bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic fatigue and its correlates in long‐term survivors of cervical cancer treated with radiotherapy
Authors: Vistad I , Fosså SD , Kristensen GB , Dahl AA 
Published: July 2007

Objective  To describe the prevalence of chronic fatigue (CF) and associated variables in locoregional cervical cancer survivors (CCSs) surveyed >5 years after radiotherapy. Demographic, clinical and psychological characteristics of the CCSs were compared with normative data.Design  Cross‐sectional study.Setting  Department of Gynaecologic Oncology at Rikshospitalet‐Radiumhospitalet Medical Center, Oslo, Norway.Population  Seventy‐nine CCSs aged ≤79 years, treated between 1994 and 1999, representing 62% of those invited. Normative data were based on various population studies of Norwegian women.Methods  Data were collected by means of a mailed questionnaire, which included demographic variables and instruments covering fatigue, mental distress, sexual functioning, somatic impairments and quality of life (QOL).Main outcome measures  Self‐reported fatigue score and caseness of CF based on the fatigue questionnaire.Results  CCSs showed 30% CF versus 13% reported in the general population (P= 0.001). CCSs with CF had a significantly lower QOL, higher levels of anxiety and depression and more physical impairments than those without CF. In a multivariable regression model, depression was the only variable significantly associated with CF in CCSs.Conclusions  More CCSs have CF than age‐matched women in the general population. CF should be of clinical concern since these women also frequently have treatable mental and physical problems.
The emotional burden of miscarriage for women and their partners: trajectories of anxiety and depression over 13 months
Authors: Cumming GP , Klein S , Bolsover D , Lee AJ , Alexander DA , Maclean M , Jurgens JD 
Published: July 2007

Objective  To identify the trajectories of anxiety and depression in women and in their partners over 13 months after miscarriage.Design  A prospective study with follow up at 6 and 13 months after miscarriage.Setting  Three Scottish Early Pregnancy Assessment Units.Sample  Of the 1443 eligible individuals approached, 686 (48.3%) consented to participate (432 women; 254 men). Complete data were obtained from 273 women and 133 men at baseline, 6, and 13 months.Methods  On completion of the management of the index miscarriage, eligible and consenting women and men underwent an initial assessment comprising a semi‐structured interview and a standardised self‐report questionnaire. The latter was readministered at the follow‐up assessments.Main outcome measures  The hospital anxiety and depression scale (HADS), a reliable and valid measure of general psychopathology for use in nonpsychiatric samples.Results  Compared with depression, anxiety was overall the greater clinical burden. Over the 13‐month period, women reported higher levels of anxiety and depression than men. Over time, a significantly greater level of adjustment was reported by women particularly with regards to the resolution of anxiety symptoms. The effect of time on HADS scores in either gender was similar between subgroups of socio‐demographic and clinical factors.Conclusions  These findings verify that early pregnancy loss represents a significant emotional burden for women, and to some extent for men, especially with regards to anxiety. For many, the detrimental effects of miscarriage are enduring and display a complex course of resolution. These findings are discussed in terms of their clinical implications for early identification and management.
Costs of NHS maternity care for women with multiple pregnancy compared with high‐risk and low‐risk singleton pregnancy
Authors: Mistry H , Dowie R , Young TA , Gardiner HM ,   TelePaed Project Team
Published: July 2007

Objective  To compare antenatal and obstetric costs for multiple pregnancy versus singleton pregnancy risk groups and to identify factors driving cost differentials.Design  Observational study over 15 months (2001–02).Setting  Four district hospitals in southeast England.Population  Consecutive women with multiple pregnancy and singleton women with risk factors for fetal congenital heart disease (CHD) (pregestational diabetes, epilepsy, or family history of CHD) or Down syndrome, and a sample of low‐risk singleton women.Methods  Clinical care was audited from the second trimester anomaly scan until postnatal discharge, and the resource items were costed. Multiple regression analysis determined predictors of costs.Main outcome measures  NHS mean costs of antenatal and obstetric care for different types of pregnancy.Results  A total of 959 pregnancies were studied. Three percent of 243 women with multiple pregnancy reached 40 weeks of gestation compared with 54–55% of 163 low‐risk and 322 Down syndrome risk women and 36% of 231 cardiac risk women. Antenatal costs for cardiac risk (£1,153) and multiple pregnancy (£1,048) were nearly double the costs for other two groups (P < 0.001). As 63% of multiple births were delivered by caesarean section, the obstetric cost for multiple pregnancy (£3,393) was £1,000 greater overall. Pregestational diabetes was the most influential factor driving singleton costs, resulting in similar total costs for multiple pregnancy women (£4,442) and for women with diabetes (£4,877).Conclusions  Our analyses confirm that multiple pregnancies are substantially more costly than most singleton pregnancies. Identifying women with diabetes as equally costly is pertinent because of the findings of the Confidential Enquiry into Maternal and Child Health that standards of maternal care for diabetics often are inadequate.
GLOBAL HEALTH ETHICS FOR STUDENTS
Authors: PINTO ANDREW D. , UPSHUR ROSS E.G. 
Published: July 2007

ABSTRACTAs a result of increased interest in global health, more and more medical students and trainees from the ‘developed world’ are working and studying in the ‘developing world’. However, while opportunities to do this important work increase, there has been insufficient development of ethical guidelines for students. It is often assumed that ethics training in developed world situations is applicable to health experiences globally. However, fundamental differences in both clinical and research settings necessitate an alternative paradigm of analysis. This article is intended for teachers who are responsible for preparing students prior to such experiences. A review of major ethical issues is presented, how they pertain to students, and a framework is outlined to help guide students in their work.
Limited Reintroduction Does Not Always Lead to Rapid Loss of Genetic Diversity: An Example from the American Chestnut (Castanea dentata; Fagaceae)
Authors: Pierson Sarah A. M. , Keiffer Carolyn H. , McCarthy Brian C. , Rogstad Steven H. 
Published: July 2007

Abstract In restoring species, reasons for introducing limited numbers of individuals at different locations include costs of introduction and maintenance, limited founder supply, and risk “bet hedging.” However, populations initiated from few founders may experience increased genetic drift, inbreeding, and diversity loss. We examined the genetic diversity of an isolated stand of more than 5,000 American chestnut trees relative to that of the 9 surviving stand founders (out of 10 total) planted in the 1880s. We used minisatellite DNA probes to reveal 84 genetic markers (circa 24 loci) among the nine founders, and their genetic diversity was compared with three separate plots of descendant trees, as well as with two natural stands. The descendants were circa 7.3% more heterozygous than the founders (mean estimated H= 0.556 vs. 0.518, respectively; p < 0.0001). Genetic differentiation was not pronounced (FST < 0.031), and no markers, including those at low frequency among the founders, were lost in the descendants. The founders and natural transects were not significantly different in H or similarity (mean proportion of bands shared). Special planting or mating protocols for establishment of a vigorous American chestnut population from a low number of founders may not be required to avoid strong effects of genetic drift and inbreeding. These results demonstrate that loss of genetic diversity following reintroduction of a limited number of founders is not always inevitable, such as this case where the species is highly outcrossing, expression of heterozygous advantage may occur, the original founders remain as gene contributors over generations, and the establishing population expands constantly and rapidly.
Restoring Rivers One Reach at a Time: Results from a Survey of U.S. River Restoration Practitioners
Authors: Bernhardt Emily S. , Sudduth Elizabeth B. , Palmer Margaret A. , Allan J. David , Meyer Judy L. , Alexander Gretchen , Follastad‐Shah Jennifer , Hassett Brooke , Jenkinson Robin , Lave Rebecca , Rumps Jeanne , Pagano Laura 
Published: July 2007

Abstract Despite expenditures of more than 1 billion dollars annually, there is little information available about project motivations, actions, and results for the vast majority of river restoration efforts. We performed confidential telephone interviews with 317 restoration project managers from across the United States with the goals of (1) assessing project motivations and the metrics of project evaluation and (2) estimating the proportion of projects that set and meet criteria for ecologically successful river restoration projects. According to project managers, ecological degradation typically motivated restoration projects, but post‐project appearance and positive public opinion were the most commonly used metrics of success. Less than half of all projects set measurable objectives for their projects, but nearly two‐thirds of all interviewees felt that their projects had been “completely successful.” Projects that we classified as highly effective were distinct from the full database in that most had significant community involvement and an advisory committee. Interviews revealed that many restoration practitioners are frustrated by the lack of funding for and emphasis on project monitoring. To remedy this, we recommend a national program of strategic monitoring focused on a subset of future projects. Our interviews also suggest that merely conducting and publishing more scientific studies will not lead to significant improvements in restoration practice; direct, collaborative involvement between scientists, managers, and practitioners is required for forward progress in the science and application of river restoration.
Freshwater Habitat Restoration Actions in the Pacific Northwest: A Decade’s Investment in Habitat Improvement
Authors: Katz Stephen L. , Barnas Katie , Hicks Ryan , Cowen Jeff , Jenkinson Robin 
Published: July 2007

Abstract Across the Pacific Northwest (PNW), both public and private agents are working to improve riverine habitat for a variety of reasons, including improving conditions for threatened and endangered salmon. These projects are moving forward with little or no knowledge of specific linkages between restoration actions and the responses of target species. Targeted effectiveness monitoring of these actions is required to redress this lack of mechanistic understanding, but such monitoring depends on detailed restoration information—that is, implementation monitoring. This article describes the process of assembling a database of restoration projects intended to improve stream and river habitat throughout the PNW. We designed the database specifically to address the needs of regional monitoring programs that evaluate the effectiveness of restoration actions. The database currently contains spatially referenced, project‐level data on over 23,000 restoration actions initiated at over 35,000 locations in the last 15 years (98% of projects report start or end dates between 1991 and 2005) in the states of Washington, Oregon, Idaho, and Montana. Data sources included federal, state, local, nongovernmental organization, and tribal contributors. The process of database production identified difficulties in the design of regional project tracking systems. The technical design issues range from low‐level information such as what defines a project or a location to high‐level issues that include data validation and legalities of interagency data sharing. The completed database will inform efficient monitoring design, effectiveness assessments, and restoration project planning.
Systematic Postproject Appraisals to Maximize Lessons Learned from River Restoration Projects: Case Study of Compound Channel Restoration Projects in Northern California
Authors: Tompkins Mark R. , Kondolf G. M. 
Published: July 2007

Abstract We conducted systematic postproject appraisals (PPAs) of seven compound channel restoration projects, supplementing available data with new field data and analyses to produce comparable datasets for all seven projects. We describe how systematic PPAs can be developed and illustrate a systematic PPA for compound channel projects organized around performance with respect to geomorphic, habitat, and conveyance objectives. We found that preexisting monitoring programs for a group of similar restoration projects can be supplemented with relatively low‐effort data collection and analyses to produce lessons on a “class” of restoration projects. Using this approach to assess a set of seven compound channel projects, we found that two fully achieved geomorphic objectives, three appear likely to achieve geomorphic objectives with additional time and/or minor interventions, and two did not achieve geomorphic objectives. Further, four projects achieved habitat objectives and three projects appeared likely to achieve objectives if given more time to develop and/or a minor intervention to mitigate limitations on critical ecological processes. Finally, four of the projects satisfied conveyance objectives, and the remaining three appeared likely to satisfy objectives with minor interventions to maintain design roughness and geometry conditions. Based on observations from our new systematic PPA approach applied to compound channels in Mediterranean climates, we suggest application of systematic PPAs for other classes of river restoration projects to evaluate scale and geomorphic setting issues in project design, to refine postproject monitoring guidelines, and to predict vegetation recruitment, growth, and succession patterns to avoid potential vegetation problems.
Evaluating Stream Restoration in the Chesapeake Bay Watershed through Practitioner Interviews
Authors: Hassett Brooke A. , Palmer Margaret A. , Bernhardt Emily S. 
Published: July 2007

AbstractRiver restoration is an integral part of restoring the Chesapeake Bay. As part of the National River Restoration Science Synthesis (NRRSS), we conducted 47 independent interviews with stream restoration project managers randomly selected from a database of 4,700 projects in the Chesapeake Bay watershed. Here we present results from those interviews and characterize patterns in project goals, design, and expenditures, trends in project evaluation, and characterize project success as reported by interviewees. Interviewed practitioners reported that the majority of their projects were designed by private consultants. One‐third of projects were part of a watershed management plan and 70% were linked to other projects within the same watershed. Most interviewees considered their projects to be successful, and 76% of projects had conducted some form of project‐associated monitoring. Although most interviewees based their evaluation of success on observations or monitoring data, respondents indicated that very few projects had explicitly stated quantifiable project objectives within their design plans. Many interviewed practitioners specifically commented at the end of the surveys on the important role of stakeholder involvement and the need for initiatives to fund project monitoring.
Introduction to the Older Patient: A “First Exposure” to Geriatrics for Medical Students
Authors: Adelman Ronald D. , Capello Carol F. , LoFaso Veronica , Greene Michele G. , Konopasek Lyuba , Marzuk Peter M. 
Published: July 2007

In 2003, Weill Cornell Medical College developed a 4‐hour module to introduce the geriatric patient within the required first‐year doctoring course. The educational intervention highlights the importance of communication between older patients and physicians, the utility of an enhanced social history and functional assessment, and the pitfalls of ageism in the medical setting. The module incorporates film, the performing arts, and small‐group exposure to a community‐residing older person.To evaluate the module's effect, four successive classes of first‐year medical students (2003–2006) responded to a 14‐item questionnaire and three opened‐ended questions at the end of the 4‐hour curriculum. Quantitative and qualitative analysis reveal consistently strong positive student feedback to this module. Almost all students agreed that the learning objectives were clear (99%) and had been met (99%).Several curricular interventions received high endorsement from the respondents in their questionnaire and narrative comments. Most (94%) were in strong agreement that meeting the older patient in the small group was a worthwhile experience. Also, students appreciated observing an example of a substandard interview (76% in strong agreement) and then a demonstration of effective communication (83% in strong agreement) through dramatic enactments. The majority of students (97%) commented that exposure to these presentations enabled them to see ageist behavior firsthand and to observe how ageist attitudes interfere with appropriate diagnosis and medical care. This approach to introducing the older patient may be of use at other medical schools. Future studies will need to evaluate the long‐term effect of this educational intervention.
The Quality of Pharmacotherapy in Older Veterans Discharged from the Emergency Department or Urgent Care Clinic
Authors: Hastings S. Nicole , Sloane Richard J. , Goldberg Kenneth C. , Oddone Eugene Z. , Schmader Kenneth E. 
Published: July 2007

OBJECTIVES: To determine the prevalence and type of suboptimal pharmacotherapy that older veterans discharged from the emergency department (ED) or urgent care clinic (UCC) receive and to examine factors associated with suboptimal pharmacotherapy in this population.DESIGN: Retrospective, cohort study.SETTING: An academically affiliated Department of Veterans' Affairs (VA) Medical Center.PARTICIPANTS: Four hundred twenty‐one veterans aged 65 and older who were prescribed a new medication at the time of discharge from the ED or UCC.MEASUREMENTS: The primary dependent variable, suboptimal pharmacotherapy, was a composite measure defined as one or more drug‐related problems, based on drugs‐to‐avoid criteria, drug–drug interactions, drug–disease interactions, and failure to satisfy an explicit quality indicator for prescribing or medication monitoring.RESULTS: A total of 757 drugs were prescribed to the 421 patients at the time of discharge from the ED or UCC (mean number±standard deviation per patient 1.65±1.1). The most frequently prescribed medications were nonsteroidal antiinflammatory drugs (n=59), opioid analgesics (n=47), and fluoroquinolone antibiotics (n=46). Overall, 134 (31.8%) subjects were found to have suboptimal pharmacotherapy with regard to their discharge medications; 49 (11.6%) were prescribed a drug to avoid, 53 (12.6%) received a drug that introduced a new drug–drug interaction, 24 (5.7%) were given a drug that introduced a drug–disease interaction, and 74 (17.6%) did not have a quality indicator satisfied (61% of these evaluated prescribing and 39% evaluated medication monitoring). No consistent associations between patient or visit characteristics and suboptimal pharmacotherapy were identified in multivariable models.CONCLUSION: A substantial number of older adults discharged from the ED or UCC may be at risk for adverse events due to suboptimal prescribing and inadequate medication monitoring. Further study is needed to examine the relationship between suboptimal pharmacotherapy and adverse clinical outcomes.
Predicting Caregiver Burden from Daily Functional Abilities of Patients with Mild Dementia
Authors: Razani Jill , Kakos Bernadette , Orieta‐Barbalace Carla , Wong Jennifer T. , Casas Rachel , Lu Po , Alessi Cathy , Josephson Karen 
Published: July 2007

OBJECTIVES: To assess the relationship between performance‐ and informant‐based measures of activities of daily living (ADLs) in patients with early dementia and burden or psychological distress experienced by the patients' caregivers.DESIGN: Descriptive study.SETTING: Ambulatory center.PARTICIPANTS: Thirty‐four patient‐caregiver dyads in which the patient had mild dementia (Mini‐Mental State Examination score >17).MEASUREMENTS: A performance‐based ADL measure (the Direct Assessment of Functional Status (DAFS)) was administered to patients with mild dementia. Caregivers completed an informant‐based measure of patient functional status (instrumental activities of daily living). Caregivers also completed the Caregiver Burden Inventory (CBI) and the Brief Symptom Inventory (BSI).RESULTS: Significant correlations were found between the informant‐based ADL measure and caregiver burden (CBI) and psychological distress (BSI) (correlation coefficient (r)=−0.34 to −0.71, all P<.05). Alternatively, fewer and weaker relationships were observed between the DAFS (performance‐based) ADL measure and caregiver burden or distress ratings (r=−0.32 to −0.43, all P<.05). Of the seven tasks assessed using the DAFS, impairments in orientation, communication, financial, and transportation skills in patients were associated with greater time and developmental burden and greater hostility in caregivers. Impairment in financial skills in patients was the strongest predictor of time‐dependence burden and hostility in caregivers, whereas impairment in patient transportation skills was the best predictor of developmental burden.CONCLUSIONS: The ADL abilities of cognitively impaired patients can predict caregiver burden and psychological distress, with informant‐based measures having the greatest association with patient impairment.
Expression of receptor activator of nuclear factor kappa B ligand relates to inflammatory bone resorption, with or without occlusal trauma, in rats
Authors: Yoshinaga Y. , Ukai T. , Abe Y. , Hara Y. 
Published: July 2007

Background and Objective:  Receptor activator of nuclear factor kappa B ligand (RANKL) is an important factor in osteoclast differentiation, activation and survival; however, its involvement in inflammatory bone resorption, with or without occlusal trauma, is unclear. The purpose of the present study was to investigate the distribution of RANKL‐expressing cells in rat periodontium during lipopolysaccharide‐induced inflammation with or without occlusal trauma.Material and Methods:  Lipopolysaccharide was injected into rat gingiva of the lower left first molar to induce inflammation. In addition, the occlusal surface of the upper left first molar of rat was raised by placing a gold inlay to induce occlusal trauma in the lower left first molars. The distribution of RANKL‐expressing cells was immunohistochemically observed.Results:  In the inflammatory model, many osteoclasts were observed at the apical inter‐radicular septum on day 5 and they were reduced by day 10. On the other hand, in the inflammatory model with occlusal trauma, many osteoclasts were still observed on day 10. RANKL expression was similar to the changes in osteoclast number. The expression of RANKL increased in endothelial cells, inflammatory cells and periodontal ligament cells.Conclusion:  These findings clearly demonstrated that RANKL expression on endothelial cells, inflammatory cells and periodontal ligament cells is involved in inflammatory bone resorption and the expression is enhanced by traumatic occlusion. These results suggest that RANKL expression on these cells is closely involved in the increase of osteoclasts induced by occlusal trauma.