bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term results of artificial bowel sphincter for the treatment of severe faecal incontinence. Are they what we hoped for?
Authors: Ruiz Carmona M. D. , Alós Company R. , Roig Vila J. V. , Solana Bueno A. , Pla Martí V. 
Published: July 2008

AbstractObjective  This study evaluates the long‐term morbidity, functional results and quality of life (QOL) after treatment of severe faecal incontinence (FI) with the Acticon® Neosphincter (American Medical Systems, Minneapolis, Minnesota, USA).Method  Between 1996 and 2002, 17 consecutive patients (14 female, 3 male; median age 46) underwent sphincter implantation. Clinical evaluation, incontinence severity and QOL were assessed. Anorectal manometry, endoanal ultrasound and pudendal nerve latency were performed preoperatively and at several stages of follow‐up. The study was completed in December 2007.Results  Mean follow‐up was 68 months (range: 3–133). Morbidity occurred in 100% of patients from which 65% required at least one re‐operation. After the first implant, 11 devices had to be removed (65%). Seven patients had a new implant. At the final stage, Acticon® was activated in 9 cases (53%). Severity of FI improved from a median of 17.5 preoperatively to 9 (P = 0.005), 5.5 (P = 0.005) and 10 (P = 0.092) at 6, 12 months and at the end of follow‐up, respectively. There was a significant improvement in QOL in all postoperative controls (P < 0.05). Severity of FI did not show a correlation with QOL in the preoperative period, but did at 6, 12 months and at the end of follow‐up. Mean maximum resting pressure significantly increased with the full anal cuff.Conclusion  There is a high rate of morbidity, surgical re‐interventions and explants after Acticon® implant. Patients should be clearly informed about this before surgery. However, patients who have not had Acticon® Neosphincter explanted, experience a significant improvement in anal continence and QOL.
Role of anorectal manometry in children with severe constipation
Authors: Noviello C. , Cobellis G. , Papparella A. , Amici G. , Martino A. 
Published: July 2008

AbstractObjective  Constipation is one of the most frequent disorders of the digestive tract in children and it can be an important problem in paediatric and surgical practice. Most of the time, the cause is psychological or because of a slowing of colonic transit, but it can be a sign of organic gastrointestinal outlet obstruction. Some patients with chronic constipation are resistant to a medical approach and they present with a severe form of constipation that needs recurrent hospital admission. Anorectal manometry (ARM) is a noninvasive procedure and it helps to explain the mechanisms of defecation disorders. The aim of the present study was to evaluate the role of ARM in children with severe constipation.Method  From October 2003 to October 2006, in the Paediatric Surgery Unit, 85 children – aged more than 1 year – with severe constipation were seen. The mean age was 5 years (range, 1–13). At presentation, every child had abdominal and rectal examination in order to identify abdominal distension or faecal masses. Bowel preparation with enemas was performed before ARM in patient with a rectal faecaloma. Myoelectric activity of the internal anal sphincter and resting anal tone was recorded; recto‐anal inhibitory reflex (RAIR) was tested to exclude Hirschsprung’s disease (HD). Anal tone was considered normal until 50 cm H2O. When the RAIR was absent, the patient underwent rectal suction biopsies (RSB) for histology and acetylcholinesterase histochemistry. In cases of normal or high anal tone with the RAIR present, the child had bowel cleaning, medical treatment, 2‐ and 6‐month follow‐up. Children with ineffective treatment at follow‐up underwent RSB. In case of HD, a laparoscopic‐assisted endorectal pull‐through (ERPT) according to Georgeson’s technique was performed.Results  Seventy per cent of the patients had bowel preparation before ARM. In four patients the ARM was impossible to assess because of crying. In 28 patients, the anal tone result was higher than 50 cm H2O and local treatment with anaesthetic agents was used for 8 weeks. Seventeen patients underwent RSB: 11 patients with RAIR absent/unclear, 4 noncooperative children and 2 patients with ineffective medical treatment at follow‐up. HD was diagnosed in 2 patients and laparoscopic‐assisted ERPT was performed. The remaining patients had good results at 6‐month follow‐up.Conclusion  ARM is a noninvasive diagnostic tool to study the mechanism of defecation in children with constipation in order to prescribe the appropriate treatment. This procedure can be used in every child – aged more than 1 year – with severe constipation and assessment of the RAIR can select the cases for RSB.
Genital system anatomy and development of Ovatella myosotis by three‐dimensional computer visualization
Authors: Ruthensteiner Bernhard , Stocker Bettina 
Published: July 2008

AbstractAdult anatomy as well as organogenesis of the genital system of the ellobiid pulmonate Ovatella myosotis is investigated in detail by means of serial sectioning and three‐dimensional computer reconstruction and visualization. From the middle portion of the adult, which has four nidamental glands, a spermoviduct leads to a common genital aperture. From here two separate structures, the vas deferens and a groove on the body surface, lead anteriorly. The latter is termed the egg groove because it carries the egg ribbon anteriorly, a function that is recognized here for the first time in the Ellobiidae. The evolution of this structure is discussed. In development, the organ system arises from four separate anlagen: (1) the ovotestis anlage, (2) the pallial anlage giving rise to the hermaphrodite duct, fertilization pouch–spermatheca complex, nidamental glandular complex and spermoviduct, (3) the bursa copulatrix anlage and (4) the anlage of the copulatory organ, vas deferens and egg groove. This development mode strongly resembles that of the siphonariid Williamia radiata, supporting its interpretation as a plesiomorphy in Pulmonata. Similarities in development of primitive pulmonates and evolution in gastropods lead to the assumption that ontogenesis of this organ system reflects evolution to some degree.
Morphological variation of the five vole species of the genus Microtus (Mammalia, Rodentia, Arvicolinae) occurring in Greece
Authors: Fraguedakis‐Tsolis Stella E. , Chondropoulos Basil P. , Stamatopoulos Costas V. , Giokas Sinos 
Published: July 2008

AbstractMorphometric data for the five vole species of the genus Microtus living in Greece are old, sparse, poor and insufficiently analysed. This work aims to give the first comprehensive morphometric analysis of body and skull inter‐ and intraspecific variation for M. (M.) guentheri, M. (M.) rossiaemeridionalis, M. (Terricola) subterraneus, M. (T.) felteni and M. (T.) thomasi, applying multivariate statistics to 28 linear morphometric variables. It was based on ample material (202 adult individuals) using samples from localities that adequately cover the entire distributional range of each species in Greece. The five species and the two subgenera (Microtus and Terricola) were morphometrically clearly distinguished and discriminating variables were revealed. However, morphometrics did not provide robust criteria to infer phylogenetic relations among species. Furthermore, three species, M. (M.) guentheri, M. (M.) rossiaemeridionalis and M. (T.) thomasi, exhibited considerable intraspecific size or shape variation, which was mostly random and not associated with geographical proximity. Comparisons with data in the literature, mainly concerning populations of these species from adjacent areas, indicate that the Greek M. (M.) guentheri, M. (M.) rossiaemeridionalis and M. (T.) thomasi tend to be smaller than their conspecifics, while M. (T.) subterraneus and M. (T.) felteni are about equal in size to their Balkan relatives.
Low‐acrylamide French fries and potato chips
Authors: Rommens Caius M. , Yan Hua , Swords Kathy , Richael Craig , Ye Jingsong 
Published: July 2008

SummaryAcrylamide is produced in starchy foods that are baked, roasted or fried at high temperatures. Concerns about the potential health issues associated with the dietary intake of this reactive compound led us to reduce the accumulation of asparagine, one of its main precursors, in the tubers of potato (Solanum tuberosum). This metabolic change was accomplished by silencing two asparagine synthetase genes through ‘all‐native DNA’ transformation. Glasshouse‐grown tubers of the transformed intragenic plants contained up to 20‐fold reduced levels of free asparagine. This metabolic change coincided with a small increase in the formation of glutamine and did not affect tuber shape or yield. Heat‐processed products derived from the low‐asparagine tubers were also indistinguishable from their untransformed counterparts in terms of sensory characteristics. However, both French fries and potato chips accumulated as little as 5% of the acrylamide present in wild‐type controls. Given the important role of processed potato products in the modern Western diet, a replacement of current varieties with intragenic potatoes could reduce the average daily intake of acrylamide by almost one‐third.
Psychosocial Precursors and Correlates of Differing Internalizing Trajectories from 3 to 15 Years1
Authors: Letcher Primrose , Smart Diana , Sanson Ann , Toumbourou John W. 
Published: July 2008

AbstractPsychosocial precursors and correlates of parent‐reported internalizing behavior trajectories across the age span of 3–15 years were explored using a community‐based cohort of Australian children. Six internalizing trajectories had previously been identified for both girls (N = 810) and boys (N = 874) in this sample, comprising stable low, high, decreasing, and increasing pathways. Infancy and toddler temperamental traits (inhibition/shyness, irritability), behavior problems, and parent–child relationship difficulties constituted significant risks for subsequent problematic internalizing profiles. Several gender‐specific trends were evident, with temperamental reactivity and shyness, less optimal parenting, and peer difficulties more salient for girls on increasing trajectories whereas externalizing problems were more prominent among boys on increasing trajectories. Factors associated with recovery from elevated symptoms included higher levels of social competence, better parent and peer relations, and more positive school adjustment. Findings suggest that individual characteristics and relationship experiences may be involved in the development and course of internalizing problems.
Mainland Chinese Adolescents' Judgments and Reasoning about Self‐determination and Nurturance Rights
Authors: Lahat Ayelet , Helwig Charles C. , Yang Shaogang , Tan Dingliang , Liu Chunqiong 
Published: July 2008

AbstractYounger (13 years) and older (17 years) adolescents (N = 160) from urban and rural China responded to written scenarios in which children's rights to self‐determination and nurturance conflicted with the desires of authorities. They also evaluated scenarios in which children's desire to exercise self‐determination was in conflict with their own welfare interests (nurturance). Older participants and those from urban settings were more likely than younger participants and those from rural settings to endorse self‐determination, both when in conflict with authority and nurturance. When supporting self‐determination, participants appealed to individual rights, autonomy, and personal choice in their justifications. The findings indicate that concepts of diverse types of rights are maintained by adolescents from both modern and traditional settings in China.
Access Intervention in an Integrated, Prepaid Group Practice: Effects on Primary Care Physician Productivity
Authors: Conrad Douglas , Fishman Paul , Grembowski David , Ralston James , Reid Robert , Martin Diane , Larson Eric , Anderson Melissa 
Published: July 2008

Objective. To estimate the joint effect of a multifaceted access intervention on primary care physician (PCP) productivity in a large, integrated prepaid group practice.Data Sources. Administrative records of physician characteristics, compensation and full‐time equivalent (FTE) data, linked to enrollee utilization and cost information.Study Design. Dependent measures per quarter per FTE were office visits, work relative value units (WRVUs), WRVUs per visit, panel size, and total cost per member per quarter (PMPQ), for PCPs employed >0.25 FTE. General estimating equation regression models were included provider and enrollee characteristics.Principal Findings. Panel size and RVUs per visit rose, while visits per FTE and PMPQ cost declined significantly between baseline and full implementation. Panel size rose and visits per FTE declined from baseline through rollout and full implementation. RVUs per visit and RVUs per FTE first declined, and then increased, for a significant net increase of RVUs per visit and an insignificant rise in RVUs per FTE between baseline and full implementation. PMPQ cost rose between baseline and rollout and then declined, for a significant overall decline between baseline and full implementation.Conclusions. This organization‐wide access intervention was associated with improvements in several dimensions in PCP productivity and gains in clinical efficiency.
Specialty and Full‐Service Hospitals: A Comparative Cost Analysis
Authors: Carey Kathleen , Burgess James F. , Young Gary J. 
Published: July 2008

Objective. To compare the costs of physician‐owned cardiac, orthopedic, and surgical single specialty hospitals with those of full‐service hospital competitors.Data Sources. The primary data sources are the Medicare Cost Reports for 1998–2004 and hospital inpatient discharge data for three of the states where single specialty hospitals are most prevalent, Texas, California, and Arizona. The latter were obtained from the Texas Department of State Health Services, the California Office of Statewide Health Planning and Development, and the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. Additional data comes from the American Hospital Association Annual Survey Database.Study Design. We identified all physician‐owned cardiac, orthopedic, and surgical specialty hospitals in these three states as well as all full‐service acute care hospitals serving the same market areas, defined using Dartmouth Hospital Referral Regions. We estimated a hospital cost function using stochastic frontier regression analysis, and generated hospital specific inefficiency measures. Application of t‐tests of significance compared the inefficiency measures of specialty hospitals with those of full‐service hospitals to make general comparisons between these classes of hospitals.Principal Findings. Results do not provide evidence that specialty hospitals are more efficient than the full‐service hospitals with whom they compete. In particular, orthopedic and surgical specialty hospitals appear to have significantly higher levels of cost inefficiency. Cardiac hospitals, however, do not appear to be different from competitors in this respect.Conclusions. Policymakers should not embrace the assumption that physician‐owned specialty hospitals produce patient care more efficiently than their full‐service hospital competitors.
Comparing the Performance of Tree Stakes and Seedlings to Restore Abandoned Tropical Pastures
Authors: Zahawi Rakan A. , Holl Karen D. 
Published: July 2008

Abstract Tree seedlings are commonly planted to restore abandoned agricultural lands, whereas vegetative plantings have received little study. We evaluated the ability of 10 tree species to establish and survive over 3 years by planting 2‐m‐tall vegetative stakes at three sites in southern Costa Rica. We quantified above‐ and belowground stake and seedling biomass for two species (Erythrina poeppigiana and Gliricidia sepium) after 1 year and canopy cover and height of E. poeppigiana stakes and saplings at 3 years. We also compared economic, logistical, and ecological advantages of each methodology. Erythrina poeppigiana and E. berteroana had the highest number of live stakes by the study’s conclusion (>90%) and were among species with largest canopies. Most others ranged between 40 and 70% with highly site‐specific survival and growth rates, whereas three species did poorly. Four species developed fruit by year 3, including Ficus pertusa and Acnistus arborescens, that are consumed by frugivores. Above‐ and belowground biomass was 7–50 times greater in stakes (65–125 g) than seedlings (2–15 g). Stake roots were considerably more extensive and reached lengths more than 6 m. Erythrina poeppigiana stakes had higher canopy cover than saplings after 3 years but not height. Seedlings are 2–10 times more expensive to establish, although transporting stakes is more cumbersome and the suite of species that establish vegetatively is limited. This underused technique should be included in the growing repertoire of tropical forest restoration tools. Given tradeoffs in propagation methods, a combination is likely to be most efficient and successful.
Sawdust Addition Reduces the Productivity of Nitrogen‐Enriched Mountain Grasslands
Authors: Spiegelberger T. , Müller‐Schärer H. , Matthies D. , Schaffner U. 
Published: July 2008

Abstract Anthropogenic nutrient enrichment of mountain grasslands has boosted grasses and fast‐growing unpalatable plants at the expense of slow‐growing species, resulting in a significant loss in biodiversity. A potential tool to reduce nutrient availability and aboveground productivity without destroying the perennial vegetation is carbon (C) addition. However, little is known about its suitability under severe climatic conditions. Here, we report the results of a 3‐year field study assessing the effects of sawdust addition on soil nutrients, aboveground productivity, and vegetational composition of 10 grazed and ungrazed mountain grasslands. Of particular interest was the effect of C addition on grasses and on the tall unpalatable weed Veratrum album. After 3 years, soil pH, ammonium, and plant‐available phosphorus were not altered by sawdust application, and nitrate concentrations were marginally higher in treatment plots. However, the biomass of grasses and forbs (without V. album) was 20–25% lower in sawdust‐amended plots, whereas the biomass of V. album was marginally higher. Sawdust addition reduced the cover of grasses but did not affect evenness, vegetation diversity, or plant species richness, although species richness generally increased with decreasing biomass at our sites. Our results suggest that sawdust addition is a potent tool to reduce within a relatively short time the aboveground productivity and grass cover in both grazed and ungrazed mountain grasslands as long as they are not dominated by tall unpalatable weeds. The technique has the advantage that it preserves the topsoil and the perennial soil seed bank.
Responses of Plant Communities to Incremental Hydrologic Restoration of a Tide‐Restricted Salt Marsh in Southern New England (Massachusetts, U.S.A.)
Authors: Smith Stephen M. , Roman Charles T. , James‐Pirri Mary‐Jane , Chapman Kelly , Portnoy John , Gwilliam Evan 
Published: July 2008

Abstract Hydrologic restoration of Hatches Harbor, a tide‐restricted marsh on Cape Cod (Massachusetts), has resulted in significant plant community changes 7 years following the reintroduction of seawater. Since 1999, incremental increases in flow through a tide‐restricting dike have facilitated the rapid decline of salt‐intolerant vegetation, while encouraging the expansion of native salt marsh taxa. These changes show strong spatial gradients and are correlated with marsh surface elevation, distance from the point of seawater entry, and porewater salinity. Common reed (Phragmites australis) has not decreased in abundance but has migrated a considerable distance upslope. In the wake of this retreat native halophytes have proliferated. Now that maximum flow through the existing dike structure has been reached, continued recovery may be limited less by changing physicochemical conditions and more by rates of growth, seed dispersal, and seed germination of salt marsh taxa.
High Dose Transdermal Buprenorphine for Moderate to Severe Pain in Spanish Pain Centres—A Retrospective Multicenter Safety and Efficacy Study
Authors: Barutell Carlos , Camba Alberto , González‐Escalada José‐Ramón , Rodríguez Manuel ,   the Opioid Group of the Spanish Society for the Study of Pain
Published: July 2008

▪ AbstractObectives:  To assess the effectiveness of transdermal buprenorphine in patients suffering from moderate to severe pain. Secondary objectives included gathering information about the causes of pain, management of episodic pain, and the safety profile.Methods:  Retrospective data were collected from 1,465 patients with moderate to severe pain, ie, ≥50 mm on a 0 to 100 mm visual analog scale (VAS), that were switched to transdermal buprenorphine, and received a dose ≥52.5 μg/hour for at least 14 days during the previous 12 months. Pain could have any etiology. Most patients (72.1%) were on tramadol and/or paracetamol (40.7%) before switching to buprenorphine. Using case report forms, efficacy was determined from changes in VAS score compared with 24 hours prior to the first patch application. Safety was evaluated by retrieving information about the nature and incidence of adverse events (AE), whether they were related to the study compound, and the percentage considered being serious.Results:  An absolute reduction of 25.1 points in VAS score was seen over a median period of 3.7 months treatment. In addition, the VAS score was reduced by at least 10% in 88.4% of patients and the incidence of episodic pain fell significantly. Treatment was rated as “Good” or “Very Good” by 82.5% of patients. Out of 1,465 patients, 50.2% experienced an AE; this was related to the drug in 48.8%, and considered serious in 4.0%.Conclusions:  Transdermal buprenorphine was an effective and considerably safe drug for relieving chronic moderate to severe pain. ▪
The Fifth Vital Sign—What Does It Mean?
Authors: Walid Mohammad Sami , Donahue Stephen N. , Darmohray Dana M. , Hyer Jr Leon A. , Robinson Jr Joe Sam 
Published: July 2008

AbstractAcute pain is reported as a presenting symptom in over 80% of physician visits. Chronic pain affects an estimated 76.2 million Americans—more than diabetes, heart disease, and cancer combined. It has been estimated to be undertreated in up to 80% of patients in some settings. Pain costs the American public more than $100 billion each year in health care, compensation, and litigation. That's why pain was officially declared “The Fifth Vital Sign.” Henceforth the evaluation of pain became a requirement of proper patient care as important and basic as the assessment and management of temperature, blood pressure, respiratory rate, and heart rate. The numeric pain scale certainly has a place in care and in pain management; however, it is important to assess the patient's communication and self‐management style and to recognize that patients, like pain, are on a continuum with varied styles of communication and adaptation. It is easy to get lost in the process, even when the process is initiated with the best of intentions. In the quest for individualized medicine, it might be best to keep pain assessment in the individualization arena.