly services such as those offered by headspace.