bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes Analysis for Hearing Conservation Programs
Authors: Helfer Thomas M. , Shields Anne R. , Gates Kathy E. 
Published: April 2006

In health care, an increasing interest in accountability for outcomes, proof of quality care, and cost effectiveness is forcing many practitioners, including audiologists, in the direction of using outcomes analysis to provide proof of performance in their practices. Critical to the conduct of outcomes analysis are the selection of valid outcomes metrics and application of appropriate statistical processes.Modeling of clinical protocols is a useful exercise for developing outcomes data and data management standards. The authors describe the implications for wider use of outcomes modeling once the Health Insurance Portability and Accountability Act (HIPAA) administrative simplification law is implemented. This legislation will set up a wholly new administrative data set that has strong potential to provide outcomes metrics to a variety of Audiology practices. The modeling exercise described here was originally intended to derive assessment outcomes for evaluating hearing conservation program effectiveness in military populations from an administrative database implemented within the Military Health System starting in 1997. The outcomes modelers, however, soon realized the broader applicability of modeling techniques for other special populations and Audiology practices, particularly with the oncoming startup of HIPAA legislative mandates.The modeling exercise demonstrates a process of structuring standard health-care codes to produce outcomes data for epidemiologic and cost analyses, thereby providing better information to guide health-care practices toward improving quality and cost effectiveness. This information in time series should also provide a record of continuous quality improvement. The authors present a general hearing surveillance protocol for evaluating occupational hearing loss. The protocol is used as a specific instance to demonstrate the shaping of an outcomes metrics model. This same process can be applied more generally when used to model outcomes data from other audiology practices. Implementation of the administrative data model described here began at more than 400 Department of Defense (DOD) medical treatment facilities worldwide as of October 1, 1999. The exercise of developing similar outcomes metrics for newborn hearing screening programs, school hearing conservation programs, and other clinical and rehabilitative audiology practices in the civilian sector remains to be done.
The Effects of Taste and Consistency on Swallow Physiology in Younger and Older Healthy Individuals
Authors: Ding Ruiying , Logemann Jeri A. , Larson Charles R. , Rademaker Alfred W. 
Published: April 2006

Recent studies done on healthy older individuals have demonstrated elevated taste thresholds for sweet, sour, and salty taste. At suprathreshold levels, such individuals have also shown less ability to discriminate between different intensities of the same tastant. This study was designed to provide information on swallow timing and muscle contraction intensity variables in healthy older people during swallowing of liquid and cottage cheese consistencies in 3 taste conditions (sweet, salty, and sour). Taste and consistency were incorporated in the design of this study to determine not only the effect of taste and consistency independently, but also the effects of taste and consistency in combination. Surface electromyography (EMG) at 3 sites—the orbicularis oris inferior region, submental muscle region, and infrahyoid muscle region—were included in the study.Results revealed that the start of submental muscle activation was significantly later in older participants than in younger participants. The 3 taste conditions had higher EMG levels and shorter activation times than the no-taste condition, although different taste conditions and different muscle sites were affected differently. With thicker consistency, substantially increased EMG amplitude and duration were noted for all three sites. A more pronounced effect of taste was manifested as earlier submental or infrahyoid muscle activation when the three tastants were added to a thicker consistency. Interaction of taste, consistency, and age was also noted for onset time at the submental and infrahyoid sites.
Antibody Response to Influenza Vaccination in Nursing Home Residents and Healthcare Workers During Four Successive Seasons in Niigata, Japan
Authors: Sato Mizuho , Saito Reiko , Tanabe Naohito , Nishikawa Makoto , Sasaki Asami , Gejyo Fumitake , Suzuki Hiroshi 
Published: April 2006

AbstractObjective:To evaluate the antibody response to influenza vaccines in nursing home residents and healthcare workers (HCWs) and its relation to residents' functional and chronic disease status during four successive seasons.Design:Before-after study.Setting:Nine nursing homes during the 1998-1999 season and two during the 1999-2000, 2000-2001, and 2001-2002 seasons.Participants:Two hundred fifty-nine residents and 79 HCWs during the 1998-1999 season; 180 and 71, respectively, during the 1999-2000 season; 162 and 71, respectively, during the 2000-2001 season; and 153 and 79, respectively, during the 2001-2002 season.Results:Multivariate analysis indicated that the mean fold increase in the geometric mean titers (GMTs) of hemagglutination inhibition (HI) antibodies and the response rate (the proportion of vaccinées resulting in a significant, at least fourfold increase in antibody titer) were good and no significant differences occurred for almost all strains in both residents and HCWs. The GMTs of HI antibodies and the protection rate (the proportion of participants with HI antibody titers & 40) were increased in both residents and HCWs, but were significantly lower for almost all strains in residents than in HCWs. Furthermore, multivariate analysis indicated that subdivision of residents into three groups by level of daily activities and into four groups according to underlying diseases revealed only minor differences in immune responses.Conclusions:Antibody responses to the influenza vaccine were lower in residents than in HCWs. However, residents showed similar antibody responses regardless of their level of daily activity or underlying diseases.
A comparison of the Seeing Optical Stylet and the gum elastic bougie in simulated difficult tracheal intubation: a manikin study
Authors: Evans A. , Morris S. , Petterson J. , Hall J. E. 
Published: April 2006

SummaryManagement of the difficult airway is one of the major challenges that anaesthetists face. The flexible fibreoptic scope is widely available but its use requires a level of skill, training and continued practice that is not universally found in all anaesthetists, particularly trainees. The Seeing Optical Stylet is a new, semirigid fibreoptic stylet ‘scope. We compared the Seeing Optical Stylet with a gum elastic bougie in a simulated Cormack and Lehane Grade 3 laryngoscopy in a manikin. Forty‐four anaesthetists were timed while intubating the manikin's trachea with both devices. The mean (SD) time taken with the Seeing Optical Stylet was 20.8 (9.3) s and with the bougie 30 (19.8) s (p = 0.001). Oesophageal intubation occurred six times with the bougie but did not occur with the Seeing Optical Stylet (p = 0.011). We conclude that the Seeing Optical Stylet may be superior to the bougie in difficult tracheal intubation. We feel that the results of this manikin trial are sufficiently encouraging to proceed to a clinical trial in patients.
Local clinical quality monitoring for detection of excess operative deaths
Authors: Arrowsmith J. E. , Powell S. J. , Nashef S. A. M. 
Published: April 2006

SummaryA monitoring system for cardiac surgery has been in use at Papworth Hospital for 10 years. We wished to determine whether this system would have detected an increase in deaths associated with a single practitioner, whether a poorly performing doctor or a serial killer such as Dr Harold Shipman, whose activites went undetected in the absence of a monitoring system for nearly a quarter of a century. Random extra deaths were artificially introduced into the practice of a surgeon and an anaesthetist in a way that broadly reproduced Shipman's pattern. The standard monitoring system was then used to analyse the hypothetical data thus generated. Using the current standard monitoring, the excess deaths would have been detected in less than 10 months. Suspicions would have been raised even earlier. Robust local quality monitoring of risk‐adjusted outcomes is possible and, in our opinion, essential.
New insights into the regulation of iron homeostasis
Authors: Deicher R. , Hörl W. H. 
Published: April 2006

AbstractHepcidin evolves as a potent hepatocyte‐derived regulator of the body's iron distribution piloting the flow of iron via, and directly binding, to the cellular iron exporter ferroportin. The hepcidin‐ferroportin axis dominates the iron egress from all cellular compartments that are critical to iron homeostasis, namely placental syncytiotrophoblasts, duodenal enterocytes, hepatocytes and macrophages of the reticuloendothelial system. The gene that encodes hepcidin expression (HAMP) is subject to regulation by proinflammatory cytokines, such as IL‐6 and IL‐1; excessive hepcidin production explains the relative deficiency of iron during inflammatory states, eventually resulting in the anaemia of inflammation. The haemochromatosis genes HFE (the human leukocyte antigen‐related gene), TfR2 (the transferrin receptor‐2 gene) and HJV (the haemojuvelin gene) potentially facilitate the transcription of HAMP. Disruption of each of the four genes leads to a diminished hepatic release of hepcidin consistent with both a dominant role of hepcidin in hereditary haemochromatosis and an upstream regulatory role of HFE, TfR2 and HJV on HAMP expression. The engineered generation of hepcidin agonists, mimetics or antagonists could largely broaden current therapeutic strategies to redirect the flow of iron.
Stem cells in the lung parenchyma and prospects for lung injury therapy
Authors: Yen C. C. , Yang S. H. , Lin C. Y. , Chen C. M. 
Published: April 2006

AbstractUntil recently, it was thought that only embryonic stem cells were pluripotent and that adult stem cells were restricted in their differentiative and regenerative potential to become the tissues in which they reside. However, the discovery that adult stem cells in one tissue can contribute to the formation of other tissues, especially after injury or cell damage, implies that stem cells have developmental plasticity. For example, haematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs) from bone marrow can be used to regenerate diverse tissues at distant sites, including the lung. This article reviews the character of stem cells in the lung parenchyma and focuses on the potential uses of adult stem cells in research of lung injury and lung disease therapies.
Decreased tongue mobility – an explanation for difficult endotracheal intubation?
Authors: Rosenstock C. , Kristensen M. S. 
Published: April 2006

Established parameters predictive of difficulty in airway management were inconclusive in five ear, nose and throat (ENT) patients. All presented with degrees of tongue fixation – restriction of movement. Initially, experienced anaesthetists concluded that conventional endotracheal intubation would present no problems. Later, there were adjustments to this conclusion, with the ultimate being that four of the patients underwent fibre‐optic intubation: one electively, two after repeated failed conventional attempts and one after a failed attempt of retrograde intubation. The last patient underwent elective retrograde intubation. All intubations were performed uneventfully in anaesthetized or sedated patients under spontaneous respiration.We found that tongue fixation was a direct cause of failed conventional endotracheal intubation, and recommend that a detailed tongue status investigation should be routine during Mallampati evaluation. Any abnormality should be seen as predictive of difficult/impossible conventional direct laryngoscopic intubation.
Improved resuscitation outcome in emergency medical systems with increased usage of sodium bicarbonate during cardiopulmonary resuscitation
Authors: Bar‐Joseph G. , Abramson N. S. , Kelsey S. F. , Mashiach T. , Craig M. T. , Safar P. ,   for the Brain Resuscitation Clinical Trial III (BRCT III) Study Group
Published: April 2006

Background:  The use of sodium bicarbonate (SB) in cardiopulmonary resuscitation (CPR) is controversial. This study analyzes the effects of SB use on CPR outcome in the Brain Resuscitation Clinical Trial III (BRCT III), which was a multicenter randomized trial comparing high‐dose to standard‐dose epinephrine during CPR. Sodium bicarbonate use in BRCT III was optional.Methods:  The entire BRCT III database was reviewed. Analysis included only patients who arrested out of the hospital and whose time from collapse to initiation of ACLS was no longer than 30 min (total n = 2122 patients). Sodium bicarbonate use by the 16 participating study sites was analyzed. The study sites were divided according to their SB usage profile: ‘low SB user’ sites administered SB in less than 50% of CPRs and their first epinephrine to SB time exceeded 10 min; and ‘high SB user’ sites used SB in over 50% of CPRs and their first epinephrine to SB time was <10 min.Results:  Sites' SB usage rates ranged between 3.1% and 98.2% of CPRs. Sodium bicarbonate usage rates correlated inversely with the sites' intervals from collapse (r = − 0.579 P = 0.018) from initiation of ACLS (r = − 0.685 P = 0.003) and from first epinephrine (r = − 0.611 P = 0.012) to SB administration.Mean ROSC rate in the ‘high SB user’ sites was 33.5% (CI = 30.0–37.0) compared to 25.7% (CI = 23.1–28.4) in the ‘low SB user’ sites. In the ‘high SB user’ sites, hospital discharge rate was 5.3% (CI = 3.6–7.0) compared to 3% (CI = 2.0–4.0) in the ‘low SB user’ sites, and 5.3% (CI = 3.6–7.0) had a favorable neurological outcome compared to 2.1% (CI = 1.2–3.0) in the ‘low SB user’ sites. Collapse to ACLS interval was 8.5 min (CI = 8.1–9.0) in the ‘high SB user’ sites compared to 10.2 min (CI = 9.8–10.6) in the ‘low SB user’ sites, and their ACLS to first epinephrine interval was 7.0 min (CI = 6.5–7.5) compared to 9.7 min (CI = 9.3–10.2). Multivariate regression analysis found that belonging to ‘high SB user’ sites independently increased the chances for ROSC (OR 1.36, CI 1.08–1.7) and for achieving a good neurological outcome (OR 2.18, CI 1.23–3.86).Conclusions:  Earlier and more frequent use of SB was associated with higher early resuscitability rates and with better long‐term outcome. Sodium bicarbonate may be beneficial during CPR, and it should be subjected to a randomized clinical trial.
Diagnosing drug‐seeking behaviour in an adult emergency department
Authors: McNabb Charley , Foot Carole , Ting Joseph , Breeze Katina , Stickley Mark 
Published: April 2006

AbstractObjective:  The objective of the present study were to determine factors used by ED doctors to diagnose drug seeking and their attitude towards management of this patient group.Methods:  Prospective, descriptive study, of doctors working in a tertiary hospital ED. Doctors voluntarily identified patients they suspected were drug seeking and completed a written survey.Results:  Thirty‐seven surveys were completed for presentations involving 31 patients. A patient's specific request for narcotics, previous documented episodes of suspected drug seeking, an unwillingness to try simple analgesia and demanding or aggressive behaviour were the most frequently used factors for diagnosing drug seeking. These factors are similar to, but not the same, as the criteria in the literature. Doctors commonly found consultations involving drug seeking to be unsatisfying.Conclusions:  Factors, such as those used by doctors in the present study, should not be used as diagnostic markers. Further study is warranted in order to improve the effectiveness of consultations involving drug seeking.
A simple Bayesian network to interpret the accuracy of armyworm outbreak forecasts
Authors: Holt J. , Mushobozi W. , Day R.K. , Knight J.D. , Kimani M. , Njuki J. , Musebe R. 
Published: April 2006

AbstractForecasting of outbreaks of armyworm (larvae of the moth Spodoptera exempta) employs information from rain gauges and moth traps. Rainfall is an independent variable, but moth catch is affected by rainfall, and outbreak risk is affected by both moth catch and rainfall. A simple Bayesian network was used to describe these relationships and so derive conditional probabilities. The data were from a new initiative, community‐based forecasting of armyworm in Tanzania, in which outbreak risk for a village is determined locally from a single moth trap and rain gauge located within the village. It was found that, following a positive forecast, an armyworm outbreak was approximately twice as likely to occur as would be expected by chance. If the forecast was negative because of insufficient moths, outbreaks were half as likely as would be expected by chance. If the forecast was negative because of insufficient rain, however, the outbreak probability remained similar to chance: an aspect of the forecast that requires improvement. Overall, a high forecasting accuracy can be achieved by village communities using simple rules to predict armyworm outbreaks.
The Mycobacterial 38-Kilodalton Glycolipoprotein Antigen Activates the Mitogen-Activated Protein Kinase Pathway and Release of Proinflammatory Cytokines through Toll-Like Receptors 2 and 4 in Human Monocytes
Authors: Jung Saet-Byel , Yang Chul-Su , Lee Ji-Sook , Shin A-Rum , Jung Sung-Soo , Son Ji Woong , Harding Clifford V. , Kim Hwa-Jung , Park Jeong-Kyu , Paik Tae-Hyun , Song Chang-Hwa , Jo Eun-Kyeong 
Published: April 2006

ABSTRACTAlthough the 38-kDa glycolipoprotein ofMycobacterium tuberculosisH37Rv is known to evoke prominent cellular and humoral immune responses in human tuberculosis (TB), little information is known about intracellular regulatory mechanisms involved in 38-kDa antigen (Ag)-induced host responses. In this study, we found that purified 38-kDa glycolipoprotein activates mitogen-activated protein kinases (MAPKs; extracellular signal-regulated kinase 1/2 [ERK1/2] and p38) and induces tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) in human monocytes. When the 38-kDa Ag was applied to monocytes from TB patients and healthy controls, the activation of ERK1/2 and p38 MAPK and the subsequent cytokine secretion were greater in the monocytes from the active pulmonary TB patients than in monocytes from the healthy controls. Additionally, neutralizing antibodies for Toll-like receptor 2 (TLR2) or TLR4 significantly reduced the ERK1/2 and p38 activation induced by the 38-kDa protein when the antibodies were applied to HEK293 cells overexpressing TLR2 or TLR4 as well as human primary monocytes. Furthermore, the inhibition of TLR2 significantly, and that of TLR4 partially, decreased the 38-kDa Ag-induced secretion of TNF-α and IL-6 in human monocytes. The intact protein moieties of the 38-kDa protein were responsible for biologic activities by this Ag. These data collectively demonstrate that the 38-kDa glycolipoprotein, acting through both TLR2 and TLR4, induces the activation of the ERK1/2 and p38 MAPK pathways, which in turn play an essential role in TNF-α and IL-6 expression during mycobacterial infection.
Protection by Meningococcal Outer Membrane Protein PorA-Specific Antibodies and a Serogroup B Capsular Polysaccharide-Specific Antibody in Complement-Sufficient and C6-Deficient Infant Rats
Authors: Toropainen Maija , Saarinen Leena , Vidarsson Gestur , Käyhty Helena 
Published: April 2006

ABSTRACT

The relative contributions of antibody-induced complement-mediated bacterial lysis and antibody/complement-mediated phagocytosis to host immunity against meningococcal infections are currently unclear. Further, the in vivo effector functions of antibodies may vary depending on their specificity and Fc heavy-chain isotype. In this study, a mouse immunoglobulin G2a (mIgG2a) monoclonal antibody (MN12H2) to meningococcal outer membrane protein PorA (P1.16), its human IgG subclass derivatives (hIgG1 to hIgG4), and an mIgG2a monoclonal antibody (Nmb735) to serogroup B capsular polysaccharide (B-PS) were evaluated for passive protection against meningococcal serogroup B strain 44/76-SL (B:15:P1.7,16) in an infant rat infection model. Complement component C6-deficient (PVG/c
−
) rats were used to assess the importance of complement-mediated bacterial lysis for protection. The PorA-specific parental mIgG2a and the hIgG1 to hIgG3 derivatives all induced efficient bactericidal activity in vitro in the presence of human or infant rat complement and augmented bacterial clearance in complement-sufficient HsdBrlHan:WIST rats, while the hIgG4 was unable to do so. In C6-deficient PVG/c
−
rats, lacking complement-mediated bacterial lysis, the augmentation of bacterial clearance by PorA-specific mIgG2a and hIgG1 antibodies was impaired compared to that in the syngeneic complement-sufficient PVG/c
+
rat strain. This was in contrast to the case for B-PS-specific mIgG2a, which conferred similar protective activity in both rat strains. These data suggest that while anti-B-PS antibody can provide protection in the infant rats without membrane attack complex formation, the protection afforded by anti-PorA antibody is more dependent on the activation of the whole complement pathway and subsequent bacterial lysis.
Role of the
Porphyromonas gingivalis
InlJ Protein in Homotypic and Heterotypic Biofilm Development
Authors: Capestany Cindy A. , Kuboniwa Masae , Jung Il-Young , Park Yoonsuk , Tribble Gena D. , Lamont Richard J. 
Published: April 2006

ABSTRACT

The oral pathogen
Porphyromonas gingivalis
expresses a homolog of the internalin family protein InlJ. Inactivation of
inlJ
reduced monospecies biofilm formation by
P. gingivalis
. In contrast, heterotypic
P. gingivalis
-
Streptococcus gordonii
biofilm formation was enhanced in the InlJ-deficient mutant. The results indicate a nuanced role for InlJ in regulating biofilm accumulations of
P. gingivalis
.
Plasmodium falciparum
Parasites Expressing Pregnancy-Specific Variant Surface Antigens Adhere Strongly to the Choriocarcinoma Cell Line BeWo
Authors: Haase Rikke N. , Megnekou Rosette , Lundquist Maja , Ofori Michael F. , Hviid Lars , Staalsoe Trine 
Published: April 2006

ABSTRACT

Placenta-sequestering
Plasmodium falciparum
parasites causing pregnancy-associated malaria express pregnancy-specific variant surface antigens (VSA
PAM
). We report here that VSA
PAM
-expressing patient isolates adhere strongly to the choriocarcinoma cell line BeWo and that the BeWo line can be used to efficiently select for VSA
PAM
expression in vitro.