bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the Feasibility of a One-Stop Approach to Diagnosis for Urological Patients
Authors: Coull Nadine , Rottenberg Giles , Rankin Sheila , Pardos-Martinez Maria , Coker Bola , Jenkins Elaine , O'Brien Tim 
Published: May 2009

INTRODUCTION Conventional publicly funded out-patient services in many specialties are characterised by delays, fragmented diagnostic processes, and overloaded clinics. This is bad for patients as it is clinically dangerous; bad for managers who spend hours managing the failure; bad for doctors who respond by overloading clinics; and bad for purchasers who have to fund the multiple out-patient visits needed. Sound clinical and financial reasons exist for introducing more efficient diagnostic processes. PATIENTS AND METHODS A total of 330 consecutive patients referred to the urology department of Guy' and St Thomas' NHS Foundation Trust were invited to attend one of nine one-stop clinics staffed by consultant urologists with specialist registrars, nurses, and clerical staff. Pre-clinic blood and urine tests were ordered based on the referral letter. Clinics had facilities to perform cystoscopy, ultrasound, and urinary flow studies. Correspondence was generated in real time, and a copy given to the patient. RESULTS Overall, 257 patients attended the clinics. Twenty-three patients cancelled appointments and 50 patients did not attend. Pre-clinic tests were requested in 133 patients and were completed by 86% of the patients who attended. Of patients, 42% were diagnosed and discharged; 28% were listed for surgery, extracorporeal shock wave lithotripsy (ESWL), or referred to another specialty. About 30% of patients needed further out-patient review; in approximately two-thirds to complete a diagnosis and one-third to review the results of therapy initiated. An estimated 350 appointments and 550 patient visits to hospital were saved. CONCLUSIONS A one-stop method of consultation is efficient across a range of urological presenting complaints, and dramatically reduces the need for follow–up consultations. It has potential to: (i) reduce delays to being seen in out-patients; (ii) lead to more cost-effective care; and (iii) increase safety and patient satisfaction. It should become the standard of care in urology, and is probably applicable in many other disciplines.
A Survey of the Peri-Operative Management of Urological Patients on Clopidogrel
Authors: Mukerji Gaurav , Munasinghe Indumina , Raza Asif 
Published: May 2009

INTRODUCTION Peri-operative management of patients receiving platelet inhibitors, such as clopidogrel presents a dilemma to surgeons in every surgical specialty including urology. The risk of procedure-related bleeding while continuing clopidogrel needs to be weighed against the risk of thrombo-embolism after discontinuing it. The objective of the survey was to determine current UK practice regarding clopidogrel use/cessation in patients undergoing elective urological procedures. SUBJECTS AND METHODS A 10-part questionnaire relating to pre- and postoperative clopidogrel use was mailed to all UK urology consultants listed in the British Association of Urological Surgeons' directory. RESULTS A total of 570 questionnaires were sent and 297 (52%) were returned. The majority of respondents stop clopidogrel prior to TUR surgery (96.6%), major urological surgery (91.7%), TRUS biopsy (90.6%), ESWL (81.8%) and cystoscopy and biopsy (70.1%). The time clopidogrel was stopped pre-operatively and restarted postoperatively was very variable and dependent on local guidelines or urologist preference. Almost half (49.5%) of the respondents would stop clopidogrel irrespective of its indication and 40.7% never consulted a cardiologist/haematologist before stopping clopidogrel. Less than half (43.4%) had a protocol/guideline in place concerning stopping clopidogrel before surgery. Of respondents, 43% do not routinely prescribe bridging therapy after discontinuing clopidogrel. Over half (55%) reported bleeding complications in patients who continued their clopidogrel during urological procedures and 22 (7.4%) of respondents reported an adverse thrombo-embolic event after stopping clopidogrel. The vast majority of respondents (92.8%) felt evidence-based guidelines on clopidogrel use during the peri-operative period would be useful. CONCLUSIONS This survey has highlighted a significant variation in practice with regards to pre- and postoperative management of clopidogrel in patients undergoing urological procedures. The results of this survey highlight the need for evidence-based guidelines for the peri-operative management of patients on clopidogrel.
Complications of Bariatric Surgery: Presentation and Emergency Management – a Review
Authors: Monkhouse SJW , Morgan JDT , Norton SA 
Published: May 2009

INTRODUCTION The prevalence of obesity surgery is increasing rapidly in the UK as demand rises. Consequently, general surgeons on-call may be faced with the complications of such surgery and need to have an understanding about how to manage them, at least initially. Obesity surgery is mainly offered in tertiary centres but patients may present with problems to their local district hospital. This review summarises the main complications that may be encountered. MATERIALS AND METHODS A full literature search was carried out looking at articles published in the last 10 years. Keywords for search purposes included bariatric, surgery, complications, emergency and management. CONCLUSIONS Complications of bariatric surgery have been extensively written about but never in a format that is designed to aid the on-call surgeon. The intricate details and rare complications have been excluded to concentrate on those symptoms and signs that are likely to be encountered by the emergency team.
The Environmental and Social History of African Sacred Groves: A Tanzanian Case Study
Authors: Sheridan Michael J. 
Published: May 2009

Abstract:Sacred groves figure prominently in efforts to create community-based conservation in Africa. Although they are often conceptualized in functionalist terms as relics of climax forest and peak cultural florescence, attention to the intersections of ecological and social dynamics offers a framework for understanding African sacred groves that avoids assumptions of steady states of habitat and culture. This article, based on a case study from the North Pare Mountains of northeastern Tanzania, demonstrates that the sacredness of these groves is embedded in social institutions, and that the deeply contested nature of these meanings produces African landscapes. It concludes that sacred groves, as examples of cultural and ecological co-evolution, require research based on hybrid social and natural scientific methods. The implication for conservation policy is that sacred groves are not simply local forms of conservation, and that their management demands cooperation among local, national, and global institutions.
Rethinking Patrimonialism and Neopatrimonialism in Africa
Authors: Pitcher Anne , Moran Mary H. , Johnston Michael 
Published: May 2009

Abstract:Current usages of the termspatrimonialandneopatrimonialin the context of Africa are conceptually problematical and amount to a serious misreading of Weber. His use of the termpatrimonialdelineated a legitimate type of authority, not a type of regime, and included notions of reciprocity and voluntary compliance between rulers and the ruled. Those reciprocities enabled subjects to check the actions of rulers, which most analyses of (neo) patrimonialism overlook. We apply these insights to a case study of Botswana and suggest that scholars reconsider the application of Weber's concepts to African states.
Glyphosate Weed Control Enhancement with Ammonium Sulfate and Commercial Water Conditioning Agents
Authors: Peterson Dallas E. , Thompson Curtis R. 
Published: May 2009

Abstract
Glyphosate herbicide labels generally recommend addition of ammonium sulfate (AMS) to the spray solution, which often improves weed control, especially when mixed with hard water. AMS in solution disassociates, and the sulfate binds with cations in the spray solution, preventing the development of glyphosate-cation complexes that tend to have lower absorption into plant leaves. In addition, the ammonium ion can associate with the glyphosate molecule, which helps facilitate glyphosate absorption into the leaf. The recommended AMS rate is 1–2 % w/w, and AMS is available in both dry and liquid formulations. Applicators generally find AMS inconvenient to use because of the high use rate and handling issues. Several companies are marketing low-rate water conditioner products to be used as an alternative to AMS with glyphosate. Pesticide applicators like the convenience of low-rate water conditioners, but performance of these products has been inconsistent. Field experiments were conducted near Manhattan, KS, from 2005 to 2008 to compare the efficacy of glyphosate with AMS and various commercial water conditioners on velvetleaf, sorghum, corn, and sunflower. Each experiment consisted of a sublethal (0.31 or 0.43 kg ae/ha) dose of glyphosate applied in combination with the recommended application rate of each adjuvant. Water hardness, environmental conditions, and plant growth stages varied by experiment. Control of all assay species with glyphosate was enhanced by the addition of AMS, unless control was near complete in the absence of AMS. Commercial water conditioner products that included an AMS component at the equivalent rate of 1 % w/w gave equal or slightly better control than glyphosate plus 1 % w/w AMS. Commercial water conditioners that did not provide an equivalent amount of AMS gave less control than glyphosate with 1 % or 2 % w/w AMS and were often no better than glyphosate alone for the low-rate products.
Reliability Life Prediction of VFD by Constant Temperature Stress Accelerated Life Tests and Maximum Likelihood Estimation
Authors: Zhang Jian-Ping , Wang Rui-Tao 
Published: May 2009

Abstract
In order to obtain the life information of vacuum fluorescent display (VFD) in a short time, four constant stress accelerated life tests (CSALT) are conducted with the cathode temperature increased. Lognormal function is applied for describing the life distribution of VFD. Assuming an Arrhenius model, the lognormal parameters are computed by using the maximum likelihood estimation. Furthermore, a self-developed software is employed in predicting the VFD life. The statistical analysis of the results indicates that the test design of CSALT is correct and feasible, that the average life of VFD is over 30,000 h, and that the life-stress relationship satisfies linear Arrhenius equation completely. The precise accelerated parameter is shown to be particularly useful to predict the VFD life within shorter time. Thus, this work provides significant guidelines to help engineers make decisions in design and manufacturing strategy from the aspect of reliability life.
Prediction of Cushion Performance Less Than One Inch Thick
Authors: Daum Matthew , Batt Gregory 
Published: May 2009

AbstractAn important tool packaging engineers use when designing cushions to protect products from shock is the cushion curve. Cushion curves show deceleration values along the vertical axis versus the static loading (weight divided by bearing area) along the horizontal axis for a given thickness of cushion material and given drop height. Commercially available cushion curves display a thickness of one inch and greater. However, many times packaging engineers design packages with cushions less than one inch thick. This leaves the packaging engineer to either guess deceleration levels below one inch thick by trial and error, or to extrapolate from existing cushion curve data. The purpose of this study was to determine if using existing cushion curve information would accurately predict deceleration values below one inch thick. To do this, a procedure was developed comparing information collected from expanded polystyrene cushion samples greater than one inch thick (correlating to existing cushion curves) compared to information collected from samples less than one inch thick. The comparison looked for difference between the datasets. It was found that in fact there was a statistical difference, meaning existing cushion curves should not be used to predict deceleration values for cushion thicknesses below one inch.
Successful use of weekly pegvisomant administration in patients with acromegaly
Authors: Higham C E , Thomas J D J , Bidlingmaier M , Drake W M , Trainer P J 
Published: May 2009

ContextClinical trials using 80 mg once weekly pegvisomant (pegV) in active acromegaly led to a 30% fall in serum IGF1. Subsequent studies demonstrated that daily administration of up to 40 mg/day achieved an IGF1 within reference range in 97% of patients. PegV has a half-life of >70 h suggesting weekly dosing may be possible but using higher doses than in the initial trials.ObjectiveTo determine the efficacy of weekly dosing of pegV.DesignA two center, open-label prospective study in patients with acromegaly converted from a stable daily dose of pegV (median dose 15 mg daily (range 10–20 mg od), IGF1 normal for 3 months prior to inclusion) to twice-weekly (week 0–16) followed by once-weekly (week 16–32) administration.ResultsSeven patients (4M, age 57±7 years, 6/7 prior transsphenoidal surgery, 7/7 prior radiotherapy) were recruited. Six patients completed the twice-weekly and five patients both the twice-weekly and once-weekly administration. Headaches led to two patient withdrawals at 0+24 weeks. Mean pre-dose serum IGF1 levels remained stable with the different administration regimens (IGF1 baseline 145±39 ng/ml, twice-weekly 124±39 ng/ml and once-weekly 127±22 ng/ml) and all values were within age adjusted IGF1 reference range. PegV dose was reduced in two patients and five opted to continue weekly administration at trial termination. Safety and quality of life parameters remained stable.ConclusionsTwice and once-weekly administration of pegV is effective in controlling serum IGF1 levels in acromegaly and although not formally assessed, continuation of weekly dosing in five patients at study conclusion suggests patient preference for this regimen.
Distal gastric bypass surgery for the treatment of hypothalamic obesity after childhood craniopharyngioma
Authors: Schultes Bernd , Ernst Barbara , Schmid Florian , Thurnheer Martin 
Published: May 2009

ContextObesity resulting from damage to the hypothalamus, i.e. hypothalamic obesity, is a severe condition that currently lacks any effective evidence-based therapy.ObjectiveOur goal was to describe the course of hypothalamic obesity in a craniopharyngioma patient treated with distal gastric bypass surgery and to outline distinct aspects of multidisciplinary case management.Patient and methodsA 29-year-old man, who had undergone craniopharyngioma resection at the age of 8, was referred to our Interdisciplinary Obesity Centre with a body mass index (BMI) of 52.0 kg/m2, type 2 diabetes and obstructive sleep apnoea syndrome (OSAS). After careful preoperative preparation, including the adjustment of hormone substitution therapy for panhypopituitarism, nutritional counselling and a supervised exercise program, he underwent a distal gastric bypass operation.ResultsEighteen months after the operation the patient's BMI had decreased to 31.9 kg/m2, type 2 diabetes was in complete remission, and OSAS appeared to be improved. Also, feelings of hunger were markedly reduced after the operation. A standard regimen of supplements successfully prevented any severe nutritional deficiencies. After weight loss, the dose of hydrocortisone could be distinctly reduced without any signs of adrenal insufficiency while GH substitution had to be markedly increased to achieve normal IGF1 levels.ConclusionsOur case demonstrates that within a multidisciplinary team approach, a distal gastric bypass operation can be a safe and highly effective therapy for patients with hypothalamic obesity. Also, our findings hint at an effect of gastric bypass surgery on hunger and eating behaviour that may not essentially rely on hypothalamic mechanisms.
Kinase Mutations and Efficacy of Imatinib in Korean Patients with Advanced Gastrointestinal Stromal Tumors
Authors: Kim Tae Won , Ryu Min-Hee , Lee Heungnam , Sym Sun Jin , Lee Jae-Lyun , Chang Heung Moon , Park Young Suk , Lee Kyung Hee , Kang Won Ki , Shin Dong Bok , Bang Yung-Jue , Lee Jung Shin , Kang Yoon-Koo 
Published: May 2009

AbstractPurpose.This study analyzed the relationship between treatment outcome and kinase mutational status in Korean patients with advanced gastrointestinal stromal tumors (GISTs).Experimental Design.Clinical data were collected from 113 consecutive patients with metastatic or unresectable GISTs treated with imatinib from June 2001 through June 2005 at five institutions in Korea. KIT exons 9, 11, 13, and 17 and PDGFRA exons 12 and 18 were examined.Results.The median patient age was 57 years (range, 31–82 years). The overall response rate was 67.2%. KIT mutations were found in exon 11 (n = 92, 81.4%) and exon 9 (n = 10, 8.8%). One patient had a PDGFRA exon 18 mutation. The overall mutation rate was 91.2%. Response rates were 68.4%, 50.0%, and 80.0% in patients with KIT exon 11 mutations, KIT exon 9 mutations, and no kinase mutations, respectively. With a median follow-up of 49.0 months, the median progression-free survival (PFS) time was 42.0 months and median overall survival (OS) time was not reached. PFS and OS times did not differ significantly according to KIT genotype.Conclusion.This study was unable to find an association between KIT mutational status and clinical outcome of imatinib in Korean patients with advanced GISTs. There was a trend toward better outcomes for patients with wild-type KIT or exon 11 mutations compared with exon 9 mutations, although this was not statistically significant. Compared with previous studies in western populations, these results suggest that ethnic differences may influence the relationship between KIT genotype and clinical outcome to imatinib.
High Incidence of Hypocalcemia and Serum Creatinine Increase in Patients with Bone Metastases Treated with Zoledronic Acid
Authors: Zuradelli Monica , Masci Giovanna , Biancofiore Giuseppe , Gullo Giuseppe , Scorsetti Marta , Navarria Pierina , Tancioni Flavio , Berlusconi Marco , Giordano Laura , Santoro Armando 
Published: May 2009

Abstract

Background.
Zoledronic acid belongs to the new generation of bisphosphonates with demonstrated clinical benefit for the treatment of bone metastases from different kinds of neoplasms. Hypocalcemia and serum creatinine elevation are expected adverse events during this therapy. The monitoring of serum calcium and creatinine is therefore recommended. The primary aim of this study was to establish the actual incidence of hypocalcemia and serum creatinine elevation during treatment with zoledronic acid. Skeletal-related events and side effects were also assessed.

Methods.
Serum creatinine and calcium levels were evaluated in 240 consecutive patients (83 males, 157 females; mean age, 62 years) with metastatic bone lesions from different solid tumors treated with zoledronic acid.

Results.
Overall, 93 of 240 patients (38.8%) developed hypocalcemia, which was grade (G)1 in 45 patients (48.4%), G2 in 37 patients (39.8%), G3 in 10 patients (10.8%), and G4 in one patient (1.1%). The median time to occurrence of hypocalcemia (any grade) was 2.3 months after the beginning of the treatment (range, 0–34.9 months).
Increased serum creatinine was observed in 33 of 240 patients (13.7%), of whom 19 had G1 (57.6%), 11 had G2 (33.3%), and three had G3 (9.1%). The median time to serum creatinine increase (for any grade) was 4.7 months (range, 0–29.2 months).

Conclusions.
Our analysis shows a high incidence of hypocalcemia and increased serum creatinine level during treatment with zoledronic acid. These results strongly support the need for accurate monitoring of plasma calcium and creatinine levels.
Neuroendocrine Tumors of the Pancreas
Authors: Ehehalt Florian , Saeger Hans D. , Schmidt C. Max , Grützmann Robert 
Published: May 2009

Learning Objectives
Assess the basic aspects of PNET tumor biology, pathogenesis, and classification. Explain the epidemiology and evaluate the prognosis of PNET patients. Engage in rational clinical management of PNETs.
This article is available for continuing medical education credit at CME.TheOncologist.com
Proactive Management of Adverse Events Maintains the Clinical Benefit of Ixabepilone
Authors: Yardley Denise A. 
Published: May 2009

Abstract
Ixabepilone is a novel microtubule-stabilizing agent with clinical efficacy in advanced breast cancer, including patients whose disease has progressed on prior anthracyclines and taxanes. The safety profile of single-agent ixabepilone and combination ixabepilone plus capecitabine therapy is reviewed, outlining the steps to effectively manage and prevent common adverse events. Ixabepilone is generally well tolerated, and importantly, its toxicity profile does not overlap with that of capecitabine. Peripheral sensory neuropathy and neutropenia are the most common toxicities associated with ixabepilone; both can be effectively managed by monitoring patients and then, depending on severity, instituting a treatment delay until recovery and reducing the ixabepilone dose for subsequent treatment cycles. Ixabepilone dose reductions are recommended for most grade 3 events, excluding transient fatigue, arthralgia, and myalgia, whereas treatment discontinuation is recommended for persistent grade 3 neuropathy or any grade 4 nonhematological toxicity. Because ixabepilone exposure is greater in patients with hepatic impairment and those receiving concomitant strong cytochrome P-450 CYP3A4 inhibitors, dose adjustments and restrictions are recommended according to the degree of hepatic impairment, whether ixabepilone is administered alone or in combination with capecitabine, and whether a strong CYP3A4 inhibitor is being coadministered. Patients should be premedicated with oral H1 and H2 antihistamines to prevent hypersensitivity reactions. Unlike taxanes, corticosteroid premedication is not required unless a hypersensitivity reaction occurred during a previous cycle or during treatment with another Cremophor-containing agent. By effectively managing adverse events and taking steps to minimize them, clinicians can ensure that patients derive the maximum benefit from ixabepilone therapy.
Elevated Triglycerides Correlate With Progression of Diabetic Neuropathy
Authors: Wiggin Timothy D. , Sullivan Kelli A. , Pop-Busui Rodica , Amato Antonino , Sima Anders A.F. , Feldman Eva L. 
Published: May 2009

OBJECTIVE
To evaluate mechanisms underlying diabetic neuropathy progression using indexes of sural nerve morphometry obtained from two identical randomized, placebo-controlled clinical trials.

RESEARCH DESIGN AND METHODS
Sural nerve myelinated fiber density (MFD), nerve conduction velocities (NCVs), vibration perception thresholds, clinical symptom scores, and a visual analog scale for pain were analyzed in participants with diabetic neuropathy. A loss of ≥500 fibers/mm2 in sural nerve MFD over 52 weeks was defined as progressing diabetic neuropathy, and a MFD loss of ≤100 fibers/mm2 during the same time interval as nonprogressing diabetic neuropathy. The progressing and nonprogressing cohorts were matched for baseline characteristics using an O'Brien rank-sum and baseline MFD.

RESULTS
At 52 weeks, the progressing cohort demonstrated a 25% decrease (P &lt; 0.0001) from baseline in MFD, while the nonprogressing cohort remained unchanged. MFD was not affected by active drug treatment (P = 0.87), diabetes duration (P = 0.48), age (P = 0.11), or BMI (P = 0.30). Among all variables tested, elevated triglycerides and decreased peroneal motor NCV at baseline significantly correlated with loss of MFD at 52 weeks (P = 0.04).

CONCLUSIONS
In this cohort of participants with mild to moderate diabetic neuropathy, elevated triglycerides correlated with MFD loss independent of disease duration, age, diabetes control, or other variables. These data support the evolving concept that hyperlipidemia is instrumental in the progression of diabetic neuropathy.