bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the determinants of NHS performance ratings: lessons for performance assessment systems
Authors: Jacobs Rowena , Martin Stephen , Goddard Maria , Gravelle Hugh , Smith Peter 
Published: September 2006

Objectives: A basic tenet of effective performance management is that decision makers should be held responsible only for aspects of performance over which they have control. We examine the degree to which variations in the performance of health care organizations are explained by a range of factors that are subject to differing degrees of managerial control. Methods: We use multiple regression methods and data on 304 National Health Service (NHS) Primary Care Trusts (PCTs) in England for 2002/03 to analyse the relationship between their performance, as measured by 'star ratings' and nine key performance targets, and a large number of explanatory variables. We classify the explanatory variables into five groups along a spectrum from 'no managerial control' to 'total managerial control'. We also analyse the relationship between PCTs that are service purchasers and their main providers to assess the degree to which their performance is linked. Results: For all of the key performance targets, most of the variation in performance is unexplained, although variables in groups 1, 2 and 3 (less managerial control) explain the largest proportion of variation. We find some evidence that socioeconomic and geographic factors have an impact on performance. We also find a positive relationship between the performances of purchaser and provider organizations. Conclusions: The star ratings did not allow for the different environmental circumstances within which PCTs operate and which affect their performance. Policy-makers should exercise caution in using such performance indicators to regulate health care organizations.
A systematic review of evidence about extended roles for allied health professionals
Authors: McPherson Kathryn , Kersten Paula , George Steve , Lattimer Val , Breton Alice , Ellis Bridget , Kaur Dawn , Frampton Geoff 
Published: September 2006

Objective: Extending the role of allied health professionals has been promoted as a key component of developing a flexible health workforce. This review aimed to synthesize the evidence about the impact of these roles. Methods: A systematic review of extended scope of practice in five groups: paramedics, physiotherapists, occupational therapists, radiographers, and speech and language therapists. The nature and effect of these roles on patients, health professionals and health services were examined. An inclusive approach to searching was used to maximize potential sources of interest including multiple databases, 'grey' literature and subject area experts. An expanded Cochrane Collaboration method was used in view of the anticipated lack of randomized controlled trials and heterogeneity of designs. Papers were only excluded after the search stage for lack of relevance. Results: A total of 355 papers was identified as meeting relevance criteria and 21 studies progressed to full review and data extraction. The primary reason for exclusion from data extraction was that the study included neither qualitative nor quantitative data or because methodological flaws compromised data quality. It was not possible to evaluate any pooled effects as patient health outcomes were rarely considered. Conclusions: A range of extended practice roles for allied health professionals have been promoted and are being undertaken, but their health outcomes have rarely been evaluated. There is also little evidence as to how best to introduce such roles, or how best to educate, support and mentor these practitioners.
A comparison of formal consensus methods used for developing clinical guidelines
Authors: Hutchings Andrew , Raine Rosalind , Sanderson Colin , Black Nick 
Published: September 2006

Objectives: To compare two consensus development methods commonly used for developing clinical guidelines in terms of the judgments produced, closeness of consensus, amount of change between rounds, concordance with research evidence and reliability. Methods: In all, 213 general practitioners and mental health professionals from England participated in four Delphi and four nominal groups. They rated the appropriateness of four treatments (cognitive behavioural therapy [CBT], behavioural therapy [BT], brief psychodynamic interpersonal therapy [BPIT] and antidepressants) for three conditions. First, participants rated the appropriateness of interventions independently, using a postal questionnaire. For nominal groups, the ratings were fed back and discussed at a meeting, and then group members privately completed the questionnaire again. For Delphi groups, there was feedback but no discussion, and the entire process was conducted by postal questionnaire. Results: The effect of consensus method on final ratings varied with therapeutic intervention, with nominal groups rating CBT and antidepressants more favourably than Delphi groups. Consensus was closer in the nominal than in the Delphi groups in both rounds. There was no overall difference between groups in their concordance with research evidence (odds ratio 1.13, 95% confidence interval 0.79–1.61). In this study, the Delphi method was more reliable ( κ coefficients 0.88 and 0.89 compared with 0.41 and 0.65 for nominal groups). Conclusions: The advantages of nominal groups (more consensus; greater understanding of reasons for disagreement) could be combined with the greater reliability of the Delphi approach by developing a hybrid method.
Does continuity of care with a family physician reduce hospitalizations among older adults?
Authors: Menec Verena H , Sirski Monica , Attawar Dhiwya , Katz Alan 
Published: September 2006

Objective: To examine the relation between continuity of primary care and hospitalizations. Methods: Survey data from a representative sample of older adults aged 67 or over living in the province of Manitoba ( n = 1863) were linked to administrative data, which provide complete records of physician visits and hospitalizations. A visit-based measure of continuity of care was derived using a majority-of-care definition, whereby individuals who made 75% of all their visits to family physicians (FPs) to the same FP were classified as having high continuity of care, and those with less than 75% of their visits to the same FP as having low continuity of care. Whether individuals were hospitalized (for either ambulatory care-sensitive conditions or all conditions) was also determined from administrative records. Results: High continuity of care was associated with reduced odds of ambulatory care-sensitive hospitalizations (adjusted odds ratio = 0.67, confidence interval 0.51–0.90) controlling for demographic and self-reported, health-related measures. It was not related to hospitalizations for all conditions, however. Conclusions: The study highlights the importance of continuity of primary care in reducing potentially avoidable hospitalizations.
Gathering data for health care regulation: learning from experience in England and Wales
Authors: Attride-Stirling Jennifer , Humphrey Charlotte , Tennison Barry , Cornwell Jocelyn 
Published: September 2006

Objectives: Between 2000 and 2004, the Commission for Health Improvement (CHI) undertook a comprehensive programme of reviews of progress with clinical governance in National Health Service trusts (provider organizations) in England and Wales. An internal retrospective evaluation of the main instruments and processes used to gather evidence for these reviews was undertaken to identify lessons for the future development of health care regulation methods. Methods: A multimethod retrospective study involving review of data-gathering tools previously undertaken by CHI, an intranet-based survey and confidential interviews with CHI staff. The study reviewed 11 instruments and processes used to gather information about trusts from routine data-sets, internal documents, staff, patients and the public, local statutory bodies, and community and voluntary stake-holders. Analysis focused on inputs required (skills and resources required to use the approaches effectively and challenges associated with their use) and value obtained (relevance and quality of the information obtained and its contribution to clinical governance review conclusions). Results/conclusions: Most of the instruments and processes evaluated had the potential to elicit worthwhile information for clinical governance reviews, but in practice their value varied considerably. A range of factors, within and beyond CHI, was found to affect the quality of the data obtained. Based on this learning, lessons are identified whose implementation would help optimize the quality of data gathering for health care regulation.
Might how you look influence how well you are looked after? A study which demonstrates that GPs perceive socio-economic gradients in attractiveness
Authors: O'Reilly Dermot , Steele Keith , Patterson Chris , Milsom Penny , Harte Pat 
Published: September 2006

Objective: To test the hypothesis that more disadvantaged patients are perceived by general practitioners (GPs) as being less attractive than their more affluent peers. Design: Three hundred and twenty five consecutive ambulant patients attending 15 GPs' surgeries in Northern Ireland, UK, had three digital photographs taken; two of their face (smiling and non-smiling) and one of their face and upper trunk. Photographs were assessed by 30 GPs from practices other than those used to select the patients. Patients were subdivided into 'more affluent', 'average' and 'more deprived' groups based on their household tenure, level of educational attainment and car availability. The age and sex of the GP-assessors was recorded along with the average deprivation score for their own practice population. The relationship between patient, GP and practice characteristics was explored using multilevel modelling to take account of the hierarchical nature of the dataset. The main outcome measure was the perceived attractiveness score of the patient as rated by the GP. Results: Of those invited, 301 (92%) participated in the study. The mean age of patients was 49.6 (standard deviation 6.1) years and 59% were female. GPs rated younger patients more attractive than older patients; each additional 10 years reduced the attractiveness scores by an average of 2.7 points (95% confidence intervals 1.4–3.9, P < 0.001). Patients from higher socio-economic backgrounds were assessed as more attractive than their less affluent peers, the mean difference being 7.8 points (5.8–9.9, P < 0.001). The difference in attractiveness scores between affluent and deprived patients was greatest when the GP assessor came from a practice serving predominantly deprived patients. Conclusion: The perceived difference in the average attractiveness scores between affluent and deprived patients is large and, though this study does not prove it, there is sufficient circumstantial evidence to indicate that it might play a significant role in modifying the medical encounter.
Use of Routinely Collected Amniotic Fluid for Whole-Genome Expression Analysis of Polygenic Disorders
Authors: Nagy Gyula Richárd , Gyõrffy Balázs , Galamb Orsolya , Molnár Béla , Nagy Bálint , Papp Zoltán 
Published: September 2006

Abstract
Background: Neural tube defects related to polygenic disorders are the second most common birth defects in the world, but no molecular biologic tests are available to analyze the genes involved in the pathomechanism of these disorders. We explored the use of routinely collected amniotic fluid to characterize the differential gene expression profiles of polygenic disorders.
Methods: We used oligonucleotide microarrays to analyze amniotic fluid samples obtained from pregnant women carrying fetuses with neural tube defects diagnosed during ultrasound examination. The control samples were obtained from pregnant women who underwent routine genetic amniocentesis because of advanced maternal age (&gt;35 years). We also investigated specific folate-related genes because maternal periconceptional folic acid supplementation has been found to have a protective effect with respect to neural tube defects.
Results: Fetal mRNA from amniocytes was successfully isolated, amplified, labeled, and hybridized to whole-genome transcript arrays. We detected differential gene expression profiles between cases and controls. Highlighted genes such as SLA, LST1, and BENE might be important in the development of neural tube defects. None of the specific folate-related genes were in the top 100 associated transcripts.
Conclusions: This pilot study demonstrated that a routinely collected amount of amniotic fluid (as small as 6 mL) can provide sufficient RNA to successfully hybridize to expression arrays. Analysis of the differences in fetal gene expressions might help us decipher the complex genetic background of polygenic disorders.
Spatial Modeling to Project Southern Appalachian Trout Distribution in a Warmer Climate
Authors: Flebbe Patricia A. , Roghair Laura D. , Bruggink Jennifer L. 
Published: September 2006

AbstractIn the southern Appalachian Mountains, the distributions of native brook trout Salvelinus fontinalis and introduced rainbow trout Oncorhynchus mykiss and brown trout Salmo trutta are presently limited by temperature and are expected to be limited further by a warmer climate. To estimate trout habitat in a future, warmer climate, we produced a regional map of wild trout habitat based on information from stream samples, expert knowledge, and suitable land cover. We then developed a quantile regression model of the elevation–latitude boundary for the present distribution of trout; this constitutes a more direct, spatially explicit approach to modeling trout distribution than the use of thermal limits. In combination with a lapse rate model, the boundary model was used to project future wild trout distributions over a range of higher temperatures. If the predictions of the Hadley Centre global circulation model (GCM) are assumed, about 53% of trout habitat would be lost; if the more extreme Canadian Centre GCM is used, 97% would be lost. With increasing temperature, fragmentation would increase, leaving populations in small, isolated patches vulnerable to extirpation because of the decreased likelihood of recolonization. The regional trout habitat map and the models produced here were useful for making these predictions, and the map could be used for assessing the impacts of other regional stressors.
Chlamydia trachomatis and Neisseria gonorrhoeae Infections Among Men and Women Entering California Prisons
Authors: Bernstein Kyle T. , Chow Joan M. , Ruiz Juan , Schachter Julius , Horowitz Evalyn , Bunnell Rebecca , Bolan Gail 
Published: September 2006

Objective. We estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection among newly arriving inmates at 6 California prisons. Methods. In this cross-sectional study in 1999, urine specimens collected from 698 men aged 18 to 25 years and 572 women aged 18 years or older were tested at intake for C trachomatis and N gonorrhoeae using ligase chain reaction. An analysis of demographic and arrest-related correlates of C trachomatis and N gonorrhoeae infection was performed. Results. The overall C trachomatis prevalence was 9.9% (95% CI=7.8%, 12.3%) among men aged 18 to 25 years, 8.9% (95% CI = 2.9%, 22.1%) among women aged 18 to 25 years, and 3.3% (95% CI=2.0%, 5.1%) among women overall. Three N gonorrhoeae cases were detected with an overall prevalence of 0.24% (95% CI=0.05%, 0.69%). Conclusions. The prevalence of C trachomatis infection at entry to California prisons, especially among young female and male inmates, was high, which supports routine screening at entry into prison. In addition, screening in a jail setting where most detainees are incarcerated before entry into the prison setting may provide an excellent earlier opportunity to identify these infections and treat disease to prevent complications and burden of infection in this high-risk population.
Privatization of Public Services: Organizational Reform Efforts in Public Education and Public Health
Authors: Gollust Sarah E. , Jacobson Peter D. 
Published: September 2006

The public health and the public education systems in the United States have encountered problems in quality of service, accountability, and availability of resources. Both systems are under pressure to adopt the general organizational reform of privatization. The debate over privatization in public education is contentious, but in public health, the shift of functions from the public to the private sector has been accepted with limited deliberation. We assess the benefits and concerns of privatization and suggest that shifting public health functions to the private sector raises questions about the values and mission of public health. Public health officials need to be more engaged in a public debate over the desirability of privatization as the future of public health.
Treatment for Cigarette Smoking Among Depressed Mental Health Outpatients: A Randomized Clinical Trial
Authors: Hall Sharon M. , Tsoh Janice Y. , Prochaska Judith J. , Eisendrath Stuart , Rossi Joseph S. , Redding Colleen A. , Rosen Amy B. , Meisner Marc , Humfleet Gary L. , Gorecki Julie A. 
Published: September 2006

Objectives. Using a brief contact control, we tested the efficacy of a staged care intervention to reduce cigarette smoking among psychiatric patients in outpatient treatment for depression. Methods. We conducted a randomized clinical trial that included assessments at baseline and at months 3, 6, 12, and 18. Three hundred twenty-two patients in mental health outpatient treatment who were diagnosed with depression and smoked ≥1 cigarette per day participated. The desire to quit smoking was not a prerequisite for participation. Staged care intervention participants received computerized motivational feedback at baseline and at 3, 6, and 12 months and were offered a 6-session psychological counseling and pharmacological cessation treatment program. Brief contact control participants received a self-help guide and referral list of local smoking-treatment providers. Results. As we hypothesized, abstinence rates among staged care intervention participants exceeded those of brief contact control participants at months 12 and 18. Significant differences favoring staged care intervention also were found in occurrence of a quit attempt and stringency of abstinence goal. Conclusion. The data suggest that individuals in psychiatric treatment for depression can be aided in quitting smoking through use of staged care interventions and that smoking cessation interventions used in the general population can be implemented in psychiatric outpatient settings.
Application of pyrolysis-capillary gas chromatography with NPD detection in thermal degradation of polyphosphazenes study
Authors: Paulsdorf Jürgen , Wiemhöfer Hans-Dieter , Orinák Andrej , Zámostný Petr , Bělohlav Zdeněk , Baxter David 
Published: September 2006

AbstractPolyphosphazenes represent a unique class of polymers with a backbone composed of alternating phosphorous and nitrogen atoms. The thermal behaviour and decomposition of a variety of polyphosphazenes depends on the type of side groups present. Especially those that bear aryloxy side groups, possess a high temperature stability as well as excellent flame resistance. Pyrolysis-capillary gas chromatography has been used in a study of three polyphosphazene samples for thermal stability characterisation. Degradation products were detected with three single detectors for flame ionisation (FID), nitrogen-phosphorous sensitivity (NPD) and mass spectrometry (MSD) at different pyrolysis temperatures ranging from 300°C up to 800°C. The NPD responses for phosphorous or nitrogen fragments of polyphosphazenes have been used for the construction of degradation product schemes and the examination of the thermal stability of the polyphosphazene’s backbone. Partial identification of the degradation products present in the gaseous phase was achieved by MSD. The polyphosphazenes thermal degradation conversion rates were at a maximum at 450–500°C. At various pyrolysis temperatures, the calculated N/P peak area ratio is a function of the degree of polyphosphazene-N=P-chain degradation, and reflective of the nitrogen — phosphorous detector sensitivity. NPD proved to be suitable tool for characterization of polyphospazene thermal stability.
Sympathetic nervous system and neurotransmitters: their possible role in neuroimmunomodulation of multiple sclerosis and some other autoimmune diseases
Authors: Markelov Vladimir , Trushin Maxim 
Published: September 2006

Abstract
Multiple sclerosis is still a disease without a cure. Although intensive research efforts have led to the development of drugs that modify the activity of the disease, most of them have various side effects and are expensive. At the same time it is becoming apparent that some remedies usually used to treat somatic and psychic disorders also have immunomodulating properties, and may help manage multiple sclerosis and other autoimmune diseases. We describe here the role of the sympathetic nervous system in the neuro-immune interaction in multiple sclerosis and other immune diseases with increased cellular immunity as well as neurochemical disturbances that take place in these disorders.
Osteoblast differentiation of NIH3T3 fibroblasts is associated with changes in the IGF-I/IGFBP expression pattern
Authors: Abdallah Basem 
Published: September 2006

AbstractInsulin-like growth factors (IGFs) and IGF-binding proteins (IGFBPs) are essential regulators for osteoblast proliferation and differentiation. It has been reported that Dexamethasone (Dex), an active glucocorticoid (GC) analogue, synergizes the stimulatory effect of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) on osteoblast differentiation in the mouse fibroblastic cell line NIH3T3. I investigated whether this stimulatory effect is associated with changes in the expression pattern of the IGF/IGFBP system. Quantitative real-time PCR technology was used to quantify the gene expression levels of the IGF-system during osteoblast differentiation and in response to 1,25(OH)2D3 or Dex alone under serum-containing and serum-free culture conditions. Interestingly, NIH3T3 was shown to express high mRNA levels of IGF-I, IGF-II and IGFBP-5, and low levels of both IGFBP-2 and-6. During osteoblast differentiation (days 6-12), IGF-I mRNA was repressed by more than 60%, while the transcript of IGFBP-5 was markedly up-regulated, by more than 50-fold. Similarly, treatment with Dex alone resulted in a dose-and time-dependent increase in the expression of IGFBP-5 and a decrease in IGF-I mRNA. Treatment with 1,25(OH)2D3 alone increased the mRNA levels of IGF-I and IGFBP-6 by around 4-and 7-fold, respectively, in a dose-and time-dependent manner. In conclusion, my data demonstrated that osteoblast differentiation of NIH3T3 is associated with changes in the expression pattern of IGFs/IGFBPs, which are regulated by glucocorticoid in the presence of 1,25(OH)2D3. Modulation of the IGF/IGFBP levels by glucocorticoid might suggest important roles for the IGF-system in mediating the osteoblast differentiation of the NIH3T3 cell line.