bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tensions and dilemmas of social work education in China
Authors: Yip Kam-shing 
Published: December 2006

English Social work education in China has developed dramatically over the past decade. However, because of its unique social, cultural and political back-ground and contexts, its current and future development faces tensions associated with politicization, professionalization and commercialization in the fields of values, social service delivery, social work practice and curriculum development. French L'enseignement du travail social a pris un essor considérable en Chine au cours de la dernière décennie. Toutefois, compte tenu du caractère unique des dimensions sociales, politiques et culturelles du contexte chinois, son développement actuel et futur fait face à des tensions liées à la politicisation, la professionnalisation et la commercialisation au plan des valeurs, de l'offre des services sociaux, de même qu'aux plans de la pratique du service social et de son développement. Spanish La educación en trabajo social en China se ha desarrollado dramáticamente durante la década pasada. Sin embargo, en virtud de sus antecedentes y contextos sociales, culturales y políticos únicos, su desarrollo actual y futuro enfrenta tensiones asociadas con la politizacíon, profesionalizacíon y comercializacíon en los valores, el otorgamiento de servicios sociales, la práctica del trabajo social y el desarrollo del currículum.
A retrospective review of place of death of palliative care patients in regional north Queensland
Authors: Howat A , Veitch C , Cairns W 
Published: December 2006

Background: Palliative care strives to offer patients and their families choice in the location of their management and final terminal care. The place of death has been shown to be related to various patient, carer and health service factors. Aim: This study explores place of death of palliative care patients in regional north Queensland, and investigates which patient, disease, and other factors impact on place of death. Methods: All patients under the care of the specialist Palliative Care Service (PCS) at The Townsville Hospital, who died in 2004, were identified. Medical charts for these patients were analysed for various demographic data, disease-related information and place of death. Results: Some 270 patients were analysed. A total of 162 were male, median age was 72 years, and 146 (54%) were married. Home death rate was 19% (54 patients), with 64% (173) of patients dying in hospital. Factors significantly associated with home death included younger age, married, a diagnosis of colorectal carcinoma, and the involvement of community nurses. There was a trend towards male patients being more likely to die at home. Logistic regression analysis indicated that younger age and community nurse involvement were significantly associated with home death. Discussion: The results of this study are in keeping with available, largely urban-based literature, with respect to predictive factors of home death. Further prospective study, with an emphasis on choice regarding place of care and GP involvement with palliative care patients, is warranted.
Improving the delivery of palliative care in general practice: an evaluation of the first phase of the Gold Standards Framework
Authors: Thomas Keri , Noble Bill 
Published: December 2006

Background: The Gold Standards Framework (GSF) was developed to improve the delivery of palliative care in general practice. Aim: The aim of the study was to evaluate the first phase of GSF in terms of its acceptability to primary care teams, effectiveness in changing practice and professionals’ views on the consequences for patient care. Methods: A prospective longitudinal comparative survey of 12 participating, 12 matched and 18 other practices included focus groups and questionnaires. Results: Participating practices reported that the GSF was acceptable. They also reported more standards successfully achieved than matched practices. Registers, team meetings and co-ordinated care were thought to have improved communication, teamwork, patient identification, assessment and care planning. Conclusions: This small study suggests that the GSF appears to be acceptable and its early introduction to a few teams appears to have changed practice. Participants were positive about the effect on care. An evaluation of national uptake and further research into clinical outcomes is required.
Prevalence of pain in hospitalised cancer patients in Norway: a national survey
Authors: Holtan Anders , Aass Nina , Nordøy Tone , Haugen Dagny Faksvåg , Kaasa Stein , Mohr Wenche , Kongsgaard Ulf E 
Published: December 2006

Purpose: Pain severely impairs health-related quality of life and is a feared symptom among cancer patients. Unfortunately, patients often do not receive optimal care. We wanted to evaluate the quality of cancer pain treatment in Norwegian hospitals. Patients and methods: A one-day prevalence study targeting hospitalised cancer patients above 18 years of age was performed. A questionnaire based on the Brief Pain Inventory was used, and additional information regarding sex, age, diagnosis, break through pain (BTP), and treatment was included. Results: Fifty two percent of the included patients stated having cancer related pain (n = 453), and mean pain during the previous 24 hours for these patients was NRS 3.99 (Numeric Rating scale 1-10). Presence of metastasis, occurrence of BTP, and abnormal skin sensibility in the area of pain were associated with higher pain scores. Forty two percent of all patients used opioids. However, these patients still had higher pain scores, more episodes of BTP, and more influence of the pain on daily life functions than average. Thirty percent of patients with severe pain (NRS ≥ 5) did not use opioids, and some of these patients did not receive any analgesics at all. Conclusion: Although most cancer patients receive an acceptable pain treatment in Norwegian hospitals, there are patients who are not adequately managed. Lack of basic knowledge and individual systematic symptom assessment may be reasons for the underuse of analgesics and the resulting unnecessary suffering among the cancer patients.
Dying in hospital of terminal heart failure or severe dementia: the circumstances associated with death and the opinions of caregivers
Authors: Formiga Francesc , Olmedo Claudia , López-Soto Alfons , Navarro Margarita , Culla Alex , Pujol Ramón 
Published: December 2006

Background: Improving the care provided to elderly patients affected by end-stage chronic diseases dying in acute hospitals is a health priority. We evaluated the circumstances related to death in end-stage non-cancer patients dying in two acute care hospitals, and their caregiver’s opinions about the death. Methods: Some 102 patients, over 64 years of age, with end-stage dementia (37%) or congestive heart failure (64%), were included in the study. Caregiver’s opinions on the circumstances of death were obtained using a questionnaire. In addition, we collected data regarding written instructions on several items, including do not resuscitate (DNR) orders, decisions about care in terms of the level or intensity of interventions, information provided to relatives about the prognosis, total withdrawal of normal drug therapy, and provision of palliative care. Results: Caregivers stated that the clinical information was accurate in 67.6% of cases, and the control of symptoms was good in 55%. However, the perception of pain persisted in 14% and uncontrolled dyspnoea in 45%. The end-of-life care was assessed as: excellent 30.5%, good 36%, fairly good 25.5%, bad 6%, and very bad 2%. DNR orders were specified in 89% of patients, decisions concerning the intensity of care in 64%, and 80% of relatives were aware of the prognosis. Drug therapy was withdrawn in 64% of cases, and terminal palliative care was initiated in 79.5%. Conclusion: Our results suggest that some aspects of the palliative care provided to elderly patients with end-stage chronic diseases, admitted to acute care hospitals, could be improved. Such aspects include the clinical information provided and the successful control of specific symptoms.
A Reliable Plain Solution for Rectangular Plates with Piezoceramic Patches
Authors: Edery-Azulay Lucy , Abramovich Haim 
Published: December 2006

The present study investigates the behavior of a laminated composite plate with embedded or bonded piezoelectric materials. An exact mathematical model based on Reissner—Mindlin theory for plates (FSDT) has been developed for laminated composite plates with continuous piezoelectric layers. The flexural behavior has been solved based on Levy's method for plates. Therefore, the study has been limited to obtain exact solutions only for the cases of plates with at least two opposite simply supported edges, and only continuous piezoelectric layers. For a plate with piezoelectric patches, an approximate energy solution is presented, using Reissner—Mindlin theory, where the lateral displacement and the two bending rotations are expressed as infinite series. The point of merit for this model is its simplicity and reliability (depending on the number of terms) to solve a plate with any required boundary conditions and lay-ups. Furthermore, this model can be easily adapted to solve piezo-composite plates with an unlimited number of piezoelectric patches in arbitrary locations over the plate. A comprehensive parametric investigation has been performed to study the behavior of a plate actuated by extension or shear piezoelectric mechanisms. This investigation has been performed to yield results for plates with various boundary conditions and arbitrary patch locations.
Acute fingertip injuries
Authors: Chakravarthy J , Qureshi A , Waldram M A , Porter K 
Published: December 2006

The nail is unique to primates as a specialized structure on the dorsum of the distal portion of each finger, thumb and toe. The nail allows for increased sensory perception on the volar pulp by compressing sensory organs against the unyielding nail. The nail is vital for increased prehension which is so unique in primate function. In addition it protects the fingertip and also serves as a temperature regulator. Fingertips are often our first contact with the environment, are one of the most common injuries presenting to a hand surgeon and may seriously impair the abilities of individuals if injured. The fingertip is the most sensitive part of the hand and has a large area of representation in the sensory cortex. The severity of injury to the nail bed is commonly underestimated because the nail conceals the true extent of injury. The consequences of mismanaged fingertip injuries is often manifest in the form of chronic nail and fingertip deformities, which are more difficult to treat than the original injury. It is therefore important for junior doctor to competently assess the patient, appreciate the potential disabilities and to arrange prompt referral to a hand unit. This article discusses the relevant anatomy, physiology and management of acute perionychial injuries.
The other side of clinical trial monitoring; assuring data quality and procedural adherence
Authors: Williams George W 
Published: December 2006

BackgroundData monitoring can mean different things. It can mean statistical methodologies for clinical trial monitoring, interim data analysis, monitoring for quality control or assurance or safety reporting to regulatory agencies. PurposeThe various facets of data monitoring will be discussed and reviewed from primarily an industry perspective. MethodsBy careful attention to the design and conduct of a clinical trial, the expense of monitoring can be markedly reduced. Careful attention should be given to the qualifications of investigators in the selection of clinical sites and central facilities. Site personnel must be adequately trained. The sponsor should utilize appropriately qualified individuals to supervise the overall conduct of the trial. The monitor should visit the investigator at the site of the investigation frequently enough to ensure acceptable quality. The monitor is responsible for inspecting the case report forms at regular intervals. Quality control should be applied to each stage of data handling to ensure that all data are reliable and have been processed correctly. The auditor will assess whether the site is being monitored in accordance with the monitoring plan. The determination of the extent and nature of monitoring should be based on considerations such as the objective, design and complexity of the trial. Statistical sampling may be an acceptable method for selecting the data to be verified. The monitor should ensure that adverse events are reported. Study data will be monitored on an ongoing basis to ensure patient safety. The sponsor may utilize a Data Monitoring Committee to protect the validity of a trial. ConclusionsDiscussions between industry, academia and regulatory groups regarding the optimal extent and methods for monitoring of clinical trials are encouraged.
Cost-effectiveness as an outcome in randomized clinical trials
Authors: Hlatky Mark A , Owens Douglas K , Sanders Gillian D 
Published: December 2006

BackgroundEconomic outcomes are now included in many contemporary randomized trials and provide an additional dimension to the assessment of interventions. Economic data collection and analysis pose several methodologic challenges, however. PurposeThis paper reviews methods of incorporating economic outcomes in clinical trials. ResultsData on medical resource utilization and cost can readily be collected along with data on clinical outcomes. The cost of planned interventions can be measured with reasonable accuracy, but costs due to unplanned clinical events are more difficult to measure reliably. The total cost depends critically on these relatively infrequent, yet costly, adverse outcomes, which may partially, or even completely, offset any difference between the planned costs of the randomized therapies. Newer therapies are typically more expensive than older therapies, so the most important question is whether patient outcomes are improved sufficiently to justify the added expense. Cost-effectiveness analysis helps gauge the value provided by a new therapy. The cost-effectiveness of an intervention compared with an alternative is defined as the ratio of the incremental costs and the incremental clinical benefits, measured as dollars per quality-adjusted life-year added. The follow-up period in most clinical trials is generally long enough to measure the added cost of therapy, but may not capture the full benefits of treatment. The limited time horizon of clinical trials makes it necessary to use a model to extrapolate the observed effect of treatment and project the increase in life expectancy. The resulting cost-effectiveness ratio is sensitive to assumptions about the long-term efficacy of treatment, particularly whether the treatment effect will continue or dissipate over time. ConclusionEconomic outcomes can be measured alongside clinical outcomes in randomized trial. While the use of cost-effectiveness models falls outside the strictly empirical, within-trial analysis framework that is embraced by most clinical trialists, it provides an explicit approach to assessing whether the intervention under study provides a clinically meaningful improvement in outcome that is worthwhile.
Cost-effectiveness analyses alongside randomised clinical trials
Authors: Gray Alastair M 
Published: December 2006

BackgroundMany health economists increasingly advocate the use of model-based evaluations rather than trial-based evaluations. PurposeThe purpose of this paper is to review the merits and limitations of RCT-based evaluations of cost-effectiveness. ResultsThe paper draws on the examples of large studies such as the United Kingdom Prospective Diabetes Study and the Heart Protection Study to suggest that large randomised trials offer a number of advantages to health economists wishing to estimate cost-effectiveness, including access to patient-level data, unbiased estimates of resource use as well as effects, the estimation of cost-effectiveness in sub-groups of patients, and an enhanced ability to build and validate extrapolation models. ConclusionsWhile many methodological issues remain to be resolved, the use of patient-level data derived from clinical trials as a basis for economic evaluations is likely to remain an important part of the health economics evidence base, and will also continue to provide the data required for methodological research.
Clinical trials bureaucracy: unintended consequences of well-intentioned policy
Authors: Califf Robert M 
Published: December 2006

BackgroundAs randomized controlled trials have become the ‘gold standard’ for medical research, a complex regulatory structure for the conduct of clinical trials has emerged. However, this structure has not been adequately assessed to ensure that regulations governing human subjects research actually produce the desired effects. PurposeOur purpose is to identify some of the major shortcomings in the current regulatory system of human clinical trials oversight, and to propose some potential solutions to these problems. MethodsWe discuss the evolution of the current US regulatory environment and its application in the context of several widely-used drug therapies. ResultsDespite numerous randomized controlled trials, performed within a structure of extensive documentation and data collection, serious shortcomings in a number of pharmaceutical therapies were not detected until after the drugs were approved and widely adopted by clinicians. ConclusionThe current system of regulatory bureaucracy in clinical trials has led to an extremely expensive research paradigm that, in spite of complex systems of oversight and exhaustive data collection, cannot be shown to adequately ensure the integrity of the research process and the protection of human research subjects. Some parts of the system, including Research Ethics Review Boards, may not be well-suited to carrying out their core mission of overseeing research conduct, and other aspects of clinical trials regulatory structure, such as monitoring/auditing review and adverse event reporting, may constitute a waste of money and resources. Misdirected data collection and adverse events reporting divert valuable resources and hamper development of large, simple clinical trials powered to definitively answer important research questions. Careful scrutiny of the utility of current or proposed regulatory schemes is required to ensure the integrity of human subjects research and to enhance the effectiveness of research dollars.
Generalizing results of randomized trials to clinical practice: reliability and cautions
Authors: Flather Marcus , Delahunty Nicola , Collinson Julian 
Published: December 2006

BackgroundWell designed randomized controlled trials provide reliable evidence of treatment effects, but there is no consensus on how best to apply these results to clinical practice. The main concerns are that populations enrolled in trials are more selected than those treated in a clinical setting, and whether the treatment effects observed in trials will also be observed in clinical practice. MethodsAn informal literature review was undertaken to find studies analysing the issue of generalizing trial results (external validity) to clinical practice. ResultsMost of the studies focused on differences in patients characteristics (age, gender, severity of disease, concomitant treatments and so on) between the clinical trial population and a ‘real world’ clinical population. None provided good evidence of a reduction in the treatment effect in the trial compared to what might happen in clinical practice for simple pharmacological treatments. However complex treatments like surgery or percutaneous interventional procedures, had a greater potential for variation. Extrapolating treatments to different health care settings from the trial can result in important variations in treatment effects. ConclusionsComplex therapies need careful consideration before they can be applied routinely from trials into practice, and applying results from one health care environment to a different one should be carried out with caution. Generalizing results from well conducted trials to clinical practice can mostly be carried out with confidence, especially for simple therapies with good evidence of benefit.
Fixation du lithium en traces dans une phengite de synthèse
Authors: Maurel P. , Volfinger M. 
Published: December 2006

RésuméOn effectue la synthèse hydrothermale d'une phengite à partir d'un gel de composition 90% muscovite-10% céladonite, en présence de chlorure de lithium, à 500°C, 1000 bars. Le produit final obtenu contient environ 2000 ppm de Li. L'étude de la cinétique de la dissolution, en milieu HCl 2·4 n, des éléments majeurs et du lithium montre que 33% du lithium sont très faiblement liés au mica et vraisemblablement adsorbés. Ce qui reste de Li entre en substitution isomorphique dans le réseau de la phengite, sans doute en sites octaédriques.
Origin of Middle Jurassic and Lower Cretaceous fuller's earths in England
Authors: Jeans C. V. , Merriman R. J. , Mitchell J. G. 
Published: December 2006

AbstractThe controversy on the origin of the English Mesozoic fuller's earths is reviewed. Findings of (1) unaltered, devitrified, zeolitized and argillized glass, (2) fragments of holocrystalline and hypocrystalline igneous rocks, and (3) high temperature feldspar and sphene, conclusively demonstrate their volcanic origin. The bulk chemistries of the Bathonian and Lower Cretaceous earths are similar and suggest derivation from ash of trachytic composition. The two earths can be differentiated mineralogically and petrographically by: (a) the presence of sphene, and zeolites replacing glass in the Lower Cretaceous earths; (b) the presence of minor amounts of basaltic glass in the Bathonian earths.K/Ar radioisotope dating on high-temperature alkali feldspar gives (1) 152–159 Ma for the Bathonian fuller's earth, and (2) 118–125 Ma and 142–148 Ma for the Lower Cretaceous fuller's earths. The distribution of the Mesozoic fuller's earths and the origin of their parent ash is discussed.
Absorption de composes humiques par une montmorillonite H+, Al3+ Présence de smectites à couches interfoliaires organo-minérales dans les andosols
Authors: Moinereau J. 
Published: December 2006

RésuméL'auteur étudie l'absorption par une montmorillonite H-AI, d'acides organiques extraits d'Andosols dans une gamme de pH allant de 1,5 à 5. Quand il y a absorption entre les feuillets, on observe une résistance particulière de la montmorillonite à l'écrasement après chauffage, même pour des températures supérieures à 500°C Un complexe organo-minéral ou organique résistant à la chaleur se forme entre les feuillets de la montmorillonite, comme le révèlent les courbes d'ATD et les spectres IR. On retrouve les propriétés originelles de la montmorillonite par peroxydation.Des argiles gonflantes 2/1 à complexes organo-minéraux et/ou organiques entre les feuillets sont observées dans les Andosols. Les propriétés de telles argiles rappellent en partie celles des chlorites gonflantes ou des pseudochlorites.
Convergence de comportement entre les interstratifies kaolinite-smectite et les fire-clays
Authors: Thiry M. , Weber F. 
Published: December 2006

RésuméL'étude de fire-clays provenant de deux séries continentales d'âge Eocène inférieur montre des corrélations très nettes entre la fréquence des défauts d'empilement des feuillets et certaines propriétés qui opposent les fire-clays aux kaolinites bien ordonnées: faible taux de ‘gonflement’ à l'hydrazine, capacité d'échange cationique élevée. Ces faits ainsi que les filiations observés dans l'une des séries étudiées entre interstratifiés smectitekaolinite et fire-clay condusient à émettre l'hypothèse que les défauts de structure des fire-clays sont dus à la présence de feuillets de type smectite, interstratifiés à faible fréquence, entre les feuillets de type kaolinite.