bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutrient resorption and patterns of litter production and decomposition in a Neotropical Savanna
Authors: KOZOVITS A. R. , BUSTAMANTE M. M. C. , GAROFALO C. R. , BUCCI S. , FRANCO A. C. , GOLDSTEIN G. , MEINZER F. C. 
Published: August 2007

Summary

Deposition of nutrients due to anthropogenic activities has the potential to change nutrient availability in nutrient‐limited ecosystems with consequences for plant and ecosystem processes.
Species‐specific and ecosystem responses to the addition of nutrients were studied in a field experiment conducted in a Savanna (Cerrado sensu stricto) on dystrophic soil in central Brazil. Three fertilization treatments (N, P and N plus P additions) and unfertilized control were replicated in four 15 × 15 m plots per treatment.
Five of the dominant woody species were studied. Specific leaf area (SLA) was not affected by the treatments, but species responded differently in terms of foliar nutrient concentration, resorption efficiency and proficiency to the increased soil N and P availability.
Responses of N and P resorption suggested different levels of regulation for these two limiting elements, with a decrease in N and P resorption proficiency depending on the treatment. In general, under N fertilization, senesced leaves presented higher N concentration, whereas combined fertilization with N and P resulted in senesced leaves richer in P. The concomitant variation in P resorption efficiency and proficiency indicates a stronger regulation between them compared to N.
Results indicated a highly efficient and complete P resorption, while N concentrations in senesced leaves indicated intermediate or incomplete resorption efficiencies, supporting the idea that Cerrado plants might be more limited by P than by N.
At the ecosystem level, higher N concentration in the leaf litter was measured at the end of the dry season in the +NP‐fertilized plots, resulting in a significantly faster decomposition rate in relation to the control treatment. Responses of litterfall and decomposition rates indicated that the system was generally more responsive to the combined addition of N and P than to fertilization with N or P alone over the relatively short time span of this study.
Prophylaxis in adults with haemophilia
Authors: HAY C. R. M. 
Published: August 2007

Summary. The indications for and the efficacy of prophylaxis in adults with haemophilia remain controversial. It is unclear whether the benefits of secondary prophylaxis outweigh the costs, because adults with haemophilia usually already have established arthropathy. The objectives of secondary prophylaxis in this group are therefore more limited than the objectives of primary prophylaxis in children. It is also uncertain whether primary prophylaxis should stop or continue once adulthood is reached. Some individuals with near‐normal joints may stop prophylaxis in early adulthood and then bleed infrequently. Others who stop prophylaxis begin to bleed frequently and suffer progressive arthropathy; these patients should probably have continued prophylaxis. There is no satisfactory method for selecting patients for continued prophylaxis. Adult prophylaxis is less well studied than prophylaxis in children. A few studies with a small number of patients suggest that adults treated with prophylaxis experienced fewer bleeding episodes, less pain and improved quality of life compared with those treated on demand. The mean annual cost of prophylaxis tends be substantially higher for adults than for children, largely owing to the high cost of clotting factor. Here we review the literature regarding the prophylactic treatment of adult patients with haemophilia A, including studies of the discontinuation of prophylaxis. These studies and others all show clinical benefit from prophylaxis in adulthood and suggest the possibility that optimized prophylaxis (e.g. tailoring an intermediate‐ or low‐dose regimen in patients who bleed infrequently) may improve clinical outcome. The cost‐effect argument is more difficult to sustain in adults compared with children; however, the cost of prophylaxis may be counterbalanced by indirect factors, such as days gained at work, reduced hospitalizations, reduced need for orthopaedic surgery and improved quality of life.
Physiotherapy, rehabilitation and sports in countries with limited replacement coagulation factor supply
Authors: BUZZARD B. M. 
Published: August 2007

Summary. It is well documented that physiotherapy and rehabilitation benefit people with haemophilia by strengthening the key muscle groups and protecting joints from the adverse effects of repeated haemorrhages. Rehabilitation, in conjunction with the availability of replacement coagulation factor products, has revolutionized approaches to the management of patients with haemophilia in developed countries and has led to a substantial decrease in both the morbidity and mortality rates among the haemophilic population. Modern treatment approaches have also enabled persons with haemophilia to participate in sporting activities along with their peers; however, these improvements in care have not been achieved in developing nations, where health‐care resources and facilities are scarce and the supply of coagulation factor products is limited. This article attempts to address the following questions about the management of haemophilic patients in developing countries: Can physiotherapy, rehabilitation and sports prevent disabilities and preserve independence? Is participation in sports activities possible in developing countries? Do countries differ with regard to guidelines for participation in sports? Should we be encouraging participation in sports or allowing patients with haemophilia to do as they choose?
Orthopaedic issues in sports for persons with haemophilia
Authors: SEUSER AXEL , BOEHM PETER , KURME ANATOL , SCHUMPE GÜNTER , KURNIK KARIN 
Published: August 2007

Summary. Persons with haemophilia should not feel limited in their ability to participate in sports. After consultation with a physician or other health‐care provider and with a proper understanding of the risks involved and the strategies for managing these risks, patients with haemophilia can – and should – enjoy physical activities. We have analysed numerous reports of sports injury statistics and used them to rank a variety of sports according to their degree of injury risk. In addition, we have developed a brief orthopaedic examination and a five‐item fitness check that evaluates the level of physical fitness of patients with haemophilia. Using these tools, we can appropriately recommend specific sports activities best suited for each patient. In addition, we recommend that patients who regularly participate in sports maintain adequate levels of clotting factor through the use of regular prophylaxis. With proper physical evaluation and preparation, patients with haemophilia can realize the physical and emotional benefits of participation in sports.
Prostaglandin E2 modulates dendritic cell function during chlamydial genital infection
Authors: Liu Wei , Kelly Kathleen Ann 
Published: August 2007

SummaryInflammatory responses mediated by antigen‐presenting dendritic cells (DCs), can be modulated by the presence of prostaglandins (PG), including prostaglandin E2 (PGE2). PGE2 modifies the production of an immune response by altering DC function through PGE2 receptors. PGE2 is produced by epithelial cells lining the murine female reproductive tract during Chlamydia muridarum infection and likely manipulates the antichlamydial immune response during antigen uptake in the genital mucosa. Our data demonstrate that the PGE2 present locally in the genital tract upon chlamydial genital infection enhanced the recruitment of CD11b+ conventional DCs, but not CD45R+ plasmacytoid DCs, to infected genital tract tissue and draining lymph nodes in vivo. Furthermore, exposure to PGE2in vitro during infection of murine bone‐marrow‐derived conventional DCs (cDCs) boosted interleukin‐10 mRNA and protein while not influencing interleukin‐12p40 production. Infection of cDCs markedly increased mRNA production of the costimulatory molecules CD86, CD40 and a member of the C‐type lectin family, DEC‐205, but addition of PGE2 increased other costimulatory molecules and C‐type lectins. Also, exposure of PGE2 to infected cDCs increased FcγRIII and FcγRIIb, suggesting that PGE2 enhances the uptake and presentation of C. muridarum and augments production of the antichlamydial adaptive immune response. Taken together, the data suggest that exposure of infected cDCs to PGE2 drives production of a diverse adaptive immune response with implications for regulating tissue inflammation.
Immune responses against severe acute respiratory syndrome coronavirus induced by virus‐like particles in mice
Authors: Lu Xinya , Chen Yao , Bai Bingke , Hu Hui , Tao Ling , Yang Jihong , Chen Jianjun , Chen Ze , Hu Zhihong , Wang Hanzhong 
Published: August 2007

SummaryVirus‐like particles (VLPs) represent a promising vaccine against severe acute respiratory syndrome coronavirus (SARS CoV). In this study, recombinant baculovirus vAcS and vAcME were constructed to express the S protein and the M and E proteins of SARS CoV, respectively. Electron microscope analysis demonstrated the formation of VLPs in vAcME and vAcS coinfected insect cells. Mice immunized four times with VLPs developed high antibody titres against SARS CoV. In addition, VLPs elicited cell‐mediated immunity as demonstrated by enhanced interferon‐γ and interleukin‐4 production. VLPs also conferred protective immunity against the infection of Spike protein pseudotyped murine leukaemia virus. Our findings demonstrate that SARS CoV VLPs are immunogenic and can elicit strong SARS CoV‐specific humoral and cellular immune responses in mice. This is the first study describing the immunogenicity of SARS CoV VLPs, providing valuable data for developing a protective vaccine against SARS CoV infection.
Major ampullate spidroins from Euprosthenops australis: multiplicity at protein, mRNA and gene levels
Authors: Rising A. , Johansson J. , Larson G. , Bongcam‐Rudloff E. , Engström W. , Hjälm G. 
Published: August 2007

AbstractSpider dragline silk possesses extraordinary mechanical properties. It consists of large fibrous proteins called spidroins that display modular structures. It is known to consist of two proteins: the major ampullate spidroin (MaSp) 1 and MaSp2. This study analyses MaSp sequences from the nursery‐web spider Euprosthenops australis. We have identified a previously uncharacterized MaSp2 sequence and a new MaSp‐like spidroin, which display distinct homogenous submotifs within their respective Gly‐rich repeats. Furthermore, a group of MaSp1 cDNA clones show unexpected heterogeneity. Genomic PCR identified several MaSp1 gene variants within individual spiders, which suggests the presence of a gene cluster in E. australis. Finally, the evolution of spidroin genes is discussed in relation to phylogenetic analysis of nonrepetitive C‐terminal domains from diverse species.
Quality of stroke rehabilitation clinical practice guidelines
Authors: Hurdowar Amanda , Graham Ian D. , Bayley Mark , Harrison Margaret , Wood‐Dauphinee Sharon , Bhogal Sanjit 
Published: August 2007

Abstract
Background and purpose  Clinical practice guidelines (CPGs) are systematically developed statements that assist practitioners to provide appropriate evidence‐based care. The purpose of this study was to evaluate the quality of currently published CPGs for stroke care and to examine the reliability and validity of the appraisal of guidelines, research and evaluation (AGREE) instrument.
Methods  Multiple databases and Internet resources were searched for stroke care CPGs. Guidelines included were published in English or French from 1998 to 2004 and developed by a group process. Four appraisers evaluated each CPG using the AGREE instrument. The AGREE consists of 23 items, ranked on a 4‐point Likert scale, that is organized into six domains. A standardized score is calculated separately for each domain and ranges from 0 to 100.
Results  Eight guidelines were identified. The AGREE quality scores were high for the ‘scope and purpose’ domain (mean ± SE = 71.2 ± 5.48, intra‐class correlation (ICC) = 0.66), and ‘clarity and presentation’ (mean ± SE = 70.6 ± 4.43, ICC = 0.66). There was wide variation in ratings of ‘rigour of development’ (mean ± SE = 60.7 ± 7.1, ICC = 0.75) and ‘stakeholder involvement’ (mean ± SE = 52.6 ± 7.14, ICC = 0.89). The ‘editorial independence’ (mean ± SE = 38.1 ± 8.72, ICC = 0.88) and ‘applicability’ (mean ± SE = 35.1 ± 4.93, ICC = 0.75) had the lowest scores.
Conclusions  There is considerable variability in quality of stroke care guidelines but stroke guidelines score higher on the AGREE rigour of development domain than CPGs from other medical fields. The Scottish Intercollegiate Guideline Network, Veterans Affairs/Department of Defence, Royal College of Physicians, and the New Zealand Guidelines Group consistently scored the highest across the domains. Stroke rehabilitation clinicians should consider these results in selecting a guideline. CPG development groups can improve their AGREE scores by considering the cost of implementing their CPGs, pilot testing their CPGs, recording conflict of interest of development panel members and providing tools supporting application of the their CPGs.
Deterministic versus evidence‐based attitude towards clinical diagnosis
Authors: Soltani Akbar , Moayyeri Alireza 
Published: August 2007

AbstractGenerally, two basic classes have been proposed for scientific explanation of events. Deductive reasoning emphasizes on reaching conclusions about a hypothesis based on verification of universal laws pertinent to that hypothesis, while inductive or probabilistic reasoning explains an event by calculation of some probabilities for that event to be related to a given hypothesis. Although both types of reasoning are used in clinical practice, evidence‐based medicine stresses on the advantages of the second approach for most instances in medical decision making. While ‘probabilistic or evidence‐based’ reasoning seems to involve more mathematical formulas at the first look, this attitude is more dynamic and less imprisoned by the rigidity of mathematics comparing with ‘deterministic or mathematical attitude’. In the field of medical diagnosis, appreciation of uncertainty in clinical encounters and utilization of likelihood ratio as measure of accuracy seem to be the most important characteristics of evidence‐based doctors. Other characteristics include use of series of tests for refining probability, changing diagnostic thresholds considering external evidences and nature of the disease, and attention to confidence intervals to estimate uncertainty of research‐derived parameters.
Changes in perceived effect of practice guidelines among primary care doctors
Authors: Cheng Lee , Nieman Linda Z. , Becton James L. 
Published: August 2007

Abstract
Rationale, aims and objectives  Evidence suggests that when doctors use systematically developed clinical practice guidelines they have the potential to improve the safety, quality and value of health care. The purpose of this study was to evaluate recent changes in the perceptions of practice guidelines among US primary care doctors.
Methods  Data were collected from the Community Tracking Survey 1996–97 and 2000–01. All results were weighted and adjusted to reflect the complex survey design.
Results  Over the 5 years, the proportion of primary care doctors who said that practice guidelines had at least a moderate effect on their practice of medicine increased from 45.8% to 60.7%. This increase was nearly equal among primary care doctors of family medicine, internal medicine and paediatrics. In the 2001 survey, a higher perceived effect of practice guidelines was described by female doctors (OR = 1.39, 95% CI 1.19–1.63) and doctors who were practising in a large model group (OR = 1.73; 95% CI 1.04–2.89). Doctors who graduated from medical school within 10 years of the survey were more likely to report that practice guidelines had a positive effect on their practice of medicine than doctors who graduated 10 or more years before the survey.
Conclusion  The perceived effect of practice guidelines on primary care doctors increased over time. Improved dissemination of guidelines and curriculum changes may have led recent primary care graduates to view practice guidelines as more important.
Impact of consensus development conference guidelines on primary care of bronchiolitis: are national guidelines being followed?
Authors: Touzet Sandrine , Réfabert Luc , Letrilliart Laurent , Ortolan Bernard , Colin Cyrille 
Published: August 2007

Abstract
Aim  To measure the impact of French national consensus guidelines on the clinical practices of primary care paediatricians and general practitioners.
Design  Non‐randomized intervention study, with a first survey 1 year before the consensus development conference and a second survey 1 year after.
Intervention  Implementation of bronchiolitis management guidelines through the medical press and the Internet.
Subjects  Paediatricians and general practitioners treating infants 1 year of age and under consulting for a first‐time episode of bronchiolitis.
Results  Ninety‐three doctors and 510 infants were included during the first phase of the study and 96 doctors and 394 infants during the second phase. This study showed a slight increase in adherence to the guidelines for non‐validated drugs (6.6% adherence before and 14.3% after), general advice (29.0% adherence before and 57.1% after) and flow modulation respiratory physical therapy (91.9% adherence before and 98.8% after). Increase in adherence to guidelines for other practices, that is, hospitalization, prescribing antibiotics and complementary examinations, was not statistically significant. Adherence to the guidelines on providing general advice increased the most between the two studies.
Conclusion  The guidelines helped practitioners evolve slightly in their approach to the treatment of bronchiolitis. Non‐validated drugs remain frequently used. Additional resources for implementing the guidelines should be provided to improve primary care doctors’ practices.
Evaluating primary care doctors’ evidence‐based medicine skills in a busy clinical setting
Authors: Shuval Kerem , Shachak Aviv , Linn Shai , Brezis Mayer , Reis Shmuel 
Published: August 2007

Abstract
Rationale, aims and objectives  To date, primary care doctors’ (PCDs) evidence‐based medicine (EBM) skills have rarely been studied. We conducted a cross‐sectional study to evaluate PCDs’ practical EBM skills and to determine risk markers associated with these skills.
Methods  The study sample consisted of 70 PCDs (70.7% response rate) practising in a busy urban setting from a large health maintenance organization. Participants were given a short validated questionnaire gauging attitudes, barriers, online medical resources utilization, as well as demographic and personal characteristics. Additionally, doctors completed an online and written exam evaluating their ability to formulate clinical questions, and retrieve medical information efficiently. Data analysis was performed using both bivariate and multivariate analysis (linear regression).
Results  PCDs found it difficult to formulate clinical questions both in the written and online exam, mostly neglecting to mention the Patient and Comparison components of PICO (patient, intervention, comparison and outcome). Search strategies primarily dispensed with the use of MeSH terms, ignoring appropriate limits. Doctors final scores were low (score = 41.5/100, SD = 16.2). In bivariate analysis clinical experience was negatively correlated with the final score (r = −0.36, P = 0.01), and specialists’ scores were significantly higher than general practitioners’ scores (46.7/100 and 31.5/100 respectively, P < 0.001). In multivariate analysis, doctors specialization was the only statistically significant predictor of the final score (B = 12.74, P = 0.002), while controlling for participating in a prior EBM course.
Conclusions  This study emphasizes the need for enhancing PCDs practical EBM skills. Future research and interventions should focus on this population emphasizing the specific needs of subpopulations (i.e. general practitioners and doctors without previous EBM training).
Medical evidence and health policy: a marriage of convenience? The case of proton pump inhibitors
Authors: Van Driel Mieke L. , Vander Stichele Robert , De Maeseneer Jan , De Sutter An , Christiaens Thierry 
Published: August 2007

Abstract
Rationale  In Belgium, several policies regulating reimbursement of acid suppressant drugs and evidence‐based recommendations for clinical practice were issued in a short period of time, creating a unique opportunity to observe their effect on prescribing.
Aims and objectives  To describe the evolution of prescriptions for acid suppressants and explore the interaction of policies and practice recommendations with prescribing patterns.
Method  Monthly claims‐based data for proton pump inhibitors (PPIs) and H2‐antihistamines by general practitioners, internists and gastroenterologists were obtained from the Belgian national health insurance database (1997–2005). The evolution of reimbursed defined daily doses and expenses after introduction of reimbursement regulations and dissemination of practice recommendations was explored.
Results  Recommendations had no impact on prescribing. All changes can be related to concomitant policies. Lifting reimbursement restrictions for cheaper products did not control growth or save costs in the long term. Only restricting reimbursement of all PPIs managed to curb the growth. We observed an unintended increase of non‐omeprazole PPIs by gastroenterologists.
Conclusions  Reimbursement policies influence prescribing, but their effect can be unintended. A dialogue between policymakers and guideline developers, and evidence‐based policies that are linked to clinical guidelines, could be an effective way to pursue both cost‐containment and quality of care.
No exit? Intellectual integrity under the regime of ‘evidence’ and ‘best‐practices’
Authors: Murray Stuart J. , Holmes Dave , Perron Amélie , Rail Geneviève 
Published: August 2007

AbstractNo exit? Have we arrived at an impasse in the health sciences? Has the regime of ‘evidence’, coupled with corporate models of accountability and ‘best‐practices’, led to an inexorable decline in innovation, scholarship, and actual health care? Would it be fair to speak of a ‘methodological fundamentalism’ from which there is no escape? In this article, we make an argument about intellectual integrity and good faith. We take this risk knowing full well that we do so in a hostile political climate in the health sciences, positioning ourselves against those who quietly but assiduously control the very terms by which the public faithfully understands ‘integrity’ and ‘truth’. In doing so, we offer an honest critique of these definitions and of the systemic power that is reproduced and guarded by the gatekeepers of ‘Good Science’.