bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘It's about changing services and building relationships’: evaluating the development of Children in Care Councils
Authors: Thomas Nigel , Percy‐Smith Barry 
Published: October 2011

ABSTRACTThe introduction of Children in Care Councils under the Care Matters reforms in England set a challenge for local authorities to find effective ways by which children in care could contribute their views to the planning and provision of services. This paper discusses a review of progress across London which combined a survey of boroughs with focus group discussions with young people, local authority staff and elected members. The research found that considerable progress had been made in that virtually all boroughs had some mechanism for representing children in care, and that staff and young people were proud of their achievements. However, major challenges remain – to embed a culture of participation in services, to ensure continuity, to reach all children including the many placed ‘out of borough’ and to defend what has been achieved in the face of severe cuts in public spending. The paper highlights a tension between empowering young people and meeting targets as corporate parents. The results support other research pointing to the need for a better understanding of the relationship between participation in governance and participation grounded in ordinary life.
Iatrogenic hyperthyroidism does not promote weight loss or prevent ageing‐related increases in body mass in thyroid cancer survivors
Authors: Polotsky Hanah N. , Brokhin Matvey , Omry Gal , Polotsky Alex J. , Tuttle R Michael 
Published: October 2011

SummaryContext  Thyroid cancer survivors represent a unique population in which the potential long‐term effects of brief periods of intentional thyroid hormone withdrawal and/or prolonged periods of iatrogenic hyperthyroidism on body weight and body mass were evaluated.Objectives  The objectives of this study were to characterize body mass changes over several years in a cohort of thyroid cancer patients with iatrogenic hyperthyroidism and to compare these changes with the expected weight gain in age‐matched healthy control populations. We also evaluated the possibility that the method of preparation [thyroid hormone withdrawal (THW) vs recombinant human TSH (rhTSH)] for radioactive iodine remnant ablation may be associated with differences in body mass at the time of the final follow‐up.Design/Setting/Patients/Interventions  A retrospective review identified 153 patients with thyroid cancer who underwent total thyroidectomy at one major medical centre. Of the 153 patients, 143 also had radioactive iodine remnant ablation: 70 after THW and 73 after rhTSH.Main Outcome Measures  Change in weight and BMI at 1–2 and 3–5 years of follow‐up points were examined. Annualized weight variation within the cohort was compared with age‐matched population controls expressed in kilogram/year.Results  Significant weight gain was noted for the full cohort after 3–5 years of follow‐up as compared to baseline (76 ± 21 kg at baseline vs 79 ± 23 kg at 3–5 years of follow‐up, P < 0·01), which represented a 3·2% increase. Female and male patients with thyroid cancer experienced 0·46 and 0·94 kg/year gain in weight, respectively, which is similar or somewhat higher than previously published age‐matched population controls (ranging from 0·23 to 0·34 kg/year). When expressed as per cent change and comparing the final weight to the pre‐operative baseline, the rhTSH group experienced approximately a 1·7% increase in weight compared with the 3·9% increase seen with THW patients (P = 0·02). When expressed as kg/year change, the rhTSH cohort had 0·34 kg/year change compared with the 0·64 kg/year change seen in the thyroid hormone withdrawal patients (P = 0·02).Conclusion  In otherwise, healthy patients with differentiated thyroid cancer, significant weight gain occurred during the 3–5 years of follow‐up despite ongoing thyrotropin suppression. The data suggest that mild iatrogenic hyperthyroidism does not promote weight loss or prevent ageing‐related weight gain. Greater weight gain was seen in patients prepared for radioactive remnant ablation with THW than with rhTSH.
Urinary liver‐type fatty acid‐binding protein level as a predictive biomarker of contrast‐induced acute kidney injury
Authors: Manabe Kenichi , Kamihata Hiroshi , Motohiro Masayuki , Senoo Takeshi , Yoshida Susumu , Iwasaka Toshiji 
Published: October 2011

Eur J Clin Invest 2012; 42 (5): 557–563AbstractBackground  Contrast‐induced acute kidney injury (CI‐AKI) is a well‐known complication of contrast medium exposure in patients with chronic kidney disease. However, there are no biological markers to accurately predict the onset of CI‐AKI. Liver‐type fatty acid‐binding protein (L‐FABP), an intracellular carrier protein for free fatty acids, is markedly upregulated and abundantly expressed in the proximal tubules after renal ischaemia. We prospectively investigated whether urinary L‐FABP is a suitable marker for the prediction of CI‐AKI.Methods  We performed a prospective study of 220 consecutive patients with chronic kidney disease who underwent elective catheterization [serum creatinine (Cr) ≥ 1·2 mg/dL (106 M)]. Serum Cr and L‐FABP levels were measured immediately before and 1 and 2 days after the procedure. CI‐AKI was defined as an increase in serum Cr level of ≥ 0·3 mg/dL within 48 h after the procedure.Results  We observed the development of CI‐AKI in 19 patients (8·6%). Urinary L‐FABP levels were significantly higher in patients with CI‐AKI than those without CI‐AKI before contrast medium exposure. Receiver operating characteristic analysis showed that baseline urinary L‐FABP level exhibited 82% sensitivity and 69% specificity, at a cut‐off value of 24·5 μg/g Cr. Using multivariate analysis, we found that independent predictors of CI‐AKI development were L‐FABP level of ≥ 24·5 μg/g Cr [odds ratio (OR): 9·10; 95% confidence interval (CI), 3·20–28·9], and left ventricular ejection fraction ≤ 40% (OR, 3·42; 95% CI, 1·07–10·8).Conclusions  Urinary L‐FABP level is useful for predicting the onset of CI‐AKI before contrast medium exposure.
B‐cell agonists up‐regulate AID and APOBEC3G deaminases, which induce IgA and IgG class antibodies and anti‐viral function
Authors: Seidl Thomas , Whittall Trevor , Babaahmady Kaboutar , Lehner Thomas 
Published: October 2011

SummaryB cells express two critical deaminases in the development of adaptive and innate immunity. Activation‐induced cytidine deaminase (AID) functions in class switch recombination, somatic hypermutation and may result in affinity maturation of antibodies. Apolipoprotein B mRNA‐editing enzyme catalytic polypeptide‐like 3G (APOBEC3G; A3G) is an innate anti‐retroviral factor that inhibits HIV replication. We have studied a number of B‐cell agonists with the aim of identifying the most effective agents that will up‐regulate both deaminases and thereby enhance adaptive and innate immunity. CD40 ligand (CD40L) with interleukin‐4 or HLA‐class II antibodies significantly up‐regulated both AID and A3G in isolated human CD19+ B cells. The functions of these deaminases were demonstrated by enhancement of B‐cell surface expression of IgA and IgG and inducing significantly higher IgA and IgG4 antibodies. An enhanced A3G function was then demonstrated by inhibition of HIV‐1 replication in co‐culture of CD4+ T cells with autologous B cells, treated with CD40L and CD4 or HLA antibodies, compared with unstimulated human B cells. The dual B‐cell‐induced deaminase functions may be critical in IgA and IgG antibodies inhibiting pre‐entry and A3G that of post‐entry HIV‐1 transmission and suggests a novel strategy of immunization, especially relevant to mucosal infections.
Lévy flight and Brownian search patterns of a free‐ranging predator reflect different prey field characteristics
Authors: Sims David W. , Humphries Nicolas E. , Bradford Russell W. , Bruce Barry D. 
Published: October 2011

Summary1. Search processes play an important role in physical, chemical and biological systems. In animal foraging, the search strategy predators should use to search optimally for prey is an enduring question. Some models demonstrate that when prey is sparsely distributed, an optimal search pattern is a specialised random walk known as a Lévy flight, whereas when prey is abundant, simple Brownian motion is sufficiently efficient. These predictions form part of what has been termed the Lévy flight foraging hypothesis (LFF) which states that as Lévy flights optimise random searches, movements approximated by optimal Lévy flights may have naturally evolved in organisms to enhance encounters with targets (e.g. prey) when knowledge of their locations is incomplete.2. Whether free‐ranging predators exhibit the movement patterns predicted in the LFF hypothesis in response to known prey types and distributions, however, has not been determined. We tested this using vertical and horizontal movement data from electronic tagging of an apex predator, the great white sharkCarcharodon carcharias, across widely differing habitats reflecting different prey types.3. Individual white sharks exhibited movement patterns that predicted well the prey types expected under the LFF hypothesis. Shark movements were best approximated by Brownian motion when hunting near abundant, predictable sources of prey (e.g. seal colonies, fish aggregations), whereas movements approximating truncated Lévy flights were present when searching for sparsely distributed or potentially difficult‐to‐detect prey in oceanic or shelf environments, respectively.4. That movement patterns approximated by truncated Lévy flights and Brownian behaviour were present in the predicted prey fields indicates search strategies adopted by white sharks appear to be the most efficient ones for encountering prey in the habitats where such patterns are observed. This suggests thatC. carchariasappears capable of exhibiting search patterns that are approximated as optimal in response to encountered changes in prey type and abundance, and across diverse marine habitats, from the surf zone to the deep ocean.5. Our results provide some support for the LFF hypothesis. However, it is possible that the observed Lévy patterns of white sharks may not arise from an adaptive behaviour but could be an emergent property arising from simple, straight‐line movements between complex (e.g. fractal) distributions of prey. Experimental studies are needed in vertebrates to test for the presence of Lévy behaviour patterns in the absence of complex prey distributions.
Cognitive balanced model: a conceptual scheme of diagnostic decision making
Authors: Lucchiari Claudio , Pravettoni Gabriella 
Published: October 2011

AbstractRationale  Diagnostic reasoning is a critical aspect of clinical performance, having a high impact on quality and safety of care. Although diagnosis is fundamental in medicine, we still have a poor understanding of the factors that determine its course.According to traditional understanding, all information used in diagnostic reasoning is objective and logically driven. However, these conditions are not always met. Although we would be less likely to make an inaccurate diagnosis when following rational decision making, as described by normative models, the real diagnostic process works in a different way. Recent work has described the major cognitive biases in medicine as well as a number of strategies for reducing them, collectively called debiasing techniques. However, advances have encountered obstacles in achieving implementation into clinical practice.Aims and objectives  While traditional understanding of clinical reasoning has failed to consider contextual factors, most debiasing techniques seem to fail in raising sound and safer medical praxis. Technological solutions, being data driven, are fundamental in increasing care safety, but they need to consider human factors. Thus, balanced models, cognitive driven and technology based, are needed in day‐to‐day applications to actually improve the diagnostic process. The purpose of this article, then, is to provide insight into cognitive influences that have resulted in wrong, delayed or missed diagnosis.Conclusions  Using a cognitive approach, we describe the basis of medical error, with particular emphasis on diagnostic error. We then propose a conceptual scheme of the diagnostic process by the use of fuzzy cognitive maps.
Timeliness in discharge summary dissemination is associated with patients' clinical outcomes
Authors: Li Jordan Y. Z. , Yong Tuck Y. , Hakendorf Paul , Ben‐Tovim David , Thompson Campbell H. 
Published: October 2011

AbstractRationale, aims and objectives  To determine the relation of the readmission rate of general medical patients to either the existence of a discharge summary or the timeliness of its dispatch.Methods  This was a retrospective study on discharge summaries of all discharges from the general medical service at a tertiary referral teaching hospital from January 2005 to December 2009. The main outcome measures were readmission rate to hospital within 7 or 28 days of dischargeResults  A total of 16 496 patient admissions were included in the analysis. Of these discharges, 3397 (20.6%) patients did not have a summary completed within a week of discharge. There were significant linear trends between patients' readmission rates within 7 (P < 0.001) or 28 days (P < 0.001) and categories reflecting the delay in dispatch of their discharge summaries. The absence of a discharge summary was associated with a 79% increase in the rate of readmission within 7 days [95% confidence interval (CI) 42 to 124% increase; P < 0.001] and a 37% increased rate of readmission within 28 days (95% CI 17 to 61% increase; P < 0.001). If aged less than 80 years, the absence of a discharge summary was associated with a 127% increase in readmission rate within 7 days (95% CI 72 to 202% increase; P < 0.001) and a 55% increase within 28 days (95% CI 25 to 91% increase; P < 0.001) after discharge.Conclusions  Delayed transmission or absence of a discharge summary is associated with readmission of the patient; more so in patients less than 80 years old. If no summary is generated by 7 days after discharge, the rate of readmission within 7 or 28 days after discharge is indistinguishable from no summary being written at all.
High‐resolution cell outline segmentation and tracking from phase‐contrast microscopy images
Authors: AMBÜHL M.E. , BREPSANT C. , MEISTER J.‐J. , VERKHOVSKY A.B. , SBALZARINI I.F. 
Published: October 2011

SummaryAccurate extraction of cell outlines from microscopy images is essential for analysing the dynamics of migrating cells. Phase‐contrast microscopy is one of the most common and convenient imaging modalities for observing cell motility because it does not require exogenous labelling and uses only moderate light levels with generally negligible phototoxicity effects. Automatic extraction and tracking of high‐resolution cell outlines from phase‐contrast images, however, is difficult due to complex and non‐uniform edge intensity. We present a novel image‐processing method based on refined level‐set segmentation for accurate extraction of cell outlines from high‐resolution phase‐contrast images. The algorithm is validated on synthetic images of defined noise levels and applied to real image sequences of polarizing and persistently migrating keratocyte cells. We demonstrate that the algorithm is able to reliably reveal fine features in the cell edge dynamics.
Sleep disorders in Behçet’s disease, and their relationship with fatigue and quality of life
Authors: TASCILAR NIDA F. , TEKIN NILGÜN S. , ANKARALI HANDAN , SEZER TUNA , ATIK LEVENT , EMRE UFUK , DUYSAK SIBEL , CINAR FIKRET 
Published: October 2011

SummaryBehçet’s disease, a systemic vasculitis, can cause varying degrees of activity limitation, fatigue and quality of life impairment. To date, there have been no studies regarding sleep disturbance and its relationship with fatigue and life quality in Behçet’s disease. We aimed to evaluate sleep disorders and polysomnographic parameters, and to determine their relationship with fatigue and quality of life in Behçet’s disease. Fifty‐one patients with Behçet’s disease without any neurological involvement were interviewed regarding sleep disorders. Twenty‐one subjects with no sleep complaints were included as the control group. Sleep‐related complaints were evaluated in a face‐to‐face interview. Sleep quality, excessive daytime sleepiness, fatigue, depression, anxiety, disease activity/severity, and quality of life questionnaires and an overnight polysomnography were performed. Prevalences of restless legs syndrome (35.3%) and obstructive sleep apnea syndrome with/without other sleep disorders (32.5%) were higher than in the control group and the general population. Fatigue was higher in patients with restless legs syndrome and obstructive sleep apnea syndrome, and in those with lower minimum oxygen saturation; hence, only patients with restless legs syndrome had quality of life impairment. Sleep efficiency index and sleep continuity index were lower, and wake after sleep onset, respiratory disturbance index and apnea–hypopnea index were higher than in controls (P < 0.01). Neither sleep disorders nor polysomnographic parameters were related to disease activity and severity. In conclusion, it is important to question sleep disorder followed by a polysomnography, if necessary, in order to improve quality of life and fatigue in Behçet’s disease.
Effect of upper airway surgery on heart rate variability in patients with obstructive sleep apnoea syndrome
Authors: CHOI JI HO , YI JONG SOOK , LEE SEUNG HOON , KIM CHEON SIK , KIM TAE HOON , LEE HEUNG MAN , LEE BONG‐JAE , LEE SANG HAG , CHUNG YOO‐SAM 
Published: October 2011

SummaryTo determine whether surgery influences cardiovascular autonomic modulation in obstructive sleep apnoea syndrome (OSAS), the present study was performed to evaluate the effect of upper airway (UA) surgery on heart rate variability (HRV) using frequency domain analysis for patient groups who have had either successful or unsuccessful surgery. We compared body mass index (BMI), polysomnographic [apnoea index (AI), apnoea‐hypopnoea index (AHI), minimum SaO2] and HRV [very low frequency (VLF) power, low frequency (LF) power, high frequency (HF) power, HF/LF ratio, LFnu = LF/(LF + HF), HFnu = HF/(LF + HF)] parameters between the unsuccessful (n = 14) and successful (n = 22) surgical groups before and after UA surgery. Significant changes were observed for the successful patient group with respect to mean AI (from 29.1 ± 21.3 to 2.0 ± 3.2 events h−1, P < 0.001), AHI (from 38.6 ± 20.0 to 5.6 ± 5.1 events h−1, P < 0.001), minimum SaO2 (from 73.3 ± 12.7 to 86.3 ± 6.5%, P < 0.001), VLF power (from 25599 ± 12906 to 20014 ± 9839 ms2, P = 0.013), LF power (from 17293 ± 7278 to 14155 ± 4980 ms2, P = 0.016), LFnu (from 0.700 ± 0.104 to 0.646 ± 0.128, P = 0.031) and HFnu (from 0.300 ± 0.104 to 0.354 ± 0.128, P = 0.031); however, mean BMI, HF power and LF/HF ratio did not change significantly after UA surgery. No significant changes were observed in the unsuccessful surgical group. Successful UA surgery may improve cardiac sympathetic and parasympathetic modulation in patients with OSAS.
Predictors of antibiotic use in African communities: evidence from medicines household surveys in five countries
Authors: Vialle‐Valentin C. E. , LeCates R. F. , Zhang F. , Desta A. T. , Ross‐Degnan D. 
Published: October 2011

SummaryObjectives  To investigate antibiotic use in five national household surveys conducted with the WHO methodology to identify key determinants of antibiotic use in the community.Methods  Data from The Gambia, Ghana, Kenya, Nigeria and Uganda surveys were combined. We used logistic regression models that accounted for the clustered survey design to identify the determinants of care seeking outside the home and antibiotic use for 2914 cases of recent acute illness.Results  Overall, 95% of individuals with acute illness took medicines, 90% sought care outside their homes and 36% took antibiotics. In multivariate analyses, illness severity was a strong predictor of seeking care outside the home. Among those who sought outside care, the strongest predictor of antibiotic use was the presence of upper respiratory symptoms (OR: 3.02, CI: 2.36–3.86, P < 0.001), followed by gastrointestinal symptoms or difficulty breathing, and antibiotics use was less likely if they had fever. The odds of receiving antibiotics were higher when visiting a public hospital or more than one healthcare facility.Conclusions  The nature and severity of symptoms and patterns of care seeking had the greatest influence on decisions to take antibiotics. Antibiotics were widely available and inappropriately used in all settings. Policies to regulate antibiotics distribution as well as interventions to educate prescribers, dispensers and consumers are needed to improve antibiotic use.
Daily exhaled nitric oxide measurements and asthma exacerbations in children
Authors: van der Valk R. J. P. , Baraldi E. , Stern G. , Frey U. , de Jongste J. C. 
Published: October 2011

To cite this article: van der Valk RJP, Baraldi E, Stern G, Frey U, de Jongste JC. Daily exhaled nitric oxide measurements and asthma exacerbations in children. Allergy 2012; 67: 265–271.Abstract
Background:  Fractional exhaled Nitric Oxide (FeNO) is a biomarker for eosinophilic airway inflammation and can be measured at home on a daily basis. A short‐term increase in FeNO may indicate a higher risk of future asthma exacerbations.
Objective:  To assess changes in FeNO before and after asthma exacerbations compared to a stable control period.
Methods:  A post hoc analysis was performed on daily FeNO measurements over 30 weeks in children with asthma (n = 77). Moderate exacerbations were defined by an increase in symptom scores and severe exacerbations by prescription of prednisone. Individual mean and maximum FeNO, the variability of FeNO assessed by the coefficient of variation (CV), and slopes of FeNO in time were all quantified in 3‐week blocks. Cross‐correlation of FeNO with symptoms and autocorrelation of FeNO were assessed in relation to exacerbations and examined as predictors for exacerbations compared to reference periods using logistic regression.
Results:  Fractional exhaled nitric oxide could be assessed in relation to 25 moderate and 12 severe exacerbations. The CV, slope, cross‐correlation, and autocorrelation of daily FeNO increased before moderate exacerbations. Increases in slope were also randomly seen in 19% of 2‐week blocks of children without exacerbations. At least 3–5 FeNO measurements in the 3 weeks before an exacerbation were needed to calculate a slope that could predict moderate exacerbations. No specific pattern of FeNO was seen before severe exacerbations.
Conclusion:  Fractional exhaled nitric oxide monitoring revealed changes in FeNO prior to moderate exacerbations. Whether this can be used to prevent loss of asthma control should be further explored.