bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relationship between prostate volume and prostate‐specific antigen variability: data from the Baltimore Longitudinal Study of Aging and the Johns Hopkins Active Surveillance Program
Authors: Nichols John H. , Loeb Stacy , Metter E. Jeffrey , Ferrucci Luigi , Carter H. Ballentine 
Published: November 2011

Study Type – Prognostic (cohort)Level of Evidence 2bWhat's known on the subject? and What does the study add?Previous studies have attempted to characterize the normal biological variability in PSA among men without prostate cancer. These reports suggest that PSA variability is unrelated to age, but there are conflicting data on its association with the baseline PSA level. There are limited published data regarding the effects of prostate volume on PSA variability. A prior study assessing whether prostate volume changes would confound the use of PSA velocity in clinical practice reported that prostate volume changes were not significantly related to PSA changes. This study did not directly address the effect of baseline prostate volume on serial PSA variability.The objective of the current study was to further examine the relationship between prostate volume and PSA variability. Our hypothesis was that larger baseline prostate volume would be associated with increased PSA variability in men without known prostate cancer and in those with suspected small‐volume disease. The results of the study suggest that baseline PSA, not prostate volume, is the primary driver of PSA variability in these populations.OBJECTIVE
To clarify the relationship between serial prostate‐specific antigen (PSA) variability and prostate volume in both cancer‐free participants from the Baltimore Longitudinal Study of Aging (BLSA) and patients with low‐risk prostate cancer from the Johns Hopkins Active Surveillance Program (AS).
MATERIALS AND METHODS
In all, 287 men from the BLSA and 131 patients from the AS were included in the analysis, all with at least two PSA measurements and concurrent prostate volume measurements.
PSA variability was calculated in ng/mL per year, and a linear mixed‐effects model was used to determine the relative effects of prostate volume, baseline PSA and age on PSA change over time.
RESULTS
In a model with prostate volume, age and baseline PSA, there was no significant relationship between prostate volume and PSA variability (BLSA, P= 0.57; AS, P= 0.49).
Only baseline PSA showed a significant relationship to PSA yearly variability (PSAYV) (P < 0.001). Specifically, a one unit higher baseline PSA (ng/mL) corresponded on average to 0.09 and 0.06 ng/mL per year higher PSAYV in the BLSA and AS populations, respectively.
CONCLUSIONS
The results of the present study suggest that the primary driver of PSA variability is the baseline PSA level, rather than prostate volume.
Clinicians might consider the baseline PSA level to help predict the expected variability in serial PSA measurements.
Effect of delaying surgery on radical prostatectomy outcomes: a contemporary analysis
Authors: Korets Ruslan , Seager Catherine M. , Pitman Max S. , Hruby Gregory W. , Benson Mitchell C. , McKiernan James M. 
Published: November 2011

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?For patients electing surgical treatment, the question of the effect of surgical delay on clinical outcomes in prostate cancer is controversial. In this study we examined the effect of delay from diagnosis to surgery on outcomes in men with localized prostate cancer and found no association between time to surgery and risk of biochemical recurrence, even for patients with longer delays and high‐risk disease. Men with localized prostate cancer can be reassured that reasonable delays in treatment will not influence disease outcomes.OBJECTIVE
To examine the effect of time from last positive biopsy to surgery on clinical outcomes in men with localized prostate cancer undergoing radical prostatectomy (RP).
PATIENTS AND METHODS
We conducted a retrospective review of 2739 men who underwent RP between 1990 and 2009 at our institution.
Clinical and pathological features were compared between men undergoing RP ≤ 60, 61–90 and >90 days from the time of prostate biopsy.
A Cox proportional hazards model was used to analyse the association between clinical features and surgical delay with biochemical progression. Biochemical recurrence (BCR)‐free rates were assessed using the Kaplan–Meier method.
RESULTS
Of the 1568 men meeting the inclusion criteria, 1098 (70%), 303 (19.3%) and 167 (10.7%) had a delay of ≤60, 61–90 and >90 days, respectively, between biopsy and RP. A delay of >60 days was not associated with adverse pathological findings at surgery.
The 5‐year survival rate was similar among the three groups (78–85%, P= 0.11).
In a multivariate Cox model, men with higher PSA levels, clinical stages, Gleason sums, and those of African‐American race were all at higher risk for developing BCR.
A delay to surgery of >60 days was not associated with worse biochemical outcomes in a univariate and multivariate model.
CONCLUSIONS
A delay of >60 days is not associated with adverse pathological outcomes in men with localized prostate cancer, nor does it correlate with worse BCR‐free survival.
Patients can be assured that delaying treatment while considering therapeutic options will not adversely affect their outcomes.
Pathological stage distribution in patients treated with radical prostatectomy reflecting the need for protocol‐based active surveillance: results from a contemporary European patient cohort
Authors: Seiler Daniel , Randazzo Marco , Klotz Laurence , Grobholz Rainer , Baumgartner Martin , Isbarn Hendrik , Recker Franz , Kwiatkowski Maciej 
Published: November 2011

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Low‐risk prostate cancer is frequently diagnosed in the context of PSA screening or during a routine check‐up. For those patients, to avoid possible overtreatment AS is an increasingly chosen treatment option. However, the concept of AS could possibly misclassify potentially dangerous PCa as a low‐risk disease resulting in inferior cancer control outcomes.In the present study, we could demonstrate that the histopathological results of patients treated by RP in course of AS are significantly better if the selection criteria for AS are entirely fulfilled. Our findings underline the importance of a strict and precise admittance procedure for patients with early prostate cancer who are willing to undergo an AS programme.OBJECTIVE
To compare the histopathological outcomes of patients treated with radical prostatectomy (RP) after an initial active surveillance (AS) for localized, low‐risk prostate cancers (PCa) among men who fulfilled the Epstein criteria at diagnosis with those who did not.
PATIENTS AND METHODS
In all, 283 patients with localized PCa were initially managed at our institution with AS.
In all, ≈50% originated from the European Randomized Study of Screening for Prostate Cancer (ERSPC) participants from Switzerland: 75 (26.5%) patients underwent treatment during follow‐up and 61 were treated with RP (21.6%).
These patients were stratified into those who did (n= 39) vs those who did not (n= 22) entirely fulfil AS inclusion criteria according to Epstein et al. at PCa diagnosis.
RESULTS
Patients who did completely fulfil the AS inclusion criteria had significantly lower prostate‐specific antigen (PSA)‐values (4.9 vs 7.8 ng/mL; P= 0.02), a significantly lower PSA density at diagnosis (0.09 vs 0.2 ng/mL/ccm; P= 0.007) and at RP, a higher proportion of organ‐confined cancers (89.7% vs 59.1%, P= 0.02) and fewer positive surgical margins (25.6% vs 40.9%).
However, the rate of favourable histopathological outcome, defined as organ‐confined disease with negative surgical margins, was statistically significantly higher in the group fulfilling AS criteria (69.2% vs 40.9%; P= 0.03).
CONCLUSIONS
In our AS series, 26.5% of the patients underwent definitive therapy.
Most patients treated with RP had organ‐confined disease in the majority of cases, especially when the Epstein criteria were rigorously fulfilled at PCa diagnosis.
This underlines the importance of a strict and precise per protocol AS for patients with early PCa, otherwise there is a risk of missing more significant disease.
European Commission Adoption of IPSAS to Reform Financial Reporting
Authors: GROSSI G. , SOVERCHIA M. 
Published: November 2011

The article offers an overview of the modernization of the European Commission (EC) accounting system. It represents an integral part of an overall rationalization of the EC organizational, administrative and financial dimensions which has been carried out over the last decade. The reformed accounting system is a dual one: it is based both on cash accounting, to manage budget appropriations, and on accrual accounting, to draw up the financial statements.Seventeen accounting rules, which draw upon International Public Sector Accounting Standards (IPSAS) and are based on accrual accounting, were issued by the EC and are the foundation of this reformed system. Drawing on semi‐structured interviews with Commission officials, this article tracks the key turning points, trajectories and outcomes of events within the implementation stage of this part of the EC accounting reform with a focus on the consolidation of annual accounts. The compilation of the consolidated financial statement (CFS) has become more complex. The original European Union (EU) organizational structure (Parliament, Council, Commission, Court of Justice and Court of Auditors) has broadened with the addition of agencies that were created during the early 1990s. Since 2005, these agencies have been included in the CFS of the EU, compiled according to IPSASs 6, 7 and 8.This article examines how the EU consolidation process has evolved over time and the drivers behind the reformed accounting systems and in particular the new consolidation approach, which is a result of the combination of the Continental and Anglo‐Saxon governmental accounting approaches.
Why do Social Innovations in Rural Development Matter and Should They be Considered More Seriously in Rural Development Research? – Proposal for a Stronger Focus on Social Innovations in Rural Development Research
Authors: Neumeier Stefan 
Published: November 2011

AbstractThe article discusses social innovation from a rural development perspective. The central questions addressed are: What are social innovations and why are they important for rural development? How can we gain more insights into the role and functioning of social innovations in rural development? Drawing on different approaches to conceptualise social innovations pursued in economy, management, sociology, psychology and regional economics, planning and development studies, the article outlines the central aspects on which the concept is built. Based on these insights a proposal for a concise basic definition of social innovations is given and a model of the social innovation process is introduced. Reasoning that a lack of social innovation is often one of the strongest restraints of the vitality and further development of rural communities in developed, democratic, capitalist, industrial countries, the second part orf the article highlights the need to put a stronger focus on social innovations in future rural development research. Building on these insights, the third part addresses open research questions and explains why an actor‐oriented network approach seems to be a promising potential methodological way to approach social innovations in rural development research.
Testing children of mothers with HIV infection: experience in three south‐west London HIV clinics
Authors: Andrews S , Handyside R , Carpenter L , Price A , Majewska W , Prime K 
Published: November 2011

ObjectiveThere are several reported cases of vertically infected children presenting with advanced HIV infection in the UK. The children of women with HIV infection are at increased risk of being infected. There are few data available on the number of such children that are yet to be tested for HIV. This study looked at the HIV testing status of children whose mothers attend HIV services at three south‐west London clinics.MethodsCase notes of women attending the clinics from 1 January to 30 June 2009 were reviewed. When data were incomplete, women were prospectively interviewed.ResultsCase notes of 605 women were reviewed; 478 women had 1107 children. The majority of women (386; 81%) were of Black African ethnicity. Sixty‐one per cent (675 of 1107) of the children were known to have been tested for HIV. The children resident abroad were more likely to be untested compared with those resident in the UK; 186 of 255 (73%) vs. 246 of 852 (29%). A quarter (106 of 432) of the untested children were ≤18 years old; 49 (46%) of these were resident in the UK. The most common reason given by the mothers for not testing was a perceived ‘unlikely risk’.ConclusionsA significant number of children at risk of vertically transmitted HIV infection, including 49 children ≤18 years and resident in the UK, were identified through this study. The mothers are being encouraged to have these children tested and a multidisciplinary team involving adult and paediatric HIV healthcare professionals has been set up to negotiate and facilitate testing.
Shifting species interactions in terrestrial dryland ecosystems under altered water availability and climate change
Authors: McCluney Kevin E. , Belnap Jayne , Collins Scott L. , González Angélica L. , Hagen Elizabeth M. , Nathaniel Holland J. , Kotler Burt P. , Maestre Fernando T. , Smith Stanley D. , Wolf Blair O. 
Published: November 2011

Species interactions play key roles in linking the responses of populations, communities, and ecosystems to environmental change. For instance, species interactions are an important determinant of the complexity of changes in trophic biomass with variation in resources. Water resources are a major driver of terrestrial ecology and climate change is expected to greatly alter the distribution of this critical resource. While previous studies have documented strong effects of global environmental change on species interactions in general, responses can vary from region to region. Dryland ecosystems occupy more than one‐third of the Earth's land mass, are greatly affected by changes in water availability, and are predicted to be hotspots of climate change. Thus, it is imperative to understand the effects of environmental change on these globally significant ecosystems.Here, we review studies of the responses of population‐level plant‐plant, plant‐herbivore, and predator‐prey interactions to changes in water availability in dryland environments in order to develop new hypotheses and predictions to guide future research. To help explain patterns of interaction outcomes, we developed a conceptual model that views interaction outcomes as shifting between (1) competition and facilitation (plant‐plant), (2) herbivory, neutralism, or mutualism (plant‐herbivore), or (3) neutralism and predation (predator‐prey), as water availability crosses physiological, behavioural, or population‐density thresholds. We link our conceptual model to hypothetical scenarios of current and future water availability to make testable predictions about the influence of changes in water availability on species interactions. We also examine potential implications of our conceptual model for the relative importance of top‐down effects and the linearity of patterns of change in trophic biomass with changes in water availability. Finally, we highlight key research needs and some possible broader impacts of our findings. Overall, we hope to stimulate and guide future research that links changes in water availability to patterns of species interactions and the dynamics of populations and communities in dryland ecosystems.
A once‐per‐day, drug‐in‐food protocol for prolonged administration of antiepileptic drugs in animal models
Authors: Ali Atif , Dua Yashomati , Constance Jonathan E. , Franklin Michael R. , Dudek F. Edward 
Published: November 2011

SummaryPurpose:  Convenient and effective methods for administering potential antiepileptic drugs (AEDs) chronically should facilitate many experiments in animal models of chronic epilepsy with spontaneous recurrent seizures. This proof‐of‐principle study aimed to optimize a once‐per‐day, drug‐in‐food protocol by testing the effect of carbamazepine (CBZ) on the frequency of convulsive seizures in rats with kainate‐induced epilepsy.Methods:  Adult male rats were given repeated low‐dose kainate injections until convulsive status epilepticus persisted for >3 h. After the rats developed spontaneous recurrent seizures, food pellets with CBZ (30, 100, or 300 mg/kg/day) were provided once per day in three 2‐week trials (n = 7–9 rats) involving 5 days of CBZ or control treatment, separated by two recovery days within a trial. The total amount of food provided and consumed per day corresponded to a normal caloric diet (60 g/kg/day).Key Findings:  When provided once per day, all animals ate the CBZ‐containing food irregularly but continuously throughout the 24‐h day. With this daily feeding protocol, CBZ significantly reduced the frequency of spontaneous convulsive seizures in a dose‐dependent manner. It is important to note that the effect of CBZ was consistent across the 5 days and throughout each day of the trials. With food administered at 9:00 a.m., and blood assayed at 5:00 p.m., higher food levels of CBZ resulted in higher plasma concentrations of CBZ.Significance:  This AED‐in‐food protocol is simple, efficient, inexpensive, reliable, and noninvasive; it allows easier long‐term drug administration and is less stressful and more humane than other methods of AED administration.
Delirium and Sedation Recognition Using Validated Instruments: Reliability of Bedside Intensive Care Unit Nursing Assessments from 2007 to 2010
Authors: Vasilevskis Eduard E. , Morandi Alessandro , Boehm Leanne , Pandharipande Pratik P. , Girard Timothy D. , Jackson James C , Thompson Jennifer L. , Shintani Ayumi , Gordon Sharon M. , Pun Brenda T. , Wesley Ely E. 
Published: November 2011

ObjectivesTo describe the reliability and sustainability of delirium and sedation measurements of bedside intensive care unit (ICU) nurses.DesignProspective cohort study.SettingA tertiary care academic medical center.ParticipantsFive hundred ten ICU patients from 2007 to 2010; 627 bedside nurses.MeasurementsBedside nurses and well‐trained reference‐rater research nurses independently measured delirium and sedation levels in routine care. Bedside nurses were instructed to use the Confusion Assessment Method for the Intensive Care Unit (CAM‐ICU) every 12 hours to measure delirium and the Richmond Agitation‐Sedation Scale (RASS) every 4 hours to measure sedation. CAM‐ICU and RASS assessment agreement were computed using weighted kappa statistics across the entire population and subgroups (e.g., ICU type). Sensitivity and specificity of bedside nurse identification of delirium were calculated to understand sources of discordance.ResultsSix thousand one hundred ninety‐eight CAM‐ICU and 6,880 RASS measurement pairs obtained on 3,846 patient‐days. For CAM‐ICU measurements, agreement between bedside and research nurses was substantial (weighted kappa = 0.67, 95% confidence interval (CI) = 0.66–0.70) and stable over 3 years of data collection. RASS measures also demonstrated substantial agreement (weighted kappa = 0.66, 95% CI = 0.64–0.68), which was stable across all years of data collection. The sensitivity of delirium nurse assessments was 0.81 (95% CI = 0.78–0.83), and the specificity was 0.81 (95% CI = 0.78–0.85).ConclusionBedside nurse measurements of delirium and sedation are sustainable and reliable sources of information. These measures can be used for clinical decision‐making, quality improvement, and quality measurement activities.
Antipsychotics in the Treatment of Delirium in Older Hospitalized Adults: A Systematic Review
Authors: Flaherty Joseph H. , Gonzales Jeffrey P. , Dong Birong 
Published: November 2011

ObjectivesTo examine evidence of the efficacy of antipsychotics in the treatment of delirium in older hospitalized adults.DesignSystematic literature review.SettingHospital.ParticipantsOlder adults with delirium.MeasurementsThe MEDLINE (January 1980–December 2010) and Cochrane Databases were searched using the keywords “delirium” and “antipsychotics.” References of review articles were reviewed to identify additional studies. Study selection criteria included prospective design, more than 10 participants (in treatment arms), mean age 60 and older, standardized criteria for diagnosing delirium, and validated delirium rating scales for reporting outcomes.ResultsThirteen articles met selection criteria: six single‐agent and seven comparison studies. Of these, eight (62%) had fewer than 25 participants in treatment arms, 10 (77%) recruited participants from psychiatry referrals, and eight (62%) did not clearly describe their screening methods. All single‐agent studies were open‐label studies. Of the comparison studies, five (71%) used randomization, but only one of these (a placebo‐controlled study) used adequate allocation concealment methods, and only one other study (comparing two antipsychotics) described a double‐blind method in detail. In the only placebo‐controlled study (which was stopped early), no statistically significant differences in mean delirium severity scores were found at individual time points (Days 2, 3, 4, 7, 10). The other 12 studies reported improvements in delirium severity or resolution of delirium based on cutoff scores of the scales, but it is not clear from any of these studies what the natural course of delirium would have been without use of antipsychotics.ConclusionBecause of severe methodological limitations, the studies in this review do not support the use of antipsychotics in the treatment of delirium in older hospitalized adults. Additional well‐designed randomized placebo‐controlled trials are needed.
Association Between Prescribing of Anticholinergic Medications and Incident Delirium: A Cohort Study
Authors: Campbell Noll , Perkins Anthony , Hui Siu , Khan Babar , Boustani Malaz 
Published: November 2011

ObjectivesTo describe the association between anticholinergic medications and incident delirium in hospitalized older adults with cognitive impairment and to test the hypothesis that anticholinergic medications would increase the risk of incident delirium.DesignObservational cohort study.SettingUrban public hospital in Indianapolis, Indiana.ParticipantsOne hundred forty‐seven participants aged 65 and older with cognitive impairment who screened negative for delirium at the time of admission to a general medical ward.MeasurementsCognitive function at the time of admission was assessed using the Short Portable Mental Status Questionnaire (SPMSQ). Anticholinergic medication orders between the time of admission and the final delirium assessment were evaluated. Anticholinergic medication orders were identified using the Anticholinergic Cognitive Burden Scale. Delirium was assessed using the Confusion Assessment Method.ResultsFifty‐seven percent of the cohort received at least one order for possible anticholinergic medications, and 28% received at least one order for definite anticholinergic medications. The incident rate for delirium was 22% of the entire cohort. After adjusting for age, sex, race, baseline SPMSQ score, and Charlson Comorbidity Index, the odds ratio (OR) for developing delirium in those with orders for possible anticholinergic medications was 0.33 (95% confidence interval (CI) = 0.10–1.03). The OR for developing delirium among those with orders for definite anticholinergic medications was 0.43 (95% CI = 0.11–1.63).ConclusionThe results did not support the hypothesis that prescription of anticholinergic medications increases the risk of incident delirium in hospitalized older adults with cognitive impairment. This relationship needs to be established using prospective study designs with medication dispensing data to improve the performance of predictive models of delirium.