bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring and monitoring outputs in social care: the problem of measuring quality
Authors: Malley Juliette , Netten Ann 
Published: December 2008

The focus of this article is the measurement of quality within the context of a new approach to measuring government-funded social care services. The approach builds on principles set out in a UK review led by Professor Sir Tony Atkinson. At its heart are the concepts of capacity for benefit, describing the potential benefit to users from services, and quality, reflecting the extent to which the benefit is realized. We report on a study designed to explore the suitability of a weighted user satisfaction measure to measure quality, examining in particular its sensitivity to changes in the quality of social care over time. The study finds some problems with using weighted user satisfaction. We discuss potential reasons for these problems, including the possibility of gaming and the specification of the measure, and discuss a way forward in the context of the requirement to draw upon routine sources of data. Points for practitioners The article describes a practical approach to measuring and monitoring outcomes and productivity in social care. Routine measures are used as far as possible, weighted to reflect outcomes for services users. The concepts of Capacity for Benefit and quality in this context potentially allow commissioners and managers to distinguish the impact on productivity of: the potential of services as they are currently configured, the dependency of service users, and the quality of delivery. The article identifies key issues and problems in using measures of satisfaction both as performance indicators and monitoring quality of services in the proposed approach.
Convergence without diffusion? A comparative analysis of the choice of performance indicators in tax administration and social security
Authors: van Stolk Christian , Wegrich Kai 
Published: December 2008

This article cross-nationally compares the choice of performance indicators in two core fields of state activity, tax administration and social security. Exploring the selection of performance indicators in six countries (Australia, Canada, Netherlands, Sweden, the UK and the US), the article analyses the driving forces for the choice of particular indicators in the context of national administrative traditions and more recent reform agendas on the one hand and the trend towards international exchange and `benchmarking' on the other hand. The article explores the relative significance and interaction of different driving forces of choice and how this shapes the development and application of performance indicators. To that end, it combines instutionalist approaches with the literature on the mechanisms and effects of international exchange and policy diffusion. Our analysis suggests that existing broad similarities are linked to similarities in core activities and values underlying contemporary public service reforms. Variation in the choice of performance indicators (PIs) reflects domestic factors such as governance arrangements through which broad reform trends are filtered. These arrangements also mediate any direct international learning. Points for practitioners This article aims to contribute to the debate around how organizations could learn from the experience of others in designing performance indicators and management systems. Potential for cross-national and cross-sectional learning is particularly high in categories where a particular organization has not yet developed performance indicators but others have done so already. But any cross-reading from other countries' choices should take into account that the definition and use of performance indicators is to a substantial extent driven by domestic institutional traditions, governance arrangements and wider national approaches to performance management. The design of performance indicators should in particular take into account the accountability relations in which agencies are embedded.
The intricate implementation of performance measurement systems: exploring developments in professional-service organizations in the Dutch non-profit sector
Authors: Teelken Christine 
Published: December 2008

Institutional and organizational theory supports the argument that current features of performance measurement systems (PMS) in public organizations are generally unsuitable for the actual nature of these professional organizations. Longitudinal and cross-sectional studies in the health care and higher education sectors in the Netherlands have shown that, despite external pressures, the implementation of such systems is slower than intended and seems to occur outside the primary process of the organization. Two rounds of interviews with quality coordinators in 2003 and 2006 showed that the gap between performance measurement systems and the operational process continued to exist, although its nature had changed. In general, quality coordinators responded pragmatically to the changes imposed upon them, as peer review and collegial trust played a vital part. The empirical findings illustrate that institutional and professional theories supplement each other in a fruitful way. Points for practitioners Policy-makers in the public sector involved with quality care and assurance should be aware that a well-structured performance measurement system (PMS) is no guarantee of smooth implementation. On the contrary, the implementation deserves attention in its own right. The more sophisticated and demanding the design of PMS, the more likely it is that employees find ways to work round such a system and only use it in a superficial or compliant manner. If implementation is not taken seriously into account, this will only lead to a greater gap between reality and rhetoric.
Long-term relapses after 12-month treatment forMycobacterium kansasiilung disease
Authors: Santin M. , Dorca J. , Alcaide F. , Gonzalez L. , Casas S. , Lopez M. , Guerra M. R. 
Published: December 2008

Long-lasting therapy forMycobacterium kansasiilung disease with rifampin-containing multidrug regimens is needed to avoid relapses. The aim of the present study is to evaluate a short multidrug treatment regimen forM. kansasiilung disease.A retrospective observational study of 75 patients withM. kansasiilung disease was conducted in a teaching hospital from January 1990 to December 2005.In total, 75 (67.6%) out of 111 patients diagnosed withM. kansasiilung disease completed a 12-month multidrug treatment regimen, including rifampin, isoniazid and ethambutol, supplemented with streptomycin during the first 2–3 months. After a 41.5-month median follow-up, five (6.6%) patients relapsed. The relapse rate was 2.19 (95% confidence interval 0.71–5.12) per 100 person·yrs. Treatment compliance was considered to be appropriate in all five patients and no drug resistance developed in any case.In conclusion, a 12-month fixed-course treatment is effective in most cases ofMycobacterium kansasiilung disease, but may not be long enough for all patients.
Long-term macrolide therapy in chronic inflammatory airway diseases
Authors: Crosbie P. A. J. , Woodhead M. A. 
Published: December 2008

In addition to direct antibacterial actions, 14- and 15-member-ring macrolides have immune modulating effects that appear to be the reason for clinical benefit in diffuse panbronchiolitis.A literature search was conducted for studies of the clinical effectiveness of macrolides in other chronic lung conditions.A number of studies were identified that showed short-term beneficial outcomes or the potential for such outcomes in cystic fibrosis, bronchiectasis, chronic obstructive pulmonary disease, asthma and post-transplant obliterative bronchiolitis. The studies were limited by small patient numbers, different outcome measures and short-term follow-up, and were not designed to assess potentially harmful effects.Further large prospective and long-term studies are required in order to identify potential benefit and harm before these agents can be recommended routinely for these conditions.
Animal models of ventilator-associated pneumonia
Authors: Luna C. M. , Sibila O. , Agusti C. , Torres A. 
Published: December 2008

Animal models are an essential step between “in vitro” testing and clinical studies. Different animal models have been useful for the study of pathophysiology, diagnosis and therapy in ventilator-associated pneumonia (VAP).Aspiration has been studied in dog and cat models and bacteriological diagnosis has been evaluated in baboons. Pigs have been used for studying either spontaneous or induced VAP. Intubated piglets in prone position were administered analgesia and muscle paralysis was induced, and the intubated piglets underwent mechanical ventilation for several days. In this model, spontaneous VAP due to common bacterial pig colonisation develops within a few days. Pneumonia can also be induced by inoculating high concentrations of microorganisms (Pseudomonas aeruginosaand methicillin-resistantStaphylococcus aureus).Different clinical, physiological, microbiological and pathological parameters of infection have been studied in this model. In addition, administration of antibiotics and inflammatory modulators and their consequences in microbiological eradication and local and systemic inflammation have been evaluated with interesting translational results.Although bronchial inoculation of healthy subjects does not resemble the common pathophysiological mechanisms, the experimental model of ventilator-associated pneumonia induced by the inoculation of high concentrations of microorganisms in mechanically ventilated piglets is useful for the study of the local and systemic responses of lung infection and for the determination of potential measures of prevention or therapeutic modulation.
Macrophages within NSCLC tumour islets are predominantly of a cytotoxic M1 phenotype associated with extended survival
Authors: Ohri C. M. , Shikotra A. , Green R. H. , Waller D. A. , Bradding P. 
Published: December 2008

There is a marked survival advantage for patients with nonsmall cell lung cancer (NSCLC) expressing high numbers of macrophages in their tumour islets. The primary aim of the present study was to determine the immunological phenotype of NSCLC-associated macrophages.CD68+macrophages expressing markers of a cytotoxic M1 phenotype or a noncytotoxic M2 phenotype were identified in the islets and stroma of surgically resected tumours from 20 patients with extended survival (median 92.7 months) and 20 with poor survival (median 7.7 months), using immunohistochemistry.The islet density of both M1 and M2 macrophages was markedly increased in extended compared with poor survival patients. In the extended survival group, M1 islet density was significantly increased compared with M2 density, 70% of islet macrophages were positive for M1 markersversus38% for M2, and the islet:stromal ratio of M1 macrophages was markedly increased compared with M2. The 5-yr survival for patients with above and below median expression of M1 macrophages in the islets was >75 and <5%, respectively.Macrophages infiltrating the tumour islets in nonsmall cell lung cancer were predominantly of the M1 phenotype in patients with extended survival. The survival advantage conferred by islet macrophage infiltration may be related to their cytotoxic antitumour activity.
Asthma therapy: how far have we come, why did we fail and where should we go next?
Authors: Janssen L. J. 
Published: December 2008

Reversible airflow obstruction and nonspecific airway hyperresponsiveness are: 1) the two key features of asthma; 2) the primary concern for asthma patients; and 3) both directly caused by the airway smooth muscle (ASM). As such, controlling bronchoconstriction should be of primary importance. Unfortunately, all existing pharmacological asthma therapies that specifically target the ASM are based on decades old strategies.In the present study, the evolution of pharmacological asthma therapy will be briefly discussed, some explanations will be suggested as to why substantial new advances in this area have not occurred in several years and, finally, several new directions for novel asthma therapies will be proposed.
Smoking characteristics of Polish immigrants in Dublin
Authors: Kabir Zubair , Clarke Vanessa , Keogan Sheila , Currie Laura M , Zatonski Witold , Clancy Luke 
Published: December 2008

AbstractBackgroundThis study examined two main hypotheses: a) Polish immigrants' smoking estimates are greater than their Irish counterparts (b) Polish immigrants purchasing cigarettes from Poland smoke "heavier" (≥ 20 cigarettes a day) when compared to those purchasing cigarettes from Ireland. The study also set out to identify significant predictors of 'current' smoking (some days and everyday) among the Polish immigrants.MethodsDublin residents of Polish origin (n = 1,545) completed a previously validated Polish questionnaire in response to an advertisement in a local Polish lifestyle magazine over 5 weekends (July–August, 2007). The Office of Tobacco Control telephone-based monthly survey data were analyzed for the Irish population in Dublin for the same period (n = 484).ResultsAge-sex adjusted smoking estimates were: 47.6% (95% Confidence Interval [CI]: 47.3%; 48.0%) among the Poles and 27.8% (95% CI: 27.2%; 28.4%) among the general Irish population (p < 0.001). Of the57% of smokers (n = 345/606) who purchased cigarettes solely from Poland and the 33% (n = 198/606) who purchased only from Ireland, 42.6% (n = 147/345) and 41.4% (n = 82/198) were "heavy" smokers, respectively (p = 0.79). Employment (Odds Ratio [OR]: 2.89; 95% CI: 1.25–6.69), lower education (OR: 3.76; 95%CI: 2.46–5.74), and a longer stay in Ireland (>24 months) were significant predictors of current smoking among the Poles. An objective validation of the self-reported smoking history of a randomly selected sub-sample immigrant group, using expired carbon monoxide (CO) measurements, showed a highly significant correlation coefficient (r = 0.64) of expired CO levels with the reported number of cigarettes consumed (p < 0.0001).ConclusionPolish immigrants' smoking estimates are higher than their Irish counterparts, and particularly if employed, with only primary-level education, and are overseas >2 years.
Gelatinase (MMP-2 and -9) expression profiles during gestation in the bovine endometrium
Authors: Kizaki Keiichiro , Ushizawa Koichi , Takahashi Toru , Yamada Osamu , Todoroki Junichi , Sato Takashi , Ito Akira , Hashizume Kazuyoshi 
Published: December 2008

Abstract

Background
Various molecules participate in implantation and maintaining endometrial function during gestation. The remodeling of endometrial matrices is a necessary process in the coordination of gestational progress. Matrix-metalloproteinases (MMPs) like gelatinases (MMP-2 and -9) and collagenase (MMP-1) are considered to play important roles in this process. We examined MMP-2 and -9 expression using zymography, in situ hybridization, real-time PCR, and microarray analysis to clarify their roles in the bovine endometrium during gestation.

Methods
Endometria, placentomes, and fetal membranes were collected from Japanese black cows that were killed on day 15 to 252 of gestation or during their estrous cycle. The gene expression of MMP-related molecules (mainly MMP-2 and -9) was examined using a custom-made microarray, real-time RT-PCR, and in-situ hybridization. Gelatinase activity was detected by zymography and film in situ zymography.

Results
Both gelatinases were expressed in the endometrium and fetal tissues throughout gestation. MMP-2 gene expression declined with the progress of gestation, but its intensity was maintained at a high level during the peri-implantation period and increased in late gestation. The expression level of MMP-9 was stably maintained, but was relatively low compared to that of MMP-2. These gene expression patterns matched those detected by zymography for the proteins. Microarray analysis suggested that the functions of MMP-2 during implantation and the last part of gestation are closely related with those of other molecules such as tissue inhibitors of metalloproteinase (TIMP)-2, a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 1, membrane type 1 (MT1)-MMP, and extracellular matrix metalloproteinase inducer (EMMPRIN).

Conclusion
We detected MMP-2 and -9 gene expression in the bovine endometrium and placentome throughout gestation. These data suggest that MMP-2 is one of the main endometrial remodeling factors for implantation and pre-partum in cattle. In cows, as is the case in humans and rodents, gelatinases participate in endometrial remodeling, and their activities depend on the balance of activators and inhibitors; i.e., TIMP, MT-MMP, EMMPRIN, MMP-2, MMP-9, and so on.
Microsatellite instability at a tetranucleotide repeat in type I endometrial carcinoma
Authors: Choi Yoo Duk , Choi Jin , Kim Jo Heon , Lee Ji Shin , Lee Jae Hyuk , Choi Chan , Choi Ho Sun , Lee Min Cheol , Park Chang Soo , Juhng Sang Woo , Nam Jong Hee 
Published: December 2008

Abstract

Background
Microsatellite instability (MSI) at tri- or tetranucleotide repeat markers (elevated microsatellite alterations at selected tetranucleotide repeat, EMAST) has been recently described. But, the underlying genetic mechanism of EMAST is unclear. This study was to investigate the prevalence of EMAST, in type I endometrial carcinoma, and to determine the correlation between the MSI status and mismatch repair genes (MMR) or p53.

Methods
We examined the 3 mono-, 3 di-, and 6 tetranucleotide repeat markers by PCR in 39 cases of type I endometrial carcinoma and performed the immunohistochemistry of hMSH2, hMLH1, and p53 protein.

Results
More than two MSI at mono- and dinucleotide repeat markers was noted in 8 cases (MSI-H, 20.5%). MSI, at a tetranucleotide repeat, was detected in 15 cases (EMAST, 38.5%). In remaining 16 cases, any MSI was not observed. (MSS, 42.1%), MSI status was not associated with FIGO stage, grade or depth of invasion. The absence of expression of either one of both hMSH2 or hMLH1 was noted in seven (87.5%) of eight MSI-H tumors, one (6.3%) of 16 MSS tumors, and five (33.3%) of 15 EMAST tumors. (p = 0.010) The expression of p53 protein was found in one (12.5%) of eight MSI-H tumors, five (31.3%) of 16 MSS tumors, and seven of 15 EMAST tumors. (p = 0.247)

Conclusion
Our results showed that about 38.5% of type I endometrial carcinomas exhibited EMAST, and that EMAST was rarely associated with alteration of hMSH2 or hMLH1.
Repetition of acute poisoning in Oslo: 1-year prospective study
Authors: Heyerdahl Fridtjof , Bjornaas Mari Asphjell , Dahl Rune , Hovda Knut Erik , Nore Anne Kathrine , Ekeberg Oivind , Jacobsen Dag 
Published: December 2008

BackgroundThe repetition of acute poisoning occurs frequently. The intention may change between episodes and many poisonings are treated outside the hospital setting. Few studies have taken this into account.AimsTo quantify the repetition frequency regardless of the level of health care or the intention behind the poisoning, and to identify possible risk factors for repetition.MethodA prospective multicentre study of all acute poisonings in Oslo treated in hospital, at an out-patient clinic or by the ambulance service. Repetition was estimated using Kaplan– Meier calculations, and predictive factors were identified using Cox regression analysis.ResultsThe estimated 1-year repetition rate was 30% (95% CI 24–35). Independent predictors of repetition were middle age (30–49 years), poisoning with opiates or sedatives, unemployment or living on social welfare, a previous suicide attempt, and a history of psychiatric treatment. Intention was not a significant predictor.ConclusionsRepetition of acute poisoning is high, irrespective of the level of healthcare and the intention behind the poisoning.
Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis
Authors: Crumlish Niall , Whitty Peter , Clarke Mary , Browne Stephen , Kamali Moayyad , Gervin Maurice , McTigue Orfhlaith , Kinsella Anthony , Waddington John L. , Larkin Conall , O'Callaghan Eadbhard 
Published: December 2008

BackgroundThe critical period hypothesis proposes that deterioration occurs aggressively during the early years of psychosis, with relative stability subsequently. Thus, interventions that shorten the duration of untreated psychosis (DUP) and arrest early deterioration may have long-term benefits.AimsTo test the critical period hypothesis by determining whether outcome in non-affective psychosis stabilises beyond the critical period and whether DUP correlates with 8-year outcome; to determine whether duration of untreated illness (DUI) has any independent effect on outcome.MethodWe recruited 118 people consecutively referred with first-episode psychosis to a prospective, naturalistic cohort study.ResultsNegative and disorganised symptoms improved between 4 and 8 years. Duration of untreated psychosis predicted remission, positive symptoms and social functioning at 8 years. Continuing functional recovery between 4 and 8 years was predicted by DUI.ConclusionsThese results provide qualified support for the critical period hypothesis. The critical period could be extended to include the prodrome as well as early psychosis.
Diagnostic accuracy of 123I-FP-CIT SPECT in possible dementia with Lewy bodies
Authors: O'Brien John T. , McKeith Ian G. , Walker Zuzana , Tatsch Klaus , Booij Jan , Darcourt Jacques , Marquardt Moritz , Reininger Cornelia ,   for the DLB Study Group
Published: December 2008

Background123I-FP-CIT SPECT (single photon emission computed tomography) can help in the differential diagnosis of probable dementia with Lewy bodies (Lewy body dementia) and Alzheimer's disease.AimsOur aim was to determine the accuracy of 123I-FP-CIT SPECT in diagnosing people with possible dementia with Lewy bodies.MethodWe undertook a 12-month follow-up of 325 individuals with probable or possible Lewy body or non-Lewy body dementia who had previously undergone 123I-FP-CIT SPECT. A consensus panel masked to SPECT findings, established diagnosis at 12 months in 264 people.ResultsOf 44 people with possible dementia with Lewy bodies at baseline, at follow-up the diagnosis for 19 people was probable dementia with Lewy bodies (43%), in 7 people non-Lewy body dementia (16%) and for 18 individuals it remained possible dementia with Lewy bodies (41%). Of the 19 who at follow-up were diagnosed with probable dementia with Lewy bodies, 12 had abnormal scans at baseline (sensitivity 63%); all 7 individuals with a possible diagnosis who were diagnosed as having Alzheimer's disease at follow-up had normal scans (specificity 100%).ConclusionsOur findings confirm the diagnostic accuracy of 123I-FP-CIT SPECT in distinguishing Lewy body from non-Lewy body dementia and also suggest a clinically useful role in diagnostically uncertain cases, as an abnormal scan in a person with possible dementia with Lewy bodies is strongly suggestive of dementia with Lewy bodies.
Antidepressants on trial: how valid is the evidence?
Authors: Parker Gordon 
Published: December 2008

SummaryA recent meta-analysis concluded that newer antidepressant drugs are equivalent to or no better than placebos, a conclusion at some variance with their commonly judged clinical effectiveness. The ‘disconnect’ between randomised controlled trials and clinical practice would benefit from dissection of contributing factors, and redressing limitations to current trial procedures.