bluuebunny/crossref_metadata_2025_split huggingface dataset:
The evidence‐based medicine model of clinical practice: scientific teaching or belief‐based preaching?
Authors: Charles Cathy , Gafni Amiram , Freeman Emily 
Published: November 2010

AbstractRationale  Evidence‐based medicine (EBM) is commonly advocated as a ‘gold standard’ of clinical practice. A prominent definition of EBM is: the integration of best research evidence with clinical expertise and patient values. Over time, various versions of a conceptual model or framework for implementing EBM (i.e. how to practice EBM) have been developed.Aims and objectives  This paper (i) traces the evolution of the different versions of the conceptual model; (ii) tries to make explicit the underlying goals, assumptions and logic of the various versions by exploring the definitions and meaning of the components identified in each model, and the methods suggested for integrating these into clinical practice; and (iii) offers an analytic critique of the various model iterations.Methods  A literature review was undertaken to identify, summarize, and compare the content of articles and books discussing EBM as a conceptual model to guide physicians in clinical practice.Results  Our findings suggest that the EBM model of clinical practice, as it has evolved over time, is largely belief‐based, because it is lacking in empirical evidence and theoretical support. The model is not well developed and articulated in terms of defining model components, justifying their inclusion and suggesting ways to integrate these in clinical practice.Conclusion  These findings are significant because without a model that clearly defines what constitutes an EBM approach to clinical practice we cannot (i) consistently teach clinicians how to do it and (ii) evaluate whether it is being done.
The value of tailored communication for person‐centred outcomes
Authors: van Dulmen Sandra 
Published: November 2010

AbstractRationale  When entering a consulting room a person becomes a patient with double needs, that is, the need to feel known and understood and the need to know and understand, also referred to as affective and instrumental needs, respectively. The fulfilment of these needs highly depends on the communication skills of both doctor and patient, which help to bridge the inherent distance that exists between these two persons. There is ample evidence that this bridge becomes stronger the more the communication is tailored to the person behind the patient. Besides, such tailored communication may also prove to be effective for reaching favourable health outcomes.Methods  Descriptive study focusing on the value of tailored communication in promoting person‐centred instrumental and affective health outcomes.Results  Research shows that tailored communication contributes to health outcomes known to be crucial for recovery and quality of life, that is, information recall, medication adherence, reassurance and need fulfilment.Conclusion  There is empirical evidence for the value of tailored communication for person‐centred outcomes. Communicating in a purposeful way while at the same time respecting patients' values and feelings should therefore become the standard in health care practice.
Association of OLE RNA with bacterial membranes via an RNA–protein interaction
Authors: Block Kirsten F. , Puerta‐Fernandez Elena , Wallace Jason G. , Breaker Ronald R. 
Published: November 2010

SummaryOrnate, large, extremophilic (OLE) RNAs are large, non‐coding transcripts characterized by their ornate secondary structure and presence predominantly in Gram‐positive, extremophilic bacteria. A gene for an OLE‐associated protein (OAP) is almost always located immediately downstream of the OLE gene. OAP has no extensive homology to other proteins and is predicted to form multiple transmembrane domains. We show that this protein forms a ribonucleoprotein complex with OLE RNA using at least 2:1 protein : RNA stoichiometry. A series of truncated OLE RNA constructs was used to establish that most of the RNA can be deleted without eliminating protein binding. Two primary binding sites are present within the RNA, although additional binding determinants exist and extensive structural stabilization is induced by OAP. RNA fluorescence in situ hybridization (FISH) was used in Escherichia coli to demonstrate that ribonucleoprotein complex formation localizes the RNA near cell membranes of this heterologous system. Therefore, the majority of the complex structure formed by OLE RNA may perform a biochemical function that requires membrane localization.
Immunovirological outcomes and resistance patterns at 4 years of antiretroviral therapy use in HIV‐infected patients in Cambodia
Authors: Pujades‐Rodríguez Mar , Schramm Birgit , Som Leakena , Nerrienet Eric , Narom Prak , Chanchhaya Ngeth , Ferradini Laurent , Balkan Suna 
Published: November 2010

SummaryObjectives  To report immunovirological outcomes and resistance patterns in adults treated with triple combination antiretroviral therapy (cART) for 4 years in an HIV programme of Phnom Penh, Cambodia.Methods  It is a longitudinal study and cross‐sectional evaluation of adults receiving cART for 4 years. CD4 cell counts and HIV‐1 RNA were quantified, and resistance patterns were determined. Drug‐related toxicity was assessed by clinicians and through laboratory testing.Results  After 4 years of cART start, the cumulative probability of retention in care was 0.80 and survival among patients not lost to follow‐up was 0.85. A total of 349 patients (98% of eligible) participated in the cross‐sectional evaluation. Ninety per cent were receiving first‐line therapy, 29% stavudine‐ and 58% zidovudine‐containing regimens (compared with 94% and 3% at cART initiation). Ninety‐three per cent of patients were clinically asymptomatic, and severe lipodystrophy and dyslipidemia were diagnosed in 7.2% and 4.0%, respectively. Good treatment adherence was reported by 83% of patients. Median CD4 T‐cell count was 410 cells/μl [IQR 290–511], and 90% of patients had >200 cells/μl. Only 15 (4%) patients had detectable HIV viral load (eight had <200 CD4 cells/μl), five had thymidine analogue mutations, and nine were resistant to two drug classes. In an intention‐to‐treat analysis, 26.1% (95% CI 22.0–30.5) of patients had failed first‐line therapy.Conclusions  In this Cambodian cohort of adults who started cART at an advanced stage of HIV disease, we observed good clinical and immunovirological outcomes and self‐reported treatment adherence at 4 years of therapy.
Genetic variability in Plasmodium vivax aldolase gene in Korean isolates and the sensitivity of the Binax Now malaria test
Authors: Cho Chi‐Hyun , Nam Myoung Hyun , Kim Jang Su , Han Eun Taek , Lee Won Ja , Oh Jun Seo , An Seong Soo A. , Lim Chae Seung 
Published: November 2010

SummaryIntroduction of rapid malaria diagnostic tests (RDT) initiated numerous field evaluations in various epidemiologic settings. But the efficiency of some RTD kits based on aldolase raised reservations for direct implementation of RDT into clinical settings. We performed Binax Now malaria test in 84 Korean Plasmodium vivax isolates and compared it with the traditional Giemsa stain microscopy test as the reference standard. The sensitivity of Binax Now was 62.0% for P. vivax cases (52/84, 95% CI 51.2–71.6%) with 100.0% specificity (50/50, 95% confidence interval 92.9–100%). After the aldolase gene sequence analysis of 84 isolates, two synonymous mutations in aldolase gene were identified in both Binax Now positive and negative samples. No significant association between the mutations and Binax Now malaria tests was found. Thus, the genetic variability would not explain the poor performance of P. vivax RDTs by detecting aldolase in ROK isolates.
Would rational use of antibiotics be compromised in the era of test‐based management of malaria?
Authors: Baiden Frank , Webster Jayne , Owusu‐Agyei Seth , Chandramohan Daniel 
Published: November 2010

Editorial: L’utilisation rationnelle des antibiotiques sera‐t‐elle compromise dans l’ère de la prise en charge de la malaria basée sur les tests?L’OMS a publié des directives révisées sur le traitement de la malaria qui recommandent la confirmation parasitologique avant le début du traitement des patients fébriles, y compris les enfants de moins de cinq ans. Le respect des nouvelles directives conduirait à un grand nombre de maladies fébriles confirmées comme étant non‐malariques. Sans les compétences et la capacité de distinguer les causes de fièvre non malarique dans les régions à pauvres ressources, la tendance serait pour les cliniciens à recourir à l’utilisation présomptueuse d’antibiotiques dans tous les cas à test négatif. Une augmentation significative de l’utilisation inappropriée des antibiotiques en Afrique subsaharienne va accroître le problème mondial de la résistance aux antibiotiques. Des interventions ciblées sont nécessaires pour améliorer l’utilisation rationnelle des antibiotiques dans l’ère de la prise en charge de la malaria basée sur les tests. Cela comprend des modifications appropriées dans les directives actuelles de la PCIME, l’équipement et la reformation du personnel dans les services de soins primaires, l’établissement de systèmes de surveillance sentinelle pour déterminer l’étiologie de la maladie fébrile non‐malarique et les profils de sensibilité aux antibiotiques, ainsi qu’un mécanisme efficace pour la diffusion des données de surveillance afin d’améliorer le diagnostic et la prise en charge des maladies fébriles chez les enfants.
Strain filtering and transmission of a mixed infection in a social insect
Authors: ULRICH Y. , SADD B. M. , SCHMID‐HEMPEL P. 
Published: November 2010

AbstractMixed‐genotype infections have attracted considerable attention as drivers of pathogen evolution. However, experimental approaches often overlook essential features of natural host–parasite interactions, such as host heterogeneity, or the effects of between‐host selection during transmission. Here, following inoculation of a mixed infection, we analyse the success of different strains of a trypanosome parasite throughout the colony cycle of its bumblebee host. We find that most colonies efficiently filter the circulating infection before it reaches the new queens, the only offspring that carry infections to the next season. A few colonies with a poor filtering ability thus contributed disproportionately to the parasite population in the next season. High strain diversity but not high infection intensity within colony was associated with an increased probability of transmission of the infection to new queens. Interestingly, the representation of the different strains changed dramatically over time, so that long‐term parasite success could not be predicted from short‐term observations. These findings highlight the shaping of within‐colony parasite diversity through filtering as a crucial determinant of year‐to‐year pathogen transmission and emphasize the importance of host ecology and heterogeneity for disease dynamics.
Limited gene flow may enhance adaptation to local optima in isolated populations of the Roesel’s bush cricket (Metrioptera roeselii)
Authors: CASSEL‐LUNDHAGEN A. , KAŇUCH P. , LOW M. , BERGGREN Å. 
Published: November 2010

AbstractVariation in morphological traits along latitudinal gradients often manifests as size clines. In insects, both positive and negative correlations are seen, and the mechanism behind the response is unclear. We studied variation in seven morphological traits of Roesel’s bush cricket,Metrioptera roeselii, sampled from seven latitude‐matched‐pair populations that were either geographically isolated from or connected to the species continuous distribution range. The aim was to examine whether morphological traits differed between isolated and continuous populations, and whether latitudinal variation was apparent. The data were used to indicate whether variation in trait means originates from plastic responses to the environment or genetic adaptation to local conditions. To evaluate the influence of gene flow on trait means, we analysed the genetic variation in seven microsatellites. Data showed that individuals from isolated populations display a positive relationship between latitude and body size, whereas individuals from continuous populations show little or no such relationship. The combined morphological and genetic data suggest that the isolated populations have adapted to local optima, while gene flow between continuous populations appears to counteract this process.
Testing the molecular and evolutionary causes of a ‘leapfrog’ pattern of geographical variation in coloration
Authors: CADENA C. D. , CHEVIRON Z. A. , FUNK W. C. 
Published: November 2010

AbstractUnderstanding the mechanisms accounting for the evolution of phenotypic diversity is central to evolutionary biology. We use molecular and phenotypic data to test hypotheses for ‘leapfrog’ patterns of geographical variation, in which phenotypically similar, disjunct populations are separated by distinct populations of the same species. Phylogenetic reconstructions revealed independent evolution of melanic plumage characters in different populations in the Neotropical avian genus Arremon. Thus, phenotypic similarities between distant populations cannot be explained by close phylogenetic affinity. Nor can they be attributed to recurring mutations in the MC1R gene, a locus involved in melanic pigmentation. A coalescent analysis indicates that plumage traits have become fixed at a faster rate than expected under genetic drift, suggesting that selection underlies their repeated evolution. In contrast to views that genetic drift drives phenotypic differentiation in Neotropical montane birds, our results imply that geographical variation preceding speciation may reflect the action of deterministic selective processes.
Altitudinal and seasonal variation in microsatellite allele frequencies of Drosophila buzzatii
Authors: BARKER J. S. F. , FRYDENBERG J. , SARUP P. , LOESCHCKE V. 
Published: November 2010

AbstractVariation in climate, particularly temperature, is known to affect the genetic composition of populations. Although there have been many studies of latitudinal variation, comparisons of populations across altitudes or seasons, particularly for animal species, are less common. Here, we study genetic variation (microsatellite markers) in populations of Drosophila buzzatii collected along altitudinal gradients and in different seasons. We found no differences in genetic variation between 2 years or between seasons within years. However, there were numerous cases of significant associations between allele frequencies or expected heterozygosities and altitude, with more than half showing nonlinear relationships. While these associations indicate possible selection and local altitudinal adaptation, direct tests gave strong evidence for selection affecting two loci and weaker evidence for five other loci. Two loci that are located within an inversion (including the one with strongest evidence for selection) show a linear increase in genetic diversity with altitude, likely due to thermal selection. Parallel associations with altitude here and with latitude in Australian populations indicate that selection is operating on chromosomal regions marked by some of the loci.
Prognostic variables and nomograms for renal cell carcinoma
Authors: Flanigan Robert C , Polcari Anthony J , Hugen Cory M 
Published: November 2010

AbstractThe term renal cell carcinoma (RCC) is used to describe a heterogeneous group of tumors that vary histologically, genetically and molecularly. Extensive research has been conducted to identify characteristics that predict outcomes among patients with RCC. In addition to histological subtype these include tumor size, patient age, mode of presentation and various hematological indices, among others. Several groups have incorporated these clinical and pathological features into nomograms which help the clinician better define individual patient prognosis and direct the optimum therapeutic approach. In the present article we review these prognostic variables and nomograms for RCC.
Quality of pathological reporting for renal cell cancer: implications for systemic therapy, prognostication and surveillance
Authors: Shuch Brian , Pantuck Allan J. , Pouliot Frederic , Finley David S. , Said Jonathan W. , Belldegrun Arie S. , Saigal Chris 
Published: November 2010

Study Type – Prognosis (retrospective cohort)Level of Evidence 2b What’s known on the subject? and What does the study add? Pathology reporting is an important aspect of cancer care for all solid malignancies and the College of American Pathologists has set forth specific guidelines. Many prognostic nomograms for kidney cancer rely on important pathologic characteristics but it is unknown if current reporting practices permit use of these models.This study shows limitations in the current pathological reporting practices for kidney cancer. Guidelines set forth by the College of American Pathologists are frequently not met and this could limit the use of prognostic models and enrollment into adjuvant trials. Efforts should be made to improve reporting practices by methods such as standard template reporting.OBJECTIVE

To evaluate whether current nephrectomy pathology reports are sufficient to allow clinicians to use prognostic nomograms, tailor surveillance, enroll patients into adjuvant trials and select systemic therapy for renal cell carcinoma (RCC).

PATIENTS AND METHODS

Nephrectomy pathology reports were obtained from the LA County Tumor Registry. Key reporting elements identified by the College of American Pathology (CAP) and utilized in RCC prognostic models were abstracted. Hospital type was coded as community, teaching or cancer centre.
Reporting quality was assessed across hospital type and year.

RESULTS

A total of 317 of 344 sampled reports (92.2%) met the inclusion criteria. Tumour size and margin status were commonly reported. Some 90.2% and 84.2% of reports provided data on histology and Fuhrman grade. Tumour classification was omitted in 27.8%.
Microvascular invasion and necrosis were infrequently reported (44.5% and 25.6%, respectively). Only 59.9% of reports met CAP guidelines for tumour classification, margin, size, histology and grade.
Two prognostic nomograms (Stage, Size, Grade and Necrosis system and Kattan) could rarely be utilized (15.8% and 12.3%, respectively), whereas the UCLA Integrated Staging System could be used frequently (65.6%). There were discrepancies satisfying CAP guidelines between community, teaching and cancer centre hospitals, with 54.7%, 70.5% and 75% of reports meeting CAP criteria (P= 0.0102).

CONCLUSIONS

Current RCC pathology reporting fails to satisfy CAP guidelines, does not permit the use of prognostic systems, and may hinder enrollment into adjuvant trials and the selection of systemic therapy. Important reporting discrepancies exist between hospital types, with cancer centres performing best.
Quality improvement initiatives to encourage consistent, comprehensive and clinically relevant pathology reports would improve the quality of RCC patient care.
Prognostic risk stratification of pathological stage T2N0 bladder cancer after radical cystectomy
Authors: Sonpavde Guru , Khan Myrna M. , Svatek Robert S. , Lee Richard , Novara Giacomo , Tilki Derya , Lerner Seth P. , Amiel Gilad E. , Skinner Eila , Karakiewicz Pierre I. , Bastian Patrick J. , Kassouf Wassim , Fritsche Hans‐Martin , Izawa Jonathan I. , Ficarra Vincenzo , Dinney Colin P. , Lotan Yair , Fradet Yves , Shariat Shahrokh F. 
Published: November 2010

Study Type – Therapy (individual cohort)Level of Evidence 2bWhat’s known on the subject? and What does the study add?Patients with urothelial carcinoma of the bladder (UCB) and pathological (p) stage T2N0 disease exhibit a range of clinical outcomes with an overall estimated 10–25% experiencing recurrence and death after radical cystectomy (RC). Nomograms to prognosticate UCB post‐RC have been developed in heterogeneous datasets of patients across different stages and do not address factors unique to pT2N0 disease.A user‐friendly prognostic risk model was devised for patients with pT2N0 UCB undergoing RC based on residual pathological stage at RC (pT2a, pT2b, <pT2), grade (high, low) and lymphovascular invasion (present or absent). The three risk groups exhibited five‐year recurrence‐free survivals of 95%, 86% and 62%, respectively. These data warrant validation and may help design adjuvant therapy trials as well as tailor the intensity of post‐operative monitoring.OBJECTIVE• To stratify risk of pathological (p) T2N0 urothelial carcinoma of the bladder after radical cystectomy (RC) based on pathological factors to facilitate the development of adjuvant therapy trials for high‐risk patients.PATIENTS AND METHODS• The study comprised 707 patients from a database of patients with pT2N0 urothelial carcinoma of the bladder who had undergone RC and not received perioperative chemotherapy.• The effect of residual pT‐stage at RC, age, grade, lymphovascular invasion and number of lymph nodes removed on recurrence‐free survival was evaluated using Cox regression analyses. A weighted prognostic model was devised with significant variables.RESULTS• The median follow up was 60.9 months. In multivariable analyses, residual disease at RC (pT2a: hazard ratio (HR) 1.740, P = 0.03; for pT2b: HR 3.075, P < 0.001; both compared with <pT2), high‐grade (HR 2.127, P = 0.09) and lymphovascular invasion (HR 2.234, P < 0.001) were associated with recurrence‐free survival (c = 0.70).• Three risk groups were devised based on weighted variables with 5‐year recurrence‐free survival of 95% (95% CI 87–98), 86% (95% CI 81–90) and 62% (95% CI 54–69) in the good‐risk, intermediate‐risk and poor‐risk groups, respectively (c = 0.68). The primary limitation is the retrospective and multicenter feature.CONCLUSIONS• A prognostic risk model for patients with pT2N0 bladder cancer undergoing RC with generally adequate lymph node dissection was constructed based on residual pathological stage at RC, grade and lymphovascular invasion.• These data warrant validation and may enable the selection of patients with high‐risk pT2N0 urothelial carcinoma of the bladder for adjuvant therapy trials.
Ethnicity, Development and Gender: Tsáchila Indigenous Women in Ecuador
Authors: Radcliffe Sarah , Pequeño Andrea 
Published: November 2010

ABSTRACTIn recent decades, indigenous populations have become the subjects and agents of development in national and international multicultural policy that acknowledges poverty among indigenous peoples and their historic marginalization from power over development. Although the impact of these legal and programmatic efforts is growing, one persistent axis of disadvantage, male–female difference,1 is rarely taken into account in ethno‐development policy and practice. This article argues that assumptions that inform policy related to indigenous women fail to engage with indigenous women's development concerns. The institutional separation between gender and development policy (GAD) and multiculturalism means that provisions for gender in multicultural policies are inadequate, and ethnic rights in GAD policies are invisible. Drawing on post‐colonial feminism, the paper examines ethnicity and gender as interlocking systems that structure indigenous women's development experiences. These arguments are illustrated in relation to the case of the Tsáchila ethno‐cultural group in the South American country of Ecuador.