bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modelling survival in acute severe illness: Cox versus accelerated failure time models
Authors: Moran John L. , Bersten Andrew D. , Solomon Patricia J. , Edibam Cyrus , Hunt Tamara ,   The Australian and New Zealand Intensive Care Society Clinical Trials Group
Published: September 2010

AbstractBackground  The Cox model has been the mainstay of survival analysis in the critically ill and time‐dependent covariates have infrequently been incorporated into survival analysis.Objectives  To model 28‐day survival of patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), and compare the utility of Cox and accelerated failure time (AFT) models.Methods  Prospective cohort study of 168 adult patients enrolled at diagnosis of ALI in 21 adult ICUs in three Australian States with measurement of survival time, censored at 28 days. Model performance was assessed as goodness‐of‐fit [GOF, cross‐products of quantiles of risk and time intervals (P ≥ 0.1), Cox model] and explained variation (‘R2’, Cox and ATF).Results  Over a 2‐month study period (October–November 1999), 168 patients with ALI were identified, with a mean (SD) age of 61.5 (18) years and 30% female. Peak mortality hazard occurred at days 7–8 after onset of ALI/ARDS. In the Cox model, increasing age and female gender, plus interaction, were associated with an increased mortality hazard. Time‐varying effects were established for patient severity‐of‐illness score (decreasing hazard over time) and multiple‐organ‐dysfunction score (increasing hazard over time). The Cox model was well specified (GOF, P > 0.34) and R2 = 0.546, 95% CI: 0.390, 0.781. Both log‐normal (R2 = 0.451, 95% CI: 0.321, 0.695) and log‐logistic (R2 0.470, 95% CI: 0.346, 0.714) AFT models identified the same predictors as the Cox model, but did not demonstrate convincingly superior overall fit.Conclusions  Time dependence of predictors of survival in ALI/ARDS exists and must be appropriately modelled. The Cox model with time‐varying covariates remains a flexible model in survival analysis of patients with acute severe illness.
Exploring the requirements for a decision aid on familial breast cancer in the UK context: a qualitative study with patients referred to a cancer genetics service
Authors: Iredale Rachel , Rapport Frances , Sivell Stephanie , Jones Wendy , Edwards Adrian , Gray Jonathon , Elwyn Glyn 
Published: September 2010

AbstractRationale  Patients concerned about a family history of breast cancer can face difficult decisions about screening, prophylactic surgery and genetic testing. Decision aids can facilitate patient decision making and currently include leaflets and computerized tools. These are largely aimed at the North American market. However, no decision aids concerning familial breast cancer exist in the UK.Methods  Focus groups were held with 39 women over 18 years of age referred to a cancer genetics clinic, and who had been given a risk assessment for developing breast cancer. Each focus group examined three existing North American decision aids (1 paper‐based and 2 CD‐ROMs) and explored what a decision aid in a UK context should look like and the information it should contain.Results  There was enthusiasm for the development of decision aids that suit the local context in terms of its health care policy, in paper‐based and CD‐ROM formats. This paper identifies areas of agreement and disagreement in terms of both content and presentation styles, and also reports some of the suggestions received about where, when and with whom decision aids should be used. Participants suggested that decision aids would be most effective when they allowed a user‐selected range of formats.Conclusion  There is still significant unmet demand for information and decision support in the context of publicly funded health care. The patient perspective provides a unique insight into issues of design, style and communication.
Measuring the process of quality of care for ST‐segment elevation acute myocardial infarction through data‐mining of the electronic discharge notes
Authors: Chang Sheng‐Nan , Lin Jou‐Wei , Liu Shi‐Chi , Hwang Juey‐Jen 
Published: September 2010

AbstractBackground  Measuring parameters in the management of acute myocardial infarction (AMI) has been used as the standard for evaluating quality of care (QC). The purpose of this study was to elucidate the completeness of information retrieval from electronic discharge notes (EDN) as well as to measure QC for AMI in Taiwan.Methods  All the narrative reports in EDN in the clinical information systems (CIS) of National Taiwan University Hospital from 2002 to 2004 were retrieved, and the patients who presented to the emergency room (ER) with AMI were identified. Ten parameters related to QC for AMI were measured through data‐mining of EDN alone as well as through an extensive search of the CIS and paper medical records.Results  Information retrieval from EDN alone could obtain some parameters with a high recall, such as the use and timing of reperfusion therapy and the prescription of medication at discharge. Other parameters, such as the early management at ER and lipid profile after discharge, could not be retrieved from EDN. The use of medication and early reperfusion therapy was comparable to the US standards, while lipid control at and after discharge were suboptimal.Conclusions  This study has demonstrated that information retrieval from EDN alone could faithfully extract sufficient measures of QC for AMI in some aspects, as well as could quantify the current process of QC for AMI in Taiwan.
Pharmaceutical care of patients with gestational diabetes mellitus
Authors: Elnour A. A. , El Mugammar I. T. , Jaber T. , Revel T. , McElnay James C. 
Published: September 2010

AbstractRationale, aims and objective  To investigate whether the introduction of a programme of optimising drug treatment, intensive education and self‐monitoring of patients diagnosed with gestational diabetes mellitus (GDM) at an early stage (<20 gestational weeks), will improve management outcomes as determined by objective measures of patient knowledge about diabetes, glycaemia control, maternal/neonatal complications, and health‐related quality of life.Methods  The study was a randomized, controlled, longitudinal, prospective clinical trial performed at Al‐Ain Hospital, Al‐Ain, United Arab Emirates. Over an 18‐month period, patients diagnosed with GDM were recruited and were randomly assigned to either an intervention or a control group, in a ratio of 3:2. Intervention patients received a structured pharmaceutical care service (including education and introduction of intensive self‐monitoring) while control patients received traditional services. Patients were followed up from time of recruitment until 6 months postnatally at scheduled outpatient clinics. A range of clinical and humanistic outcome measures, including maternal and neonatal complications, were used to assess the impact of the intervention.Results  A total of 165 patients (99 intervention, 66 control) completed the study. The intervention patients exhibited a range of benefits from the provision of the programme when compared with control group patients. Statistically significant (P < 0.05) improvements were shown in the intervention group for knowledge of diabetes, health‐related quality of life (as determined by the SF36), control of plasma glucose and HbA1c, maternal complications [e.g. decreased incidence of pre‐eclampsia (5.1% vs. 16.7%), eclampsia (1.0% vs. 7.6%), episodes of severe hyperglycaemia (3.0% vs. 19.7%) and need for Caesarean section (7.1% vs. 18.2%)], and neonatal complications [e.g. decreased incidence of neonatal hypoglycaemia (2.0% vs. 10.6%), respiratory distress at birth (4.0% vs. 15.2%), hyperbilirubinaemia (1.0% vs. 12.1%) and large for gestational age (9.0% vs. 22.7%)].Conclusion  The research provides clear evidence that provision of pharmaceutical care adds value to the management of GDM as exemplified by improved maternal and neonatal outcomes.
Towards an ethics of authentic practice
Authors: Murray Stuart J. , Holmes Dave , Perron Amélie , Rail Geneviève 
Published: September 2010

AbstractThis essay asks how we might best elaborate an ethics of authentic practice. Will we be able to agree on a set of shared terms through which ethical practice will be understood? How will we define ethics and the subject's relation to authoritative structures of power and knowledge? We begin by further clarifying our critique of evidence‐based medicine (EBM), reflecting on the intimate relation between theory and practice. We challenge the charge that our position amounts to no more than ‘subjectivism’ and ‘antiauthoritarian’ theory. We argue that an ethical practice ought to question the authority of EBM without falling into the trap of dogmatic antiauthoritarianism. In this, we take up the work of Hannah Arendt, who offers terms to help understand our difficult political relation to authority in an authentic ethical practice. We continue with a discussion of Michel Foucault's use of ‘free speech’ or parrhesia, which he adopts from Ancient Greek philosophy. Foucault demonstrates that authentic ethical practice demands that we ‘speak truth to power.’ We conclude with a consideration of recent biotechnologies, and suggest that these biomedical practices force us to re‐evaluate our theoretical understanding of the ethical subject. We believe that we are at a crucial juncture: we must develop an ethics of authentic practice that will be commensurable with new and emergent biomedical subjectivities.
Using paper chart based clinical reminders to improve guideline adherence to lipid management
Authors: Hung Chi‐Sheng , Lin Jou‐Wei , Hwang Juey‐Jen , Tsai Ru‐Yi , Li Ai‐Tzu 
Published: September 2010

Abstract
Rationale, aims and objectives  The objective of this study was to apply a paper‐based clinical reminder to improve the adherence to lipid guidelines.
Methods  Patients with coronary heart disease (CHD) without lipid‐lowering therapy (LLT) were recruited, and medical records were reviewed. Eligible subjects were randomized; a clinical reminder stating current standards and local insurance policy was stamped on the paper chart in the study group but not in the control. The primary outcome was new LLT subscription in the 6‐month follow‐up period, and the secondary end point was the composite result of LLT or lipid profile check‐up.
Results  Ninety‐two patients were assigned to the study group and 102 to the control group. The primary outcome showed no difference at the end of 6 months (OR: 1.70, P = 0.248, 95% CI: 0.69–4.19). The secondary end point was significantly higher in the reminder group (OR: 2.81, P = 0.001, 95% CI: 1.57–5.04).
Conclusion  A paper chart based clinical reminder providing update clinical recommendations could modify the doctor's behaviour and improve the attention to lipid levels. However, its effect cannot be transformed into an increase in LLT or a decrease in low‐density lipoprotein level owing to local policy constraint.
Coding accuracy of abdominal aortic aneurysm repair procedures in administrative databases – a note of caution
Authors: Jetty Prasad , van Walraven Carl 
Published: September 2010

AbstractBackground  Administrative databases have been used to compare methods used for abdominal aortic aneurysm (AAA) repair. This requires the use of procedural codes whose accuracy has not been established. In this study we measured the accuracy of procedural codes for open AAA repair and endovascular aneurysm repair (EVAR) in administrative databases.Methods  Between April 2000 and July 2005, we identified all surgeries of non‐ruptured AAA using open or EVAR technique at a tertiary‐care teaching hospital. During the same time period, we identified all patients who were coded with either an open AAA repair or EVAR.Results  During the study period, 514 people had an elective AAA repair or were coded with one. Coding quality of open AAA repair was poor (sensitivity 48.1%; specificity 77.4%; accuracy 52.9%) while that for EVAR was slightly better (sensitivity 58.2%; specificity 100%; accuracy 93.6%). We developed an algorithm that included similar procedures and considered anaesthetic type to improve the identification of both open repair (sensitivity 97.7%; specificity 86.9%; accuracy 95.9%) and EVAR (sensitivity 84.8%; specificity 99.5%; accuracy 97.3%).Conclusion  Administrative database codes that are routinely used to identify open AAA repairs or EVARs are inaccurate. However, slight modifications to the coding algorithms permit the use of administrative databases to study AAA repair.
Improving reliability of clinical care practices for ventilated patients in the context of a patient safety improvement initiative
Authors: Pinto Anna , Burnett Susan , Benn Jonathan , Brett Stephen , Parand Anam , Iskander Sandra , Vincent Charles 
Published: September 2010

AbstractAims  To investigate perceived factors relating to the reliable application of four clinical care practices targeting ventilator‐associated pneumonias, in the context of a patient safety improvement initiative called the Safer Patients Initiative (SPI).Methods  Qualitative case study. Seventeen semi‐structured individual interviews with clinical operational leads, programme coordinators and executive managers who were involved in the implementation of the programme's critical care work stream during its pilot phase. The interviews had a focus on perceived aspects pertaining to the reliable implementation of the four clinical practices, promoted by the Institute for Healthcare Improvement as the ‘ventilator care bundle’.Results  Thematic analysis of the verbatim transcripts revealed three overarching themes experienced by the participants during the implementation of the clinical practices included in the SPI ventilator care bundle: the power of measurement, feedback to peers and experts and improvement tools specific to SPI. Consistent measurement of compliance with the four elements of the bundle and outcomes made the staff realize that their engagement in previous improvement work for ventilated patients was inadequate and motivated them to apply the introduced clinical practices more reliably. Feedback to experts and peers of staff compliance with the four clinical practices and outcome improvement was perceived as a very influential aspect of SPI. Small tests of change (Plan‐Do‐Study‐Act cycles), teaching sessions and daily goal sheets were quoted as particularly useful tools throughout the implementation of the four clinical care practices.Conclusions  Future initiatives that aim to improve the adherence of clinical staff with clinical practice guidelines in intensive care units could benefit from integrating in their methodology consistent measurement and feedback practices of both process compliance and outcome data.
Of glaciers and refugia: a decade of study sheds new light on the phylogeography of northwestern North America
Authors: SHAFER AARON B. A. , CULLINGHAM CATHERINE I. , CÔTÉ STEEVE D. , COLTMAN DAVID W. 
Published: September 2010

AbstractGlacial cycles have played a dominant role in shaping the genetic structure and distribution of biota in northwestern North America. The two major ice age refugia of Beringia and the Pacific Northwest were connected by major mountain chains and bordered by the Pacific Ocean. As a result, numerous refugial options were available for the regions taxa during glacial advances. We reviewed the importance of glaciations and refugia in shaping northwestern North America’s phylogeographic history. We also tested whether ecological variables were associated with refugial history. The recurrent phylogeographic patterns that emerged were the following: (i) additional complexity, i.e. refugia within refugia, in both Beringia and the Pacific Northwest; and (ii) strong evidence for cryptic refugia in the Alexander Archipelago and Haida Gwaii, the Canadian Arctic and within the ice‐sheets. Species with contemporary ranges that covered multiple refugia, or those with high dispersal ability, were significantly more likely to have resided in multiple refugia. Most of the shared phylogeographic patterns can be attributed to multiple refugial locales during the last glacial maximum or major physiographic barriers like rivers and glaciers. However, some of the observed patterns are much older and appear connected to the orogeny of the Cascade‐Sierra chain or allopatric differentiation during historic glacial advances. The emergent patterns from this review suggest we should refine the classic Beringian‐southern refugial paradigm for northwestern North American biota and highlight the ecological and evolutionary consequences of colonization from multiple refugia.
The overwintering stages of Ectobius lapponicus (L.) (Dictyoptera: Blattidae)
Authors: BROWN V. K. 
Published: September 2010

SYNOPSISAn account is given of the overwintering stages of Ectobius lapponicus, involving the determination of a diapause in the egg and one of the nymphal instars. The significance of these periods in the life cycle is discussed.
Defence glands in the giant spiny phasmid Extatosoma tiaratum
Authors: STRONG L. 
Published: September 2010

ABSTRACTAdults of Extatosoma tiaratum liberate a strong smell when handled. The smell is associated with a colourless, volatile liquid which is apparently harmless to man. It is ejected on to the thorax of the insect, and on to the hands of the investigator, from a pair of tubercles located on the anterior border of the prothorax. The tubercles have a slit‐like aperture through which the secretion is sprayed on attack. The secretion is produced by two glands in the thorax, each comprising a pair of tubes which unite just beneath the tubercle. The tubes consist of a thick, glandular epithelium lined with a thin layer of cuticle; most of the gland is enveloped in a layer of muscle. The defence reaction is discussed in relation to that of other phasmids.
Chorionic sculpturing in some sandfly eggs (Diptera, Psychodidae)1
Authors: WARD RICHARD D. , READY PATRICIA A. 
Published: September 2010

ABSTRACTThe outer chorionic sculpturing of the eggs of thirteen species of neotropical sandflies was examined by scanning electron microscope. Sculpture patterns are species specific and include polygons, parallel ridges and mountain or volcano‐like structures. Two closely related and undescribed species of the intermedia group were distinguished by this means. The role of sculpturing in plastron respiration is discussed.
Femoral combs—a secondary sexual character in British Oscinellinae (Diptera: Chloropidae)
Authors: ISMAY J. 
Published: September 2010

ABSTRACTA specialised but variable group of setae on the middle femur of males of Chloropidae is described and its taxonomic importance discussed. This femoral comb has been found in 15 out of 24 genera of Oscinellinae, but was not found in 15 genera of Chloropinae.
Pre‐sowing herbicides in irrigated cotton (Gossypium barbadense L.) and ground nut (Arachis hypogaea L.) in the Sudan. I. Weed control and crop yields achieved with trifluralin and benfluralin.
Authors: JENNINGS E. A. , DRENNAN D. S. H. 
Published: September 2010

Summary:Trifluralin in cotton and benfluralin in groudnut. incorporated pre‐planting. gave satisfactory control of grass weeds and increased crop yields substantially. Oxadiazon as a pre‐planting treatment did not give satisfactory additional control of dicotyledons resistant to the first two herbicides. A post‐sowing mechanical ridging operation controlled some herbicide resistant weeds, but its effects depended on timing, weed species and growing conditions. Supportive hand weeding of resistant weeds (mainly dicotyledons) was most effective 4 weeks after crop emergence. Crop yields similar to clean weeded controls were achieved by combining trifluralin or benfluralin with moderate supportive hand weeding and re‐ridging. Herbicide applications could be made several months before crop planting during the dry season, giving more effective use of spray equipment and operatives. Delays of up to 24 hours between spraying and incorporation by normal cultivation could be tolerated without loss of herbicidal activity.
Identification et activité biologique d'une impureté du diuron technique
Authors: BLEIN J.P. , DUCRUET J.M. , GAUVRIT C. 
Published: September 2010

Summary:I‘activité biologique d'un résidu de synthese du diuron, identi‐fiéåla 1.3‐his‐(3,4‐dichlorophényl) urée. a éiéétudiée sur E. coli. mitochondries de pomme de terre. chloroplasies et lipo‐somes.Ce composé inhibe la croissanee d'E. coli et semble modifier les permétions membraires. II ayit comme un découplant trés actif des oxydations phosphorylames: il bloque la réaction de Hill de chloroplastes isoles et modifie les pro‐priété des membranes liposomales. Cette activité est comparée à celle dea diuron technique et purifié et peut †tre responsablede certames actions du diuron technique.
Weed interference and control in white yam (Dioscorea rotundata Poir)
Authors: AKOBUNDU I. OKEZIE 
Published: September 2010

Summary:The climbing growth habit of white yam (Dioscorea rotundata) coupled with its inability to shade the ground completely at any stage of its growth and development makes it very susceptible to weed interference. The critical period of weed interference in white yam was between the 8th and 16th week after planting (w.a.p.) for yam planted at the onset of rains. Keeping yam plants weedy for 16 w.a.p. or beyond significantly reduced tuber yield; keeping them weed‐free for the same period resulted in a significant increase in tuber yield. A minimum of three weedings within 16 w.a.p. are necessary to minimize yield reduction caused by weeds. The lowest weed weight and highest crop yield from herbicide treatments were obtained where a mixture of fluometuron and metolachlor each at 2.0 kg a.i./ha was used for pre‐emergence weed control.
Movement of fluometuron, simazine, 36Cl− and 144Ce3+ in soil under field conditions: qualitative aspects
Authors: HANCE R.J. , EMBLING S.J. , HILL D. , GRAHAM‐BRYCE I.J. , NICHOLLS P. 
Published: September 2010

Summary:The distributions of two herbicides and two radioactive ions in field plots at two sites were determined at periods up to 187 days following surface applications in the spring. The results demonstrated the variability characteristic of field situations. At one site some fluometuron moved a short distance down the profile but after 187 days most remained above 6 cm whereas at the other site there was essentially no movement below 3 cm. At both sites simazine was almost entirely confined to the top 3 cm. The adsorption characteristics of the two compounds are similar so the greater mobility of fluometuron is probably a consequence of its greater solubility, Measurements of 36Cl− indicated a significant movement of water through the 30 cm depth studied. 144Ce3+ used as a tracer of soil particles was of similar mobility to simazine.In general the movement of chloride and the two herbicides can be interpreted in terms of the concept of mobile and immobile fractions of soil water in which a proportion of the mobile water does not reach equilibrium with solutes in the bulk of the soil. Soil structural effects may therefore be more important than adsorption in controlling the movement of solutes and redistribution in association with soil particles can be significant. A parallel laboratory experiment showed that the results from a standard leaching column procedure did not necessarily indicate field performance.