bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serious unconventional complications of surgery with stapler for haemorrhoidal prolapse and obstructed defaecation because of rectocoele and rectal intussusception
Authors: Naldini G. 
Published: December 2009

AbstractAim  Treatment of haemorrhoidal prolapse by stapled haemorrhoidopexy (SH) and obstructed defaecation syndrome with the stapled transanal rectal resection (STARR) technique is becoming increasingly popular with patients and surgeons. Unfortunately, serious complications have been identified. The aim of the present study was to analyse the complications and their treatment to see where they might be avoided and to determine best management.Method  All Units of Coloproctology belonging to the Italian Unitary Society of Coloproctology (SIUCP) were asked to return documentation of serious complications following SH and STARR.Results  Forty‐six reports were received from 23 centres. Twenty‐seven serious complications were reported. Twenty occurred after SH (13 PPH 03, 7 PPH 01) (Endo‐surgery Inc., Cincinnati, Ohio, USA) and seven after STARR. Complications were treated by abdominal operation in nine patients [colostomy (3), ileostomy (2), Hartmann’s resection (1) and anterior resection (1)].Conclusion  Stapled haemorrhoidopexy and STARR can result in serious complications requiring major surgery for their treatment.
Bladder malignancies in children aged <18 years: results from the Surveillance, Epidemiology and End Results database
Authors: Alanee Shaheen , Shukla Aseem R. 
Published: December 2009

Study Type – Prognosis (inception cohort) Level of Evidence 1bOBJECTIVETo present descriptive statistics for bladder tumours in children, calculated from the Surveillance, Epidemiology and End Results (SEER) database, as bladder malignancies are relatively uncommon in children, causing difficulty in understanding their incidence and survival.PATIENTS AND METHODSThe SEER database was interrogated to report the incidence of bladder malignancies in children from birth to 18 years old. Race and sex differences were assessed. The 5‐year survival by disease stage at diagnosis and 5‐year conditional survival after surviving for 1–3 years is reported for 1973–2003. The incidence and survival rates for bladder embryonal rhabdomyosarcoma were further characterized.RESULTSWe identified 140 cases of bladder cancers in the selected cohort. Papillary urothelial neoplasm of low malignant potential (PUNLMP) and rhabdomyosarcoma comprised 50.7% and 36.4% of the tumours, respectively. The incidence of bladder malignancies significantly increased between 1973 and 2003. Conditional survival calculated for 1 and 2 years after disease diagnosis was 93.6% and 97.5%. Fifty‐one cases of embryonal rhabdomyosarcoma were identified. The male to female incidence ratio was ≈2:1 for these tumours. The 5‐year survival rates were 50–80% over the past three decades.CONCLUSIONSWe present the most contemporary survey of the SEER database for the incidence and survival for bladder tumours in children. Depending on the patient’s age, PUNLMP and rhabdomyosarcoma predominated in different proportions. The 2–3‐year conditional survival and overall survival were excellent. We also identified improving survival for embryonal bladder rhabdomyosarcoma with time.
Bat metacommunity structure on Caribbean islands and the role of endemics
Authors: Presley Steven J. , Willig Michael R. 
Published: December 2009

ABSTRACTAim  We evaluate characteristics of species ranges (i.e. coherence, species turnover and range boundary clumping) to determine the structure of bat metacommunities and metaensembles from Caribbean islands. We evaluate the effects of endemic species on that structure, and quantify associations between island characteristics and latent environmental gradients that structure these metacommunities and metaensembles.Location  Sixty‐five Caribbean islands throughout the Bahamas, Greater Antilles and Lesser Antilles.Methods  Metacommunity structure is an emergent property of a set of ecological communities at different sites defined by species distributions across geographic or environmental gradients. We analysed elements of metacommunity structure (coherence, range turnover and range boundary clumping) to determine the best‐fit pattern for metacommunities from all Caribbean islands, as well as from the Bahamas, the Greater Antilles and the Lesser Antilles separately. For each island group, analyses were conducted for all bats and for each of two broadly defined guilds (i.e. carnivores and herbivores). In addition, analyses were conducted for all species and for a subset in which endemic species were removed from the fauna. Spearman rank correlations identified island characteristics (area, elevation, latitude, longitude) that were associated significantly with island scores for ordination axes based on reciprocal averaging.Results  Metacommunity structure for all bats and for carnivores was similar for each island group, with Clementsian distributions (i.e. discrete communities with groups of species replacing other groups of species along the gradient) for all islands, the Bahamas and the Lesser Antilles, but with nested distributions for the Greater Antilles. Herbivore distributions were random for the Bahamas, but were Clementsian for all other island groups. Removal of endemic species affected the best‐fit model of metacommunity structure in only 3 of 12 cases. In general, ordination scores for islands were correlated with longitude or latitude, but not with island area or elevation.Main conclusions  Characteristics of bat species ranges and associated metacommunity structure were primarily dependent on the number and geographic arrangement of primary sources of colonization, and not on interspecific interactions, species‐specific levels of environmental tolerance, or the physical characteristics of islands. Endemic species did not greatly affect metacommunity structure in Caribbean bats.
Estimating and controlling for spatial structure in the study of ecological communities
Authors: Peres‐Neto Pedro R. , Legendre Pierre 
Published: December 2009

ABSTRACTAim  Variation partitioning based on canonical analysis is the most commonly used analysis to investigate community patterns according to environmental and spatial predictors. Ecologists use this method in order to understand the pure contribution of the environment independent of space, and vice versa, as well as to control for inflated type I error in assessing the environmental component under spatial autocorrelation. Our goal is to use numerical simulations to compare how different spatial predictors and model selection procedures perform in assessing the importance of the spatial component and in controlling for type I error while testing environmental predictors.Innovation  We determine for the first time how the ability of commonly used (polynomial regressors) and novel methods based on eigenvector maps compare in the realm of spatial variation partitioning. We introduce a novel forward selection procedure to select spatial regressors for community analysis. Finally, we point out a number of issues that have not been previously considered about the joint explained variation between environment and space, which should be taken into account when reporting and testing the unique contributions of environment and space in patterning ecological communities.Main conclusions  In tests of species‐environment relationships, spatial autocorrelation is known to inflate the level of type I error and make the tests of significance invalid. First, one must determine if the spatial component is significant using all spatial predictors (Moran's eigenvector maps). If it is, consider a model selection for the set of spatial predictors (an individual‐species forward selection procedure is to be preferred) and use the environmental and selected spatial predictors in a partial regression or partial canonical analysis scheme. This is an effective way of controlling for type I error in such tests. Polynomial regressors do not provide tests with a correct level of type I error.
Percentile distributions of waist circumference for 7–19‐year‐old Polish children and adolescents
Authors: Nawarycz L. Ostrowska , Krzyżaniak A. , Stawińska‐Witoszyńska B. , Krzywińska‐Wiewiorowska M. , Szilagyi‐Pągowska I. , Kowalska M. , Krzych Ł. , Nawarycz T. 
Published: December 2009

SummaryThe aim of the study was to develop waist circumference (WC) percentiles in Polish children and youth and to compare these with the results obtained in other countries. The study comprised a random group of 5663 Polish children aged 7–18 years. Smoothed WC percentile curves were computed using the LMS method. The curves displaying the values of the 50th (WC50) and the 90th (WC90) percentile were then compared with the results of similar studies carried out in children from the UK, Spain, Germany, Turkey, Cyprus, Canada and the USA. WC increased with age in both boys and girls and in all observed age periods the boys were seen to dominate. For 18‐year‐old Polish boys and girls the values of WC90 were 86.5 and 78.2, respectively, and were lower than the current criteria developed by the International Diabetes Federation. Both WC50 and WC90 were higher in Polish boys and girls compared with their counterparts in the UK, Turkey and Canada and significantly lower than in children from the USA, Cyprus and Spain. The percentile curves for Polish children and youth, which were developed here for the first time, are base curves that can be applied in analysing trends as well as making comparisons with results of similar studies performed in other countries.
Treatment of clinical insulin resistance in children: a systematic review
Authors: Quinn S. M. , Baur L. A. , Garnett S. P. , Cowell C. T. 
Published: December 2009

SummaryThe objective of this study was to evaluate the effectiveness of interventions aimed at improving clinical insulin resistance and/or pre‐diabetes in children. This study is a systematic review and meta‐analysis. Five electronic databases were searched for randomized controlled trials of at least 2‐months' duration. The outcomes were fasting insulin, homeostasis model assessment of insulin resistance (HOMA‐IR), body mass index (BMI) and adverse outcomes. Four randomized controlled trials were identified. All compared the effect of 6 months of metformin plus or minus lifestyle intervention with placebo plus or minus lifestyle intervention. After pooling results from three trials, the mean difference after 6 months favoured the intervention with a statistically significant mean decrease in fasting insulin, HOMA‐IR and BMI of 9.6 µU mL−1 (95% confidence interval [CI]: 6.3, 13.0 µU mL−1; I2 = 76%), 2.7 (95% CI: 1.7, 3.6; I2 = 74%) and 1.7 kg m−2 (95% CI: 1.1, 2.3 kg m−2; I2 = 75) respectively. Mild gastrointestinal symptoms were reported in 19% (2–29%; median and range) of participants taking metformin. Metformin improves markers of insulin sensitivity and reduces BMI in children and adolescents with clinical insulin resistance or pre‐diabetes. Stronger evidence from high‐quality studies of longer duration and larger sample size are required before clinical conclusions about the optimal treatment protocol in this population can be drawn.
Multihulls: A Technique for Spatial Representation and Processing with Variable Shape Fidelity, Applied to Gazetteers
Authors: Hastings Jordan T. 
Published: December 2009

AbstractSpatial processing is increasingly prevalent in the modern computing milieu. In particular, geographic information retrieval and location‐based services such as GoogleEarth and MapQuest depend on spatial operations in conjunction with gazetteers to georeference geographic features. However, many gazetteers contain only point locations or simple bounding rectangles, which make for erratic and sometimes poor georeferencing. Convex hulls can provide better georeferencing results at modest computational cost, but their shape fidelity is still erratic. Full GIS capabilities are actually overfit for many geospatial and georeferencing purposes, because of the limited accuracy of the underlying data. The financial and technical demands of GIS also exclude it from many markets. Described here is a new technique, multihulls, based on the iterative refinement of convex hulls. Multihulls achieve arbitrary shape fidelity at a small increment in computational cost, consistent with the data, outside a GIS, making them attractive for many geospatial and georeferencing applications, especially gazetteers.
Consumer‐Oriented Health Care Reform Strategies: A Review of the Evidence on Managed Competition and Consumer‐Directed Health Insurance
Authors: BUCHMUELLER THOMAS C. 
Published: December 2009

Context: For many years, leading health care reform proposals have been based on market‐oriented strategies. In the 1990s, a number of reform proposals were built around the concept of “managed competition,” but more recently, “consumer‐directed health care” models have received attention. Although price‐conscious consumer demand plays a critical role in both the managed competition and consumer‐directed health care models, the two strategies are based on different visions of the health care marketplace and the best way to use market forces to achieve greater systemwide efficiencies. Methods: This article reviews the research literature that tests the main hypotheses concerning the two policy strategies. Findings: Numerous studies provide consistent evidence that consumers’ health plan choices are sensitive to out‐of‐pocket premiums. The elasticity of demand appears to vary with consumers’ health risk, with younger, healthier individuals being more price sensitive. This heterogeneity increases the potential for adverse selection. Biased risk selection also is a concern when the menu of health plan options includes consumer‐directed health plans. Several studies confirm that such plans tend to attract healthier enrollees. A smaller number of studies test the main hypothesis regarding consumer‐directed health plans, which is that they result in lower medical spending than do more generous plans. These studies find little support for this claim. Conclusions: The experiences of employers that have adopted key elements of managed competition are generally consistent with the key hypotheses underlying that strategy. Research in this area, however, has focused on only a narrow range of questions. Because consumer‐directed health care is such a recent phenomenon, research on this strategy is even more limited. Additional studies on both topics would be valuable.
Aging in America in the Twenty‐first Century: Demographic Forecasts from the MacArthur Foundation Research Network on an Aging Society
Authors: OLSHANSKY S. JAY , GOLDMAN DANA P. , ZHENG YUHUI , ROWE JOHN W. 
Published: December 2009

Context: The aging of the baby boom generation, the extension of life, and progressive increases in disability‐free life expectancy have generated a dramatic demographic transition in the United States. Official government forecasts may, however, have inadvertently underestimated life expectancy, which would have major policy implications, since small differences in forecasts of life expectancy produce very large differences in the number of people surviving to an older age. This article presents a new set of population and life expectancy forecasts for the United States, focusing on transitions that will take place by midcentury. Methods: Forecasts were made with a cohort‐components methodology, based on the premise that the risk of death will be influenced in the coming decades by accelerated advances in biomedical technology that either delay the onset and age progression of major fatal diseases or that slow the aging process itself. Findings: Results indicate that the current forecasts of the U.S. Social Security Administration and U.S. Census Bureau may underestimate the rise in life expectancy at birth for men and women combined, by 2050, from 3.1 to 7.9 years. Conclusions: The cumulative outlays for Medicare and Social Security could be higher by $3.2 to $8.3 trillion relative to current government forecasts. This article discusses the implications of these results regarding the benefits and costs of an aging society and the prospect that health disparities could attenuate some of these changes.
The Effect of Networks on the Selection of Migrants and Destinations: Colombians in Galicia (Spain)
Authors: Lamela Carmen , Pérez‐Caramés Antía , Fernández‐Suárez Belén 
Published: December 2009

AbstractThis article presents findings from a research project on Colombian transnational migration to a secondary and peripheral region of Spain. The transnational character of our object of study means that our methodology is mainly of an anthropological nature. But our analysis is also guided by demographic data and theories, so it can be considered a sample of work in the new field of anthropological demography. The article’s main purpose is to explore migration network effects on inflows, given the weakness of other pull factors. We believe that local or regional levels of analysis might reveal other aspects about migration determinants that get lost at the national level. Moreover, the links between migrant networks and the size of immigration flows should be more evident at the regional level of analysis. Both statistical data analysis and ethnographic evidence point to the same conclusion: network dynamics do not sufficiently explain inflows behaviour, nor migration strategies and Colombians migrants’ interaction in destination. Instead, we can infer the importance of powerful push factors, and of migration history and social change in the country of origin. A transnational mother profile plays a relevant role in the analysis of this case and of cumulative causation theory. Gathered testimonies and observed evolution of Colombian migration to Spain and Galicia suggest the activation of feminised networks and the inhibition of family reunification.
ORIGINAL ARTICLE: Pain in people with learning disabilities in residential settings – the need for change
Authors: Beacroft Monica , Dodd Karen 
Published: December 2009

Accessible summary Pain is not recognised and managed well for people with learning disabilities in residential settings – People with learning disabilities are not getting timely and appropriate ‘as required’ medication for their pain. Staff do not use pain recognition tools or communication aids. Some staff still believe that people with learning disabilities have a higher pain threshold than people without a learning disability. They also let this belief affect how they manage pain. This research matters to people with learning disabilities. It is important that staff and carers recognise and manage pain well. We have developed a pain training pack for staff and carers and leaflets for both people with learning disabilities and staff and carers.SummaryThis audit investigated residential staff beliefs around pain thresholds and strategies they adopt to recognise and manage pain in people with learning disabilities across Surrey. A structured interview was constructed to elicit information. Results demonstrated that pain is not being effectively recognised or managed by residential staff in Surrey. It highlighted the need for training for staff in how to recognise and manage pain, as well as the need for appropriate pain recognition tools and communication aids to be utilised to support people with learning disabilities to be able to communicate their pain to others. It also indicated the need for better communication between staff and other services that the person with learning disabilities accesses.
Screening for mental health problems in adults with learning disabilities using the Mini PAS‐ADD Interview
Authors: Devine Maurice , Taggart Laurence , McLornian Paula 
Published: December 2009

Accessible summaryThis study interviewed the key workers of 96 adults with learning disabilities using the Mini PAS‐ADD Interview to identify whether they had a potential mental health problem. Prevalence rates of mental health across the UK and in other countries have been published but such figures are not known in Northern Ireland. This study found:

33.3% of the sample was identified to have a potential mental health problem.
This sample was found to score higher on the sub‐scales of depression and psychosis compared with other prevalence studies.
The community informants (i.e. nurses and social workers) were found to be competent in using the Mini PAS‐ADD Interview as identified by the sample of in‐depth psychiatric interviews undertaken by a psychiatrist.

SummaryPrevalence rates vary considerably regarding the mental health of people with learning disabilities. This variation is a consequence of the assessment methods used to identify such clinical conditions and also different populations studied. The aim of this study was to screen for mental health problems in adults with mild‐to‐moderate learning disabilities. This study took place in one region of the UK providing community‐based services to 96 adults with mild‐to‐moderate learning disabilities. Using the Mini PAS‐ADD Interview schedule, a number of specifically trained interviewers, interviewed staff who supported these adults with learning disabilities in their particular work/day care setting to determine whether or not participants had a potential mental health problem. This study found a 33.3% prevalence rate of mental health problems in this community sample. This sample was found to score higher on the sub‐scales of depression and psychosis compared with other prevalence studies. The Mini PAS‐ADD Interview was found have an overall sensitivity of 1 (100%); its specificity was 77%. The results of this study fall between previous community prevalence studies that range from 14% to 50%. The practical issues of the screening process are discussed. Methodological limitations are also highlighted in accurately predicting prevalence rates of mental health problems in the learning disability population by clinical staff.
Interaction between Fibrinogen and IL‐6 Genetic Variants and Associations with Cardiovascular Disease Risk in the Cardiovascular Health Study
Authors: Carty Cara L. , Heagerty Patrick , Heckbert Susan R. , Jarvik Gail P. , Lange Leslie A. , Cushman Mary , Tracy Russell P. , Reiner Alexander P. 
Published: December 2009

SUMMARYThe inflammatory cytokine interleukin‐6 (IL‐6) is a main regulator of fibrinogen synthesis, though its interaction with fibrinogen genes (FGA, FGB, FGG) and subsequent impact on cardiovascular disease (CVD) risk is not well‐studied.We investigated joint associations of fibrinogen and IL6 tagSNPs with fibrinogen concentrations, carotid intima‐media thickness, and myocardial infarction or ischemic stroke in 3900 European‐American Cardiovascular Health Study participants. To identify combinations of genetic main effects and interactions associated with outcomes, we used logic regression. We also evaluated whether the relationship between fibrinogen SNPs and fibrinogen level varied by IL‐6 level using linear regression models with multiplicative interaction terms. Combinations of fibrinogen and IL6 SNPs were significantly associated with fibrinogen level (p < 0.005), but not with other outcomes. Fibrinogen levels were higher in individuals having FGB1437 (rs1800790) and lacking FGA6534 (rs6050) minor alleles; these SNPs interacted with IL6 rs1800796 to influence fibrinogen level. Marginally significant (p= 0.03) interactions between IL‐6 level and FGA and FGG promoter SNPs associated with fibrinogen levels were detected.We identified potential gene‐gene interactions influencing fibrinogen levels. Although IL‐6 responsive binding sites are present in fibrinogen gene promoter regions, we did not find strong evidence of interaction between fibrinogen SNPs and IL6 SNPs or levels influencing CVD.