bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Systems' Responsiveness and Its Characteristics: A Cross‐Country Comparative Analysis
Authors: Robone Silvana , Rice Nigel , Smith Peter C. 
Published: July 2011

Objectives. Responsiveness has been identified as one of the intrinsic goals of health care systems. Little is known, however, about its determinants. Our objective is to investigate the potential country‐level drivers of health system responsiveness.
Data Source. Data on responsiveness are taken from the World Health Survey. Information on country‐level characteristics is obtained from a variety of sources including the United Nations Development Program (UNDP).
Study Design. A two‐step procedure. First, using survey data we derive a country‐level measure of system responsiveness purged of differences in individual reporting behavior. Secondly, we run cross‐sectional country‐level regressions of responsiveness on potential drivers.
Principal Findings. Health care expenditures per capita are positively associated with responsiveness, after controlling for the influence of potential confounding factors. Aspects of responsiveness are also associated with public sector spending (negatively) and educational development (positively).
Conclusions. From a policy perspective, improvements in responsiveness may require higher spending levels. The expansion of nonpublic sector provision, perhaps in the form of increased patient choice, may also serve to improve responsiveness. However, these inferences are tentative and require further study.
Depression and the Health Care Experiences of Medicare Beneficiaries
Authors: Martino Steven C. , Elliott Marc N. , Kanouse David E. , Farley Donna O. , Burkhart Q. , Hays Ron D. 
Published: July 2011

Objectives. To compare health care experiences of Medicare beneficiaries with and without symptoms of depression and investigate the role of patient confidence in shaping these experiences.
Data Sources. Data came from the 2009 CAHPS Medicare 4.0 Fee‐for‐Service (FFS) Survey, which was fielded to a national probability sample of 298,492 FFS Medicare beneficiaries.
Study Design. Linear regression was used to model associations of depression with four global ratings and three composite measures of health care and to test whether beneficiaries' confidence in their ability to recognize the need for care mediates these associations.
Principal Findings. Beneficiaries with depressive symptoms reported worse experiences with care across the full range of patient experience covered by the CAHPS survey. Depressive symptoms were associated with decreased patient confidence and decreased confidence was in turn associated with poorer reports of care.
Conclusions. Our study highlights depressive symptoms as a risk factor for poorer experiences of health care and highlights depressed patients' confidence in recognizing their need for care and for designing programs to improve the health care of this population.
Hepatitis D virus‐specific cytokine responses in patients with chronic hepatitis delta before and during interferon alfa‐treatment
Authors: Grabowski Jan , Yurdaydìn Cihan , Zachou Kalliopi , Buggisch Peter , Hofmann Wolf P. , Jaroszewicz Jerzy , Schlaphoff Verena , Manns Michael P. , Cornberg Markus , Wedemeyer Heiner ,   the HIDIT‐1 study group
Published: July 2011

Abstract
Background: Hepatitis delta is caused by infection with the hepatitis D virus (HDV) and is considered the most severe form of viral hepatitis. Treatment options for hepatitis delta are limited, with only 25% of patients responding to interferon (IFN)‐alfa‐based therapies. The role of the adaptive immune system in controlling HDV infection during spontaneous or treatment‐induced viral clearance is not well understood.
Methods: We studied HDV‐specific cytokine production of peripheral blood mononuclear cells stimulated with HDV peptide pools as well as serum cytokine levels in well‐characterized patients with chronic HDV infection before and during pegylated‐interferon‐alfa±adefovir therapy.
Results: Hepatitis D virus‐specific interleukin (IL)‐2, IFN‐γ‐, interferon‐inducible protein‐10 and IL‐10‐responses were detectable in 53%, 35%, 65% and 6% of hepatitis delta patients. HDV‐specific IFN‐γ responses tended to be more common in patients with low HDV viral loads. HDV‐specific cytokine responses declined during pegylated (PEG)‐IFNa therapy and patterns of changes were associated with the treatment response. Serum cytokine levels also showed distinct changes during PEG‐IFNa treatment.
Conclusion: We suggest that cellular HDV‐specific immune responses contribute to the control of HDV infection and that cytokine responses may indicate response to type‐I‐IFN‐based antiviral therapy of hepatitis delta.
A comparative evaluation of rotation thromboelastometry and standard coagulation tests in hemodilution‐induced coagulation changes after cardiac surgery
Authors: Ogawa Satoru , Szlam Fania , Chen Edward P. , Nishimura Takashi , Kim Heezoo , Roback John D. , Levy Jerrold H. , Tanaka Kenichi A. 
Published: July 2011

BACKGROUND: Coagulopathy after cardiopulmonary bypass (CPB) is caused by multiple perturbations in cellular and humoral elements of coagulation. A timely and comprehensive method to evaluate hemostasis would be helpful in the management of bleeding patients after CPB. The assessment of whole blood coagulation using rotation thromboelastometry (ROTEM) was compared to coagulation tests routinely performed during cardiac surgery.STUDY DESIGN AND METHODS: Blood was obtained from 26 patients undergoing CPB surgery at baseline, at 60 minutes on CPB, at the end of CPB, and on admission to intensive care unit. ROTEM tests (extrinsically activated [EXTEM], intrinsically activated [INTEM], specific clot formation [FIBTEM]), prothrombin time, activated partial thromboplastin time, platelet (PLT) count, fibrinogen, prothrombin level, antithrombin level, and thrombin generation (TG) measurement were performed.RESULTS: We observed strong correlations between FIBTEM‐amplitude at 10 minutes (A10) and fibrinogen level (r = 0.87; p < 0.001) and between EXTEM/ INTEM‐A10 variables and PLT count (r = 0.72 and 0.67, respectively; p < 0.001). Receiver operating characteristic analysis demonstrated that EXTEM‐A10 and INTEM‐A10 are predictive of thrombocytopenia below 80 × 109/L (area under the curve [AUC], 0.83 and 0.82, respectively), and FIBTEM‐A10 was highly predictive of fibrinogen level below 200 mg/dL (AUC, 0.96). There were only weak correlations found between TG peak and clot formation time of EXTEM or INTEM (r = 0.30 and 0.29, respectively; p < 0.05).CONCLUSION: ROTEM variables demonstrated clinically relevant correlations with PLT counts and fibrinogen levels. In particular, decreasing levels of fibrinogen can be quickly determined (<15‐20 min) using FIBTEM.
Mechanical and Electrical Properties of Multiwalled CNT‐Alumina Nanocomposites Prepared by a Sequential Two‐Step Processing of Ultrasonic Spray Pyrolysis and Spark Plasma Sintering
Authors: Lee Kyubock , Mo Chan Bin , Park Seung Bin , Hong Soon Hyung 
Published: July 2011

The high tensile strength and electrical conductivity as well as high aspect ratio of carbon nanotube (CNT) are known to effectively improve the brittleness and electrical properties of ceramic materials; however, the agglomeration of CNTs during in the synthetic process and the poor interfacial bonding between CNTs and matrix materials still present challenges. Herein, multiwalled carbon nanotube (MWNT)‐alumina composites were prepared, with homogeneously dispersed MWNTs in an alumina matrix, using a sequential two‐step process via ultrasonic spray pyrolysis followed by a spark plasma sintering process. To mix these two materials at the molecular level, MWNT‐alumina composites were prepared using a precursor solution containing Al ions instead of solid aluminum oxide particles as the starting material. The agglomeration of MWNTs at high concentration, which is a main obstacle to solution processing, was minimized using ultrasonic spray pyrolysis. The dc conductivity of pure α‐alumina, possessing substantial insulating properties, was increased to 12.2 S/m by incorporating 2.48 wt% of MWNTs with a low percolation threshold under 0.18 wt%. With the same amount of MWNT, the fracture toughness of the composite was increased 2.5 times. The improved electrical and mechanical properties of the composites are discussed based on the microstructural characteristics of the composites.
Hydrothermal Synthesis of Nanosized Na0.5Bi0.5TiO3
Authors: Šetinc Tina , Spreitzer Matjaž , Logar Manca , Suvorov Danilo 
Published: July 2011

The synthesis of sodium bismuth titanate Na0.5Bi0.5TiO3 (NBT) was studied using the hydrothermal treatment of TiO2 (anatase) and Bi(NO3)3·5H2O in a highly concentrated NaOH solution. The process parameters such as the alkaline conditions, the temperature, the reaction time, and the concentration, as well as the influence of the Bi/Ti ratio and microwave heating were investigated in detail. The as‐prepared NBT powders were characterized by X‐ray powder diffraction, transmission electron microscopy, energy‐dispersive spectrometry, and inductively coupled plasma atomic emission spectrometry. The results show that secondary sodium titanate phases formed along with the NBT phase in the initial stage of the reaction. Their stability was susceptible to the treatment conditions and the Bi/Ti ratio. Pure and well crystallized NBT nanoparticles were obtained after 48 h of reaction time at 200°C, 12M NaOH, 0.1M Bi(NO3)3·5H2O and a stoichiometric amount of TiO2 relative to the Bi precursor. A chemical analysis of the powders showed a slight sodium deficiency and bismuth surplus with respect to their nominal composition, i.e., Na:Bi:Ti = 0.47 ± 0.02:0.53 ± 0.02:1.00 ± 0.04. The obtained NBT particles were 50–100 nm in size and exhibited great potential for further integration in composite thin films.
Electric Current Pulse Activated 6H→3C Transformation in Silicon Carbide Compacts
Authors: Limeng Liu , Feng Ye , Yu Zhou 
Published: July 2011

6H‐SiC powder mixed with Si3N4, Al2O3, Y2O3, and AlN was sintered in a spark plasma sintering (SPS) equipment. The 6H→3C SiC transformation was concerned. Research results indicated the polytype transformation completed in less than 30 s by imposing a 14 458 W (6.2 V, 2332 A) transitory DC current at 1700°C upon cooling down from 2000°C. The fast transformation kinetic and the significant 3C‐SiC grain growth accompanying the phase transformation were suspected to be correlated with the pulsed SPS direct current.
Prevalence of Trichomonas vaginalis Infection in Symptomatic Adolescent Females Presenting to a Pediatric Emergency Department
Authors: Goyal Monika , Hayes Katie , McGowan Karin L. , Fein Joel A. , Mollen Cynthia 
Published: July 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:763–766 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  Adolescent females are disproportionately affected by sexually transmitted infections (STIs). Although Trichomonas vaginalis (TV) has been declared the most common nonviral STI, TV testing is not routinely conducted in the emergency department (ED), and when it is performed, insensitive testing methods are often used. Therefore, this study sought to determine the prevalence of TV and factors associated with TV infection among symptomatic adolescent females presenting to a pediatric ED.Methods:  This was a prospective prevalence study of female patients ages 14 to 19 years presenting to a pediatric ED with lower abdominal pain and/or genitourinary (GU) complaints. Patients were tested for TV, Neisseria gonorrhoeae (GC), and Chlamydia trachomatis (CT).Results:  Of the 276 patients who met inclusion criteria, 203 underwent TV testing; prevalence was 9.9% (95% confidence interval [CI] = 5.7% to 14.0%). Assuming all eligible patients who did not have TV testing were not infected with TV, sensitivity analysis revealed a minimum TV prevalence of 7.2% (95% CI = 4.2% to 10.3%). The overall prevalence of any STI was 22.5% (95% CI = 17.5% to 27.4%), with CT being the most prevalent (19.7%; 95% CI = 14.5 to 24.9). Aside from vaginal discharge (odds ratio [OR] = 3.7; 95% CI = 1.1 to 11.3), there were no other factors significantly associated with TV infection.Conclusions:  A substantial proportion of adolescent females presenting to a pediatric ED with lower abdominal or GU symptoms had TV infection. TV testing should be considered as part of the evaluation of adolescent females presenting to the ED with lower abdominal, urinary, or vaginal complaints.
Early Career Academic Productivity Among Emergency Physicians With R01 Grant Funding
Authors: Scott Van Epps J. , Younger John G. 
Published: July 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:759–762 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  The objective was to describe the early academic career activities of emergency physician (EP) scientists with recent Research Project Grant Program (R01) grant funding from the National Institutes of Health (NIH).Methods:  The curricula vitae of all EP scientists in the United States currently funded by the NIH were analyzed for evidence of advanced research training and frequency and type of publication and grant writing. Each investigator was surveyed for demographic features and estimation of protected time during their early career development.Results:  Eighteen investigators were identified. The median length of time from completion of residency to receipt of their first R01 grant was 11 years (interquartile range [IQR] = 11 to 15 years), and the median age of investigators at the time of this award was 43 years (IQR = 39 to 47 years). At the time of their award, researchers were publishing five peer‐reviewed manuscripts a year (IQR = 1 to 8 manuscripts) and had already received considerable external funding. Ninety‐four percent of those studied had pursued a research fellowship, an advanced degree, or an NIH K‐award following residency.Conclusions:  For EPs, receipt of an R01 from the NIH requires more than a decade of work following the completion of training. This period is characterized by pursuit of advanced research training, active and accelerating publication and collaboration, and acquisition of smaller extramural grants.
Electrocardiogram Findings in Emergency Department Patients with Syncope
Authors: Quinn James , McDermott Daniel 
Published: July 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:714–718 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  To determine the sensitivity and specificity of the San Francisco Syncope Rule (SFSR) electrocardiogram (ECG) criteria for determining cardiac outcomes and to define the specific ECG findings that are the most important in patients with syncope.Methods:  A consecutive cohort of emergency department (ED) patients with syncope or near syncope was considered. The treating emergency physicians assessed 50 predictor variables, including an ECG and rhythm assessment. For the ECG assessment, the physicians were asked to categorize the ECG as normal or abnormal based on any changes that were old or new. They also did a separate rhythm assessment and could use any of the ECGs or available monitoring strips, including prehospital strips, when making this assessment. All patients were followed up to determine a broad composite study outcome. The final ECG criterion for the SFSR was any nonsinus rhythm or new ECG changes. In this specific study, the initial assessments in the database were used to determine only cardiac‐related outcomes (arrhythmia, myocardial infarction, structural, sudden death) based on set criteria, and the authors determined the sensitivity and specificity of the ECG criteria for cardiac outcomes only. All ECGs classified as “abnormal” by the study criteria were compared to the official cardiology reading to determine specific findings on the ECG. Univariate and multivariate analysis were used to determine important specific ECG and rhythm findings.Results:  A total of 684 consecutive patients were considered, with 218 having positive ECG criteria and 42 (6%) having important cardiac outcomes. ECG criteria predicted 36 of 42 patients with cardiac outcomes, with a sensitivity of 86% (95% confidence interval [CI] = 71% to 94%), a specificity of 70% (95% CI = 66% to 74%), and a negative predictive value of 99% (95% CI = 97% to 99%). Regarding specific ECG findings, any nonsinus rhythm from any source and any left bundle conduction problem (i.e., any left bundle branch block, left anterior fascicular block, left posterior fascicular block, or QRS widening) were 2.5 and 3.5 times more likely associated with significant cardiac outcomes.Conclusions:  The ECG criteria from the SFSR are relatively simple, and if used correctly can help predict which patients are at risk of cardiac outcomes. Furthermore, any left bundle branch block conduction problems or any nonsinus rhythms found during the ED stay should be especially concerning for physicians caring for patients presenting with syncope.
No shallow talk: Cryptic strategy in the vocal communication of Blainville's beaked whales
Authors: Aguilar de Soto Natacha , Madsen Peter T. , Tyack Peter , Arranz Patricia , Marrero Jacobo , Fais Andrea , Revelli Eletta , Johnson Mark 
Published: July 2011

AbstractCommunicating animals must balance fitness benefits against the costs of signaling, such as increased predation risk. Cetaceans communicate mainly with sound and near‐surface vocalizations can place signalers at risk from shallow‐diving top‐predators with acute hearing such as killer whales. Beaked whales are deep divers living in small cohesive groups with little social defense from predation. Little if anything is known about their acoustic communication. Here, eight Blainville's beaked whales were studied with suction cup attached DTags to provide the first report on social communication as a function of diving behavior for any of the 21 ziphiid species. Tagged whales produced two previously unrecorded signals with apparent communicative functions: (1) fast series of ultrasonic frequency modulated clicks (rasps) were recorded from six individuals, and (2) harmonically rich short whistles with a mean fundamental frequency of 12 kHz were recorded from one whale at up to 900 m depth, the deepest whistles recorded from a marine mammal. Blainville's were silent 80% of the time, whenever shallower than 170 m depth and during the prolonged (19 min) silent ascents from vocal dives. This behavior limits the ability of shallow‐diving predators to track Blainville's acoustically and may provide a striking example of the evolutionary influence of the risk of predation on animal communication.
Defining bottlenose dolphin (Tursiops truncatus) stocks based on environmental, physical, and behavioral characteristics
Authors: Toth Jacalyn L. , Hohn Aleta A. , Able Kenneth W. , Gorgone Antoinette M. 
Published: July 2011

AbstractThe population structure of bottlenose dolphins, Tursiops truncatus, along the U.S. Atlantic coast has recently been redefined from one homogenous population into five coastal stocks. Local studies indicate even finer structure, primarily based on isolation of dolphins inhabiting estuaries. We identified population structuring of non‐estuarine coastal bottlenose dolphins during a study in New Jersey, the northern range along the Atlantic Coast. Using photo‐identification and distribution survey results, an analysis identified two major clusters of individuals significantly separated by five variables (distance from shoreline, group size, occurrence of the barnacle Xenobalanus globicipitis, avoidance behavior, and individual coloration). Sightings assigned to cluster 1 occurred in nearshore shallow waters (0–1.9 km, x̄= 3.5 m), and those assigned to cluster 2 occurred further offshore in deeper waters (1.9–6 km, x̄= 9.5 m). Only eight of 194 individuals (4%) were identified in both regions. Collectively, this suggests an occurrence of two stocks that are spatially, physically, and behaviorally distinguishable over a small distance. These results indicate that complexity in Tursiops population structure is not limited to latitudinal gradients or barriers created by estuarine habitats, but also by partitioning of habitat as a function of distance from shore and depth over small distances.
The behavioral context of common dolphin (Delphinus sp.) vocalizations
Authors: Henderson E. E. , Hildebrand J. A. , Smith M. H. , Falcone E. A. 
Published: July 2011

AbstractCorrelations between surface behavior and concurrent underwater vocalizations were modeled for common dolphins (Delphinus spp.) in the Southern California Bight (SCB) over multiple field seasons. Clicks, pulsed calls, and whistles were examined, with a total of 50 call features identified. Call features were used to classify behavior using random forest decision trees, with rates of correct classification reaching 80.6% for fast travel, 84.6% for moderate travel, 59.8% for slow travel, and 58% for foraging behavior. Common dolphins spent most of their time traveling. The highest number of clicks, pulsed calls, and complex whistles were produced during fast travel. In contrast, during foraging there were few pulsed calls and whistles produced, and the whistles were simple with narrow bandwidths and few harmonics. Behavior and vocalization patterns suggest nocturnal foraging in offshore waters as the primary feeding strategy. Group size and spacing were strongly correlated with behavior and rates of calling, with higher call rates in dispersed traveling groups and lower call rates in loosely aggregated foraging groups. These results demonstrate that surface behavior can be classified using vocalization data, which builds the framework for behavioral studies of common dolphins using passive acoustic monitoring techniques.
Estimating the carrying capacity of French Frigate Shoals for the endangered Hawaiian monk seal using Ecopath with Ecosim
Authors: Parrish Frank A. , Howell Evan A. , Antonelis George A. , Iverson Sara J. , Littnan Charles L. , Parrish James D. , Polovina Jeffrey J. 
Published: July 2011

AbstractThe carrying capacity of the French Frigate Shoals (FFS) region for the endangered Hawaiian monk seal was appraised using an updated version of the original FFS Ecopath model (Polovina 1984). Model parameters were updated using recent literature, and data from surveys of the seal population and its bottom‐associated prey. Together they produced a static mass balance model for 1998 when the prey surveys began. The Ecopath‐estimated monk seal biomass was 0.0045 t/km2, which was in close agreement with the biomass calculated from monk seal field beach counts (0.0046 t/km2). Model simulations through time were done in Ecosim using the Ecopath balanced model and included fisheries data time series from 1998 to 2008. Monk seal biomass declined concurrently with decreases in benthic bottomfish biomass, which were influenced by large‐scale changes in the environment of the North Pacific. This model scenario was extended from 2010, when the last permitted fishery in the Northwestern Hawaiian Islands was closed, through to 2040, assuming a constant environmental signal. Model results for this time period did not show a recovery of monk seals that exceeded the initial 1998 model biomass levels, highlighting the importance of including environmental variability in estimates of monk seals recovery at FFS.