bluuebunny/crossref_metadata_2025_split huggingface dataset:
Innovation and Implementation in the Public Sector: An Examination of Public Entrepreneurship
Authors: Mack W.R. , Green Deanna , Vedlitz Arnold 
Published: April 2008

AbstractThis article develops an empirical measure of public entrepreneurship and uses it to discover the correlates that distinguish between those participants in a policy domain who are seen as more or less important in the entrepreneurial process. Looking at two rural regions dealing with telemedicine technologies, the authors examine the role of personal attributes and situational attributes in predicting who will emerge as the most mentioned public entrepreneurs on these issues in their community. Status in the local community, membership in the health professions, and strong local focus and ties are the most instrumental variables in distinguishing between those in a policy domain who are more likely to be identified as entrepreneurial. The authors provide an empirical test that can, for the first time, identify in a comparative context the traits that distinguish more entrepreneurial individuals from less entrepreneurial ones (or nonentrepreneurial ones) participating in the same policy domain.
Informed Consent for Research: Current Practices in Academic Emergency Medicine
Authors: Monico Edward , Larkin Gregory Luke , Degutis Linda 
Published: April 2008

AbstractBackground:  The emergency department (ED) environment presents unique barriers to the process of obtaining informed consent for research.Objectives:  The objective was to identify commonalities and differences in informed consent practices for research employed in academic EDs.Methods:  Between July 1, 2006, and June 30, 2007, an online survey was sent to the research directors of 142 academic emergency medicine (EM) residency training programs identified through the Accreditation Council for Graduate Medical Education (ACGME).Results:  Seventy‐one (50%) responded. The average number of simultaneous clinical ED‐based research projects reported was 7.3 (95% confidence interval [CI] = 5.53 to 9.07). Almost half (49.3%) of respondents reported that EM residents are responsible for obtaining consent. Twenty‐nine (41.4%) participating institutions do not require documentation of an individual resident’s knowledge of the specific research protocol and consent procedure before he or she is allowed to obtain consent from research subjects.Conclusions:  It is common practice in academic EDs for clinical investigators to rely on on‐duty health care personnel to obtain research informed consent from potential research subjects. This practice raises questions regarding the sufficiency of the information received by research subjects, and further study is needed to determine the compliance of this consent process with federal guidelines.
Use of a Standardized Order Set for Achieving Target Temperature in the Implementation of Therapeutic Hypothermia after Cardiac Arrest: A Feasibility Study
Authors: Hope Kilgannon J. , Roberts Brian W. , Stauss Mary , Jo Cimino Mary , Ferchau Lynn , Chansky Michael E. , Phillip Dellinger R. , Parrillo Joseph E. , Trzeciak Stephen 
Published: April 2008

AbstractObjectives:  Induced hypothermia (HT) after cardiac arrest improved outcomes in randomized trials. Current post–cardiac arrest treatment guidelines advocate HT; however, utilization in practice remains low. One reported barrier to adoption is clinician concern over potential technical difficulty of HT. We hypothesized that using a standardized order set, clinicians could achieve HT target temperature in routine practice with equal or better efficiency than that observed in randomized trials.Methods:  After a multidisciplinary HT education program, we implemented a standardized order set for HT induction and maintenance including sedation and paralysis, intravenous cold saline infusion, and an external cooling apparatus, with a target temperature range of 33–34°C. We performed a retrospective analysis of a prospectively compiled and maintained registry of cardiac arrest patients with HT attempted (intent‐to‐treat) over the first year of implementation. The primary outcome measures were defined a priori by extrapolating treatment arm data from the largest and most efficacious randomized trial: 1) successful achievement of target temperature for ≥85% of patients in the cohort and 2) median time from return of spontaneous circulation (ROSC) to achieving target temperature <8 hours.Results:  Clinicians attempted HT on 23 post–cardiac arrest patients (arrest location: 78% out‐of‐hospital, 22% in‐hospital; initial rhythm: 26% ventricular fibrillation/tachycardia, 70% pulseless electrical activity or asystole) and achieved the target temperature in 22/23 (96%) cases. Median time from ROSC to target temperature was 4.4 (interquartile range 2.8–7.2) hours. Complication rates were low.Conclusions:  Using a standardized order set, clinicians can achieve HT target temperature in routine practice.
Toward Vocabulary Control for Chief Complaint
Authors: Haas Stephanie W. , Travers Debbie , Tintinalli Judith E. , Pollock Daniel , Waller Anna , Barthell Edward , Burt Catharine , Chapman Wendy , Coonan Kevin , Kamens Donald , McClay James 
Published: April 2008

AbstractThe chief complaint (CC) is the data element that documents the patient’s reason for visiting the emergency department (ED). The need for a CC vocabulary has been acknowledged at national meetings and in multiple publications, but to our knowledge no groups have specifically focused on the requirements and development plans for a CC vocabulary.The national consensus meeting “Towards Vocabulary Control for Chief Complaint” was convened to identify the potential uses for ED CC and to develop the framework for CC vocabulary control. The 10‐point consensus recommendations for action were 1) begin to develop a controlled vocabulary for CC, 2) obtain funding, 3) establish an infrastructure, 4) work with standards organizations, 5) address CC vocabulary characteristics for all user communities, 6) create a collection of CC for research, 7) identify the best candidate vocabulary for ED CCs, 8) conduct vocabulary validation studies, 9) establish beta test sites, and 10) plan publicity and marketing for the vocabulary.
Java project on periodontal diseases: serotype distribution of Aggregatibacter actinomycetemcomitans and serotype dynamics over an 8‐year period
Authors: Van Der Reijden Wil A. , Bosch‐Tijhof Carolien J. , Van Der Velden Ubele , Van Winkelhoff Arie Jan 
Published: April 2008

AbstractObjective: To investigate the serotype distribution and stability of Aggregatibacter actinomycetemcomitans over an 8‐year period in untreated Indonesian subjects.Material and Methods: Clinical periodontal status and the presence of A. actinomycetemcomitans were established in 1994 and 2002 in 107 subjects from an Indonesian tea estate deprived from dental care. On an average, 3.6 isolates per patient were subcultured and serotyped using specific PCR reactions.Results: In 1994, the predominant serotype was b (53.7%), whereas a and c occurred in 17.1% and 14.6% of the subjects, respectively. In 2002, a reduction in serotypes a (7.5%) and b (30.2%) occurred. Serotypes c and e increased in prevalence from 14.6% to 35.8% and 2.4% to 9.4%, respectively. Multiple serotypes were found in 12.2% in 1994 and 17% in 2002. From 24 subjects who were positive at both time points, 14 (58.3%) had the same serotype, whereas in 10 subjects (41.7%), a different serotype was found. Mean clinical attachment loss had increased from 0.74 mm in 1994 to 1.96 mm in 2002 but could not be related to subgingival presence of A. actinomycetemcomitans.Conclusions: A. actinomycetemcomitans serotypes distribution in Indonesian young adults shifts from predominantly serotype b to a more equal prevalence of serotypes b and c. This shift suggests an opportunistic character of A. actinomycetemcomitans.
Application of internal wool lipids to hair
Authors: Méndez Sandra , Barba Clara , Lanzilotta Alisa Roddick , Kelly Rob , Parra Jose Luís , Coderch Luísa 
Published: April 2008

Purpose: Hair lipids can contribute to physicochemical phenomena such as diffusion, cell cohesion and mechanical strength, although lipids occur at much lower levels (1–6% dry weight) than proteins (>90%).Hair lipids can be diminished by hair washing and submission to chemical treatments. Studies have shown that internal wool lipids (IWL) resemble those membranes of other keratinic tissues such as human hair or stratum corneum. Results: In this work, the IWL, in the form of liposomes or from an emulsion system, were applied to untreated hair fibres and also treated hair fibres. The results showed that application of IWL to pretreated hair samples lead to an improvement in mechanical strength properties of the fibres when the IWL were applied structured as liposomes. Differential scanning calorimetry studies demonstrated that the application of IWL to pretreated hair sample led to a slight increase in the crystalline material of the fibres. Moreover, scanning electron microscopy studies showed that application of IWL liposomes to damaged hair fibres lead to an improvement of the cuticle scale, demonstrating the importance of the use of a delivery vehicle with a bilayer structure similar to the one present in the hair fibre to restore the natural properties of the fibre.
Development of a novel method to measure the elastic properties of skin including subcutaneous tissue: New age‐related parameters and scope of application
Authors: Fujimura Tsutomu , Osanai Osamu , Moriwaki Shigeru , Akazaki Syuichi , Takema Yoshinori 
Published: April 2008

Background/purpose: We have developed a new apparatus to measure the elastic properties of skin without contact using an air blown technique.Methods: Real‐time measurements of skin movement induced by air blown on the surface were measured at various times. We investigated age‐related changes in the displacement of the skin surface caused by air using various parameters. Ninety‐eight female Japanese volunteers, aged from 10 to 70 years, were used in this study.Results: The maximum distance (the denting state) that cheek skin moved reached 2–5 mm within 10–15 ms. After that, the skin generally recovered to its original state within 40–50 ms. The average maximum speed of movement was 0.49±0.08 (average±SD) m/s and the average recovery speed was 0.25±0.06 m/s. Significant changes with age were not observed in the denting state, but significant correlations with age were observed in the recovery state. The maximum recovery speed decreased significantly with age and the time required for recovery increased significantly with age. Although similar results were obtained at the corner of the mouth or the inner upper arm, different results were obtained at the below eyes and the forehead.Conclusions: This apparatus differs from other conventional instruments in that it measures the elastic properties of skin including subcutaneous tissue without contact.
ORIGINAL ARTICLE: Placental Fas/Fas Ligand Expression in Early Pregnancy Losses
Authors: Guvendag Guven Emine Seda , Okur Hamza , Beksac Mehmet Sinan 
Published: April 2008

Problem  The aim of this study was to compare the expression levels of Fas and Fas ligand (FasL) in first‐trimester placentas obtained from spontaneous abortions in patients with antiphospholipid antibody syndrome (APS) or factor V (FV) Leiden mutation, compared with values in placentas from induced abortions in patients negative for these conditions.Method of study  We studied explants from 6‐ to 10‐week‐old placentas  that had been prepared by collagenase digestion from 10 spontaneous abortions from APS‐positive patients, nine spontaneous abortions in patients positive for FV Leiden mutation, and 10 induced abortions. All tissues were analyzed by flow cytometry for expression of Fas and FasL.Results  Flow cytometric analysis showed that placental FasL expression was significantly lower in abnormal pregnancies than in normal ones. However, no such difference was observed for Fas expression.Conclusion  FasL on placental cells may be involved in the maintenance of immune privilege, thereby ensuring the safety and growth of placental tissues. Dysregulation of apoptotic mechanisms may play a critical role in spontaneous abortions.
Calculation of Sample Size for Stroke Trials Assessing Functional Outcome: Comparison of Binary and Ordinal Approaches
Authors: Bath Philip 
Published: April 2008

Background Many acute stroke trials have given neutral results. Sub-optimal statistical analyses may be failing to detect efficacy. Methods which take account of the ordinal nature of functional outcome data are more efficient. We compare sample size calculations for dichotomous and ordinal outcomes for use in stroke trials. Methods Data from stroke trials studying the effects of interventions known to positively or negatively alter functional outcome – Rankin Scale and Barthel Index – were assessed. Sample size was calculated using comparisons of proportions, means, medians (according to Payne), and ordinal data (according to Whitehead). The sample sizes gained from each method were compared using Friedman 2 way ANOVA. Results Fifty-five comparisons (54 173 patients) of active vs. control treatment were assessed. Estimated sample sizes differed significantly depending on the method of calculation ( P<00001). The ordering of the methods showed that the ordinal method of Whitehead and comparison of means produced significantly lower sample sizes than the other methods. The ordinal data method on average reduced sample size by 28% (inter-quartile range 14–53%) compared with the comparison of proportions; however, a 22% increase in sample size was seen with the ordinal method for trials assessing thrombolysis. The comparison of medians method of Payne gave the largest sample sizes. Conclusions Choosing an ordinal rather than binary method of analysis allows most trials to be, on average, smaller by approximately 28% for a given statistical power. Smaller trial sample sizes may help by reducing time to completion, complexity, and financial expense. However, ordinal methods may not be optimal for interventions which both improve functional outcome and cause hazard in a subset of patients, e.g. thrombolysis.
The Philosophy of Harmony in Classical Confucianism
Authors: Li Chenyang 
Published: April 2008

AbstractThis essay introduces the philosophy of harmony in Classical Confucianism. In the first part of the essay the author summarizes the concept of harmony as it was developed in various Confucian classics. In the second part, the author offers an account of the Confucian program of harmony, ranging from internal harmony in the person, to harmony in the family, the state, the international world, and finally to harmony in the entire universe.
Russell and the Unity of the Proposition
Authors: Stevens Graham 
Published: April 2008

AbstractIn this article I present a summary of Bertrand Russell's protracted attempts to solve the problem of the unity of the proposition, and explain the significance of the problem for Russell's philosophy. Unlike many other accounts which take the problem to be confined to Russell's early theories of propositional content, I argue that the problem (or variants of it) is a recurring theme throughout the whole of Russell's career.
Physiological consequences of the P2328S mutation in the ryanodine receptor (RyR2) gene in genetically modified murine hearts
Authors: Goddard C. A. , Ghais N. S. , Zhang Y. , Williams A. J. , Colledge W. H. , Grace A. A. , Huang C. L.‐H. 
Published: April 2008

AbstractAim:  To explore the physiological consequences of the ryanodine receptor (RyR2)‐P2328S mutation associated with catecholaminergic polymorphic ventricular tachycardia (CPVT).Methods:  We generated heterozygotic (RyR2p/s) and homozygotic (RyR2s/s) transgenic mice and studied Ca2+ signals from regularly stimulated, Fluo‐3‐loaded, cardiac myocytes. Results were compared with monophasic action potentials (MAPs) in Langendorff‐perfused hearts under both regular and programmed electrical stimulation (PES).Results:  Evoked Ca2+ transients from wild‐type (WT), heterozygote (RyR2p/s) and homozygote (RyR2s/s) myocytes had indistinguishable peak amplitudes with RyR2s/s showing subsidiary events. Adding 100 nm isoproterenol produced both ectopic peaks and subsidiary events in WT but not RyR2p/s and ectopic peaks and reduced amplitudes of evoked peaks in RyR2s/s. Regularly stimulated WT, RyR2p/s and RyR2s/s hearts showed indistinguishable MAP durations and refractory periods. RyR2p/s hearts showed non‐sustained ventricular tachycardias (nsVTs) only with PES. Both nsVTs and sustained VTs (sVTs) occurred with regular stimuli and PES with isoproterenol treatment. RyR2s/s hearts showed higher incidences of nsVTs before but mainly sVTs after introduction of isoproterenol with both regular stimuli and PES, particularly at higher pacing frequencies. Additionally, intrinsically beating RyR2s/s showed extrasystolic events often followed by spontaneous sVT.Conclusion:  The RyR2‐P2328S mutation results in marked alterations in cellular Ca2+ homeostasis and arrhythmogenic properties resembling CPVT with greater effects in the homozygote than the heterozygote demonstrating an important gene dosage effect.
CYP2C9 polymorphism in non‐steroidal anti‐inflammatory drugs‐induced gastropathy
Authors: MA Juan , YANG Xiu Yan , QIAO Liang , LIANG Liu Qin , CHEN Min Hu 
Published: April 2008

OBJECTIVE:  Non‐steroidal anti‐inflammatory drugs (NSAID) induce gastroduodenal mucosal injury and are metabolized by cytochrome P450 2C9 (CYP2C9). It is postulated that CYP2C9 genotype is associated with NSAID‐induced gastropathy. This study aims to determine whether individuals with a CYP2C9 allele mutation are susceptible to NSAID‐induced gastropathy.METHODS:  A total of 109 patients diagnosed as having rheumatic diseases and taking NSAID were appraised as having gastropathy by endoscopy, stool occult blood test and questionnaire two weeks after entering the study. Their peripheral blood was analyzed by polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP).RESULTS:  A total of 47.7% gastropathy (33% erosions, 14.7% ulcers, 2.75% ulcer bleeding) and 56% dyspeptic symptoms were presented. Only one CYP2C9*2 heterozygote (*1/*2) was found in the group with gastropathy and two variant alleles (CYP2C9*2 and CYP2C9* 3) could not be found in the group without gastropathy. There was no significant difference in both CYP2C9 genotype (0.96%vs 0%) and CYP2C9 variant allele frequency (1.92%vs 0%) between patients with and without gastropathy.CONCLUSION:  These results confirm the high prevalence of NSAID‐induced gastropathy but do not support the postulation that CYP2C9*2 and CYP2C9*3 contribute to the development of NSAID‐induced gastropathy. This may be due to the low frequency of the two alleles in the population studied.
The case for public‐private partnerships in infrastructure
Authors: Murphy Timothy J. 
Published: April 2008

Abstract: Much of the public debate about public‐private partnerships (P3s) has occurred through the lens of those who either oppose or support this increasingly popular method of delivering public infrastructure assets. Despite some scepticism in the academic literature, an analysis of the key arguments for and against P3s concludes that the P3 model can successfully deliver public infrastructure goods and services, provided that certain key thresholds are met. Lessons learned from early experiments in P3s and from the experience of the newer government P3 procurement agencies suggest that P3s can provide value for money if risk is allocated to the party best able to manage it. An appropriate risk allocation requires that governments have the expertise to identify all of the relevant risks before entering into the partnership contract. Governments must also have the contract management skills to ensure that those risks are in fact borne by the private sector. To maintain public confidence in the P3 model, governments must live up to their own obligations of transparency and accountability and not succumb to private‐sector demands for confidentiality. The article recognizes that not all government goods and services can meet the threshold but that, if they do, it argues strongly for the efficiency and effectiveness of the P3 model.Sommaire: Une grande partie du débat public au sujet des partenariats entre le secteur public et le secteur privé (les P3) a eu lieu par l'entremise de ceux qui opposent ou soutiennent cette méthode de plus en plus populaire de livrer de l'infrastructure publique. En dépit d'un certain scepticisme émanant des documents d'universitaires, une analyse des principaux arguments en faveur des P3 et contre ceux‐ci conclut que les P3 peuvent livrer avec succès des produits et services d'infrastructure publique, à condition que certains seuils clés soient atteints. Les enseignements tirés des premières expériences de P3 et de l'expérience des plus récents organismes d'approvisionnement gouvernementaux P3 laissent entendre que les P3 peuvent apporter une optimisation des ressources si le risque est attribuéà la partie la plus apte à le gérer. Une bonne répartition du risque exige que les gouvernements aient l'expertise pour identifier tous les risques pertinents avant de signer le contrat de partenariat. Les gouvernements doivent aussi avoir les compétences en gestion de contrats nécessaires pour veiller à ce que les risques soient en fait assumés par le secteur privé. Pour maintenir la confiance du public dans le modèle de P3, les gouvernements doivent respecter leurs engagements de transparence et de reddition de comptes et ne pas céder aux exigences du secteur privé concernant la protection des renseignements personnels. L'article reconnaît que tous les produits et services gouvernementaux ne peuvent pas tous atteindre le seuil de conformités mais que, lorsqu'ils y parviennent, le modèle de P3 est alors hautement efficace et efficient.
Implementation of a restrictive transfusion protocol reduces the need for allogeneic blood transfusion in proximal humerus fracture repair without affecting patient outcome: preliminary observations
Authors: CUENCA JORGE , GARCÍA‐ERCE JOSÉ A. , MUÑOZ MANUEL , MARTÍNEZ ÁNGEL A. , PEGUERO ANTONIO , HERRERA ANTONIO 
Published: April 2008

SUMMARYShoulder arthroplasty may be associated with considerable blood loss, and some patients require allogeneic blood transfusion (ABT). However, there is almost no information available for proximal humerus fracture (PHF) repair surgery. We therefore evaluated the influence of two transfusion protocols on ABT requirements in patients undergoing hemiarthroplasty surgery for PFH. We assessed the requirements for ABT in 78 patients receiving hemiarthroplasty for PHF, who were managed with a conservative transfusion protocol [hemoglobin(Hb) < 9.0 g/dL; group 1; n = 31] or a restrictive transfusion protocol (Hb < 8.0 g/dL and/or clinical signs/symptoms of anemia/hypoxemia; group 2; n = 47). Overall, the ABT rate (12% vs. 48%; P = 0.001) and the transfusion index (0.2 ± 0.7 vs. 0.9 ± 1.0 unit/patient; P = 0.001) were lower in group 2 than in group 1. The differences in transfusion rate and transfusion index between groups were significant for patients with Hb < 13.0 g/dL (75% vs. 18%, for groups 1 and 2, respectively; P = 0.001), but not for those with Hb ≥ 13.0 g/dL (20% vs. 7%; P = 0.180). The implementation of a restrictive transfusion protocol seems to be effective in reducing ABT, especially in PHF patients with preoperative Hb < 13.0 g/dL.