bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lessons learned in the implementation of an innovative consultation and liaison service for children of cancer patients in various hospital settings
Authors: Romer Georg , Saha Rina , Haagen Miriam , Pott Martina , Baldus Christiane , Bergelt Corinna 
Published: October 2006

AbstractObjective: To evaluate the process of implementing a family‐oriented consultation and liaison service in various hospital‐based settings, with special regard to problems and obstacles encountered.Method: Qualitative content analysis using categorization and sequential, phenomenological analysis of descriptive progress notes during the implementation period. The team members of the liaison service were defined as participant observers. Interpretations of the material were derived in previously defined, sequential steps in team discussions.Results: Despite a consistent concept behind the new service, the degree to which it was able to be integrated into different medical settings varied to a remarkable degree. Obstacles encountered were often linked to a lack of consideration being given to divergent concepts of care. It was necessary to give special attention to providing physicians with practical evidence of the value of the intervention. The new service was most readily utilized by families when physicians personally communicated the referrals as a standard procedure to their patients and when the referrals were not made too quickly after the parent's initial diagnosis.Conclusions: Hospital‐based services for cancer patients with children under the age of 18 should carefully address patients' fears of psychiatric stigmatization. Furthermore, they should include modules for acute crisis intervention. Implications for future implementation activities in this field are discussed. Copyright © 2006 John Wiley & Sons, Ltd.
Evidence for a novel domain of bacterial outer membrane ushers
Authors: Capitani Guido , Eidam Oliv , Grütter Markus G. 
Published: October 2006

AbstractMany pathogenic bacteria possess adhesive surface organelles (called pili), anchored to their outer membrane, which mediate the first step of infection by binding to host tissue. Pilus biogenesis occurs via the “chaperone–usher” pathway: the usher, a large outer membrane protein, binds complexes of a periplasmic chaperone with pilus subunits, unloads the subunits from the chaperone, and assembles them into the pilus, which is extruded into the extracellular space. Ushers comprise an N‐terminal periplasmic domain, a large transmembrane β‐barrel central domain, and a C‐terminal periplasmic domain. Since structural data are available only for the N‐terminal domain, we performed an in‐depth bioinformatic analysis of bacterial ushers. Our analysis led us to the conclusion that the transmembrane β‐barrel region of ushers contains a so far unrecognized soluble domain, the “middle domain”, which possesses a β‐sandwich fold. Two other bacterial β‐sandwich domains, the TT0351 protein from Thermus thermophilus and the carbohydrate binding module CBM36 from Paenibacillus polymyxa, are possible distant relatives of the usher “middle domain”. Several mutations reported to abolish in vivo pilus formation cluster in this region, underlining its functional importance. Proteins 2006. © 2006 Wiley‐Liss, Inc.
Direct folding simulation of α‐helices and β‐hairpins based on a single all‐atom force field with an implicit solvation model
Authors: Jang Soonmin , Kim Eunae , Pak Youngshang 
Published: October 2006

AbstractRecently, we have shown that a modified energy model based on the param99 force field with the generalized Born (GB) solvation model produces reliable free energy landscapes of mini‐proteins with a ββα motif (BBA5, 1FSD, and 1PSV), with the native structures of the mini‐proteins located in their lowest free energy minimum states. One of the main features in the modified energy model is a significant improvement for more balanced treatments of α and β strands in proteins. In this study, using the replica exchange molecular dynamics (REMD) simulation method with this new force field, we have carried out extensive ab initio folding studies of several well‐known peptides with α or β strands (C‐peptide, EK‐peptide, le0q, and gbl). Starting from fully extended conformations as the initial conditions, all of the native‐like structures of the target peptides were successfully identified by REMD, with reasonable representations of free energy surfaces. The present simulation results with the modified energy model are consistent with experiments, demonstrating an extended applicability of the energy model to folding studies of a variety of α‐helices, β‐strands, and α/β proteins. Proteins 2007. © 2006 Wiley‐Liss, Inc.
The gap between the concept and definitions in the Evolutionarily Significant Unit: the need to integrate neutral genetic variation and adaptive variation
Authors: de Guia Anna Pauline O. , Saitoh Takashi 
Published: October 2006

AbstractThe Evolutionarily Significant Unit (ESU) was conceptualized in 1986 as a conservation unit below the species level, theoretically applicable to a wide range of taxa. The concept has gained support, and various definitions or criteria, some of which are inconsistent with each other, have since been proposed. Recent critiques of the ESU have pointed out the dominance of definitions biased to the identification of long‐term isolation or neutral genetic variation, which has largely ignored the adaptive components. We present here the validity of such claims and show how the ESU definitions have actually been applied in research. We surveyed scientific journals for original papers supporting ESU designations and determined who among the proponents of ESU definitions have gained wider support. Our results indicate that indeed there are inconsistencies with the original concept and with the existing definitions. Although the original concept recommended both ecological and genetic data as the basis for identification of ESUs, which reflect true evolutionary variation, recent definitions have become biased to either neutral genetic variation or adaptive variation. The definition which uses genetic data to assess neutral genetic variation (long‐term isolation) has gained major support, and therefore validates the earlier claims. To bridge the gap between the original concept and the practical application, we propose the use of partial ESU and full ESU designations. The application of full ESU should be limited solely to when both information about neutral genetic variation and adaptive variation are available. In other cases, in which only a part of the variation is examined, we should use the term partial ESU (e.g., molecular‐based ESU) and continue to investigate focal populations from other aspects of variations to designate full ESU.
Transformation by RAS oncogene decreases the width of substrate‐spread fibroblasts but not their length
Authors: Kharitonova Margarita A. , Kopnin Pavel B. , Vasiliev Jury M. 
Published: October 2006

AbstractWe compared morphometric parameters of the contours of cells in four pairs of non‐transformed mouse and rat lines and of the same lines transformed by oncogenes of the RAS family. As expected, the mean areas of all RAS‐transformed lines were much smaller than those of their non‐transformed counterparts. At the same time the average length of cell projection did not regularly decrease after transformation. These results show that transformation induced by expression of RAS oncogene selectively affect only one component of spreading, namely transversal spreading and not longitudinal spreading; these changes result in an increase of antero‐posterior polarity of transformed fibroblasts.
Platysma myofascial flap for reconstruction of oropharyngeal defects after transoral laser microsurgery of locally advanced carcinomas
Authors: Jäckel M C 
Published: October 2006

Introduction: Transoral laser microsurgery of locally advanced carcinomas of the lateral oropharynx often results in exposure of major vessels of the neck and may be accompanied by a substantial risk of intra- and post-operative bleeding.Procedure: Six patients with tonsillar cancers radiologically infiltrating the parapharyngeal space underwent ipsilateral neck dissection with temporary protection of neck vessels. While the neck remained open, transoral laser resection of the primary tumour was performed. Pharyngeal defects were subsequently closed by a superiorly based platysma myofascial flap.Results: All tumours were completely resected. Intra- and post-operative bleeding complications requiring blood transfusion or surgical revision did not occur. None of the patients developed a cervical fistula. During a mean follow-up time of 24.8 months, no local and/or regional recurrence was observed.Conclusion: The described approach is oncologically safe and seems to ensure reliable protection of neck vessels during and after transoral laser resection of locally advanced oropharyngeal carcinomas, as well as to prevent fistula formation.
Perspectives on spirituality at the end of life: A
meta-summary
Authors: WILLIAMS ANNA-LEILA 
Published: October 2006

Objective: A meta-summary of the qualitative literature on
spiritual perspectives of adults who are at the end of life was undertaken
to summarily analyze the research to date and identify areas for future
research on the relationship of spirituality with physical, functional,
and psychosocial outcomes in the health care setting.Methods: Included were all English language reports from 1966
to the present catalogued in PubMed, Medline, PsycInfo, and CINAHL,
identifiable as qualitative investigations of the spiritual perspectives
of adults at the end of life. The final sample includes 11 articles,
collectively representing data from 217 adults.Results: The preponderance of participants had a diagnosis of
cancer; those with HIV/AIDS, cardiovascular disease, and ALS were also
represented. Approximately half the studies were conducted in the United
States; others were performed in Australia, Finland, Scotland, and Taiwan.
Following a process of theme extraction and abstraction, thematic patterns
emerged and effect sizes were calculated. A spectrum of spirituality at
the end of life encompassing spiritual despair (alienation, loss of self,
dissonance), spiritual work (forgiveness, self-exploration, search for
balance), and spiritual well-being (connection, self-actualization,
consonance) emerged.Significance: The findings from this meta-summary confirm the
fundamental importance of spirituality at the end of life and highlight
the shifts in spiritual health that are possible when a terminally ill
person is able to do the necessary spiritual work. Existing end-of-life
frameworks neglect spiritual work and consequently may be deficient in
guiding research. The area of spiritual work is fertile ground for further
investigation, especially interventions aimed at improving spiritual
health and general quality of life among the dying.
Psychological intervention in fluid management
Authors: FISHER LINDA , CAIRNS HUGH S. , AMIR-ANSARI BEHZAD , SCOBLE JOHN E. , CHALDER TRUDIE , TREASURE JANET 
Published: October 2006

Background: Hemodialysis is a palliative treatment for
patients with established renal failure (ERF), and volume overload is a
common problem for hemodialysis patients with low urinary output. Volume
overload is thought to be mostly attributable to interdialytic fluid
intake by the patient and is associated with an increased symptom burden
and the development of serious medical complications. Repeated episodes of
volume overload may adversely affect staff–patient relationships and
the perception of care in this patient population. The aim of this case
series study was to evaluate the effect and experience of a psychological
intervention on interdialytic weight gain in a small group of
patients.Methods: Five patients were treated. The intervention
involved using techniques derived from both cognitive behavior therapy and
motivational interviewing. The main outcome measures were interdialytic
weight gain and patient perception of the intervention.Results: Three of the five patients reduced both mean
interdialytic weight gain and the frequency with which they gained in
excess of 3% of their dry weight during the intervention phase. The
intervention was found to be acceptable to patients.Significance of results: The intervention was effective in
helping three of the five patients to reduce both the frequency and the
severity of volume overload, and two of these patients maintained this for
at least 6 months post intervention. The intervention used actively
engaged the patients and appeared to be experienced positively. The
methods used to mobilize patient resources and optimize
staff–patient relationships as vehicles of change are discussed.
Both may have implications for treatment concordance and the perception of
care delivered.
Molecular architecture of the pyruvate dehydrogenase complex: bridging the gap
Authors: Smolle M. , Lindsay J.G. 
Published: October 2006

The PDC (pyruvate dehydrogenase complex) is a high-molecular-mass (4–11 MDa) complex of critical importance for glucose homoeostasis in mammals. Its multi-enzyme structure allows for substrate channelling and active-site coupling: sequential catalytic reactions proceed through the rapid transfer of intermediates between individual components and without diffusion into the bulk medium due to its ‘swinging arm’ that is able to visit all PDC active sites. Optimal positioning of individual components within this multi-subunit complex further affects the efficiency of the overall reaction and stability of its intermediates. Mammalian PDC comprises a 60-meric pentagonal dodecahedral dihydrolipoamide (E2) core attached to which are 30 pyruvate decarboxylase (E1) heterotetramers and six dihydrolipoamide (E3) homodimers at maximal occupancy. Stable E3 integration is mediated by an accessory E3-binding protein associated with the E2 core. Association of the peripheral E1 and E3 enzymes with the PDC core has been studied intensively in recent years and has yielded some interesting and substantial differences when compared with prokaryotic PDCs.
Structure and trafficking of NMDA and GABAA receptors
Authors: Stephenson F.A. 
Published: October 2006

The fidelity of synaptic function is dependent on the expression of the appropriate neurotransmitter receptor subtype, the targeting and trafficking of receptors to synapses as well as the regulation of the actual number of receptors at synapses. GABAA (γ-aminobutyric acid type A) receptors and NMDA (N-methyl-D-aspartate) receptors are both examples of ligand-gated, heteromeric neurotransmitter receptors whose cell-surface expression is dynamic and tightly regulated. NMDA receptors are localized at excitatory synapses. These synapses are highly structured but dynamic, with the interplay between NMDA receptors and NMDA receptor-associated scaffolding proteins regulating the expression of functional cell-surface synaptic and extrasynaptic receptors. Based on current information, inhibitory synapses seem to be less ordered, and a GABAA receptor equivalent of PSD-95 (postsynaptic density-95), the scaffolding molecule pivotal to the organization of NMDA receptor complexes at synapses, is yet to be validated. In the present paper, processes regulating the trafficking, assembly and molecular organization of both NMDA receptors and GABAA receptors will be discussed.
The Intra-Urban Unemployment Gradient: The Influence of Location on Unemployment
Authors: Vipond Joan 
Published: October 2006

This paper explores the influence of location on unemployment differentials within Australia's largest city, Sydney. It is suggested that spatial frictions impede the search processes of unemployed residents. The most important friction is related to physical accessibility to work. Despite suburbanisation, in Sydney the concentration of job opportunities is still far greater in the centre than elsewhere. The second friction concerns information flows. The formal information network about job vacancies seems to service the inner area better than the fringe suburbs. As the analysis used data of 1976 and 1981, the possibility of involuntary unemployment must be considered. This creates a third spatial factor, firms' preferences for residents of areas close to their vacancies. With involuntary unemployment firms often have many similar candidates for single vacancies and may be particular in their standards of recruitment. Together, these three spatial factors imply a positive intra-urban unemployment gradient. The hypothesis was tested using multiple regression analysis of census data so that the heterogeneity of workers and jobs could be taken into account. The results show that for all types of worker-junior and adult, male and female-the greater the distance of an area from the centre of Sydney the higher was the unemployment rate of its residents. This spatial cause is additional to the more well-known reasons for unemployment differentials which concern workers' characteristics such as education. Ceteris paribus, the further a worker lives from the centre, the higher his or her probability of being unemployed.
Management of an Outbreak ofClostridium difficile–Associated Disease Among Geriatric Patients
Authors: Cherifi S. , Delmee M. , Broeck J. Van , Beyer I. , Byl B. , Mascart G. 
Published: October 2006

Objective.To describe a nosocomial outbreak ofClostridium difficile–associated disease (CDAD).Design.A traditional outbreak investigation.Setting.Geriatric department of a tertiary care teaching hospital from March through April 2003.Methods.The outbreak was detected by theC. difficilesurveillance program of the infection control unit. CDAD was diagnosed by stool culture and fecal toxin A detection with a qualitative rapid immunoassay. Isolates ofC difficilewere serotyped and genotyped using pulsed-field gel electrophoresis.Results.The incidence of CDAD increased from 27 cases per 100,000 patient-days in the 6-month period before the outbreak to 99 cases per 100,000 patient-days during the outbreak. This outbreak involved 21 of 92 patients in 4 geriatric wards, which were located at 2 geographically distinct sites and staffed by the same medical team. The mean age of patients was 83 years (range, 71-100 years). Five (24%) of the 21 patients had community-acquired diarrhea, and secondary hospital transmission resulted in 3 clusters involving 16 patients. Serotyping and genotyping were performed on isolates in stool specimens from 19 different patients; 16 of these isolates were serotype A1, whereas 3 displayed profiles different from the outbreak strain. Management of this outbreak consisted in reinforcement of contact isolation precautions for patients with diarrhea, cohorting of infected patients in the same ward, and promotion of hand hygiene. Relapses occurred in 6 (29%) of 21 patients.Conclusion.Control of this rapidly developing outbreak of CDAD was obtained with early implementation of cohorting and ward closure and reinforcement of environmental disinfection, hand hygiene, and enteric isolation precautions.
Impact of Extended-Spectrum β-Lactamase–Producing Escherichia coli and Klebsiella Species on Clinical Outcomes and Hospital Costs: A Matched Cohort Study
Authors: Lee Su Young , Kotapati Srividya , Kuti Joseph L. , Nightingale Charles H. , Nicolau David P. 
Published: October 2006

Objectives.To evaluate the economic and clinical impact of infection with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species (ESBL-EK).Design.A matched-cohort analysis of the cost of illness.Setting.An 810-bed, urban, community hospital in Hartford, Connecticut.Patients.Twenty-one case patients infected with ESBL-EK at a site other than the urinary tract were matched with 21 control subjects infected with a non–ESBL-producing organism on the basis of pathogen species, age, anatomic site of infection, hospitalization in the intensive care unit (ICU) during the time of infection, date of hospitalization, and initial antibiotics received.Results.Mean infection-related costs per patient were significantly greater for case patients than for control patients ($41,353 vs $24,902; P = .034). Infection-related length of stay was the main driver of cost, which was prolonged for case patients, compared with control patients (21 vs 11 days; mean difference, 9.7 days [95% confidence interval {CI}, 3.2-14.6 days] P = .006). The additional cost attributed to the presence of an ESBL-EK infection was $16,450 per patient (95% CI, $965-$31,937). Case patients were more likely than control patients to have clinical failure (P = .027), and the rate of treatment success for case patients whose initial treatment involved antibiotics other than carbapenems was lower than that for their matched control patients (39% vs 83%; P = .013). Treatment was successful in patients for whom initial treatment was with a carbapenem, regardless of the ESBL status of the pathogen.Conclusion.The cost of non–urinary tract infections caused by ESBL-EK was 1.7 times the cost of non–urinary tract infections caused by non-ESBL producers. Prompt recognition and appropriate antimicrobial selection may minimize this ESBL-related impact on hospital costs.
Outbreak ofSerratia marcescensColonization and Infection Traced to a Healthcare Worker With Long-Term Carriage on the Hands
Authors: Vries Jutte J. C. de , Baas Willy H. , Ploeg Kees van der , Heesink Albêrt , Degener John E. , Arends Jan P. 
Published: October 2006

Objective.To reveal the source of a nosocomial outbreak of colonization and infection with a strain ofSerratia marcescenspositive for Guiana extended-spectrumβ-lactamase 1 (GES-1) that occurred among patients in a neurosurgical intensive care unit (ICU) in a Dutch university medical center from May 2002 through March 2003.Methods.Samples from the environment and from the hands of healthcare workers (HCWs) were cultured. A retrospective case-control study was carried out.Results.Fifteen neurosurgical ICU patients who had 1 or more cultures that yielded the epidemic strain ofS. marcescensfrom May 2002 through March 2003 were defined as case patients and matched with 30 control patients. Environmental cultures did not reveal a prominent source ofS. marcescens. Cultures of specimens from the hands of 100 HCWs revealed colonization of a single HCW with the epidemic strain. Although this HCW instantly went on leave, serial cultures detected prolonged carriage of the epidemic strain on the hands of the HCW for 3 months. The skin of the HCW's hands was psoriatic. The epidemic abruptly ended after the colonized HCW went on leave. Retrospective case-control analysis showed that the patients colonized or infected withS. marcescensreceived significantly more nursing care from the colonized HCW than did control patients (P<.05). From February 2004 through October 2004, a second cluster of 3 patients was detected with the epidemic strain ofS. marcescens. In October 2004, the formerly colonized HCW appeared to have carriage of the epidemic strain on the hands again.Conclusions.A single HCW with the epidemic strain ofS. marcescenson the hands was considered the source of this outbreak.