bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expression Profiles of Bovine Adeno-Associated Virus and Avian Adeno-Associated Virus Display Significant Similarity to That of Adeno-Associated Virus Type 5
Authors: Qiu Jianming , Cheng Fang , Pintel David J. 
Published: May 2006

ABSTRACT
We present the first detailed expression profiles of nonprimate-derived adeno-associated viruses, namely, bovine adeno-associated virus (B-AAV) and avian adeno-associated virus (A-AAV), which were obtained after the infection of cell lines derived from their natural hosts. In general, the profiles of B-AAV and A-AAV were quite similar to that of AAV5; however, both exhibited features found for AAV2 as well. Like adeno-associated virus type 5 (AAV5), B-AAV and A-AAV utilized an internal polyadenylation site [(pA)p]; however, it was used to greater relative levels by B-AAV than by A-AAV. Similar to AAV5, >99% of B-AAV RNAs generated from upstream promoters were polyadenylated at (pA)p and hence not spliced. In contrast, ca. 50% of the A-AAV RNAs generated from upstream promoters read through (pA)p, as seen for AAV2. However, A-AAV generated lower levels of spliced P5 and P19 products than does AAV2, suggesting that A-AAV generates lower relative levels of Rep 68 and Rep 40. An additional difference in the expression profile of these viruses was that B-AAV generated a greater level of ITR-initiated RNAs than did A-AAV or AAV5. In addition, we demonstrate that, like AAV2, transactivation of transcription of the capsid-gene promoter of B-AAV required both adenovirus and targeting of its Rep protein to the transcription template; however, expression of the capsid-gene promoter of A-AAV was, like AAV5, largely independent of both adenovirus and its Rep proteins.
The effect of broadleaved woodland on Chalk groundwater resources
Authors: Roberts J. , Rosier P. 
Published: May 2006

The impact of broadleaved woodland on chalk groundwater resources, in Hampshire, UK, was assessed with a comparative study of beech woodland at Black Wood near Micheldever and grass at Bridgets Farm near Winchester. At both sites, parallel estimates of evaporation and detailed studies of the changes in soil water content and the direction of water movement were made.
Beneath both sites, a reduction in soil water content was observed during the summer to a depth of 6 m. However, total water potential measurements showed that upward movement of water was only occurring in the upper 2 m of the profile, whilst drainage was occurring below this point. Drainage continued even when soil moisture deficits existed in the upper part of the profile. Seasonal differences between woodland and grass do exist, however annual differences in evaporation and drainage are insignificant.
The similarity of evaporation from and drainage below the broadleaved woodland and grass sites contrasts markedly with several other studies that show greater drying below woodland. Unlike other comparisons, this study was made within a large block of woodland and both sites were on chalk. The relevance of woodland size and chalk substrate are discussed.
Gene Variants of VAMP8 and HNRPUL1 Are Associated With Early-Onset Myocardial Infarction
Authors: Shiffman Dov , Rowland Charles M. , Louie Judy Z. , Luke May M. , Bare Lance A. , Bolonick Joel I. , Young Bradford A. , Catanese Joseph J. , Stiggins Charles F. , Pullinger Clive R. , Topol Eric J. , Malloy Mary J. , Kane John P. , Ellis Stephen G. , Devlin James J. 
Published: May 2006

Objectives—Identify gene variants associated with early-onset myocardial infarction (MI).Methods and Results—We tested 11 647 single-nucleotide polymorphisms (SNPs) for association with early-onset MI in a case-control study (study 1 200 cases, 262 controls). To reduce the number of false positives among the 666 SNPs that were nominally associated with early-onset MI (P<0.05) in study 1, we tested these SNPs in study 2 (434 cases, 504 controls). We found that 8 of the 666 SNPs were associated with early-onset MI in study 2 (P<0.05) and had the same risk alleles as in study 1. These 8 SNPs were then tested for association with early-onset MI in study 3 (187 cases, 434 controls). We found that a VAMP8 variant (P=0.025; odds ratio [OR], 1.75; CI, 1.17 to 2.62) and an HNRPUL1 variant (P=0.0043; OR, 1.92; CI, 1.28 to 2.86) were associated with early-onset MI (nominalP<0.05; false discovery rate <10%) and had the same risk alleles in all 3 studies.Conclusions—Variants in 2 genes were associated with early-onset MI: VAMP8, which is involved in platelet degranulation, and HNRPUL1, which encodes a ribonuclear protein. The identification of these variants could improve understanding of disease mechanisms and suggest novel drug targets.
The Harry R. Horvitz Center for Palliative Medicine (1987-1999): Development of a novel comprehensive integrated program
Authors: Walsh Declan 
Published: May 2006

The Cleveland Clinic is a large multi-specialty group practice. The need for a palliative care program was identified and the program started in 1987. A key concept has been that the existing structure of hospice care as defined by Medicare is insufficient to address the needs of patients with incurable disease. The field of palliative medicine implies physician expertise in several key areas: (1) communication; (2) decision-making; (3) management of complications; (4) symptom control; (5) care of the dying; and (6) psychosocial care. The development of the program (the first in the United States) since 1987 has put in place the following major services, listed consecutively: (1) hospital consultation service; (2) outpatient clinics; (3) acute care inpatient service; (4) hospice and home care service; (5) acute-care palliative medicine inpatient unit; and (6) hospice inpatient facility. Program development has meant that a new program has been introduced approximately every 18 months since the start of the program. This has considerable implications for staffing, the management of change, and competition for scarce resources within a contracting health care budget. The staffing of the program has focused on developing specialized attending physicians using a multidisciplinary approach dedicated to enhancing the role of nursing in the field. The major budgeted areas are (1) the acute-care palliative medicine unit, and (2) the hospice and home care service. Specific commitment has been made to research and education because of the desire to develop an intellectual basis for the practice of palliative medicine. This requires structured activities in both areas with a systematic approach to research and education. The complexity of developing a service should not be underestimated. There has been consistent support for the program by senior leadership within the Cleveland Clinic Foundation, including the cancer center. The major lessons learned during program development have been: (1) to focus on quality of patient care; (2) to commit to academic endeavor in research and education; (3) to secure institutional commitment to program development; (4) to establish a positive, proactive, businesslike approach; (5) to defend budget and personnel, albeit within a difficult time in health care; and (6) to commit to success, i.e. , never promise anything on which you do not deliver. The future development of post-acute-care services serving predominantly the chronically ill elderly population suggest an expanded administrative and conceptual role for the future development of palliative medicine to help serve the needs of the aging population in the United States.
Not ready for hospice: Characteristics of patients in a pre-hospice program
Authors: Hayley Déon Cox , Muir J. Cameron , Stocking Carol , Hougham Gavin , Sachs Greg A. 
Published: May 2006

Context: There are many patients with terminal illness for whom hospice care would be appropriate, but they either never enroll or enroll very late. In a pre-hospice program designed to help patients make the transition into hospice, we observed that many patients did not make the transition. Objectives: To understand more about the transition to hospice and the functions of a pre-hospice program, this paper compares patients who enrolled in hospice with those who died in the pre-hospice program. Design, setting, and patients: Data were collected from a retrospective review of the charts of 123 consecutive patients who enrolled in a prehospice program between January 1, 1995, and December 31, 1996. Main outcome measures: The patient’s decision to transfer to home hospice or (perhaps, by not making a decision) to remain enrolled in the pre-hospice program until death. Results: At the end of the research period, 38 patients had transferred to hospice and 36 had died without transfer. The remaining 49 patients had uncertain outcomes at the end of the research period. Patients who transferred to hospice were older (P = .02) and more likely to have secondary insurance (P = .05). In addition, those who enrolled in hospice were more likely to live alone (P = .03) and have psychosocial concerns noted by staff on admission (P = .05). Conclusions: Many patients died in this program that was designed only for transition to hospice. We found statistically significant differences characterizing the groups associated with transferring to hospice. Further studies to find out why these differences exist will be important in order to provide excellent end-of-life care for more people.
Creating a hospice pharmacy and therapeutics committee
Authors: Snapp Janet , Kelley Debra , Gutgsell Terence L. 
Published: May 2006

Implementing a Pharmacy and Therapeutics Committee (P&T) as a management strategy for Hospice of the Bluegrass in Lexington, Kentucky, has proven to be effective in reducing costs and improving patient outcomes. Early efforts of the committee yielded the establishment of protocols and guidelines, educational programs, pharmacy newsletters for nurses, and patient education material. In the spring of 2000, Hospice of the Bluegrass developed a preferred drug list (PDL) consisting of the medications it considered essential for effective pain and symptom control. The addition of a clinical pharmacist and a P&T committee has resulted in significant cost savings and improved pharmacotherapeutic care for patients of Hospice of the Bluegrass. This model is an option for any hospice looking to achieve the same outcomes.
An investigation into the use of palliative care services by patients with prostate cancer
Authors: Green James S.A. 
Published: May 2006

The use of palliative services by prostate cancer patients was assessed in relation to other cancer patients and as a proportion of men diagnosed with prostate cancer. Retrospective analysis of palliative care referral and inpatient and outpatient activity was undertaken in respect to patients with nine types of cancer. A cohort of men diagnosed with prostate cancer in 1993 was followed for five years. The records of those that died during this period were reviewed to confirm if they had received hospice care. Of the 118 men dying of prostate cancer, 25.4 percent used hospice services, 23 percent used the hospice at home services (for an average of 68.8 days), while 7 percent used day-care services (for an average of 8.25 days). Prostate cancer patients formed the third largest cancer referral group to hospital-based palliative care services (9.5 percent). They had the third longest survival time from referral (3.8 months) and the oldest average age of death of any group. Lower than average inpatient stays, coupled with the highest average length of stay, led to the third highest use of inpatient services by patients with prostate cancer. We concluded that the morbidity from prostate cancer leads to a high use of palliative services. This significant use of resources should be included in comparisons assessing and planning health care strategies for prostate cancer.
Predictors of live hospice discharge: Data from the National Home and Hospice Care Survey (NHHCS)
Authors: Kutner Jean S. , Blake Marcia , Meyer Sue A. 
Published: May 2006

In the context of the current regulatory environment, patients may be discharged from hospice if their condition stabilizes or improves over time and the certifying physician is unable to provide a conscientious recertification of the six-month prognosis. Little is known about the characteristics or outcomes of patients who are determined by physicians to no longer be eligible for hospice care. This retrospective study was designed to characterize the rates and predictors of live hospice discharge using data from the 1996 and 1998 National Home and Hospice Care Survey (NHHCS). We compare records of live hospice discharge with hospice discharges due to death from the discharge patient files of the 1996 and the 1998 NHHCS. Of the 807,733 patients in the combined 1996 and 1998 NHHCS discharge patient file who met study inclusion criteria, 761,858 (94 percent) were deceased and 45,875 (6 percent) were discharged alive. Those who were discharged alive were more likely to be female, have received hospice care for more than 60 days, and to have had a noncancer diagnosis, particularly advanced cardiopulmonary or neurologic disease. Mean age and total number of assistive medical devices used did not differ significantly between patients who were discharged alive and those who died in hospice care. Factors most associated with live hospice discharge, using bivariate analyses, were length of service greater than 60 days (OR, 6.60; 95 percent CI, 6.47-6.73), cardiopulmonary diagnosis (OR, 3.24; 95 percent CI, 3.19-3.30), and neurologic diagnosis (OR, 2.73; 95 percent CI, 2.67-2.79). Multivariate logistic regression identified length of service greater than 60 days, cardiopulmonary diagnosis, neurologic diagnosis, female gender, worse functional status, and living in an institutional setting as being independently associated with live hospice discharge. We found that patients who were discharged alive from hospice care were more likely to have longer lengths of service, noncancer diagnoses, and better functional status than those who died while receiving hospice care. Age was not associated with discharge disposition. Given the demonstrated differences between these patients and those who died while receiving hospice care, these data provide further impetus for careful study of the appropriateness of current hospice eligibility criteria, the determinants of hospice discharge and, most important, the outcomes of patients who are discharged alive from hospice and the impact of hospice discharge on patients and their families.
Communication of a cancer diagnosis: Patients’ perceptions of when they were first told they had cancer
Authors: Walsh Declan , Nelson Kristine A. 
Published: May 2006

Fifty consecutive cancer patients cared for by a palliative medicine program were interviewed concerning the initial communication of their diagnosis. The majority of patients were satisfied with the manner and the circumstances in which the information was imparted. A minority of women were significantly more unhappy than men about the manner in which they were told. Sophisticated techniques are available to help physicians impart bad news effectively and humanely.
A longitudinal study of attitudes toward physician-assisted suicide and euthanasia among patients with noncurable malignancy
Authors: Pacheco Jaime , Hershberger Paul J. , Markert Ronald J. , Kumar Geetika 
Published: May 2006

This longitudinal study investigated whether attitudes toward physician-assisted suicide (PAS) and euthanasia (E) are stable among patients with noncurable malignancy, and whether depression and various coping strategies were related to such attitudes. Thirty patients with noncurable malignancies completed questionnaires measuring attitudes toward PAS and E, depression, and coping. Three months later, and subsequently at six-month intervals, repeated measures were obtained from 24 patients. There was a trend for patients to become less supportive of legalizing PAS and E from the initial to last attitude measurement. Depression was unrelated to attitude change. There were significant changes on two coping dimensions: use of social support for emotional reasons and use of religious resources. Our findings should be considered in clinical, legislative, and ethical debates.
The contextual nature of decision making near the end of life: Hospice patients’ perspectives
Authors: Gauthier Donna M. , Swigart Valerie A. 
Published: May 2006

Mr. C. was diagnosed with lung cancer seven months ago. The cancer then spread to his brain. He was fully aware that the physicians were treating his symptoms, not the disease; however, discussions regarding the goals of treatment did not occur. He continued the treatment regimen of chemotherapy and radiation therapy. While at home one evening, he fell and fractured his femur. His mobility and independence were at once greatly compromised. While recovering in the hospital, he made the decision to opt out of curative treatment. He stated, “I want to go home, play with my cat, smoke cigarettes, and be with my friends when they can visit.” What are the processes by which adults with life-threatening conditions make decisions about their care? What is the context of these decisions? The purpose of this study was to describe the process of decision making for adults with a terminal illness.
Treatable complications of cancer patients referred to an in-patient hospice
Authors: Morita Tatsuya , Tei You , Shishido Hideki , Inoue Satoshi 
Published: May 2006

This paper illustrates the importance of accurate diagnoses and treatments of complications in terminally ill cancer patients. The paper reports on five hospice in-patients who completely recovered from life-threatening complications; three of them had been incorrectly labeled as “imminently dying” by the referring physicians. The paper concludes that it would be beneficial for patients to receive examinations and a trial of medical treatment in their continuing treatment settings.
Dying with dignity: The good patient versus the good death
Authors: Proulx Kathryn , Jacelon Cynthia 
Published: May 2006

Death is a unique experience for each human being, yet there is tremendous societal pressure on a dying person to be a “good patient” while trying to experience the “good death.” These pressures shape patient, caregiver, and family choices in end-of-life situations. The purpose of this literature review was twofold: first, to develop an understanding of “dying with dignity” to enhance the end-of-life care received by dying patients, and second, to contribute to a concept analysis of dignity to improve the clarity and consistency of future research related to dignity in aging individuals. Articles pertaining to dying with dignity from the disciplines of nursing, medicine, ethics, psychology, and sociology were reviewed using a matrix method. 1 A dichotomy surrounding dying with dignity emerged from this review. The definition of dignity in dying identifies not only an intrinsic, unconditional quality of human worth, but also the external qualities of physical comfort, autonomy, meaningfulness, usefulness, preparedness, and interpersonal connection. For many elderly individuals, death is a process, rather than a moment in time, resting on a need for balance between the technology of science and the transcendence of spirituality.
Reduction of edema of lower extremities by subcutaneous, controlled drainage: Eight cases
Authors: Clein Lawrence J. , Pugachev Eglee 
Published: May 2006

This paper discusses the pathophysiology and modern treatment of edema. Dissatisfied with the treatment available, the authors report on the use of a closed, controlled drainage procedure in eight patients with severe edema of the lower limbs. It is important to note that this technique is used as a palliative procedure. Seven out of the eight patients considered the procedure to have been worthwhile, experienced improvement, and died comfortably. Apart from actual pain and consequent insomnia, the discomfort and misery produced by the constant leaden drag of the paralyzed, inflexible, and bolster-like limbs are important factors in the sum total of misery produced by the disease. 1 W. Sampson Handley, 1908 1
Identifying barriers to psychosocial spiritual care at the end of life: A physician group study
Authors: Chibnall John T. , Bennett Mary Lou , Videen Susan D. , Duckro Paul N. , Miller Douglas K. 
Published: May 2006

Objective. The recent literature addresses the need to improve care for dying patients. The purpose of this study was to identify barriers to the psychosocial spiritual care of these patients by their physicians. Psychosocial spiritual care is defined as aspects of care concerning patient emotional state, social support and relationships, and spiritual well-being. The study was an exploratory means for generating hypotheses and identifying directions for interventions, research, and training in care for the dying.Design and participants. The study used a qualitative group discussion format. Seventeen physicians at a university-based health sciences center representing 10 areas of medical specialty—including internal medicine, oncology, pediatrics, and geriatrics—met in two groups for 20 75-minute discussion sessions over the course of one year. Discussions were recorded, analyzed, and categorized.Results. Barriers to psychosocial spiritual care were grouped into three domains and seven themes. The cultural domain included the themes of training, selection, medical practice environment, and debt/delay. Participants believed that medical selection and training combine to marginalize psychosocial spiritual approaches to patient care, while the practice environment and debt/delay augment emotional isolation and dampen idealism. The organizational domain included the themes of dissatisfaction and time/busyness. Physicians indicated that the current reimbursement climate and time pressures contribute to dissatisfaction and the tendency to avoid patient psychosocial spiritual issues. The clinical domain included the theme of communication. Physicians were concerned about their ability to communicate nonmedical issues effectively and manage the patient’s reactions and needs in the psychosocial spiritual arena.Conclusions. This study suggests that research and educational approaches to improving the psychosocial spiritual care of the dying by physicians should address barriers at the cultural, organizational, and clinical levels. Suggestions for interventions at various levels are offered.
The use of motion sickness bands to control nausea and vomiting in a group of hospice patients
Authors: Wright Leonard D. 
Published: May 2006

Objective: To explore the potential benefits of using motion sickness bands (MSBs) to control nausea and vomiting in a hospice-based patient population. Methods: A nonblinded, yearlong observational study. Results: From February 2003 to February 2004, 33 patients entered into the study. The mean age of the study cohort was 67 years, with a predominance of females to males and cancer as the most common admitting diagnosis. Twenty-nine of the 33 patients studied showed a positive response to the intervention for a response rate of 88 percent. Conclusions: MSBs demonstrated efficacy in controlling nausea and vomiting in a group of hospice patients. Added benefits of patient empowerment and financial savings also were noted. Further study is warranted.