bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prolonged mechanical ventilation in critically ill patients: epidemiology, outcomes and modelling the potential cost consequences of establishing a regional weaning unit
Authors: Lone Nazir I , Walsh Timothy S 
Published: April 2011

Abstract
Introduction
The number of patients requiring prolonged mechanical ventilation (PMV) is likely to increase. Transferring patients to specialised weaning units may improve outcomes and reduce costs. The aim of this study was to establish the incidence and outcomes of PMV in a UK administrative health care region without a dedicated weaning unit, and model the potential impact of establishing a dedicated weaning unit.

Methods
A retrospective cohort study was undertaken using a database of admissions to three intensive care units (ICU) in a UK region from 2002 to 2006. Using a 21 day cut-off to define PMV, incidence was calculated using all ICU admissions and ventilated ICU admissions as denominators. Outcomes for the PMV cohort (mortality and hospital resource use) were compared with the non-PMV cohort. Length of ICU stay beyond 21 days was used to model the effect of establishing a weaning unit in terms of unit occupancy rates, admission refusal rates, and healthcare costs.

Results
Out of 8290 ICU admission episodes, 7848 were included in the analysis. Mechanical ventilation was required during 5552 admission episodes, of which 349 required PMV. The incidence of PMV was 4.4 per 100 ICU admissions, and 6.3 per 100 ventilated ICU admissions. PMV patients used 29.1% of all general ICU bed days, spent longer in hospital after ICU discharge than non-PMV patients (median 17 vs 7 days, P < 0.001) and had higher hospital mortality (40.3% vs 33.8%, P = 0.02). For the region, in which about 70 PMV patients were treated each year, a weaning unit with a capacity of three beds appeared most cost efficient, resulting in an occupancy rate of 73%, admission refusal rate at 21 days of 36%, and potential cost saving of £344,000 (€418,000) using UK healthcare tariffs.

Conclusions
One in every sixteen ventilated patients requires PMV in our region and this group use a substantial amount of health care resource. Establishing a weaning unit would potentially reduce acute bed occupancy by 8-10% and could reduce overall treatment costs. Restructuring the current configuration of critical care services to introduce weaning units should be considered if the expected increase in PMV incidence occurs.
Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study
Authors: Amrein Karin , Sourij Harald , Wagner Gerit , Holl Alexander , Pieber Thomas R , Smolle Karl Heinz , Stojakovic Tatjana , Schnedl Christian , Dobnig Harald 
Published: April 2011

Abstract
Introduction
Vitamin D deficiency is encountered frequently in critically ill patients and might be harmful. Current nutrition guidelines recommend very low vitamin D doses. The objective of this trial was to evaluate the safety and efficacy of a single oral high-dose vitamin D3 supplementation in an intensive care setting over a one-week observation period.

Methods
This was a randomized, double-blind, placebo-controlled pilot study in a medical ICU at a tertiary care university center in Graz, Austria. Twenty-five patients (mean age 62 ± 16yrs) with vitamin D deficiency [25-hydroxyvitamin D (25(OH)D) ≤20 ng/ml] and an expected stay in the ICU >48 hours were included and randomly received either 540,000 IU (corresponding to 13.5 mg) of cholecalciferol (VITD) dissolved in 45 ml herbal oil or matched placebo (PBO) orally or via feeding tube.

Results
The mean serum 25(OH)D increase in the intervention group was 25 ng/ml (range 1-47 ng/ml). The highest 25(OH)D level reached was 64 ng/ml, while two patients showed a small (7 ng/ml) or no response (1 ng/ml). Hypercalcemia or hypercalciuria did not occur in any patient. From day 0 to day 7, total serum calcium levels increased by 0.10 (PBO) and 0.15 mmol/L (VITD; P < 0.05 for both), while ionized calcium levels increased by 0.11 (PBO) and 0.05 mmol/L (VITD; P < 0.05 for both). Parathyroid hormone levels decreased by 19 and 28 pg/ml (PBO and VITD, ns) over the seven days, while 1,25(OH)D showed a transient significant increase in the VITD group only.

Conclusions
This pilot study shows that a single oral ultra-high dose of cholecalciferol corrects vitamin D deficiency within 2 days in most patients without causing adverse effects like hypercalcemia or hypercalciuria. Further research is needed to confirm our results and establish whether vitamin D supplementation can affect the clinical outcome of vitamin D deficient critically ill patients.

EudraCT Number
2009-012080-34

German Clinical Trials Register (DRKS)
DRKS00000750
ISsaga is an ensemble of web-based methods for high throughput identification and semi-automatic annotation of insertion sequences in prokaryotic genomes
Authors: Varani Alessandro M , Siguier Patricia , Gourbeyre Edith , Charneau Vincent , Chandler Mick 
Published: April 2011

AbstractInsertion sequences (ISs) play a key role in prokaryotic genome evolution but are seldom well annotated. We describe a web application pipeline, ISsaga (http://issaga.biotoul.fr/ISsaga/issaga_index.php), that provides computational tools and methods for high-quality IS annotation. It uses established ISfinder annotation standards and permits rapid processing of single or multiple prokaryote genomes. ISsaga provides general prediction and annotation tools, information on genome context of individual ISs and a graphical overview of IS distribution around the genome of interest.
Implementation of case management in long-term conditions in England: Survey and case studies
Authors: Challis David , Hughes Jane , Berzins Kathryn , Reilly Siobhan , Abell Jessica , Stewart Karen , Bowns Ian 
Published: April 2011

Objectives Our aim was to describe the current provision of case management arrangements in primary care for people with long-term conditions in England and identify the extent and nature of self-care support services within it. Methods Cross-sectional survey of primary care trusts (PCTs) in England and four case studies using semi-structured interviews and focus groups. Results Services were predominantly nurse-led, typically by community matrons, and delivered on a geographical basis. Often multiple arrangements existed within a PCT but integration of services with local authority adult social care was not widespread. A range of self-care support services were utilized and often tuition was provided by case managers to patients in their own homes. Assessment, care coordination and direct support to patients were the principal tasks. Often care plans were limited to primary care services and did not include service costings. Links with nurse-led services within PCTs were evident but operational links with adult social care were poorly developed. This is consistent with previous research relating to the introduction of care management in social services in England which also resulted in a plethora of organizational arrangements. Conclusions Case management for patients with long-term conditions is at an early stage of development. Effective links with a range of local services are required if care plans are going to be comprehensive.
Governance for health and wellbeing in the English NHS
Authors: Marks Linda , Cave Sally , Hunter David , Mason James , Peckham Stephen , Wallace Andrew 
Published: April 2011

Objectives Shifting the focus of health-care systems towards prevention has proved difficult to achieve. Governance structures are complex, incentives may conflict and there are many competing priorities. We explored the influence of governance and incentive arrangements on commissioning for health and well-being in the English National Health Service (NHS) and the governance paradoxes which emerge. Methods Qualitative and quantitative methods were employed. We carried out one national and two regional focus groups; a national online survey of primary care trusts (PCTs); and 99 semi-structured interviews in 10 purposively selected case study sites across England. Interviewees included decision-makers in PCTs, practice-based commissioners, Chairs of Local Involvement Networks (LINks) and of Overview and Scrutiny committees (OSCs) and Voluntary and Community Sector (VCS) members of local health and wellbeing partnerships. Results Case study sites differed in the extent to which they reflected a public health ethos throughout the commissioning cycle, incentivized preventive services through contractual flexibilities or prioritized investment in health and wellbeing. Practice-based commissioners were tangentially involved in the commissioning cycle, public health partnerships or local health needs assessment. While commissioning for health and wellbeing involves working through partnerships, performance management regimes favoured single organizational success. Preventive services were considered at increased risk in times of financial stringency. Conclusions As the NHS in England undergoes further reorganization, it is important to ensure that a systematic, strategic and population-based approach to commissioning is not lost. Governance and incentive arrangements should be critically assessed for their impact on population health and wellbeing.
The association between presenteeism and engagement of National Health Service staff
Authors: Admasachew Lul , Dawson Jeremy 
Published: April 2011

Objective Although several studies have demonstrated a relationship between staff engagement and health and wellbeing, none has analysed the association with presenteeism in the National Health Service (NHS) context. Our aim is to determine whether there is a relationship between presenteeism and staff engagement. Methods A hierarchical logistic multilevel modelling of cross-sectional data from the NHS staff survey (2009) was conducted. We controlled for a range of demographic and socioeconomic background variables, including ethnic group, gender, age and occupational group. The sample was 156,951 respondents across all 390 English NHS trusts, each providing a random sample of employees. Engagement was measured using three facets: motivation, advocacy and involvement, which were also used in a composite score. Results There was a low-to-moderate negative correlation between presenteeism and staff engagement: odds ratio 0.42 (95% confidence interval [CI] 0.42-0.43) for overall staff engagement and 0.53 (95% CI 0.52-0.54) for staff advocacy of the trust; 0.53 (95% CI 0.52-0.54) for motivation and 0.50 (95% CI 0.49-0.51) for involvement. Conclusions Putting pressure on health-care staff to come to work when unwell is associated with poorer staff engagement with their jobs.
Organizing and delivering diabetes education and self-care support: Findings of scoping project
Authors: Forbes Angus , While Alison , Griffiths Peter , Ismail Khalida , Heller Simon 
Published: April 2011

Objective To provide an overview of current research and development on the organization and delivery of diabetes education and self-care support, incorporating stakeholder perspectives. Method Four methods were used: literature review (159 papers and 52 grey literature items); patient participation event (n 5 38); online survey of professionals (n 5 423) and patients (n5 495); and, a conference. Results The literature review identified themes relating to the organization and delivery of diabetes and self-care support: structure and flexibility in models of education; accessibility; patient choice; integrating self-care within the overall care system; quality improvement; peer educators; health literacy; efficiency in delivery; telecare models; feedback technologies; care planning; psychological intervention; and self-care outcome measures. This generated four models to provide a framework to help shape the development of diabetes self-care: a diabetes education pathway; integrating self-care and clinical care; choice as a method of optimizing care; and an integrated framework for delivering diabetes self-care. Conclusion The clinical benefit of the identified models need to be evaluated.
A quest for patient-safe culture: Contextual influences on patient safety performance
Authors: Charles Kathryn , McKee Lorna , McCann Sharon 
Published: April 2011

Objectives To use organizational change theory to explore the interplay of contextual influences on patient safety. Methods A multi-level comparative case study of eight National Health Service (NHS) acute hospital trusts in England, including 144 depth interviews with senior managers, staff involved with risk analysis and reporting, middle managers, and senior and junior clinicians, supplemented with documentary data and observation of nine meetings. Organizational change theory was used to identify content, contextual and process influences on patient safety. Results Organizational stability and staff engagement appeared to influence patient safety and specific contextual factors appeared to influence both organizational stability and staff engagement, both of which were important for patient safety. These contextual factors comprised: environmental shocks; cultural characteristics; processes and structures supportive of patient safety; and trust leadership style. A model is suggested that analyses the trusts in terms of these factors and then groups them into four trust types. Conclusion The study highlights the massive and unpredictable impact of both internal and external environmental shocks and how they destabilize trusts distracting attention from patient safety. It also underlines the importance of regular self-assessment of internal and external risks and awareness of context.
Challenges and opportunities associated with the introduction of assistant practitioners supporting the work of registered nurses in NHS acute hospital trusts in England
Authors: Spilsbury Karen , Adamson Joy , Atkin Karl , Bloor Karen , Carr-Hill1 Roy , McCaughan Dorothy , McKenna Hugh , Wakefield Ann 
Published: April 2011

Objectives To understand the challenges and opportunities associated with the introduction of assistant practitioner (AP) roles supporting the work of ward-based registered nurses (RNs) in National Health Service (NHS) acute hospital trusts in England. Methods Three case studies of NHS acute hospital trusts. This paper presents qualitative findings, drawing on documentary data sources and data generated through interviews and focus group discussions. Results Introduction of APs into ward-based nursing teams has been variable, and often driven by external pressures rather than perceived organizational need. This, along with little national guidance, has created some confusion about the role, but at the same time has permitted flexible role development through ‘negotiated compromise’ at local level. While there are various areas of potential improvement in policy and practice, APs are generally perceived to have the potential to make a valuable contribution to patient care. Conclusions Findings from this study will help policy-makers, organizations and practitioners understand factors that enable and/or inhibit the integration of new assistant roles within existing occupational structures to develop innovative services and enhance patient care. These factors are important when considering how care will be delivered to maximize the skills of the entire nursing workforce.
Monte Carlo Bounds for Game Options Including Convertible Bonds
Authors: Beveridge Christopher , Joshi Mark 
Published: April 2011

We introduce two new methods to calculate bounds for zero-sum game options using Monte Carlo simulation. These extend and generalize upper-bound duality results to the case where both parties of a contract have Bermudan optionality. It is shown that the primal-dual simulation method can still be used as a generic way to obtain bounds in the extended framework, and we apply the new results to the pricing of convertible bonds by simulation. This paper was accepted by Wei Xiong, finance.
Risk Preferences at Different Time Periods: An Experimental Investigation
Authors: Abdellaoui Mohammed , Diecidue Enrico , Öncüler Ayse 
Published: April 2011

Intertemporal decision making under risk involves two dimensions: time preferences and risk preferences. This paper focuses on the impact of time on risk preferences, independent of the intertemporal trade-off of outcomes, i.e., time preferences. It reports the results of an experimental study that examines how delayed resolution and payment of risky options influence individual choice. We used a simple experimental design based on the comparison of two-outcome monetary lotteries with the same delay. Raw data clearly reveal that subjects become more risk tolerant for delayed lotteries. Assuming a prospect theory–like model under risk, we analyze the impact of time on utility and decision weights, independent of time preferences. We show that the subjective treatment of outcomes (i.e., utility) is not significantly affected by time. In fact, the impact of time is completely absorbed by the probability weighting function. The effect of time on risk preferences was found to generate probabilistic optimism resulting in a higher risk tolerance for delayed lotteries. This paper was accepted by Teck Ho, decision analysis.
Designing Multiperson Tournaments with Asymmetric Contestants: An Experimental Study
Authors: Chen Hua , Ham Sung H. , Lim Noah 
Published: April 2011

Is the right amount of effort exerted in multiperson tournaments where contestants have two different levels of initial endowments (termed “favorites” and “underdogs”)? We develop theoretical predictions for the level of effort and the effect of varying the prize structure. We test these predictions for three-person tournaments using an economic experiment in a social environment where contest outcomes are publicly announced. We find that both favorites and underdogs overexert effort relative to the theoretical point predictions. Moreover, in the treatment with two favorites and one underdog, favorites increase their effort when the number of prizes is increased from one to two, contrary to the theory prediction. We show that a generalized model that allows for psychological losses from losing for favorites and psychological gains from winning for underdogs because of social comparisons tracks the experimental results better than the standard theoretical model. This paper was accepted by Peter Wakker, decision analysis.
Iterative processes of gradient type with applications to gravimetry and magnetometry inverse problems
Authors: Vasin Vladimir , Skorik Georgy 
Published: April 2011

Abstract
The iterative processes of gradient type for nonlinear equations with differentiable operator satisfying a local condition in the neighborhood of solution are investigated. The theorems on weak and strong convergence of iterations constructed by these methods and their modified analogs are established.
The inverse gravimetry problem is considered as the application of the developed methods: retrieval of the interface between the media with different constant densities. For stable solution of the nonlinear inverse magnetometry problem the additional regularization by the Tikhonov method is used and for approximation of the regularized solution one variant of the conjugate gradient method is applied. The numerical results for model and real gravitational and magnetic data are considered.
Algorithm of finding a body projection within an absorbing and scattering medium
Authors: Anikonov Dmitry Sergeevich , Nazarov Vasilii Genadievich , Prokhorov Igor Vasilievich 
Published: April 2011

Abstract
The problem of an arbitrary medium probing by use of radiation flux on the bases of the monoenergetic transport equation is considered. The medium is assumed to comprise some bodies, which radiation characteristics differ from ones of the medium. The outgoing radiation density flux is assumed to be measured at a plane nonintersecting the bodies whereas the boundaries of the body projections (shadows) on the plane are to be found. The case when the direct imaging of the objects is embarrassing owing to a strong scattering and absorption within the medium. The current work is being carried out under a special project so the limitations imposed have a specific character. More definite, these limitations are adopted to the problem of the world ocean near-bottom zone probing.
The optimum of the M. M. Lavrent'ev method
Authors: Tanana Vitaly Pavlovich , Rudakova Tatiana Nikolaevna 
Published: April 2011

Abstract
M. M. Lavrent'ev method for solving operator equation of the first kind in the Hilbert spaces have been consider. Exact estimates of error for the M.M. Lavrent'ev method have been make. The optimum of the M. M. Lavrent'ev method have been prove.
Parameter identification methods of hydraulic models for the study of current water in open channels
Authors: Voevodin Anatoly Fedorovich , Nikiforovskaya Valentina Sergeevna 
Published: April 2011

Abstract
Both adequacy of the mathematical model and accuracy of the initial data define the adequacy of numerical results of the real process. Being the phenomenological model, the model of current water based on one-dimensional Saint-Venant equations has the parameters which cannot be determined within the scope of one-dimensional model. The most important such parameter is, for example, the Chezy coefficient (coefficient of roughness) or the wind stress coefficient. The main difficulty to use the one-dimensional model is that the parameters are hardly measured.
In this paper we suggest the numerical method of identification of such hydraulic parameters as the coefficient of roughness, the wind stress coefficient and so on, given the actual measurement data of free surface level or of flow depth. We assume that the flows is gradually varies and describes by the Saint-Venant equations. Also we assume that the identification parameters do not vary on the whole length of the channel.
The developed methods are based on the Bellman method of sensitivity and on the modified Newton method which are applied for minimization of the functional of mean square deviation of the calculated parameters of the flow from the measurement data.
The examples of recovery of hydraulic parameters, in particular, for real objects are considered.
Recent advances in analytical and numerical methods in inverse problems for PDEs (minisymposium report)
Authors: Clason Christian , Shishlenin Maxim 
Published: April 2011

Abstract
This minisymposium, held at the 5th International Conference “Inverse Problems: Modeling and Simulation”, May 24–29, 2010 in Antalya, Turkey, was dedicated to the 60th birthday of Michael V. Klibanov.
Some regularization methods for a thermoacoustic inverse problem
Authors: Kaltenbacher Barbara , Polifke Wolfgang 
Published: April 2011

Abstract
In this paper we consider the thermoacoustic inverse problem of identifying the oscillatory heat release from pressure measurements. We consider the spatially onedimensional and time harmonic case. Three different regularization methods for the stable solution of this ill-posed inverse problem are proposed: Lavrent'ev's method, regularization by discretization, and a method based on an explicit formula combined with regularized numerical differentiation. For these methods, the results of numerical experiments are documented.