bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team
Authors: Wiegersma Janke S , Droogh Joep M , Zijlstra Jan G , Fokkema Janneke , Ligtenberg Jack JM 
Published: March 2011

Abstract
Introduction
In order to minimize the additional risk of interhospital transport of critically ill patients, we started a mobile intensive care unit (MICU) with a specialized retrieval team, reaching out from our university hospital-based intensive care unit to our adherence region in March 2009. To evaluate the effects of this implementation, we performed a prospective audit comparing adverse events and patient stability during MICU transfers with our previous data on transfers performed by standard ambulance.

Methods
All transfers performed by MICU from March 2009 until December 2009 were included. Data on 14 vital variables were collected at the moment of departure, arrival and 24 hours after admission. Variables before and after transfer were compared using the paired-sample T-test. Major deterioration was expressed as a variable beyond a predefined critical threshold and was analyzed using the McNemar test and the Wilcoxon Signed Ranks test. Results were compared to the data of our previous prospective study on interhospital transfer performed by ambulance.

Results
A total of 74 interhospital transfers of ICU patients over a 10-month period were evaluated. An increase of total number of variables beyond critical threshold at arrival, indicating a worsening of condition, was found in 38 percent of patients. Thirty-two percent exhibited a decrease of one or more variables beyond critical threshold and 30% showed no difference. There was no correlation between patient status at arrival and the duration of transfer or severity of disease. ICU mortality was 28%. Systolic blood pressure, glucose and haemoglobin were significantly different at arrival compared to departure, although significant values for major deterioration were never reached. Compared to standard ambulance transfers of ICU patients, there were less adverse events: 12.5% vs. 34%, which in the current study were merely caused by technical (and not medical) problems. Although mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was significantly higher, patients transferred by MICU showed less deterioration in pulmonary parameters during transfer than patients transferred by standard ambulance.

Conclusions
Transfer by MICU imposes less risk to critically ill patients compared to transfer performed by standard ambulance and has, therefore, resulted in an improved quality of interhospital transport of ICU patients in the north-eastern part of the Netherlands.
Cytomegalovirus reactivation and associated outcome of critically ill patients with severe sepsis
Authors: Heininger Alexandra , Haeberle Helene , Fischer Imma , Beck Robert , Riessen Reimer , Rohde Frank , Meisner Christoph , Jahn Gerhard , Koenigsrainer Alfred , Unertl Klaus , Hamprecht Klaus 
Published: March 2011

Abstract
Introduction
Sepsis has been identified as a risk factor for human cytomegalovirus (CMV) reactivation in critically ill patients. However, the contribution of CMV reactivation on morbidity and mortality is still controversial. Therefore, we analyzed the incidence and impact of CMV reactivation on outcome in patients with severe sepsis.

Methods
In a prospective longitudinal double-blinded observational study, 97 adult nonimmunosuppressed CMV-seropositive patients with new onset of severe sepsis were included. Leukocytes, plasma and tracheal secretions were examined weekly for CMV-DNA by PCR. Tracheal secretions were additionally tested for HSV (Herpes Simplex Virus)-DNA. The influence of CMV-reactivation on the endpoints was analysed by Cox proportional-hazard regression analysis. Time-dependency was evaluated by landmark analysis.

Results
Six out 97 died and five were discharged from the hospital within 72 hours and were excluded of the analysis. CMV reactivation occurred in 35 of the 86 (40.69%) analysed patients. HSV infection occurred in 23 of the 35 (65.7%) CMV reactivators. In 10 patients CMV-plasma-DNAemia appeared with a DNA-content below 600 copies/ml in four cases and a peak amount of 2,830 copies/ml on average. In patients with and without CMV reactivation mortality rates were similar (37.1% vs. 35.3%, P = 0.861), respectively. However, in the multivariate COX regression analyses CMV reactivation was independently associated with increased length of stay in the ICU (30.0, interquartile range 14 to 48 vs. 12.0, interquartile range 7 to 19 days; HR (hazard ratio) 3.365; 95% CI (confidence interval) 1.233 to 9.183, P = 0.018) and in the hospital (33.0, interquartile range 24 to 62 vs. 16.0, interquartile range 10 to 24 days, HR 3.3, 95% CI 1.78 to 6.25, P < 0.001) as well as prolonged mechanical ventilation (22.0, interquartile range 6 to 36 vs. 7.5, interquartile range 5 to 15.5 days; HR 2.6,CI 95% 1.39 to 4.94; P < 0.001) and impaired pulmonary gas exchange (six days, interquartile range 1 to 17, vs. three, interquartile range 1 to 7, days in reactivators vs. non-reactivators, P = 0.038). HSV reactivation proved not to be a risk factor for these adverse effects.

Conclusions
These data indicate an independent correlation between CMV reactivation and increased morbidity in the well-defined group of nonimmunosuppressed patients with severe sepsis, but CMV reactivation had no impact on mortality in this group with low CMV-DNA plasma levels. Thus, the potential harms and benefits of antiviral treatment have to be weighed cautiously in patients with severe sepsis or septic shock.
Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients
Authors: McGrane Stuart , Girard Timothy D , Thompson Jennifer L , Shintani Ayumi K , Woodworth Alison , Ely E Wesley , Pandharipande Pratik P 
Published: March 2011

Abstract
Introduction
Non-intensive care unit (ICU) cohorts have shown an association between inflammatory disturbances and delirium, though these relationships have not been studied in critically ill patients. This study sought to investigate the relationship between two inflammatory biomarkers, procalcitonin and C-reactive protein (CRP), and duration of acute brain dysfunction in ventilated patients.

Methods
Patients enrolled in the Maximizing Efficacy of Targeted Sedation and Reducing Neurological Dysfunction (MENDS) trial were assessed daily for delirium using the Confusion Assessment Method-ICU. Plasma levels of procalcitonin and CRP were obtained within 24 hours of enrollment. Proportional odds logistic regression was used to examine the association between procalcitonin and CRP separately with delirium/coma-free days, adjusting for age, acute physiology score (APS) of the Acute Physiology And Chronic Health Evaluation (APACHE) II, sedation group (dexmedetomidine vs. lorazepam), and sepsis. Secondary analyses examined the association of these markers with other organ dysfunctions and 28-day survival.

Results
Eighty-seven patients were included in this analysis. The median age of the patients was 60 years with APACHE II scores of 28; 68% had sepsis within 48 hours of admission. Higher levels of procalcitonin were associated with fewer delirium/coma-free days [odds ratio (OR), 0.5; 95% confidence interval (CI), 0.3 to 1.0; P = 0.04], whereas higher CRP levels showed trends towards fewer delirium/coma-free days (OR, 0.6; 95% CI, 0.3 to 1.1; P = 0.08). Similar relationships were found regardless of the presence of sepsis. No associations were found between procalcitonin or CRP with 28-day survival (P = 0.40 and 0.16, respectively).

Conclusions
In our pilot study, high baseline inflammatory biomarkers predicted prolonged periods of acute brain dysfunction, implicating inflammation as an important mechanism in the pathophysiology of delirium and coma during critical illness, irrespective of whether patients had sepsis or not.
Comparative genomics of the social amoebae Dictyostelium discoideum and Dictyostelium purpureum
Authors: Sucgang Richard , Kuo Alan , Tian Xiangjun , Salerno William , Parikh Anup , Feasley Christa L , Dalin Eileen , Tu Hank , Huang Eryong , Barry Kerrie , Lindquist Erika , Shapiro Harris , Bruce David , Schmutz Jeremy , Salamov Asaf , Fey Petra , Gaudet Pascale , Anjard Christophe , Babu M Madan , Basu Siddhartha , Bushmanova Yulia , van der Wel Hanke , Katoh-Kurasawa Mariko , Dinh Christopher , Coutinho Pedro M , Saito Tamao , Elias Marek , Schaap Pauline , Kay Robert R , Henrissat Bernard , Eichinger Ludwig , Rivero Francisco , Putnam Nicholas H , West Christopher M , Loomis William F , Chisholm Rex L , Shaulsky Gad , Strassmann Joan E , Queller David C , Kuspa Adam , Grigoriev Igor V 
Published: March 2011

Abstract
Background
The social amoebae (Dictyostelia) are a diverse group of Amoebozoa that achieve multicellularity by aggregation and undergo morphogenesis into fruiting bodies with terminally differentiated spores and stalk cells. There are four groups of dictyostelids, with the most derived being a group that contains the model species Dictyostelium discoideum.

Results
We have produced a draft genome sequence of another group dictyostelid, Dictyosteliumpurpureum, and compare it to the D. discoideum genome. The assembly (8.41 × coverage) comprises 799 scaffolds totaling 33.0 Mb, comparable to the D. discoideum genome size. Sequence comparisons suggest that these two dictyostelids shared a common ancestor approximately 400 million years ago. In spite of this divergence, most orthologs reside in small clusters of conserved synteny. Comparative analyses revealed a core set of orthologous genes that illuminate dictyostelid physiology, as well as differences in gene family content. Interesting patterns of gene conservation and divergence are also evident, suggesting function differences; some protein families, such as the histidine kinases, have undergone little functional change, whereas others, such as the polyketide synthases, have undergone extensive diversification. The abundant amino acid homopolymers encoded in both genomes are generally not found in homologous positions within proteins, so they are unlikely to derive from ancestral DNA triplet repeats. Genes involved in the social stage evolved more rapidly than others, consistent with either relaxed selection or accelerated evolution due to social conflict.

Conclusions
The findings from this new genome sequence and comparative analysis shed light on the biology and evolution of the Dictyostelia.
Neural activation and radial diffusivity in schizophrenia:
combined fMRI and diffusion tensor imaging study
Authors: Koch Kathrin , Wagner Gerd , Schachtzabel Claudia , Schultz C. Christoph , Güllmar Daniel , Reichenbach Jürgen R. , Sauer Heinrich , Schlösser Ralf G. M. 
Published: March 2011

BackgroundSchizophrenia is associated with often widespread changes in white matter
structure. Most studies have investigated changes in fractional
anisotropy, whereas alterations in radial or axial diffusivity have
barely been investigated until now.AimsTo investigate radial diffusivity as a potential marker of dysmyelination
in direct relation to abnormalities in neural activation.MethodNeural activation in association with decision-making under uncertainty
was investigated in 19 people with schizophrenia and 20 healthy controls
and linked to radial diffusivity as measured by diffusion tensor
imaging.ResultsDecision-making under uncertainty was associated with a significantly
decreased activation in a frontostriatocingulate network in the
schizophrenia group. Structurally, they exhibited increased radial
diffusivity in temporal white matter that was negatively correlated with
activation in parts of the frontostriatocingulate network.ConclusionsPresent data indicate that altered diffusivity within relevant white
matter networks may be closely linked to abnormal neural activation in
schizophrenia.
Will current socioeconomic trends produce a depressing future
for men?
Authors: Dunlop Boadie W. , Mletzko Tanja 
Published: March 2011

SummaryThe changing economic and social environment of Western nations is having a
profound impact on men's lives. Men who assume a greater share of roles
traditionally filled by women will experience challenges to traditional
sources of male self-esteem, potentially heightening the risk for depressive
disorders among men.
Neurodevelopmental hypothesis of schizophrenia
Authors: Owen Michael J. , O'Donovan Michael C. , Thapar Anita , Craddock Nicholas 
Published: March 2011

SummaryThe neurodevelopmental hypothesis of schizophrenia provided a valuable framework that allowed a condition that usually presents with frank disorder in adolescence or early adulthood to be understood at least in part as a consequence of events occurring early in development. However, the implications of the neurodevelopmental hypothesis for nosological conceptions of the disorder can only now be fully appreciated. Recent research indicates genetic overlap between schizophrenia and syndromes in which psychopathology is manifest in childhood and that are often grouped together as ‘neurodevelopmental disorders' such as autism-spectrum disorders, intellectual disability and attention-deficit hyperactivity disorder. These findings challenge the aetiological basis of current diagnostic categories and, together with evidence for frequent comorbidity, suggest that we should view the functional psychoses as members of a group of related and overlapping syndromes that result in part from a combination of genetic and environmental effects on brain development and that are associated with specific and general impairments of cognitive function. This has important implications for future research and for the configuration of psychiatric services.
Off-label prescribing in people with recurrent depressive disorder attending a community mental health service
Authors: Uzoechina Chinedu E. , Hilvering Pieter , Rogers Cathryn , O'Brien Sinead , Pullela Ananth , Yousafzai Mushtaq , Meagher David J. 
Published: March 2011

Aims and methodWe investigated deliberate and inadvertent off-label prescribing in individuals with recurrent depressive disorder attending a community mental health service.ResultsOff-label prescribing occurred in 87 of 226 people with recurrent depressive disorder (38%) and involved antipsychotic agents (41), maintenance benzodiazepine use (33), antidepressant polypharmacy (28), high-dose antidepressants (19) and use of antidepressants outside of the recommended age range (16). Off-label prescribing was part of a deliberate and documented treatment plan for a half (n= 43) of individuals. Participants receiving off-label prescribing had higher total Health of the Nation Outcome Scale (HoNOS) scores, were attending more frequently and were older and had more chronic illness duration. Inadvertent off-label prescribing was related to higher scores on the behavioural disturbance subscale of the HoNOS.Clinical implicationsOff-label prescribing is a common phenomenon in people with recurrent depressive disorder and relates to greater illness severity and chronicity. Although off-label prescribing is frequently deliberate, in many cases it is undesirable and unplanned.
Impact of crisis resolution and home treatment services on user experience and admission to psychiatric hospital
Authors: Barker Victoria , Taylor Mark , Kader Ihsan , Stewart Kathleen , Le Fevre Pete 
Published: March 2011

Aims and methodCrisis resolution and home treatment (CRHT) teams began operating in Edinburgh in late 2008. We ascertained service users' and carers' experiences of CRHT using a standardised questionnaire. We also assessed the impact of CRHT on psychiatric admissions and readmissions by analysing routinely collected data from November 2003 to November 2009.ResultsThere was a 24% decrease in acute psychiatric admissions in the year after CRHT began operating, whereas the previous 5 years saw an 8% reduction in the admission rate. The mean duration of in-patient stay fell by 6.5 days (22% decrease) in the 12 months following CRHT introduction, alongside a 4% decrease in readmissions and a 17% reduction in Mental Health Act 1983 admissions. Although the mean response rate was low (29%), 93% of patients reported clinical improvement during CRHT care, 27% of patients felt totally recovered at discharge from CRHT, 90% of patients felt safe during CRHT treatment, and 94% of carers said their friend or relative got better with CRHT input.Clinical implicationsCrisis resolution and home treatment service in Edinburgh had a positive impact during the first 12 months in terms of reduced admissions, reduced duration of in-patient stay and reduced use of the Mental Health Act. The service can catalyse a more efficient use of in-patient care. Service users and carers report high rates of improvement and satisfaction with CRHT.
Mechanism of Heme Uptake by Heme Acquisition System A
Authors: Ozaki Shin-ichi , Nakahara Akira , Sato Takehiro 
Published: March 2011

Abstract
Heme acquisition system A (HasA), secreted by various gram-negative pathogens, uses a unique histidine–iron–tyrosine (His–Fe–Tyr) coordination to scavenge heme (i.e., protoporphyrin IX–Fe complex) as an iron source. In order to study heme uptake by HasA, we utilized axial ligand mutants and protoporphyrin IX. Our results suggest that the binding of heme in apoprotein is initiated by interactions between heme and hydrophobic residues in the heme pocket. Subsequently, the sequential coordination of Tyr-75 and His-32 with the iron appears to complete holoprotein formation.
Wittig Like Methylenation of Aldehydes in a Microflow System: Selective Methylenation by Differential of Plural Reactions
Authors: Takada Yoshiaki , Matsubara Seijiro 
Published: March 2011

Abstract
Methylenation of aldehydes with bis(iodozincio)methane was performed using a microflow system. Treatment of a dialdehyde with bis(iodozincio)methane in the system can divide two methylenation reactions and realize selective transformation.
What More Than Parental Income, Education and Occupation? An Exploration of What Swedish Siblings Get from Their Parents
Authors: Björklund Anders , Lindahl Lena , Lindquist Matthew J. 
Published: March 2011

Abstract
Sibling correlations are broader measures of the impact of family and community influences on individual outcomes than intergenerational correlations. Estimates of such correlations in income show that more than half of the family and community influences that siblings share are uncorrelated with parental income. We employ a data set with rich family information to explore what factors in addition to traditional measures of parents socio-economic status can explain sibling similarity in long-run income. Measures of family structure and social problems account for very little of sibling similarities beyond that already accounted for by income, education and occupation. However, when we add indicators of parental involvement in schoolwork, parenting practices and maternal attitudes, the explanatory power of our variables increases from about one-quarter (using only traditional measures of parents socio-economic status) to nearly two-thirds.
The Emergence of Institutions
Authors: Sanchez-Pages Santiago , Straub Stéphane 
Published: March 2011

Abstract
This paper analyses how institutions aimed at coordinating economic interactions may emerge. Starting from a hypothetical state of nature, agents can delegate the task of enforcing cooperation to one of them in exchange for a proper compensation. Both individual and collective commitment problems stand in the way of institution formation. These problems imply first that a potentially efficient institution may fail to emerge and also that if it emerges, it may do so inefficiently. We show that big and untrustworthy societies are more likely to support institutions whereas their emergence is more difficult in small and trusting societies, but if institutions do emerge, they tend to be more inefficient in the former type of societies. Finally, we show that the threat of secession by a subset of agents may alleviate the latter problem.
Racing for Investment under Mandatory Access
Authors: Vareda João , Hoernig Steffen 
Published: March 2011

Abstract
We analyze the impact of mandatory access on a race for investments and show that for a low (high) access price, firms wait (preempt each other). An access price increase tends to accelerate investment in general but may delay the first investment. While the first best cannot be achieved with a time-invariant access tariff, simple instruments such as ending access at a preset date or granting access holidays can improve efficiency. The former forces earlier investment when it would happen too late otherwise, while the latter allows for lower access prices later in order to delay a business-stealing second investment.
Determinants of the Differences in the Downstream Vertical Integration and Efficiency Implications in Agricultural Cooperatives
Authors: Salazar Idana , Galve Górriz Carmen 
Published: March 2011

Abstract
This study investigates the explanatory variables affecting the agricultural cooperatives decision of downstream vertical integration into the transformation of the products supplied by their members. The study also analyses the effect of the vertical integration decision on the efficiency obtained. This analysis has been carried out by means of a two-step methodology suggested by Heckman (1979) over a sample of Spanish agricultural cooperatives belonging to the Qualified Denomination of Origin La Rioja. The results obtained show that those cooperatives, which have adopted Actualisation Mechanisms of social capital, high dedication to agricultural activity, and high rate of capacity utilization are more likely to integrate within the cooperative another stage of the production cycle. Furthermore, the results show that the most efficient cooperatives are those with a higher level of downstream vertical integration.
Competition and Performance in the Marketplace for Religion: A Theoretical Perspective
Authors: Eswaran Mukesh 
Published: March 2011

Abstract
This paper, which contributes to the literature that rigorously models religious markets, offers a theoretical framework that incorporates demand and supply sides. The model can accommodate Adam Smith’s view that competition may possibly improve on monopoly’s performance and also David Hume’s opposite view that, because the clergy have an incentive to distort the message of religion, monopoly might possibly improve on competition. Impacts on religiosity of greater diversity and of increased competition in the marketplace for religion are isolated. It is shown that while greater diversity benefits the devout (as claimed by “supply-side” theorists), increased competition dilutes spiritual standards by encouraging monetary donations at the expense of genuine piety. These opposing effects of diversity and competition help reconcile apparently contradictory empirical findings on the American religious market and also those suggesting European “exceptionalism.”