bluuebunny/crossref_metadata_2025_split huggingface dataset:
A simple Bayesian Belief Network for estimating the proportion of old-forest stands in the Clay Belt of Ontario using the provincial forest inventory
Authors: Cyr D. , Gauthier S. , Etheridge D.A. , Kayahara G.J. , Bergeron Y. 
Published: March 2010

The differences between boreal forest landscapes produced by natural disturbance regimes and landscapes produced by harvesting are important and increasingly well documented. To continue harvesting operations while maintaining biodiversity and other ecosystem services, government policies and certification processes are pushing for practices that preserve landscape features within their range of natural variability. One major shortcoming in the implementation of such a strategy is the lack of complete spatial or temporal information about these landscape features, such as the proportion of old stands, which are believed to act as a coarse filter for conservation if they remain representative enough of natural conditions. The objective of this study was to quantify the proportion of old stands in a very large landscape by combining fragmentary knowledge from two different sources, i.e., a provincial forest inventory and existing fire history reconstructions using a Bayesian Belief Network. This study was conducted over a 6.5 Mha landscape located within the Clay Belt of the province of Ontario, Canada, and suggests that more than 72.4% of this area is occupied by stands where no fire occurred during the last 150 years. The implications for management and potential for future research are discussed.
Circumferential Pulmonary Vein Ablation With Additional Linear Ablation Results in an Increased Incidence of Left Atrial Flutter Compared With Segmental Pulmonary Vein Isolation as an Initial Approach to Ablation of Paroxysmal Atrial Fibrillation
Authors: Sawhney Navinder , Anousheh Ramtin , Chen Wei , Feld Gregory K. 
Published: March 2010

Background—
There has been growing concern that linear ablation is associated with an increased risk of iatrogenic arrhythmias in patients undergoing ablation for atrial fibrillation (AF). Therefore, we compared circumferential pulmonary vein ablation plus left atrial linear ablation (CPVA+LALA) with segmental pulmonary vein isolation (PVI)in patients with paroxysmal AF.

Methods and Results—

Sixty-six consecutive patients with paroxysmal AF were prospectively randomly assigned to receive PVI versus CPVA+LALA (consisting of encircling lesions around the pulmonary veins), a roof line, and a mitral isthmus line with documentation of bidirectional mitral isthmus block. All patients were seen at 1, 3, 6, and every 12 months after ablation, with 14-day continuous ECG monitoring every 6 months. At 16.4±6.3 months after 1 ablation procedure, 19 patients (58%) remained free of atrial arrhythmias after PVI versus 17 patients (51%) after CPVA+LALA (
P
=0.62). After PVI, 14 patients had recurrent paroxysmal AF, whereas after CPVA+LALA, 8 patients had recurrent AF, 6 had atypical left atrial flutter (LAFL), and 2 had both AF and LAFL (
P
=0.32 between PVI versus CPVA+LALA for AF but
P
=0.002 for LAFL). Twenty-eight patients (85%) remained arrhythmia-free after 1.3±0.5 PVI procedures versus 28 patients (85%) after 1.4±0.6 CPVA+LALA procedures (
P
=NS). Fluoroscopy time was longer after CPVA+LALA versus PVI (91 versus 73 minutes,
P
=0.04).

Conclusions—
As an initial ablation approach in patients with paroxysmal AF, more LAFL occurred after CPVA+LALA and fluoroscopy times were longer compared with segmental PVI.
The complexities of interprofessional learning/working: Has the agenda lost its way?
Authors: Lewy Lisa 
Published: March 2010

Objective: The increasing emphasis of interprofessional working (IPW) and learning (IPL) encourages healthcare professionals to be educated together. However, is the language and understanding clear and consistent across health care? Research Questions: Is there a sound evidence base underpinning IPL/IPW? Do healthcare professionals and workforce arrangements support across professional working? Methodology: To answer these questions a detailed review was carried out investigating UK policy and educational developments in relation to international interprofessional research. Data Sources: Healthcare documents in relation to IPL from the UK Department of Health; World Health Organization; themes from international and European IPL networks/conferences, international healthcare journal article search (Metalib); UK Healthcare Commission documents; and UK healthcare statistics and data. Results: The definition of IPL and the associated IPL agenda within health is broad, which enables flexibility and creativity. However, this may also contribute to the weak evidence base which demonstrates the effectiveness of IPL. Conclusion: To focus the agenda on developing effective healthcare teams within an IPL framework would enable common understanding, language and evaluation processes.
An evaluation of an occupational health advice service
Authors: Shearn P , Ford Norma J , Murphy R G 
Published: March 2010

Objective: The objective of this article is to identify the profile of service users of an occupational health (OH) support service and establish areas of need, and to gather client feedback on the experience of participating in the support service and perceived outcomes and the impact of the advice received. Design and Setting: We carried out quantitative analyses of the characteristics of the service users and a quantitative survey of service users of GP surgeries and public events. Method: During 717 contacts with workers via opportunistic consultations, OH advisers collected participant information and details of occupational histories. To establish the outcomes and impact of the service, a telephone survey was conducted with a convenience sample of 165 participants 3 months after the initial consultation. Results: Contacting clients through opportunistic meetings was a useful way of reaching a cross section of workers and delivering OH support and advice. Overall, there was apparent need for OH support amongst employees from all sectors and sizes of workplace. The research identified that more than a third of clients reported work-related health conditions and more than 10 per cent had taken work-related sickness absence over the previous 12 months. More than 70 per cent of those that provided feedback rated the discussion as useful or very useful. The reported benefits were that the consultations led to perceived improvements in knowledge and confidence for tackling OH issues for the majority of respondents. More than a quarter of respondents reported taking actions to improve their work situation after consultation with the adviser. Conclusion: Work-related illnesses can be addressed through support services that provide employees with independent OH advice and guidance. Furthermore, there is an apparent need for employee OH support that is based outside of the workplace.
Food safety knowledge and behaviours of children (5-7 years)
Authors: Eves Anita , Bielby Gill , Egan Bernadette , Lumbers Margaret , Raats Monique , Adams Martin 
Published: March 2010

Objective: The objective of this study was to determine knowledge of food hygiene amongst young children (5—7 years), and facilitators and barriers to application of knowledge. Few studies exist that explore the knowledge and attitudes of young children towards food hygiene. This is an important age group, as it is a time when attitudes and behaviours are developing, which may then be carried through to adulthood. Design: To determine knowledge, age-appropriate activities were designed, with teachers, based on expected learning outcomes for this age group. In-depth interviews were carried out to determine attitudes towards and barriers to observing hygienic practices. Setting: Infant schools were selected across the United Kingdom, differing in number of children registered, level of deprivation of location, attainment and proportion of children from ethnic minorities. Methods: Activities were completed in 21 schools by 732 children (5—7 years). Interviews were conducted with 30 children. Findings: Children were generally well informed about handwashing occasions and good practice when preparing foods. They did not, however, always wash their hands when they knew they should, and some misconceptions were established at a young age. Children who understood the reasons for good practices, and who benefited from good facilities, were more likely to perform desired hygiene-related behaviours. The need for a collaborative approach between educators, health promotion professionals and parents was emphasized.
Parents’ and children’s self-report of parenting factors: How much do they agree and which is more strongly associated with early adolescent alcohol use?
Authors: Pasch Keryn E , Stigler Melissa H , Perry Cheryl L , Komro Kelli A 
Published: March 2010

Objective: The purpose of this study was to determine whether parents’ and children’s reports of parenting practices were correlated, whether the reports were differentially associated with alcohol use, and which report had the strongest association with alcohol use. Method: We carried out a cross-sectional and longitudinal study in public schools in Chicago, IL. Participants included 1373 ethnically diverse students and parents involved in an alcohol use prevention intervention. Surveys were conducted with sixth-grade and eighth-grade students. Mixed-effects regression analyses were used to model relationships cross-sectionally and longitudinally. Results: Parents’ and children’s perceptions of parenting practices, while significantly correlated, were not strongly associated. Analyses within each parenting domain found parents’ report of parental monitoring and children’s reports of alcohol-specific communication, general communication and relationship satisfaction were associated with alcohol use behaviours and intentions. After adjusting for all other parenting practices, parents’ report of parental monitoring and children’s report of alcohol-specific communication were most strongly related to alcohol use behaviours and intentions both cross-sectionally and longitudinally. Conclusions: When comparing results across studies, it is important to identify whose report was used, parent or child, as the results may differ based on the reporter. Studies with limited resources may consider using parents’ reports about parental monitoring and using children’s reports for alcohol-specific communication, general communication and relationship satisfaction.
Perceived health status and utilization of specialty care: Racial and ethnic disparities in patients with chronic diseases
Authors: Glover Saundra , Bellinger Jessica D , Bae Sejong , Rivers Patrick A , Singh Karan P 
Published: March 2010

Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality Survey ( n = 6722). Multivariate logistic regression and chi-squared analyses were used. Results: Hypertension was the most common chronic disease (25 per cent). Respondents with negative perceived health and minorities were less likely to report specialty care. Non-English language and foreign-born status were predictors of low specialty care use. Conclusions: Efforts to improve outcomes should be tailored and provided in a culturally and linguistically appropriate manner. Bilingual efforts to promote specialty care and methods to eliminate patient and system level barriers are needed.
Comparison of health locus of control between physicians and the general public
Authors: Tokuda Y , Okubo T , Yanai H , Jacobs J , Ohde S , Takahashi O , Omata F , Hinohara S , Fukui T 
Published: March 2010

Objective: Health locus of control (HLC) is associated with health behaviours. We aimed to investigate the difference of HLC to understand the potential gap in health beliefs between physicians and the general public. Design and setting: Physicians and the general public were surveyed in Japan using a cross-sectional survey. Data on the Japanese version of the HLC scale (HLCS-J) from 2194 members of the general public and 895 physicians were available. Method: Multi-group structural equation modelling analysis was used for examining differential item functioning (DIF) in the HLCS-J between the groups. Results: Uniform DIF was identified for the dimensions of internal, professional control and control by spiritual powers. Mean score for chance control (17.2) among physicians was greater than that (14.9) among the general public (adjusted p<0.001), while mean score for family control (21.7) among physicians was lower than that (22.1) among the general public (adjusted p<0.001). Conclusion: Physicians are more likely to have a higher chance control but lower family control than the general public. Further studies are needed to evaluate the relationships between individual physicians’ HLC and their health behaviours.
Sequential meta-analysis: an efficient decision-making tool
Authors: van der Tweel Ingeborg , Bollen Casper 
Published: March 2010

Background A cumulative meta-analysis of successive randomized controlled trials (RCTs) can be used to decide whether enough evidence has been obtained comparing a control and an intervention treatment or whether a new RCT should be initiated. In general, no adjustment is made for repeatedly testing the null hypothesis of treatment equivalence on cumulative data. Neither can the power of the statistical test be quantified. Recently, trial sequential analysis (TSA) was suggested to ‘. . . establish when firm evidence is reached in cumulative meta-analysis’. TSA is based on α-spending functions and necessitates a prior estimate of the total information size. Various information sizes were suggested. Purpose The aim of this study is to compare TSA with sequential meta-analysis (SMA) following Whitehead’s boundaries approach. Methods We compare TSA and SMA by re-analysis of a number of published examples. Results Re-analysis of the examples shows that for an SMA: (1) no prior estimate for total information size is necessary and thus one set of boundaries suffices; (2) stopping a cumulative meta-analysis for futility is an option; (3) the power can be quantified; (4) point and interval estimates are adjusted for the multiple testing; and (5) gains in efficiency can be achieved, both for efficacy and for futility and thus ethical and economical benefits can be obtained. Limitations Estimates for between-trial variability are unstable for a small number of trials. The behavior of a newly proposed estimate should be subject of further investigation. Conclusion SMA is a useful tool to investigate the cumulative evidence from successive RCTs.
A Bayesian dose-finding trial with adaptive dose expansion to flexibly assess efficacy and safety of an investigational drug
Authors: Berry Scott M , Spinelli Walter , Littman Gary S , Liang John Z , Fardipour Parvin , Berry Donald A , Lewis Roger J , Krams Michael 
Published: March 2010

Background Adaptive dose-ranging trials are more efficient than traditional approaches and may be designed to explicitly address the goals and decisions inherent in learn-phase drug development. We report the design, implementation, and outcome of an innovative Bayesian, response-adaptive, dose-ranging trial of an investigational drug in patients with diabetes, incorporating a dose expansion approach to flexibly address both efficacy and safety. Purpose The design was developed to assess whether one or more doses of an investigational drug demonstrated superior efficacy to an active control while maintaining an acceptable safety profile. Methods The trial used a two-stage design, in which patients were initially allocated equally to placebo, investigational drug at a low and a medium dose, and an active control. Movement to the second stage was contingent upon evidence of efficacy (measured by change in fasting blood glucose) to add a very low dose of the investigational drug and of safety (measured by weight gain) to add a high dose of the investigational drug. The design incorporated a longitudinal model to maximize use of incomplete data, predictive probabilities to guide the decisions to terminate the trial for futility or move on to Stage 2, and a dose-response model in Stage 2 to borrow information across adjacent doses. Extensive simulations were used to fine tune trial parameters, to define operating characteristics, and to determine the required sample sizes. A data monitoring committee was provided with frequent reports to aid in trial oversight. Results In Stage 1, as trial data accrued, the predictive probability that either the low or medium dose of the investigational drug was superior to the active control fell to low values. Stage 1 termination was recommended after 199 subjects were randomized, out of a maximum trial size of 500 subjects, and the final sample size was 218. Thus the trial did not progress to Stage 2. Limitations Because of the relatively narrow dose range to be assessed, and the inability to utilize the highest dose at the beginning of the trial, a fully responsive-adaptive design incorporating dose-response modeling was not considered a viable option. This limited the efficiency gains possible with a full set of adaptive design elements. Conclusions The two-stage dose-expansion design functioned as designed, recommending early termination based on a low probability that the tested doses had efficacy greater than the active control. Clinical Trials 2010; 7: 121—135. http://ctj.sagepub.com
Does treatment effect depend on control event rate? Revisiting a meta-analysis of suicidality and antidepressant use in children
Authors: Proschan Michael A , Brittain Erica H , Fay Michael P 
Published: March 2010

Background Weisberg et al. (Clin Trials 2009, 6: 109—18) illustrate that entry criteria in randomized trials can lead to results that are biased for the target population. Presenting data from a previously published meta-analysis of the effect of antidepressants in children on suicidality, they suggest a relationship between the control event rate and relative risk. Purpose Our purpose is threefold: (1) to show that natural methods of demonstrating a relationship between the control event rate and relative treatment benefit are fraught with danger, (2) to develop better methods, and (3) to assess whether there is evidence of such a relationship in the suicidality meta-analysis. Methods We propose an improved graphical method and an exact and approximate test of whether the treatment effect increases (or decreases) with the control event rate. Results The apparent relationship in the naive plot of relative risk against control rate is actually no stronger than what would be expected by chance. Results of our test do not support the conclusion that the odds ratio for suicidality varies with the control rate (one-sided p = 0.39). Limitations We are not able to apply the exact test to this data set. Simulation results indicate that the relationship would have to be very strong to detect it with these sample sizes and control event rates. Conclusions The difficulty in showing that the treatment effect in clinical trials differs by control rate is caused by 3 factors: (1) artificial correlation between a relative risk and control rate, (2) regression dilution bias because the independent variable — the control proportion — is subject to random variability, and (3) low power because we are trying to detect an interaction. Our graph and test are useful tools. Using them, we found no support for a relationship between the control event rate and treatment effect on suicidality. Clinical Trials 2010; 7: 109—117. http://ctj.sagepub.com
Clinical trials for predictive medicine: new challenges and paradigms
Authors: Simon Richard 
Published: March 2010

Background Developments in biotechnology and genomics have increased the focus of biostatisticians on prediction problems. This has led to many exciting developments for predictive modeling where the number of variables is larger than the number of cases. Heterogeneity of human diseases and new technology for characterizing them presents new opportunities and challenges for the design and analysis of clinical trials. Purpose In oncology, treatment of broad populations with regimens that do not benefit most patients is less economically sustainable with expensive molecularly targeted therapeutics. The established molecular heterogeneity of human diseases requires the development of new paradigms for the design and analysis of randomized clinical trials as a reliable basis for predictive medicine [Simon R. An agenda for clinical trials: clinical trials in the genomic era. Clin Trials 2004; 1:468—70, Simon R. New challenges for 21st century clinical trials. Clin Trials 2007; 4: 167—9.]. Results We have reviewed prospective designs for the development of new therapeutics with candidate predictive biomarkers. We have also outlined a prediction based approach to the analysis of randomized clinical trials that both preserves the type I error and provides a reliable internally validated basis for predicting which patients are most likely or unlikely to benefit from the new regimen. Conclusions Developing new treatments with predictive biomarkers for identifying the patients who are most likely or least likely to benefit makes drug development more complex. But for many new oncology drugs it is the only science based approach and should increase the chance of success. It may also lead to more consistency in results among trials and has obvious benefits for reducing the number of patients who ultimately receive expensive drugs which expose them risks of adverse events but no benefit. This approach also has great potential value for controlling societal expenditures on health care. Development of treatments with predictive biomarkers requires major changes in the standard paradigms for the design and analysis of clinical trials. Some of the key assumptions upon which current methods are based are no longer valid. In addition to reviewing a variety of new clinical trial designs for co-development of treatments and predictive biomarkers, we have outlined a prediction based approach to the analysis of randomized clinical trials. This is a very structured approach whose use requires careful prospective planning. It requires further development but may serve as a basis for a new generation of predictive clinical trials which provide the kinds of reliable individualized information which physicians and patients have long sought, but which have not been available from the past use of post-hoc subset analysis. Clinical Trials 2010; 7: 516—524. http://ctj.sagepub.com