bluuebunny/crossref_metadata_2025_split huggingface dataset:
Natural selection of protein structural and functional properties: a single nucleotide polymorphism perspective
Authors: Liu Jinfeng , Zhang Yan , Lei Xingye , Zhang Zemin 
Published: April 2008

Abstract
Background
The rates of molecular evolution for protein-coding genes depend on the stringency of functional or structural constraints. The Ka/Ks ratio has been commonly used as an indicator of selective constraints and is typically calculated from interspecies alignments. Recent accumulation of single nucleotide polymorphism (SNP) data has enabled the derivation of Ka/Ks ratios for polymorphism (SNP A/S ratios).

Results
Using data from the dbSNP database, we conducted the first large-scale survey of SNP A/S ratios for different structural and functional properties. We confirmed that the SNP A/S ratio is largely correlated with Ka/Ks for divergence. We observed stronger selective constraints for proteins that have high mRNA expression levels or broad expression patterns, have no paralogs, arose earlier in evolution, have natively disordered regions, are located in cytoplasm and nucleus, or are related to human diseases. On the residue level, we found higher degrees of variation for residues that are exposed to solvent, are in a loop conformation, natively disordered regions or low complexity regions, or are in the signal peptides of secreted proteins. Our analysis also revealed that histones and protein kinases are among the protein families that are under the strongest selective constraints, whereas olfactory and taste receptors are among the most variable groups.

Conclusion
Our study suggests that the SNP A/S ratio is a robust measure for selective constraints. The correlations between SNP A/S ratios and other variables provide valuable insights into the natural selection of various structural or functional properties, particularly for human-specific genes and constraints within the human lineage.
Competing Norms: Canadian Rural Family Physicians’ Perceptions of Clinical Practice Guidelines and Shared Decisionmaking
Authors: Boivin Antoine , Légaré France , Gagnon Marie-Pierre 
Published: April 2008

Objectives Implementation of clinical practice guidelines (CPGs) and shared decisionmaking are both advocated in primary care. Some authors argue that CPGs can enhance informed decisions by patients and physicians, while others warn that a standardized implementation of CPGs could hinder patients’ involvement in decisionmaking. Our objective was to explore rural family physicians’ perception of the interaction between clinical practice guidelines and shared decisionmaking in medical practice. Methods A qualitative study using a semi-structured focus group interview: with 17 family physicians and residents, in a Canadian rural town. Interviews were audio-taped and transcribed verbatim. Thematic content analysis was performed and validated by the constant comparative method, member checking and group debriefing. Results Two distinct conceptions of how clinical practice guidelines should assist decisionmaking emerged. On the one hand, guidelines were seen as helping clinicians to make decisions on behalf of their patient about the best course of action. For interventions with uncertain benefit or that carried significant trade-off for patients, guidelines were seen as a tool that should inform decisionmaking between physicians and patients, providing them with details about risks, benefits, costs and alternative treatments. The pressure to apply guideline recommendations was perceived as a potential barrier to patient participation in decisionmaking. Conclusion In circumstances where physicians judge patient participation in decisionmaking to be important, physicians perceive a tension between the need to respect patients’ preferences and the pressure to apply guidelines. CPGs should include information that supports shared decisionmaking, besides their current focus on influencing prescription patterns, costs and health outcomes.
Hospital Clinicians’ Attitudes Towards a Statutory Advocacy Service for Patients Lacking Mental Capacity: Implications for Implementation
Authors: Luke Lydia , Redley Marcus , Clare Isabel , Holland Anthony 
Published: April 2008

Objectives To examine attitudes to the Mental Capacity Act's new statutory Independent Mental Capacity Advocate (IMCA) service in England and Wales and consider the implications for its delivery. Methods Quantitative data describing all referrals to the seven pilot IMCA services (January 2006-March 2007) and qualitative data from semi-structured interviews with 18 doctors, 21 senior nurses and one discharge planning manager in four general hospitals in England. Results Of 127 hospital-based referrals to the seven pilot IMCA services, 29 (23%) were for patients facing serious medical treatments, 52% of whom were judged to lack decisionmaking capacity due to a learning disability; ninety-eight (77%) were for patients facing a change of accommodation upon hospital discharge, 62% of whom were elderly and lacked capacity due to dementia. While aware of the potential benefits of the IMCA service, clinicians were generally negative about the contribution advocates could make to patients’ medical care and thought they could only contribute usefully in a minority of ethically complicated decisions. In contrast, they were more positive about the involvement of advocates in hospital discharge decisions and hoped that they would improve current discharge practice. Conclusions Clinicians held ambivalent attitudes towards the involvement of a statutory IMCA service in medical decisions, reflecting beliefs that the service was largely impractical and unnecessary given current procedures for making medical decisions in patients’ ‘best interests’. Conversely, clinicians were more likely to support advocacy in discharge decisions because they believed that non-medically qualified advocates could make a valuable contribution to decisions that were seen as predominantly social and where practice was frequently considered deficient. By holding these beliefs, clinicians are failing to have due regard for the IMCA service as a statutory measure for safeguarding patients’ interests.
Is Fast Access to General Practice all that Should Matter? A Discrete Choice Experiment of Patients’ Preferences
Authors: Gerard Karen , Salisbury Chris , Street Deborah , Pope Catherine , Baxter Helen 
Published: April 2008

Objectives To determine the relative importance of factors that influence patient choice in the booking of general practice appointments for two health problems. Methods Two discrete choice experiments incorporated into a survey of general practice patients and qualitative methods to support survey development. Results An overall response of 94% (1052/1123) was achieved. Factors influencing the average respondent's choice of appointment, in order of importance, were: seeing a doctor of choice; booking at a convenient time of day; seeing any available doctor; and having an appointment sooner rather than later (acute, low worry condition). This finding was the same for an ongoing, high worry condition but in addition the duration of the appointment was also of (small) value. Patients traded off speed of access for more convenient appointment times (a willingness to wait an extra 2.5-3 days longer to get a convenient time slot for an acute low worry/ongoing, high worry condition, respectively). However, contrary to expectation, patients were willing to trade off speed of access for continuity of care (e.g. willingness to wait five days longer to see the doctor of their choice for an acute, low worry condition). Preferences varied by a person's gender, work and carer status. Conclusions Patients hold strong preferences for the way general practice appointment systems are managed. Contrary to current policy on improving access to primary care patients value a more complex mix of factors than fast access at all costs. It is important that policy-makers and practices take note of these preferences.
Legitimacy of Hospital Reconfiguration: The Controversial Downsizing of Kidderminster Hospital
Authors: Oborn Eivor 
Published: April 2008

Objectives This paper examines the contested organizational legitimacy of hospital reconfiguration, which continues to be a central issue in health care management. Methods A qualitative study which focuses on the controversial downsizing of Kidderminster Hospital, a highly publicized landmark case of district general hospital closure. Rhetorical strategies are analysed to examine how legitimacy was constructed by stakeholder groups and how these strategies were used to support or resist change. Results Stakeholders promoting change legitimized re-organization pragmatically and morally arguing the need for centralization as a rational necessity. Stakeholders resisting change argued for cognitive and moral legitimacy in current service arrangements, contrasting local versus regionalized aspects of safety and provision. Groups managed to talk past each other, failing to establish a dialogue, which led to significant conflict and political upheaval. Conclusions Stakeholders value hospitals in different ways and argue for diverse accounts of legitimacy. Broader discourses of medical science and democratic participation were drawn into rhetorical texts concerning regionalization to render them more powerful.
Characteristics of the Emergency and Urgent Care System Important to Patients: A Qualitative Study
Authors: O'cathain Alicia , Coleman Patricia , Nicholl Jon 
Published: April 2008

Objectives To explore patients’ views and experiences of the emergency and urgent care system to inform the development of a questionnaire for routine assessment of the system's performance from the patient perspective. Methods Qualitative research with people who had recently used the system: 47 people in eight focus groups and 13 individual interviews. Results Recurrent themes included characteristics of the system which are rarely addressed in service-specific questionnaires, in particular, confusion over the most appropriate service to use for particular health problems, coordination between services and informational continuity across services. Other characteristics were identified which, although commonly included in service-specific questionnaires, could have system-level consequences. These included communication between health professionals and patients, and ease of access to services. For example, patients’ perception of poor communication with one service could increase their subsequent use of other services in the system. Proactive behaviour from health professionals was an important system characteristic because it could allay patient anxiety by making patients feel that their concerns were being taken seriously and that staff could sort out problems such as feeling ‘stuck in’ or ‘bounced around’ the system. ‘Candidacy’, whereby eligibility for health care is jointly negotiated between the user and the service provider, was evident as an issue for patients across the social spectrum when seeking help urgently. Conclusions Questionnaires designed to assess patients’ views and experiences of emergency and urgent care should address system-level as well as service-specific issues in order to address the full range of patient concerns.
Equity and Service Innovation: The Implementation of a Bibliotherapy Scheme in Wales
Authors: Porter Alison , Peconi Julie , Evans Angela , Snooks Helen , Lloyd Keith , Russell Ian 
Published: April 2008

Objective Book Prescription Wales (BPW) is a pilot bibiliotherapy scheme launched in July 2005 as a primary care treatment option for people with mild to moderate mental health problems. In an innovative model, patients are prescribed self-help books from a list, to borrow from local libraries. Our objective was to evaluate its implementation, focusing on the issue of equity of service delivery. Methods Data were gathered from Welsh Assembly Government concerning project set-up and borrowing rates. Mailed questionnaires were completed by 21/22 (95.4%) Local Health Boards and 44/64 (68.8%) Community Mental Health Teams. In addition, 327 out of 497 (66%) primary care practices were surveyed by telephone, 20 prescribers took part in in-depth telephone interviews and three focus groups were conducted with library staff. Results From July 2005-March 2006, books were borrowed 15,236 times. There was a 10-fold variation in borrowing rates across local authorities (1.07 to 10.18 loans/1000 people). The priority which Local Health Board staff reported giving to the scheme varied. Uptake among prescribers was mixed: in 35% of general practices (n 5 116) no-one participated. Prescribers reported different ways of using the bibliotherapy scheme. Library staff reported issues of patchy uptake. Conclusion Variation in usage of bibliotherapy raises questions about equity; it is unlikely to reflect the distribution of people who could potentially benefit. Factors influencing variation existed all along the implementation chain. It is not always possibly to separate demand-side and supply-side factors when considering equity and service innovation in health care.
Part of a Global Workforce: Migration of British-Trained Pharmacists
Authors: Hassell Karen , Nichols Liza , Noyce Peter 
Published: April 2008

Objectives Many countries, including the UK, have identified a shortage of pharmacists, partly due to emigration. This study was undertaken to examine the extent and nature of migration taking place among British-qualified pharmacists. Methods Mixed methods, including secondary analysis of quantitative data, qualitative research and a large self-completion survey of all British-registered pharmacists with an overseas address. Results Almost 11% of British-registered pharmacists reside overseas. Nearly three-quarters are British-trained and most are UK nationals. The US, Canada and Australia are the main destinations. The majority work as pharmacists in health services, but sizeable proportions are either retired, not working for other reasons or work in industry. Those who emigrate include those returning home, moving for career opportunities, for lifestyle reasons or as a ‘spouse trailer’. For many the move abroad is a permanent one. Conclusions Great Britain is both a source and destination country for migrating pharmacists. Emigration currently exceeds immigration. Pharmacists are not migrating to developing countries, so the profession may want to consider ways of contributing to the health care systems in developing countries which are the source of some of the immigrant pharmacists to Great Britain.
The Increasing Burden of Alcoholic Liver Disease on United Kingdom Critical Care Units: Secondary Analysis of a High Quality Clinical Database
Authors: Welch Catherine , Harrison David , Short Alasdair , Rowan Kathryn 
Published: April 2008

Objectives To investigate the effect of increasing alcohol consumption on the number of admissions to adult, general critical/intensive care units (ICUs) in England and Wales with alcoholic liver disease, their case mix, mortality, and impact on critical care and hospital activity by extrapolating from admissions to ICUs over the last 10 years. Methods Secondary analysis of a high quality clinical database from a national clinical audit using data from 385,429 admissions to174 ICUs in England and Wales between December 1995 and July 2005, of which 4219 (1.1%) had alcoholic liver disease. The extrapolated total number of admissions with alcoholic liver disease and total number of ICU bed-days occupied were calculated. Changes over time in the case mix (age, sex and APACHE II and ICNARC risk prediction models), mortality at ultimate discharge from acute hospital, and length of stay in ICU and in hospital were explored. Results The percentage of ICU admissions with alcoholic liver disease increased from 0.65% in 1996 to 1.35% in 2005, but the case mix remained similar. Mortality decreased and length of stay increased over this period. The extrapolated total number of admissions to all 229 adult, general critical care units in England and Wales increased from 550 in 1996 to 1513 in 2005, and the extrapolated total number of bed-days occupied by these admissions increased from around 3100 to over 10,000. Conclusions Admissions to ICUs in England and Wales with alcoholic liver disease tripled over the 10-year period from 1996 to 2005. The continuing increase in alcohol consumption means that this trend is likely to continue.
Career Intentions of Pharmacy Students
Authors: Willis Sarah , Hassell Karen , Noyce Peter 
Published: April 2008

Objectives In light of pharmacy workforce shortages in Great Britain, the profession's regulatory body commissioned a programme of longitudinal work to explore pharmacy career decisionmaking in relation to influences on career choice and intended career paths. Our objective was to gather data on career intentions that could be used to produce robust predictions about pharmacist supply. Methods Two annual surveys conducted with the same cohort of pharmacy students in 2005 and 2006. The questionnaires sought to clarify influences on respondents’ career intentions and their early career plans. Results Only two-thirds of respondents intended going straight into British pharmacy practice after training, with fewer white men (57%) than ethnic minority men (71%) intending to go straight into practice. Preferences for early careers reflected existing occupational segregation, with 41% of white females hoping to work in hospital pharmacy and a similar proportion of ethnic minority men (40%) hoping to work for a large multiple community pharmacy after training. Conclusions A sizeable proportion of pharmacy students do not intend entering the profession for which they have trained, a proportion which is much larger than estimated by other studies. This has significant implications for workforce planning. Existing gender and ethnic segregation in the profession may have occurred as a result of personal choice rather than being a function of constraints operating within the pharmacy labour market.
The Local Adaptation of National Recommendations for Preventing Early-Onset Neonatal Group B Streptococcal Disease in Uk Maternity Units
Authors: Cromwell David , Joffe Tracey , Hughes Rhona , Murphy Deirdre , Dhillon Charnjit , Van Der Meulen Jan 
Published: April 2008

Objective To evaluate how UK maternity unit protocols conformed to national recommendations for preventing early-onset neonatal Group B Streptococcal (GBS) disease. Methods In December 2005, all UK obstetric maternity units were contacted and asked to provide a copy of their protocol on preventing GBS disease. Information was extracted on the protocol's recommendations, its development date and the evidence cited. The protocol's recommendations were then compared against the recommendations in the Royal College of Obstetricians and Gynaecologists (RCOG) guideline. Results Protocols were obtained for 171 of the 227 units (75%), of which 120 were developed after the guideline has been published. There were 134 protocols (78%) that followed the RCOG prevention strategy, recommending a risk-based approach to selecting women for intrapartum antibiotic prophylaxis (IAP). However, the sets of risk factors named as indications for IAP differed between the protocols and only 34 of these 134 protocols were entirely consistent with the guideline. The 37 protocols (22%) that did not follow the RCOG prevention strategy recommended IAP for some risk factors but only if a bacteriological test was also GBS positive. Conclusions There are considerable differences in the GBS protocols used in maternity units in the UK despite the availability of a national guideline. Consequently, some high-risk women may not receive IAP while some women without risk factors are treated needlessly. While local adaptation may be for legitimate reasons, the processes used in some units seem to require improvement.
Decentralizing Resource Allocation: Early Experiences with District Health Boards in New Zealand
Authors: Ashton Toni , Tenbensel Tim , Cumming Jacqueline , Barnett Pauline 
Published: April 2008

Objectives In New Zealand in 2001, a system of purchasing health services by a centralized purchasing agency was replaced by 21 district health boards (DHBs) which are responsible for both providing health services directly and for purchasing services from non-government providers. This paper describes the processes associated with the allocation of health resources in the decentralized system and considers the extent to which four of the government's stated objectives are likely to be achieved. Methods Two rounds of interviews with national stakeholders and senior DHB personnel plus case studies in five districts which included key informant interviews, observation at board meetings and document analysis. Results The re-structuring of the health sector in New Zealand appears to have simultaneously enhanced and inhibited the achievement of government objectives. Local decisionmaking has encouraged greater local responsiveness and new funding arrangements have allayed concerns about inter-regional equity. The system is less commercially oriented than it was during the 1990s and collaboration between DHBs is improving. However, the combination of increased integration of purchasing and provision within DHBs and the focus on financial deficits in the early years appears to have inhibited the development of partnership relationships between DHBs and non-government providers, and of longer-term funding arrangements for high quality providers. Non-government providers perceive that DHBs have a tendency to favour their own providers when allocating contracts. Conclusions Decentralized decisionmaking is starting to make some inroads towards achieving some of the government's objectives with respect to resource allocation and purchasing.
A Bivariate Timing Model of Customer Acquisition and Retention
Authors: Schweidel David A. , Fader Peter S. , Bradlow Eric T. 
Published: April 2008

Two widely recognized components, central to the calculation of customer value, are acquisition and retention propensities. However, while extant research has incorporated such components into different types of models, limited work has investigated the kinds of associations that may exist between them. In this research, we focus on the relationship between a prospective customer's time until acquisition of a particular service and the subsequent duration for which he retains it, and examine the implications of this relationship on the value of prospects and customers. To accomplish these tasks, we use a bivariate timing model to capture the relationship between acquisition and retention. Using a split-hazard model, we link the acquisition and retention processes in two distinct yet complementary ways. First, we use the Sarmonov family of bivariate distributions to allow for correlations in the observed acquisition and retention times within a customer; next, we allow for differences across customers using latent classes for the parameters that govern the two processes. We then demonstrate how the proposed methodology can be used to calculate the discounted expected value of a subscription based on the time of acquisition, and discuss possible applications of the modeling framework to problems such as customer targeting and resource allocation.
Photochemistry of some heterocyclic systems
Authors: Claus P. , Doppler Th. , Gakis N. , Georgarakis M. , Giezendanner H. , Gilgen P. , Heimgartner H. , Jackson B. , Märky M. , Narasimhan N. S. , Rosenkranz H. J. , Wunderli A. , Hansen H.-J. , Schmid H. 
Published: April 2008

Abstract
Physiological, veterinary and clinical effects of hypothalamic releasing hormones (RH), especially LH-RH
Authors: Schally A. V. , Arimura A. , Kastin A. J. , Coy D. H. , Coy E. J. , Vilchez-Martinez J. , Redding T. W. , Geiger R. , König W. , Wissman H. 
Published: April 2008

Abstract