bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medicines Use Review: adoption and spread of a service innovation
Authors: Blenkinsopp Alison , Bond Christine , Celino Gianpiero , Inch Jackie , Gray Nicola 
Published: July 2008

Abstract

Background
Research has shown that implementation of community pharmacy Medicines Use Review and Prescription Intervention (MUR) in the first year of the service in England and Wales was less extensive than anticipated. Several barriers to MUR becoming accepted and embedded in the National Health Service (NHS) were identified.

Objective
To evaluate progress in the provision of the MUR service in England and Wales in its second year (April 1, 2006-March 31, 2007) compared with the first year; and to analyse trends from available national data from the third year of provision in 2007–2008.

Methods
The analysis drew on the following data sources: routine data on provision of MURs for community pharmacies in a stratified random sample of 31 primary care organisations in England and Wales, and national datasets on MUR provision from the Pharmaceutical Services Negotiating Committee and NHS Information Centre.

Outcome measures
The percentage of community pharmacies providing the MUR service, the numbers of MURs provided in 2006–2007 at pharmacy and primary care organisation level, and the extent of, and variation in, provision.

Key findings
The percentage of community pharmacies providing the MUR service increased from 38 to 67.2%. Overall, 62 559 MURs were provided (a more than four-fold increase on the previous year), representing 13.8% of the possible maximum. The mean number of MURs provided (per provider) increased from 36 to 85. For existing providers the mean number increased from 36 to 111 (median 78, range 0–423). For new providers the mean number was 52 (median 17, range 1–401). More than half (52%) of the pharmacies in the sample claimed for fewer than 50 MURs. Overall, 82% of MURs were provided by multiples and this percentage was lower among new providers (62%) than existing providers (89%). Thirty-three (8.1%) existing MUR providers had no recorded MURs in the second year: almost two-thirds of these (64%) were independents. Eleven pharmacies (1.5%) provided the maximum number of 400 MURs per year: all but one were branches of multiples. Of the pharmacies not yet providing MURs, 78% were independent.

Conclusions
Both numbers of MURs and numbers of providers of MUR services increased markedly during the service's second year. Those newly providing the service in the second year claimed for more than twice as many MURs as did those who had been ‘new providers' the previous year. Overall just over half of all providing pharmacies claimed for the equivalent of one MUR a week or fewer. Therefore the extent of ‘successful adoption’ of MURs is debatable. Differences in the level of provision continued between independent and multiple pharmacies in terms of both adoption of the service and the number of reviews conducted. As in the previous year, independent pharmacies were less likely to provide the MUR service and when they did the numbers conducted were lower than those provided by multiples.
Burden of Deep Vein Thrombosis in the Outpatient Setting Following Major Orthopedic Surgery
Authors: Nutescu Edith A , Shorr Andrew F , Farrelly Eileen , Horblyuk Ruslan , Happe Laura E , Franklin Meg 
Published: July 2008

Background Venous thromboembolism (VTE) is a known complication of major orthopedic surgery (MOS) with important clinical and economic consequences. Recently published orthopedic guidelines have focused on prevention of pulmonary embolism as a primary outcome, but deep vein thrombosis (DVT) occurrence should not be readily dismissed. Objective To describe the burden of DVT following hospital discharge for MOS by assessing the impact of DVT on costs and resource utilization from the Third-party payer perspective. Methods Retrospective analysis used outpatient medical and pharmacy data from the PharMetrics Patient-Centric Database (January 1, 2002–March 31. 2006). Patients 18 years of age or older with a record of MOS were eligible for inclusion. Included patients were stratified based on the presence of a DVT during the first month after hospital discharge. Characteristics of the samples were described. The impact of DVT on total 6–month costs and resource utilization (readmissions, outpatient, emergency department visits) was assessed through statistical models. Results: Of the 32,899 patients in the analysis, 1221 (3.71%) had a record of DVT during the first month following discharge for MOS. Compared with patients who did not develop DVT, patients who developed DVT postdischarge were slightly older (56.5 vs 55.8 y; p = 0.0127), had a higher occurrence of prior VTE (26.2% vs 3.4%; p < 0.0001), and had undergone recent surgical procedures other than MOS (73.0% vs 69.6%; p = 0.0116). After controlling for potential confounders, DVT was associated with a 22% and 74% increase in the average number of expected outpatient and emergency department visits, respectively, during the 6-month postdischarge period but did not significantly impact the number of readmissions. Furthermore, total 6-month costs were significantly higher for patients who developed DVT with an incremental increase of over $2000. Conclusions: The burden of DVT following hospital discharge for MOS is substantial. Specifically, DVT increases total costs and outpatient and emergency department visits.
Considerazioni su Clutorio Prisco e il suo processo (Tac. ann. III 49–51, Cass. Dio LVII 20,3–4).*
Authors: Petrini Francesco Maria 
Published: July 2008

Riassunto
Il presente elaborato ha inteso ricostruire quanto più compiutamente possibile la figura e la vicenda di Clutorio Prisco, poeta processato e condannato a morte nel 21, al culmine della sua popolarità; la sua rovina, scaturita — come quella ovidiana di pochi anni anteriore — da una singola e fatale composizione poetica, venne decisa, assenti Druso e Tiberio, dalla sola assemblea senatoria. L’indagine si è in primis concentrata sulla questione onomastica del personaggio come sulla considerazione dei relativi dati prosopografici e del contesto culturale, socio-relazionale e clientelare di appartenenza (§ 1), pervenendo, attraverso una necessaria regestazione documentaria, ad alcune nuove proposte interpretative; la seconda parte del contributo (§§ 2–3) è invece volta all'analisi specifica del processo a Clutorio, delle sue dinamiche ed implicazioni, della sua incidenza storica e della sua memoria nella tradizione storiografica. Contestualmente all'indagine è stata inoltre operata (§ 3.1) una breve rilettura degli ultimi anni della vita di Druso Minore (21–23 E. C.), evidenziando la sospetta lacuna documentaria gravante sul personaggio fin dalla prima tradizione storiografica altoimperiale
Held oder Harlekin? Der sterbende Seneca bei Tacitus
Authors: Schmal Stephan 
Published: July 2008

Zusammenfassung
Tacitus schildert den Freitod des Philosophen Seneca (65 n. Chr.) sehr ausführlich und, wie es scheint, wohlwollend als einen Akt der Seelenstärke und der philosophischen Läuterung (Tac. ann. 15.60.2–64). Doch wer Tacitus und dessen Hang zur Ironie kennt, der merkt, daß der Historiker dem Philosophen eitle Phrasen und hohles Pathos in den Mund legt. Nicht umsonst läßt er wenig später den Dichter Petronius ganz anders sterben, nämlich unter gezielter Vermeidung jeglicher Inszenierung (Tac. ann. 16.19.2 f.).
Seneca war als Politiker, als Lehrer Neros und als einer der reichsten Männer Roms höchst umstritten. Sein theatralischer Tod paßt für Tacitus zu einem Menschen und Literaten, dem der schöne Schein immer wichtiger war als Wahrheit und echter Anstand.
Constantinus rerum nouator: dal comitatus dioclezianeo ai palatini di Valentiniano I
Authors: Colombo Maurizio 
Published: July 2008

Sommario
Il mio articolo affronta principalmente quattro questioni, che riguardano l'evoluzione dell'esercito romano nel corso del IV secolo d.C.: 1) la relazione tra l'istituzione dei comites rei militaris e la creazione ufficiale dei comitatenses, entrambe innovazioni di Costantino; 2) l'ascesa della cavalleria scelta e la creazione degli auxilia sotto il regno di Costantino; 3) le dimensioni e la composizione dei comitatenses; 4) l'evoluzione ulteriore dell'esercito romano sotto i successori di Costantino. Questo studio esamina anche altri punti, ma mira soprattutto a confutare le tesi vulgate sull'esercito romano del IV secolo d.C.; alla fine del mio articolo risulterà chiaro che soltanto gli anni Sessanta di quel secolo videro gli auxilia palatina raggiungere una posizione di rilievo nell'esercito romano della Tarda Antichità.
Ansichten eines Zivilisierten über die unzivilisierte Welt: Das Sāsāniden-Bild des Georgios Pisides und sein historischer Wert für den spätantiken Iran*
Authors: Huber Irene 
Published: July 2008

Zusammenfassung
Georgios Pisides, Hofpanegyrist des Kaisers Herakleios, überliefert in seinen angeblich auf Autopsie beruhenden Carmina Details über die byzantinischen Perserfeldzüge in den zwanziger Jahren des siebten Jahrhunderts. Der Aufsatz untersucht, welches Bild der Sāsāniden in den Gedichten vermittelt wird und welche Intentionen des Dichters sich dahinter verbergen. Weiter werden die Anspielungen auf Ereignisse der iranischen Geschichte vorgestellt. Dabei wird deutlich, daß der Dichter im Dienste der Kaiserideologie steht und von zeitgenössischer Kriegspropaganda beeinflußt ist. Zudem sind weitere Faktoren wie die Unterhaltung seines Publikums sowie der Rekurs auf die klassische Literatur bestimmend. Im gesamten zeigt Pisides indes mehr Interesse, sein religiös fundiertes Kaiserbild zu bestärken als historische Informationen über den Kriegsgegner zu liefern.
Folate and Clefts of the Lip and Palate—A U.K.-Based Case-Control Study: Part II: Biochemical and Genetic Analysis
Authors: Little J. , Gilmour M. , Mossey P. A. , FitzPatrick D. , Cardy A. , Clayton-Smith J. , Hill A. , Duthie S. J. , Fryer A. E. , Molloy A. M. , Scott J. M. 
Published: July 2008

Objective: To investigate associations between nonsyndromic oral clefts and biochemical measures of folate status and the MTHFR C677T variant in the United Kingdom, where there has been no folic acid fortification program. Method: Dietary details were obtained from the mothers of 112 cases of cleft lip with or without cleft palate (CL±P), 78 cleft palate only (CP) cases, and 248 unaffected infants. Infant and parental MTHFR C677T genotype was determined. Red blood cell (RBC) and serum folate and homocysteine levels were assessed in 12-month postpartum blood samples from a subset of mothers. The data were analyzed by logistic and log-linear regression methods. Results: There was an inverse association between CL±P and maternal MTHFR CT (odds ratio [OR]  =  0.5, 95% confidence interval [CI]  =  0.31–0.95) and TT (OR  =  0.6, 95% CI  =  0.21–1.50) genotypes, with similar risk estimates for CP. There was no clear association with infant MTHFR genotype. Higher levels of maternal postpartum RBC and serum folate were associated with a lower risk for CL±P and an increased risk for CP. Higher levels of serum homocysteine were associated with a slightly increased risk for both CL±P and CP. Conclusion: While the inverse relation between the mother's having the MTHFR C677T variant and both CL±P and CP suggests perturbation of maternal folate metabolism is of etiological importance, contrasting relations between maternal postpartum levels of RBC and serum folate by type of cleft are difficult to explain.
Clicks Produced as Compensatory Articulations in Two Adolescents with Velocardiofacial Syndrome
Authors: Gibbon Fiona , Lee Alice , Yuen Ivan , Crampin Lisa 
Published: July 2008

Objective: To report perceptual and dynamic articulatory electropalatography data on clicks produced as compensatory articulations by two adolescents (S1 and S2) with velocardiofacial syndrome and velopharyngeal dysfunction. Results: The perceptual analysis showed that both speakers produced click substitutions for English targets /t/, /d/, /k/, /g/, and S2 additionally produced clicks for /p/, /b/, and /t∫/, / d3/. The adolescents produced a range of clicks, which varied in placement (bilabial, dental, alveolar, palatal), voicing (voiced, voiceless), and nasality (nasal, nonnasal). Measurements from the electropalatography data for lingual clicks revealed two articulatory closures, one in the anterior and another in the posterior region of the hard palate. The data revealed how the two closures were timed precisely to produce the click sound. The clicks involved a complex and highly coordinated sequence of tongue maneuvers similar to clicks in some southern African languages. Conclusions: Clicks are interpreted as compensatory articulations enabling some speakers with velopharyngeal dysfunction to produce plosive and affricate sounds with perceptually salient acoustic bursts in the oral cavity. Clicks as compensatory articulations merit further systematic investigation, and the procedures reported in this study are considered appropriate for such research.
Long-Term Effects of Pharyngeal Flaps on the Upper Airways of Subjects with Velopharyngeal Insufficiency
Authors: Yamashita Renata Paciello , Trindade Inge Elly Kiemle 
Published: July 2008

Objectives: To investigate the long-term effects of pharyngeal flap surgery (PFS) on nasal and nasopharyngeal dimensions of patients with velopharyngeal insufficiency (VPI) and to correlate the findings with the onset of respiratory complaints after surgery. Design/Participants: Prospective study in 58 nonsyndromic patients with repaired cleft palate and VPI, evaluated 2 days before and 5 months (POST1) and 1 year (POST2) after PFS, on average. Patients were divided into two groups: one consisting of patients with postoperative respiratory complaints (RC group) and the other without complaints (NRC group). Interventions: Superiorly based PFS. Main Outcome Measures: Respiratory complaints (self reports of mouth breathing, snoring, and other sleep obstructive events) assessed at POST1 and POST2, and minimum nasal (NCSA) and nasopharyngeal (NPA) cross-sectional areas assessed by rhinomanometry at POST2. Results: Respiratory complaints were reported by 55% and 36% of the patients evaluated at POST1 and POST2, respectively. Posterior rhinomanometry showed a significant postoperative reduction of mean NCSA in the RC and NRC groups (p < .05), to subnormal levels in some of them. The decrease was more pronounced in the RC group. No significant changes in NCSA were observed by anterior rhinomanometry. Similar results were obtained when NPA was assessed by modified anterior rhinomanometry. Conclusion: In the long-term, PFS yielded a significant reduction in upper airways dimensions beyond what should be expected and associated with persistent respiratory complaints in some cases.
Midface Osteotomy versus Distraction: The Effect on Speech, Nasality, and Velopharyngeal Function in Craniofacial Dysostosis
Authors: Pereira Valerie , Sell Debbie , Ponniah Alan , Evans Rob , Dunaway David 
Published: July 2008

Objective: To assess speech outcomes following midface advancement and to explore whether the type of advancement surgery affects speech differently in patients with craniofacial dysostosis. Design: Prospective, before-after group design. Subjects: Fifteen consecutive patients were included in the study. Eight underwent advancement by osteotomy and seven by distraction. All patients were seen preoperatively and at least once postoperatively. Main Outcome Measures: Percentage of consonants correct, nature and type of articulation errors, nasalance score, severity ratings of resonance and of velopharyngeal function using nasendoscopy and lateral videofluoroscopy, and amount of forward advancement. Results: No statistically significant differences were found between groups for pre- and postoperative changes of percentage of consonants correct (p  =  .755, median difference 3.0, 95% confidence interval for median difference [−14.22, 20.22]) and nasalance (p  =  .171, median difference  =  −12.00, 95% confidence interval for median differences [−30.46, 6.46]). There was no statistically significant correlation between amount of forward advancement and nasalance (r  =  .87, p  =  .799) and percentage of consonants correct (r  =  −.550, p  =  .064). Findings from lateral videofluoroscopy and nasendoscopy are described. Individual changes of speech outcomes are reported. Conclusions: In view of the small sample size, results need to be interpreted with caution. However, the study adds to current limited knowledge with this clinical group. Further research with bigger sample sizes and randomization of patients into the different surgical groups is warranted.
Effect of Infant Orthopedics on Facial Appearance of Toddlers with Complete Unilateral Cleft Lip and Palate (Dutchcleft)
Authors: Bongaarts Catharina A. M. , Prahl-Andersen Birte , Bronkhorst Ewald M. , Spauwen Paul H. M. , Mulder Jan W. , Vaandrager J. Michiel , Kuijpers-Jagtman Anne M. 
Published: July 2008

Objective: To evaluate the effect of infant orthopedics (IO) on facial appearance of 54 patients with unilateral cleft lip and palate (UCLP), aged 4 and 6 years. Design: Prospective two-arm randomized controlled clinical trial in three Cleft Palate Centers in the Netherlands (Dutchcleft-trial). Interventions: Patients were divided randomly into two groups. Half of the patients (IO+) had a plate until surgical closure of the soft palate at the age of ± 52 weeks; the other half (IO−) received no intervention. Main Outcome Measures: Facial appearance at 4 and 6 years of age assessed on full face photographs and photographs showing only nose and mouth. Ratings were performed on a VAS-scale by professionals and laymen. Results: At 4 years of age the full face pictures of IO+ children were scored to be more attractive than those of IO− children. However, this difference had disappeared at 6 years of age. At the age of 6, only professionals saw a significant difference on nasolabial photographs between IO+ and IO−. Regression analysis showed a minor effect of occlusion, lip revision, or type of nose reconstruction on the esthetic results. Conclusions: IO had a positive effect on full facial appearance of UCLP children at the age of 4 years, but at the age of 6, only professionals saw a positive effect of IO on the nasolabial photographs. This is irrelevant for UCLP patients since they deal with laymen in their daily life.
Anatomy and Growth of the Fetal Soft Palate: A Cadaveric Study to Improve Its Ultrasonographic Observation
Authors: Captier Guillaume , Faure Jean-Michel , Baümler Marcel , Bonnel François , Daures Jean-Pierre 
Published: July 2008

Objective: To determine the anatomy of the soft and hard palate during fetal growth in order to improve its ultrasonographic prenatal visualization. Design: Anatomic study in human formalin-fixed fetus. Methods: The heads of 18 second and third trimester fetuses were studied in the median sagittal plan. Measurements of the soft palate, the velopharynx, the root of the tongue, and the oral floor were taken. The hard palate/soft palate angle and the anterior cranial base/soft palate angle were measured. Results: The growth of the hard palate was linear, and the growth of the soft palate was polynomial (second order) during the period studied. The hard palate/soft palate angle was 150.33° ± 7.62 and 150.20° ± 6.67 in the second and third trimester, respectively. The anterior position of the soft palate in relation to the anterior cranial base was 48.8° ± 3.13 in the second trimester and 52.26° ± 3.31 in the third trimester. Its posterior position was 89.66° ± 5.51 in the second trimester and 92.97° ± 4.01 in the third trimester. Throughout the fetal period, the soft palate moved downward relative to the clivus and cervical spine. Conclusions: Despite the nonlinear growth and downward displacement of the soft palate during fetal life, its position remains stable. These results may be useful to explore the fetal soft palate using 2D and 3D ultrasonography and to improve the prenatal diagnosis of isolated cleft palate.
Dental Anomalies as Part of the Cleft Spectrum
Authors: Menezes Renato , Vieira Alexandre Rezende 
Published: July 2008

Objective: The aim of this study was to determine subphenotypes of clefts based on tooth development. Dental phenotypes (tooth agenesis, supernumerary and impacted teeth, transposition, and structural anomalies) outside the cleft area in the permanent dentition of oral cleft individuals were investigated. Design: Evaluation of dental records of cleft patients. Setting: National Museum of Health and Medicine, Washington, D.C. Patients, Participants: A collection of dental casts, radiographic and clinical records of 146 patients with oral clefts was evaluated. Main Outcome Measure: Association of dental anomalies with preferential subtypes of clefts. Results: Forty-seven individuals (32.19%) presented at least one dental anomaly outside the cleft area. Individuals with complete cleft lip and palate (CLP) presented more dental anomalies than individuals with incomplete CLP (p  =  .04). Cleft palate individuals presented more dental anomalies than CLP individuals (p  =  .048). Maxillary lateral incisors and premolars were the most affected teeth. High incidence of maxillary second premolar agenesis was observed in individuals with bilateral CLP (p  =  .04). In cases with unilateral CLP, 12.5% presented dental anomalies of the maxillary lateral incisors on the noncleft side. Cleft palate individuals presented a high incidence of mandibular premolar anomalies (p  =  .004). Conclusion: Future studies should consider the inclusion of a complete dental description to aid in the definition of cleft subphenotypes to be studied.
Evaluation of the Presence or Absence of Papilla between Tooth and Implant
Authors: Kawai E. S. , Almeida A. L. P. F. 
Published: July 2008

Objective: The purpose of this study was to evaluate the papilla level adjacent to single-tooth implants in the maxillary anterior region in individuals with cleft lip, alveolus, and palate to verify whether there is correlation among the vertical distance, horizontal distance, dental/prosthetic crown shape, and periodontal/peri-implant biotype with the presence of interproximal papilla. Design: Cross-sectional. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP). Patients: 77 papillae in 40 patients. Interventions: The periodontal/peri-implant biotype was clinically evaluated and characterized as thin or thick. Intraoral photographs were used to evaluate the presence or absence of papilla. Main Outcome Measures: Classification in scores (0 to 3) and determination of length (CL) and width (CW) of crowns adjacent to papillae. The CW/CL ratio was calculated for each crown in order to characterize it as square-shaped or triangular-shaped. The vertical and horizontal distances were obtained by radiographic evaluation. Results: The correlations between vertical distance and papilla score and horizontal distance and papilla score were statistically significant (p  =  .02 and p  =  .01). There was no significant difference between crown shape and periodontal/peri-implant biotype in distinct correlations with the papilla score (p  =  .41 and p  =  .07). Conclusion: The results suggest that the vertical and horizontal distances may have independent or combined relationship with the existence of interproximal papilla; the periodontal/peri-implant biotype (phenotype) was not correlated with the presence or absence of papilla, as well as the shape of the dental/prosthetic crown.