bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methodology of constructive technology assessment in health care
Authors: Douma Kirsten F. L. , Karsenberg Kim , Hummel Marjan J. M. , Bueno-de-Mesquita Jolien M. , van Harten Wim H. 
Published: April 2007

Objectives: Technologies in health care are evolving quickly, with new findings in the area of biotechnological and genetic research being published regularly. A health technology assessment (HTA) is often used to answer the question of whether the new technology should be implemented into clinical practice. International evidence confirms that the results of HTA research sometimes have limited impact on practical implementation and on coverage decisions; the study design is commonly based on the paradigm of stability of both the technology and the environment, which is often not the case. Constructive technology assessment (CTA) was first described in the 1980s. In addition to the traditional HTA elements, this approach also takes into account the technology dynamics by emphasizing sociodynamic processes. With a CTA approach, comprehensive assessment can be combined with an intentional influence in a favorable direction to improve quality.Methods: In this study, the methodological aspects mainly concerning the diagnostic use of CTA are explained. The methodology will be illustrated using the controlled introduction of a new technology, called microarray analysis, into the clinical practice of breast cancer treatment as a case study. Attention is paid to the operationalization of the phases of development and implementation and the research methods most appropriate for CTA.Conclusions: In addition to HTA, CTA can be used as a complementary approach, especially in technologies that are introduced in an early stage of development in a controlled way.
Cost-effectiveness of abdominal aortic aneurysm repair: A systematic review
Authors: Jonk Yvonne C. , Kane Robert L. , Lederle Frank A. , MacDonald Roderick , Cutting Andrea H. , Wilt Timothy J. 
Published: April 2007

Objectives:A systematic review of the cost-effectiveness of abdominal aortic aneurysm (AAA) repair was conducted. Although open surgery has been considered the gold standard for prevention of AAA rupture, emerging less-invasive endovascular treatments have led to increased interest in evaluating the cost and cost-effectiveness of treatment options.Methods:A systematic review of studies published in MEDLINE between 1999 and 2005 reporting the cost and/or cost-effectiveness of endovascular and/or open surgical repair of nonruptured AAAs was conducted. Case series studies with less than fifty patients per treatment were excluded.Results:Of twenty eligible articles, three were randomized controlled trials, twelve case series, four Markov models, and one systematic review. Regardless of time frame, all studies found that endovascular repair costs more than open surgery. Although the high cost of the endovascular prosthesis was partially offset by reduced intensive care, hospital length of stay, operating time, blood transfusions, and perioperative complications, hospital costs were still greater for endovascular than open surgical repair. For patients medically fit for open surgery, mid-term costs were greater for endovascular repair with no difference in overall survival or quality of life. For patients medically unfit for open surgery, endovascular repair costs more than no intervention with no difference in survival.Conclusions:Although conclusions regarding the cost-effectiveness of AAA treatment options are time dependent and vary by institutional perspective, from a societal perspective, endovascular repair is not currently cost-effective for patients with large AAA regardless of medical fitness.
Using the literature to quantify the learning curve: A case study
Authors: Cook Jonathan A. , Ramsay Craig R. , Fayers Peter 
Published: April 2007

Objectives: The aim of this study was to assess whether a literature review of a technology can allow a learning curve to be quantified.Methods: The literature for fiberoptic intubation was searched for studies reporting information relevant to the learning curve. The Cochrane Library, Medline, Embase, and Science Citation index were searched. Studies that reported a procedure time were included. Data were abstracted on the three features of learning: initial level, rate of learning, and asymptote level. Random effects meta-analysis was performed.Results: Only twenty-one studies gave explicit information concerning the previous experience of the operator(s). There were thirty-two different definitions of procedure time. From four studies of fiberoptic nasotracheal intubation, the mean starting level and time for the 10th procedure was estimated to be 133 seconds (95 percent confidence interval, 113–153) and 71 seconds (95 percent confidence interval, 62–79), respectively.Conclusions: The review approach allowed learning to be quantified for our example technology. Poor and insufficient reporting constrained formal statistical estimation. Standardized reporting of nondrug techniques with adequate learning curve details is needed to inform trial design and cost-effectiveness analysis.
Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy
Authors: Girling Alan J. , Freeman Guy , Gordon Jason P. , Poole-Wilson Philip , Scott David A. , Lilford Richard J. 
Published: April 2007

Objectives:Ongoing developments in design have improved the outlook for left-ventricular assist device (LVAD) implantation as a therapy in end-stage heart failure. Nevertheless, early cost-effectiveness assessments, based on first-generation devices, have not been encouraging. Against this background, we set out (i) to examine the survival benefit that LVADs would need to generate before they could be deemed cost-effective; (ii) to provide insight into the likelihood that this benefit will be achieved; and (iii) from the perspective of a healthcare provider, to assess the value of discovering the actual size of this benefit by means of a Bayesian value of information analysis.Methods:Cost-effectiveness assessments are made from the perspective of the healthcare provider, using current UK norms for the value of a quality-adjusted life-year (QALY). The treatment model is grounded in published analyses of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial of first-generation LVADs, translated into a UK cost setting. The prospects for patient survival with second-generation devices is assessed using Bayesian prior distributions, elicited from a group of leading clinicians in the field.Results:Using established thresholds, cost-effectiveness probabilities under these priors are found to be low (∼.2 percent) for devices costing as much as £60,000. Sensitivity of the conclusions to both device cost and QALY valuation is examined.Conclusions:In the event that the price of the device in use would reduce to £40,000, the value of the survival information can readily justify investment in further trials.
Diffusion of magnetic resonance imaging in Iran
Authors: Palesh Mohammad , Fredrikson Sten , Jamshidi Hamidreza , Jonsson Pia Maria , Tomson Goran 
Published: April 2007

Objectives:The aim of this article is to describe the diffusion of magnetic resonance imaging (MRI) in Iran, including regional variations during the period of 1990 to 2005 and international comparisons.Methods:Data on the diffusion of MRI were obtained from the Medical Equipment Office of the Ministry of Health (MOH) and, using self-administered questionnaires, from forty-one universities specializing in medical sciences. Data were gathered from the year of first purchase up to mid-2005. Information for international comparisons was obtained from the Organization for Economic Cooperation and Development health data of 2006.Results:Iran purchased its first MRI unit in 1990. Since then, the number of MRI units has increased remarkably. The diffusion curve of MRI in Iran follows an S-shaped curve with a very slow speed in the period of 1991–95. Accelerated adoption occurred later coinciding with a significant influence from the private sector, especially from 1999. Iran had ninety-three MRI units in 2005, and the number of MRI units per million in the population was 1.36.Conclusions:The number of MRI units in provinces is not in direct proportion to the number of their inhabitants. Rational adoption and equitable diffusion of MRI may require the MOH and regulatory bodies to improve their ability in health technology assessment and integrate it into the policy making regarding adoption, diffusion, and utilization of health technologies.
Pattern and factors leading to the diffusion of magnetic resonance imaging in Korean hospitals
Authors: Hahm Myung-Il , Park Eun-Cheol , Lee Sun-Hee , Nam Chung Mo , Kang Hye-Young , Lee Hoo-Yeon , Cho Woo-Hyun 
Published: April 2007

Objectives: The purpose of this study was to examine the diffusion patterns of new medical technologies in Korean hospitals. We also sought to identify critical factors leading to the decision to acquire capital-intensive medical technology. The rationale and timing of magnetic resonance imaging (MRI) acquisitions were retrospectively evaluated according to a “whether, when, and why” paradigm.Methods: We analyzed data pertaining to 232 hospitals with active medical residency programs. Of these, 185 hospitals owned or leased an MRI unit, and 47 had not acquired units as of June 2004. Data were collected from the Ministry of Health and Welfare, Korean National Statistical Office, and Korean Hospital Association databases, and variables were identified and classified as predisposing, enabling, or reinforcing factors.Results: The MRI diffusion rate curve was linear for two types of hospital but was S-shaped for tertiary hospitals, which were early adopters of MRI. Significant predictors for MRI adoption included the per capita number of regional physicians (+), total number of existing regional MRI units (−), percentage of the regional population over 65 years of age (+), private ownership of the hospital, presence of a radiology residency program, number of beds (+), and regional per capita taxable income (+).Conclusions: Diffusion of MRI technology is occurring rapidly across Korean hospitals. The factors affecting MRI adoption in Korea are similar to the factors documented in other countries, namely regional population over age 65, regional income per capita, large hospitals, and teaching hospitals. This study provides baseline information for predicting diffusion patterns of other new and/or expensive medical technologies.
Vladko Maček and the Croat Political Right, 1928–1941
Authors: BIONDICH MARK 
Published: April 2007

AbstractThe Croat Peasant Party was arguably the most important Croatian political party during the existence of the first Yugoslavia (1918–41). Under the leadership of Vladko Maček (1879–1964), it entered the most difficult period of its history: it was forced to contend with the royal dictatorship (1929–34) of King Aleksandar Karadjordjević, the Great Depression, growing nationality tensions and an increasingly volatile political climate in which the extremes of the right and left, represented in Croatia by the Ustaša and Communist parties respectively, contended for power. This article examines the contentious relationship between Maček's Croat Peasant Party and the fascist Ustaša movement between 1929 and 1941, and assesses Maček's legacy and his place in Croatia's 20th-century political history.
Pollination of exoplanets by nebulae
Authors: Napier W.M. 
Published: April 2007

AbstractThe Solar System passes within 5 pc of star-forming nebulae every ∼50–100 million years, a distance which can be bridged by protected micro-organisms ejected from the Earth by impacts. Such encounters disturb the Oort cloud, and induce episodes of bombardment of the Earth and the ejection of microbiota from its surface. Star-forming regions within the nebulae encountered may thus be seeded by significant numbers of microorganisms. Propagation of life throughout the Galactic habitable zone ‘goes critical’ provided that, in a typical molecular cloud, there are at least 1.1 habitable planets with impact environments similar to that of the Earth. Dissemination of microbiota proceeds most rapidly through the molecular ring of the Galaxy.
Irsogladine maleate potentiates the effects of nitric oxide on activation of cAMP signalling pathways and suppression of mesangial cell mitogenesis
Authors: Yao J , Zhu Y , Sun W , Sawada N , Hiramatsu N , Takeda M , Kitamura M 
Published: April 2007

Background and purpose:Deficiency in nitric oxide (NO) is a major factor leading to deterioration and progression of certain glomerular diseases. Agents enhancing NO availability and potentiality are renoprotective. Irsogladine maleate (IM), an anti‐ulcer drug, is reported to improve gastric blood flow via NO‐dependent mechanisms. We, therefore, asked whether and how IM interacted with NO on glomerular mesangial cells.Experimental approach:Mesangial cells were exposed to IM and NO donors. Activation of cAMP signalling pathways was assessed by intracellular cAMP, phosphorylation of VASP, activation of the cAMP response element (CRE) and expression of CRE‐regulated proteins.Key results:IM alone did not affect cell proliferation. However, it greatly enhanced the growth‐inhibitory effect of NO donor S‐nitroso‐N‐acetylpenicillamine (SNAP). IM acted synergistically with NO on suppression of mitogen‐activated protein kinase activation, induction of gap junction protein connexin43, increase of intracellular cAMP, and phosphorylation of VASP. With the use of the CRE‐SEAP‐based reporting system, IM and SNAP cooperatively activated cAMP response elements (CRE). A similar activation of cAMP was induced by IM with two different NO donors, the sGC activator Bay 41‐2272 and the cGMP analogue 8‐bromo‐cGMP. The effects of SNAP and IM on cAMP activation were mimicked by phosphodiesterase 3 (PDE3) and PDE4 inhibitors. In addition, IM markedly augmented cytokine‐induced expression of iNOS, production of NO and activation of CRE.Conclusion and implications:The effects of NO were greatly potentiated by IM through synergistic activation of cAMP pathway. Combined therapy with IM and NO may be developed for certain renal diseases.British Journal of Pharmacology (2007) 151, 457–466; doi:10.1038/sj.bjp.0707255
Non‐steroidal anti‐inflammatory drugs increase insulin release from beta cells by inhibiting ATP‐sensitive potassium channels
Authors: Li J , Zhang N , Ye B , Ju W , Orser B , Fox J E M , Wheeler M B , Wang Q , Lu W‐Y 
Published: April 2007

Background and purpose:Some non‐steroidal anti‐inflammatory drugs (NSAIDs) incidentally induce hypoglycemia, which is often seen in diabetic patients receiving sulphonylureas. NSAIDs influence various ion channel activities, thus they may cause hypoglycemia by affecting ion channel functions in insulin secreting beta cells. This study investigated the effects of the NSAID meclofenamic acid (MFA) on the electrical excitability and the secretion of insulin from pancreatic beta cells.Experimental approach:Using patch clamp techniques and insulin secretion assays, the effects of MFA on the membrane potential and transmembrane current of INS‐1 cells, and insulin secretion were studied.Key results:Under perforated patch recordings, MFA induced a rapid depolarization in INS‐1 cells bathed in low (2.8mM), but not high (28mM) glucose solutions. MFA, as well as acetylsalicylic acid (ASA) and flufenamic acid (FFA), excited the cells by inhibiting ATP‐sensitive potassium channels (KATP). In whole cell recordings, KATPconductance consistently appeared when intracellular ATP was diluted. Intracellular glibenclamide prevented the development of KATPactivity, whereas intracellular MFA had no effect. At low glibenclamide concentrations, MFA induced additional inhibition of the KATPcurrent. Live cell Ca2+imaging displayed that MFA elevated intracellular Ca2+at low glucose concentrations. Furthermore, MFA dose‐dependently increased insulin release under low, but not high, glucose conditions.Conclusions and Implications:MFA blocked KATPthrough an extracellular mechanism and thus increased insulin secretion. As some NSAIDs synergistically inhibit KATPactivity together with sulphonylureas, the risk of NSAID‐induced hypoglycemia should be considered when glucose‐lowering compounds are administered.British Journal of Pharmacology(2007)151, 483–493; doi:10.1038/sj.bjp.0707259
Structural and functional characterization of a novel, host penetration‐related pectate lyase from the potato cyst nematode Globodera rostochiensis
Authors: KUDLA URSZULA , MILAC ADINA‐LUMINITA , QIN LING , OVERMARS HEIN , ROZE ERWIN , HOLTERMAN MARTIJN , PETRESCU ANDREI‐JOSE , GOVERSE ASKA , BAKKER JAAP , HELDER JOHANNES , SMANT GEERT 
Published: April 2007

SUMMARYThe cell wall, a strong extraprotoplasmic layer surrounding plant cells that mainly consists of a variety of polysaccharides, constitutes a major barrier for potential parasites. Plant‐parasitic nematodes are well equipped to overcome this barrier as they produce and secrete cell‐wall‐degrading enzymes. Expression profiling of various life stages of the potato cyst nematode Globodera rostochiensis revealed a novel pectate lyase gene (Gr‐pel2, 759 bp). The Gr‐PEL2 protein showed highest similarity to pectate lyases from the facultative plant‐parasitic nematodes Bursaphelenchus mucronatus and B. xylophilus and the soil‐inhabiting saprophytic Streptomyces and Frankia species (i.e. 40–42% identity and 58–60% similarity), whereas only a remote relatedness to the previously identified Gr‐PEL1 was observed (i.e. 28% identity and 43% similarity). Transient expression of Gr‐pel2 in leaves of Nicotiana benthamiana resulted in severe malformations of the infiltrated tissues, not relating to maceration and soft rot symptoms. Ca2+ is known to be essential for pectate lyase activity, and the most likely calcium‐binding site was identified in the Gr‐PEL2 protein by combining homology modelling of the three‐dimensional structure, site‐directed mutagenesis and transient expression in leaves. A highly charged cleft in Gr‐PEL2, which is likely to be involved in substrate binding and which is also significantly more hydrophobic in Gr‐PEL1, was shown to be essential for protein activity. Our results underline the broad spectrum of pectate lyases and cell‐wall‐degrading enzymes necessary for successful parasitism by cyst nematodes.
Molecular and cytological responses of Medicago truncatula to Erysiphe pisi
Authors: FOSTER‐HARTNETT DAWN , DANESH DARIUSH , PEÑUELA SILVIA , SHAROPOVA NATASHA , ENDRE GABRIELLA , VANDENBOSCH KATHRYN A. , YOUNG NEVIN D. , SAMAC DEBORAH A. 
Published: April 2007

SUMMARYPowdery mildew is an economically important disease in a number of crop legumes; however, little is known about resistance to the disease in these species. To gain a better understanding of the genetics of resistance and plant responses to powdery mildew in legumes, we developed a pathosystem with Medicago truncatula and Erysiphe pisi. Screening accessions of M. truncatula identified genotypes that are highly susceptible, moderately resistant and highly resistant to the fungus. In the highly resistant genotype, fungal growth was arrested after appressorium development with no colony formation, while in the moderately resistant genotype a small number of colonies formed. Both resistant and moderately resistant genotypes produced hydrogen peroxide and fluorescent compounds at pathogen penetration sites, consistent with a hypersensitive response (HR), although the response was delayed in the moderately resistant genotype. Very little hydrogen peroxide or fluorescence was detected in the susceptible accession. Microarray analysis of E. pisi‐induced early transcriptional changes detected 55 genes associated with the basal defence response that were similarly regulated in all three genotypes. These included pathogenesis‐related genes and other genes involved in defence, signal transduction, senescence, cell wall metabolism and abiotic stress. Genes associated with the HR response included flavonoid pathway genes, and others involved in transport, transcription regulation and signal transduction. A total of 34 potentially novel unknown genes, including two legume‐specific genes, were identified in both the basal response and the HR categories. Potential binding sites for two defence‐related transcription regulators, Myb and Whirly, were identified in promoter regions of induced genes, and four novel motifs were found in promoter regions of genes repressed in the resistant interaction.
Results of primary percutaneous coronary intervention in a consecutive group of patients with acute ST elevation myocardial infarction at a tertiary Australian centre
Authors: Van Gaal W. J. , Clark D. , Barlis P. , Lim C. C. S. , Johns J. , Horrigan M. 
Published: April 2007

AbstractBackground: Multicentre randomized controlled trials (RCT) of primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) have consistently shown lower mortality compared with fibrinolysis, if carried out in a timely manner. Although primary PCI is now standard of care in many centres, it remains unknown whether results from RCT of selected patients are generalizable to a ‘real‐world’ Australian setting. The primary goal of this study was to evaluate whether a strategy of routine invasive management for patients with STEMI can achieve 30‐day and 12‐month mortality rates comparable with multicentre RCT. Secondary goals were to determine 30‐day mortality rates in prespecified high‐risk subgroups, and symptom‐onset‐ and door‐to‐balloon‐inflation times.Methods: A retrospective observational study of 189 consecutive patients treated with primary PCI for STEMI in a single Australian centre performing PCI for acute STEMI.Results: All‐cause mortality was 6.9% at 30 days, and 10.4% at 12 months. Mortality in patients presenting without cardiogenic shock was low (2.4% at 30 days; 5.0% at 12 months), whereas 12‐month mortality in patients with shock was higher, particularly in the elderly (29.4% for patients <75 years; 85.7% for patients ≥75 years, P = 0.01). Symptom‐onset‐to‐balloon‐inflation time was ≤4 h in 56% of patients (median 231 min); however, a door‐to‐balloon time of <90 min was achieved in only 20% (median 133 min).Conclusion: Mortality and symptom‐onset‐to‐balloon‐inflation times reported in RCT of primary PCI for STEMI are generalizable to ‘real‐world’ Australian practice; however, further efforts to reduce door‐to‐balloon times are required.