bluuebunny/crossref_metadata_2025_split huggingface dataset:
What is so difficult about managing clinical reasoning difficulties?
Authors: Audétat Marie‐Claude , Dory Valérie , Nendaz Mathieu , Vanpee Dominique , Pestiaux Dominique , Junod Perron Noelle , Charlin Bernard 
Published: January 2012

Medical Education 2012:

46

: 216–227Context  Clinical reasoning is the cornerstone of medical competence. Difficulties in this area are often identified late in clinical training. Studies point to challenges faced by clinical educators in their dual roles as clinicians and educators. Little is known about the common, yet complex, issue of how they manage clinical reasoning difficulties. We therefore sought to: (i) describe the current state of affairs in various clinical teaching settings, and (ii) explore the factors that determine the behaviour of clinical educators in this respect.Methods  Four focus groups were conducted with 26 clinical educators in general practice, internal medicine and emergency medicine in Belgium and Switzerland. Two researchers analysed the transcripts of the focus group discussions using Fishbein’s integrative model of behaviour prediction in a theory‐driven, immersion–crystallisation process. Experienced faculty members validated the findings.Results  Across diverse settings, the process of identifying and remediating clinical reasoning difficulties was unstructured. Consistent with Fishbein’s model, clinical educators’ underlying beliefs determined their behaviour. They believed in the apprenticeship model of learning in the clinical environment, in which their educational role was limited to role‐modelling and in which residents were responsible for assimilating skills. They were sceptical about the potential impact of remediation. A few more knowledgeable supervisors had a stronger sense of their educational role, but did not implement systematic procedures to manage clinical reasoning difficulties. Environmental constraints were symptomatic of a collective paradigm of residency as an apprenticeship, in which the focus is on clinical duties, rather than as an educational programme.Conclusions  In order to improve the current state of affairs in the management of clinical reasoning difficulties, a collective paradigm shift is required to alter the perception of residency as an apprenticeship to one of residency as a structured educational programme. Faculty development programmes should be designed in an integrated way so that they not only develop clinical educators’ skills, but also modify their beliefs.
Comparison of the motor discharge to the voluntary sphincters of continence in the rat
Authors: Buffini M. , O’Halloran K. D. , O’Herlihy C. , O’Connell P. R. , Jones J. F. X. 
Published: January 2012

AbstractBackground  The rat external anal sphincter (EAS) and external urethral sphincter (EUS) are voluntary muscles of continence that can display similar synchronous electromyographic (EMG) activity patterns. However, the two sphincters are quite different in structure and function. The EUS is a fast twitch muscle and contains fibers expressing type 2B myosin. In contrast, the EAS exhibits slower kinetics and lacks type 2B fibers. This striking contrast in kinetics and fiber type profiles may be shaped by differences in the basal motor drive that each sphincter receives.Methods  A double EMG approach was used to obtain spontaneously active single motor unit action potentials from the EUS and EAS simultaneously and compare their basal discharge frequencies in urethane anaesthetized rats.Key Results  The basal firing rates of motor units of the EUS and EAS were not significantly different (3.9 ± 0.9 Hz vs. 3.1 ± 1.6 Hz, respectively, n = 7 animals, P = 0.32, paired Student’s t‐test). However, auto‐correlogram analysis showed that EUS is driven by neurons with faster instantaneous firing frequencies: 30.5 ± 2.4 Hz vs 14.3 ± 0.9 Hz in the EAS (P = 0.03, paired Student’s t‐test).Conclusions & Inferences  The oscillator(s) driving the EUS operate(s) at a frequency twice that of the EAS. This may explain the presence of type 2B fibers in the EUS. In the inter‐micturition periods no cross correlation was found in motor discharge to the sphincters suggesting that the two muscles do not share a common central drive to sustain the continent tonus of the two outlet tracts.
Increased rectal wall stiffness after prostate radiotherapy: relation with fecal urgency
Authors: Krol R. , Hopman W. P. M. , Smeenk R. J. , Van Lin E. N. J. T. 
Published: January 2012

AbstractBackground  Late anorectal toxicity is a frequent adverse event of external beam radiotherapy (EBRT) for prostate cancer. The pathophysiology of anorectal toxicity remains unknown, but we speculate that rectal distensibility is impaired due to fibrosis. Our goal was to determine whether EBRT induces changes of rectal distensibility as measured by an electronic barostat and to explore whether anorectal complaints are related to specific changes of anorectal function.Methods  Thirty‐two men, irradiated for localized prostate carcinoma, underwent barostat measurements, anorectal manometry, and completed a questionnaire prior to and 1 year after radiotherapy. The primary outcome measure was rectal distensibility in response to stepwise isobaric distensions. In addition, we assessed sensory thresholds, anal pressures, and anorectal complaints.Key Results  External beam radiotherapy reduced maximal rectal capacity (227 ± 14 mL vs 277 ± 15 mL; P < 0.001), area under the pressure‐volume curve (3212 ± 352 mL mmHg vs 3969 ± 413 mL mmHg; P < 0.005), and rectal compliance (15.7 ± 1.2 mL mmHg−1vs 17.6 ± 0.9 mL mmHg−1; P = 0.12). Sensory pressure thresholds did not significantly change. Sixteen of the 32 patients (50%) had one or more anorectal complaints. Patients with urgency (n = 10) had a more reduced anal squeeze and maximum pressure (decrease 29 ± 11 mmHg vs 1 ± 7 mmHg; P < 0.05 and 31 ± 12 mmHg vs 2 ± 8 mmHg; P < 0.05 respectively) compared with patients without complaints, indicating a deteriorated external anal sphincter function.Conclusions & Inferences  Irradiation for prostate cancer leads to reduced rectal distensibility. In patients with urgency symptoms, anal sphincter function was also impaired.
Mutations defective in ribonucleotide reductase activity interfere with pollen plastid DNA degradation mediated by DPD1 exonuclease
Authors: Tang Lay Yin , Matsushima Ryo , Sakamoto Wataru 
Published: January 2012

SummaryOrganellar DNAs in mitochondria and plastids are present in multiple copies and make up a substantial proportion of total cellular DNA despite their limited genetic capacity. We recently demonstrated that organellar DNA degradation occurs during pollen maturation, mediated by the Mg2+‐dependent organelle exonuclease DPD1. To further understand organellar DNA degradation, we characterized a distinct mutant (dpd2). In contrast to the dpd1 mutant, which retains both plastid and mitochondrial DNAs, dpd2 showed specific accumulation of plastid DNAs. Multiple abnormalities in vegetative and reproductive tissues of dpd2 were also detected. DPD2 encodes the large subunit of ribonucleotide reductase, an enzyme that functions at the rate‐limiting step of de novo nucleotide biosynthesis. We demonstrated that the defects in ribonucleotide reductase indirectly compromise the activity of DPD1 nuclease in plastids, thus supporting a different regulation of organellar DNA degradation in pollen. Several lines of evidence provided here reinforce our previous conclusion that the DPD1 exonuclease plays a central role in organellar DNA degradation, functioning in DNA salvage rather than maternal inheritance during pollen development.
Response of Lolium perenne to repeated flame treatments with various doses of propane
Authors: RASK A M , ANDREASEN C , KRISTOFFERSEN P 
Published: January 2012

Rask AM, Andreasen C & Kristoffersen P (2012). Response of Lolium perenne to repeated flame treatments with various doses of propane. Weed Research 52, 131–139.SummaryIn many urban areas, use of herbicides is either unwanted or prohibited and replaced with flame weeding. The influence of dose (kg propane ha−1) and treatment interval of flame weed control was studied on Lolium perenne. Lolium perenne is a perennial grass that is very difficult to control with non‐chemical weed control methods, because of its extensive regrowth. Treatments of eight different doses and five treatment intervals were applied during two seasons from May to October. The response was measured as plant dry weight, 14 days after last treatment. All weeds were killed with doses above 80 kg propane ha−1 when treatments were carried out every other week (10 treatments per growing season and a total dose of 800 kg ha−1), and no regrowth was seen the following 2 weeks. Six treatments a year and a total dose of 631–674 kg ha−1, depending on year, controlled L. perenne effectively (90% reduction in dry weight). Split applications generally increased the effect of the treatments, especially when the number of treatments was increased from four to six. The results are in accordance with the assumption that repeated flame treatments are necessary to kill larger plants and heat tolerant weeds, such as grasses and perennial weeds that will regrow after a single treatment. Knowledge of the relation between dose and treatment intervals may be used to improve flame weeding strategies on hard surfaces.
Coral communities and reefs from Guerrero, Southern Mexican Pacific
Authors: López‐Pérez Ramón A. , Calderón‐Aguilera Luis E. , Reyes‐Bonilla Héctor , Carriquiry José D. , Medina‐Rosas Pedro , Cupul‐Magaña Amilcar L. , Herrero‐Pérezrul María D. , Hernández‐Ramírez Héctor A. , Ahumada‐Sempoal Miguel Á. , Luna‐Salguero Betsabe M. 
Published: January 2012

AbstractCorals in the Eastern Pacific extend south from the Gulf of California to Ecuador and oceanic Chile, and west from Colombia to Clipperton Atoll. Nevertheless, large stretches of the Mexican Pacific remain fundamentally unstudied. Therefore, to assess the current conditions of coral communities, a coastal fringe ∼300 km long (17°40′ N, 101°39′ W to 16°46′ N, 99°49′ W) was surveyed within the Southern Mexican Pacific, between 2005 and 2009. Fifteen stony coral species were identified at 13 coral communities and six Pocillopora‐dominated fringing reefs, with Pocillopora verrucosa and Pocillopora damicornis the primary contributing taxa. Reef development was identified in embayments or behind rocks or islands that offered shelter from northern and northwestern winds. Observations of Pocillopora effusus, Pocillopora inflata, Porites lobata, Pavona clavus, and Pavona varians expanded the species known geographic ranges by several degrees of latitude, suggesting reef building fauna comprised a mixture of widespread and relatively rare Eastern Pacific corals. Results indicated greater live coral cover in the Ixtapa‐Zihuatanejo area (15–73%) than in the Acapulco localities, which had high algal dominance; the reefs in the latter region exhibited high erosion. Regional differences are likely the result of long‐standing anthropogenic pressures around Acapulco since 1950, when it became an important tourist destination. This paper is the first detailed report of ecologically stressed corals and coral reefs from the state of Guerrero on the Mexican Southern Pacific coast.
Genetic association of FOXP3 gene polymorphisms with allograft rejection in renal transplant patients
Authors: QIU XIAO‐YAN , JIAO ZHENG , ZHANG MING , CHEN JIAN‐PING , SHI XIAO‐JIN , ZHONG MING‐KANG 
Published: January 2012

ABSTRACTAim:  FOXP3 gene is known to be important for regulatory T cell development and function, and is associated with the rejection of human kidney transplants. The present study was therefore conducted to determine the effect of FOXP3 polymorphisms on allograft rejection in renal transplant recipients.Methods:  A total of 166 adult patients were categorized into either a Rejection group (65 patients) or a No rejection group (101 patients). Rs3761547, rs3761548 and rs2232365 variant alleles in the FOXP3 gene were genotyped using a TaqMan probe technique, and their relationships with rejection were investigated.Results:  There was no significant difference in the genotype frequencies of rs3761547 and rs2232365 variants between patients with and without rejection history (P > 0.05). Binary logistic regression analysis showed that the rs3761548 AA genotype carriers were associated with about a fourfold greater risk for rejection compared with CC genotype (5 years post‐transplant: odds ratio 3.95, 95% confidence interval 1.27–12.29, P = 0.018). Kaplan–Meier analysis revealed a lower mean time to the first rejection in rs3761548 AA compared with CC genotype patients (Log rank = 4.303, P = 0.038). Multivariate Cox regression analysis indicated that rs3761548 AA genotype carriers have up to about a twofold (hazard ratio 2.37, 95% confidence interval 1.17–4.80, P = 0.017) higher risk for rejection than CC carriers.Conclusion:  Our study suggests an association between FOXP3 rs3761548 polymorphisms and allograft rejection in renal transplantation. This association should be further proven in large prospective studies because of the small sample size and confounding factors in this retrospective study.
Report of a consensus meeting on focal low dose rate brachytherapy for prostate cancer
Authors: Langley Stephen , Ahmed Hashim U. , Al‐Qaisieh Bashar , Bostwick David , Dickinson Louise , Veiga Francisco Gomez , Grimm Peter , Machtens Stefan , Guedea Ferran , Emberton Mark 
Published: January 2012

What's known on the subject? and What does the study add?Whole gland brachytherapy has been used to successfully treat prostate cancer but the protocol for focal therapy has not previously been established.The consensus findings provide guidance on patient selection for focal brachytherapy as well as recommendations for conducting therapy and patient follow‐up.Low dose rate prostate brachytherapy is an effective treatment for localized prostate cancer. Recently, it has been considered for use in a focused manner whereby treatment is targeted only to areas of prostate cancer. The objective of focal brachytherapy is to provide effective cancer control for low‐risk disease but with reduced genitourinary and rectal side‐effects in a cost‐effective way. We report on the outputs of a consensus meeting of international experts in brachytherapy and focal therapy convened to consider the feasibility and potential development of focal brachytherapy. A number of factors were considered for focal brachytherapy including optimal patient selection, disease characterization and localization, treatment protocols and outcome measures. The consensus meeting also addressed the design of a clinical trial that would assess the oncological outcomes and side‐effect profiles resulting from focal brachytherapy.
Responses to risk: Public submissions on Australian alcohol guidelines for low‐risk drinking
Authors: WILKINSON CLAIRE 
Published: January 2012

AbstractIntroduction and Aims. In 2007 the National Health and Medical Research Council issued the draft of the revised Australian alcohol guidelines. The document presented guidelines explicitly in terms of risk. This paper seeks to explore the public response to this document by analysing the submissions received during the 60 day period for public feedback.Methods. One‐hundred and three submissions were reviewed. Considerations of what interests were reflected in submissions and how interest groups responded to the framing of risk were examined.Results. Submissions were received from individuals and organisations. Analysis revealed a range of views and rhetoric. Temperance interests wanted the guidelines' thresholds to be lower; the industry critiqued the evidence base as flawed and also argued that the public was unlikely to listen to low‐risk drinking messages; submissions from public health groups and government wanted a greater rationale for the guidelines and were also concerned with the dropping of a second differentiation of a higher‐risk level; personal testimonies supported the risk assessments based on personal experiences; and those working in clinical service provision expressed concern about the reception of the guidelines among client groups.Discussion and Conclusions. The diversity of views expressed seems to have had little effect in the revision of the guidelines. Disseminating the low‐risk drinking guidelines message poses many challenges. [Wilkinson C. Responses to risk: Public submissions on Australian alcohol guidelines for low‐risk drinking. Drug Alcohol Rev 2012;31:162–169]
Person‐Centred Active Support – Increasing Choice, Promoting Independence and Reducing Challenging Behaviour
Authors: Beadle‐Brown Julie , Hutchinson Aislinn , Whelton Beckie 
Published: January 2012

Background  Previous research has found that active support is effective at increasing levels of participation in activities and supporting a good quality of life for people with intellectual disabilities. However, there has been little research on the effect of active support on other outcome measures.Methods  This study uses observational methodology, combined with staff‐rated measures, to explore the impact of the implementation of person‐centred active support on the lives of 30 people with severe and profound intellectual disabilities living in small group homes.Results  Analysis indicated that significant increases in both the amount of assistance people received and the quality of that assistance were accompanied by significant increases in engagement, participation, choice‐making opportunities and a significant reduction in challenging behaviour and in particular, self‐stimulatory behaviour.Conclusions  The paper discusses the implications of the findings for both practice and for further research.
Examining the integrity of soil metal bioavailability assays in the presence of organic amendments to metal‐spiked soils
Authors: Black A. , Mclaren R. G. , Reichman S. M. , Speir T. W. , Condron L. M. 
Published: January 2012

AbstractThis paper questions whether the presence of biosolids amendment in metal‐spiked soils alters the outcome of soil‐based assays of metal bioavailability. The effects of biosolids amendment on the efficacies of six soil metal bioavailability assays (total recoverable, EDTA, Ca(NO3)2, soil solution, diffusive gradient in thin films and free ion activity) were assessed against metal concentrations in wheat shoots (Triticum aestivum) germinated in three contrasting soils, each previously incubated for either 2 weeks or 6 months following treatment with Cd, Cu, Ni and Zn +/− biosolids amendment. Overall, Ca(NO3)2 was the most accurate method to predict Cd (r2 = 0.62), Ni (r2 = 0.73) and Zn (r2 = 0.55) bioavailability in soils and therefore was used to compare variations in responses between biosolids and nonbiosolids‐amended soils. Comparisons between these two groups revealed no significant differences in linear relationships for all four metals and soil types assessed. These findings not only support Ca(NO3)2 as a robust and valid method for determining soil metal bioavailability across metal matrices and soil types, but also that the presence of biosolids does not compromise the predictive power of this assay or any of the others examined.
Treating the Obese Dialysis Patient: Challenges and Paradoxes
Authors: Celebi‐Onder Songul , Schmidt Rebecca J. , Holley Jean L. 
Published: January 2012

AbstractObesity is a major epidemic in the general population and has added unique challenges to renal replacement therapy as choice of access, dialysis adequacy, and preparation for kidney transplantation may all be affected. There are few clinical studies on managing obese patients with end‐stage renal disease (ESRD) and no accepted strategies for the variety of problems encountered in this population. Attempts at weight loss are generally advisable to prevent obesity‐related surgical complications and improve patient and graft survival after kidney transplantation. This article reviews the unique aspects of managing obese patients with ESRD.
A Dual‐Chambered Hemodialyzer for Convection‐Enhanced Hemodialysis
Authors: Lee Kyungsoo , Mun Cho Hae , Min Byoung Goo , Won Yong Soon 
Published: January 2012

AbstractConvective clearance during hemodialysis (HD) improves dialysis outcomes in kidney failure patients, and, thus, trials have been undertaken to increase convective mass transfer, which is directly related to internal filtration rates. The authors designed a new hemodialyzer to increase the internal filtration rates, and here describe the hemodialytic efficacy of the devised unit. The developed dual‐chambered hemodialyzer (DCH) contains two separate chambers for dialysate flow within a single housing. By placing a flow restrictor on the dialysate stream between these two chambers, dialysate pressures are regulated independently. Dialysate is maintained at a higher pressure than blood pressure in one chamber, and at a lower pressure in the other chamber. The dialysis performance of the DCH was investigated using an acute canine renal failure model. Urea and creatinine reductions and albumin loss were monitored, and forward and backward filtration rates were measured. No procedurally related malfunction was encountered, and animals remained stable without any complications. Urea and creatinine reductions after 4‐h dialysis treatments were 75.2 ± 6.5% and 67.7 ± 8.9%, respectively. Post‐treatment total protein and albumin levels remained at pretreatment values. Total filtration volume was 4.98 ± 0.5 L over 4 h, whereas the corresponding backfiltration (BF) volume was 4.77 ± 0.6 L. The developed dual‐chamber dialyzer has the benefit of providing independent control of forward filtration and BF rates. HD using this dialyzer provides a straightforward means of increasing the internal filtration and convective dose.
A Call for Guidance in the Use of Left Ventricular Assist Devices in Older Adults
Authors: Vitale Caroline A. , Chandekar Rashmi , Rodgers Phillip E. , Pagani Francis D. , Malani Preeti N. 
Published: January 2012

Ethics, Public Policy and Medical EconomicsLeft ventricular assist devices (LVADs) are approved as “destination therapy” (permanent use without plans for transplantation) in individuals with advanced heart failure who are not candidates for a cardiac transplant; as such, these devices are increasingly being used in older adults. Although LVADs have been shown to increase quality of life and survival, the associated treatment burdens and complications deserve careful consideration. The current study illustrates myriad clinical challenges that can arise during long‐term mechanical support using an older adult case history. Current data on LVAD use in older adults is reviewed, and a discussion of relevant points to consider before LVAD implantation in older adults, including advance care planning, assessment of gait and cognition, and the potential for substantial caregiver burden, is undertaken.