bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing a strategic plan for child health: A Sydney case study
Authors: Alperstein Garth , Sainsbury Peter , O'Grady Sharyn 
Published: August 2008

Aim:  The aim of this paper is to describe the implementation of a strategic plan, Health Gain for Children and Youth of Central Sydney, over a 10‐year period to December 2005.Methods:  Descriptive information was obtained from the records and minutes of all relevant committees, interviews with key workers who were involved with the committees, managers and senior health professionals, and from the involvement of the authors throughout the process of the implementation.Results:  An implementation steering committee was established to oversee the implementation of the plan. Rather than adopting a uniform approach to assigning responsibility for the implementation of each strategy in the plan or developing specific costs and time frames for each strategy, a more pragmatic, flexible and opportunistic approach was taken. Most of the plan's strategies were implemented over a 7‐year time frame using a combination of service reorientation and implementation of new programmes, some of which were funded from sources not anticipated during the development of the plan. Implementation required a dedicated driver, commitment at senior level and participation by many staff at many levels. Outcomes, monitored through data collected at 5‐year intervals, revealed positive trends in a number of child and youth health indicators.Conclusions:  The successful implementation of the strategic plan required pragmatism, flexibility, opportunism and the commitment and involvement of staff at all organisational levels. It is envisaged that this approach provides a firm base for future evidence‐based developments to benefit the health and well‐being of children, youth and their families and reduce health inequities.
Attitudes to HIV testing among carers of children admitted to Port Moresby General Hospital, Papua New Guinea
Authors: Allison Waridibo E , Iobuna Varina , Kalebe Veronica , Kiromat Mobumo , Vince John , Schaefer Myrto , Kaldor John 
Published: August 2008

Aim:  To assess the acceptability of voluntary counselling and testing among the carers of children admitted to hospital in Papua New Guinea.Methods:  Forty semistructured interviews were carried out between February and April 2007.Results:  All the carers interviewed were women, mostly from Port Moresby. Virtually all of them attended primary school. About half of them attended secondary school but none completed it. Half of them knew an adult or child with HIV. Three quarters of the women interviewed would consent to having a child in their care tested for HIV, and over half of those who had never been tested would agree to be tested themselves. Correct answers to more than half the HIV knowledge questions posed were significantly related to agreement to an HIV test.Conclusions:  This study supports the need for further evaluation of knowledge about HIV/AIDS and opportunities for health promotion in this group of women, particularly in view of the implication for voluntary counselling and testing and prevention of mother‐to‐child HIV transmission programmes in Papua New Guinea.
Angiogenic cytokines in induced sputum of patients with sarcoidosis
Authors: FIREMAN Elizabeth , GILBURD Daniel , MARMOR Silvia 
Published: August 2008

Background and objective:  Sarcoidosis is a systemic granulomatous disorder of unknown aetiology involving multiple organs and often associated with non‐granulomatous microangiopathic lesions in various organs. Increased angiogenesis‐inducing ability of activated alveolar macrophages was found in bronchoalveolar specimens from patients with pulmonary sarcoidosis and from patients with extrapulmonary involvement. In contrast, decreased levels of vascular endothelial growth factor (VEGF) were found in BAL fluid recovered from sarcoid‐associated pulmonary fibrosis. This study evaluated whether sarcoidosis is associated with abnormalities of VEGF and IL‐8 in induced sputum (IS) samples.Methods:  Twenty‐three sarcoid patients and 13 controls performed IS. CD4/CD8 T‐cell subsets were measured, as were pulmonary function tests and VEGF and IL‐8.Results:  Sarcoid patients showed significantly higher mean %lymphocytes (P = 0.04), significantly higher mean CD4/CD8 ratio (P = 0.0001) and significantly lower VEGF levels (P = 0.03) than controls. Patients with stages III–IV sarcoidosis showed a lower level of VEGF compared with those with stages I–II sarcoidosis (P = 0.048). IL‐8 was detected in 10/35 samples and positively correlated with % neutrophils (P = 0.054) and eosinophils (P = 0.045). VEGF immunohistochemical staining showed a mixed pattern of expression in the same tissue samples and was low in fibrotic tissue areas.Conclusion:  VEGF in IS samples may reflect impairment in angiogenesis associated with the extent of sarcoid fibrosis and functional disorders.
Should lung transplant recipients routinely perform airway clearance techniques? A randomized trial
Authors: MUNRO Prue E , BUTTON Brenda M. , BAILEY Michael , WHITFORD Helen , ELLIS Samantha J , SNELL Gregory I. 
Published: August 2008

Background and objective:  Despite the widespread use of airway clearance (AC) techniques to clear excessive secretions and improve lung function, little is known about their efficacy following lung transplantation (LTx). This study compared the effects of two AC strategies (proactive vs reactive) on a range of clinical outcomes following LTx.Methods:  A prospective randomized trial was conducted. Uncomplicated patients were recruited 1 month postoperatively. Patients performed AC using positive expiratory pressure either twice daily (proactive strategy) or only in the presence chest infection (reactive strategy). Lung function (FEV1 and FVC), CXR (Brasfield score) and bronchoscopic airway characteristics (anastomotic healing, patency and secretions) were assessed at 1, 2 and 3 months postoperatively. Adherence was measured.Results:  Of 60 consecutive patients, 36 (18 proactive, 18 reactive) were recruited and completed the study. Both groups improved lung function (FEV1 72 ± 4% to 81 ± 4%, P < 0.0001; FVC 69 ± 3% to 81 ± 3%, P < 0.0001) and Brasfield scores (17.8 ± 0.5 to 19.8 ± 0.5, P < 0.002) over the study period. No significant differences for any outcome were found between the two groups. The vast majority of patients had fully healed, 100% patent anastomoses without secretions at 3 months. There were no significant differences between the two groups in airway characteristics and the incidence of chest infection. Adherence to both strategies was high (84% proactive, 100% reactive).Conclusions:  Proactive AC following lung transplantation was not associated with a reduced incidence of respiratory infection, alteration of CXR findings or improvement in airway characteristics.
Lowered cAMP and cGMP signalling in the brain during levodopa‐induced dyskinesias in hemiparkinsonian rats: new aspects in the pathogenetic mechanisms
Authors: Giorgi M. , D’Angelo V. , Esposito Z. , Nuccetelli V. , Sorge R. , Martorana A. , Stefani A. , Bernardi G. , Sancesario G. 
Published: August 2008

AbstractDysregulation of dopamine receptors is thought to underlie levodopa‐induced dyskinesias in experimental models of Parkinson’s disease. It is unknown whether an imbalance of the second messengers, cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP), is involved in the alterations of levodopa/dopamine signal transduction. We examined cAMP and cGMP signalling in the interconnected cortico‐striatal‐pallidal loop at the peak of levodopa‐induced dyskinesias in rats with 6‐hydroxydopamine lesions in the substantia nigra. In addition, we examined the role of phosphodiesterase (PDE) and the rate of cAMP and cGMP degradation on the severity of levodopa‐induced dyskinesias in animals pretreated with PDE inhibitor, zaprinast. Unilateral lesion of substantia nigra led to an increase in cAMP but a decrease in cGMP levels in the ipsilateral basal ganglia. After chronic levodopa treatment, cAMP and cGMP were differentially regulated in eukinetic animals: the cAMP level increased in the cortex and striatum but decreased in the globus pallidus of both hemispheres, whereas the cGMP decreased below baseline levels in the contralateral cortico‐striatal‐pallidal regions. In dyskinetic animals chronic levodopa treatment led to an absolute decrease in cAMP and cGMP levels in cortico‐striatal‐pallidal regions of both hemispheres. Pretreatment with zaprinast reduced the severity of levodopa‐induced dyskinesias, and partly prevented the decrease in cyclic nucleotides compared with pretreatment with saline‐levodopa. In conclusion, using a rat model of hemiparkinsonism, we observed a significant reduction in the levels of cyclic nucleotides in both hemispheres at the peak of levodopa‐induced dyskinesias. We propose that such a decrease in cyclic nucleotides may partly result from increased catabolism through PDE overactivity.
Effects of dexmedetomidine on intraoperative motor and somatosensory evoked potential monitoring during spinal surgery in adolescents
Authors: TOBIAS JOSEPH D. , GOBLE TIMOTHY J. , BATES GUY , ANDERSON JOHN T. , HOERNSCHEMEYER DANIEL G. 
Published: August 2008

SummaryBackground:  Dexmedetomidine may be a useful agent as an adjunct to an opioid–propofol total intravenous anesthesia (TIVA) technique during posterior spinal fusion (PSF) surgery. There are limited data regarding its effects on somatosensory (SSEPs) and motor evoked potentials (MEPs).Methods:  The data presented represent a retrospective review of prospectively collected quality assurance data. When the decision was made to incorporate dexmedetomidine into the anesthetic regimen for intraoperative care of patients undergoing PSF, a prospective evaluation of its effects on SSEPs and MEPs was undertaken. SSEPs and MEPs were measured before and after the administration of dexmedetomidine in a cohort of pediatric patients undergoing PSF. Dexmedetomidine (1 μg·kg−1 over 20 min followed by an infusion of 0.5 μg·kg−1·h−1) was administered at the completion of the surgical procedure, but prior to wound closure as an adjunct to TIVA which included propofol and remifentanil, adjusted to maintain a constant depth of anesthesia as measured by a BIS of 45–60.Results:  The cohort for the study included nine patients, ranging in age from 12 to 17 years, anesthetized with remifentanil and propofol. In the first patient, dexmedetomidine was administered in conjunction with propofol at 110 μg·kg−1·min−1 which resulted in a decrease in the bispectral index from 58 to 31. Although no significant effect was noted on the SSEPs (amplitude or latency) or the MEP duration, there was a decrease in the MEP amplitude. The protocol was modified so that the propofol infusion was incrementally decreased during the dexmedetomidine infusion to achieve the same depth of anesthesia. In the remaining eight patients, the bispectral index was 52 ± 6 at the start of the dexmedetomidine loading dose and 49 ± 4 at its completion (P = NS). There was no statistically significant difference in the MEPs and SSEPs obtained before and at completion of the dexmedetomidine loading dose.Conclusion:  Using the above‐mentioned protocol, dexmedetomidine can be used as a component of TIVA during PSF without affecting neurophysiological monitoring.
An overview of recent developments in corneal immunobiology: potential relevance in the etiogenesis of corneal disease in the horse
Authors: Matthews A. G. 
Published: August 2008

AbstractThis paper overviews some recent developments in mammalian corneal immunobiology, and discusses how these may act as pointers towards understanding the immunology underlying some common corneal diseases in the horse, including infectious ulceration and presumptively immune‐mediated non‐ulcerative disease. Specifically, three aspects of corneal immunobiology are examined: the role of Toll‐like receptors in surface immunity and in the etiogenesis of microbial ulceration, the relationship between conjunctiva associated lymphoid tissue (CALT) and immunoprotection of the corneal surface, and the mechanisms determining corneal immune privilege (IP) and how down regulation of IP may be an important factor in the genesis of corneal immunoinflammatory disease.
Epibulbar melanoma in a foal
Authors: McMullen Richard J. , Clode Alison B. , Pandiri Arun Kumar R. , Malarkey David E. , Michau Tammy Miller , Gilger Brian C. 
Published: August 2008

AbstractA case of epibulbar melanoma in a 6‐month‐old, gelded, chestnut Hanoverian foal is reported. The location and clinical appearance upon initial presentation led to the tentative diagnosis of staphyloma or a congenital mass of unknown origin. An attempt was made to surgically excise the mass under general anesthesia, but due to its infiltrative nature and intraoperative appearance, most, but not all was removed without compromising the integrity of the globe. Histopathological evaluation revealed a multinodular to packeted, poorly demarcated, unencapsulated, infiltrative exophytic melanocytic neoplasm composed of bundles and nests of plump spindloid to polygonal heavily pigmented epithelioid neoplastic cells interspersed with pigment‐laden macrophages within a fine fibrovascular stroma. Upon examination after enucleation, neoplastic cells were found to infiltrate into the lateral cornea, sclera and the choroid. This is a unique case of an epibulbar melanoma with choroidal invasion in a foal. Based on the sudden onset and rapid growth as well as the histological evidence of invasion, well‐differentiated features, heavy pigmentation, and no apparent mitoses, this neoplasm was considered to be a low‐grade malignant melanoma. At 14 months after excision there is no evidence of recurrence.
Blindness, optic atrophy and sinusitis in the horse
Authors: Barnett K. C. , Blunden A. S. , Dyson S. J. , Whitwell K. E. , Carson D. , Murray R. 
Published: August 2008

AbstractObjective  The case histories described each presented with a visual deficit, varying from permanent total blindness with ophthalmoscopic evidence of optic atrophy to variable and transient visual disturbances, including occasional blindness, but with absence of ophthalmoscopic or any other ocular abnormality.Animals studied  Three horses of widely different age and type, but all with an original history of upper respiratory tract infection.Procedure  All three cases were examined by a specialist veterinary ophthalmologist. In addition, magnetic resonance imaging (MRI) and, where possible, postmortem and histopathological examinations were performed.Results  The common factor to all three cases proved to be infection of the spheno‐palatine sinuses with subsequent distension and compression of adjacent optic nerve(s) and optic chiasm.Conclusions  Specialist veterinary ophthalmological examination proved of extremely limited value. The importance of MRI (and CT) scans for accurate diagnosis, and therefore possible successful treatment, is emphasized. Our cases were compared with similar cases in man, where visual disturbances due to spheno‐palatine sinus involvement are recognized, but rare, in similar situation.
Photodynamic therapy for the treatment of periocular squamous cell carcinoma in horses: a pilot study
Authors: Giuliano Elizabeth A. , MacDonald Ian , McCaw Dudley L. , Dougherty Thomas J. , Klauss Gia , Ota Juri , Pearce Jacqueline W. , Johnson Philip J. 
Published: August 2008

AbstractObjective Local photodynamic therapy (PDT) is a novel cancer therapy in veterinary ophthalmology. A prospective pilot study seeking to demonstrate proof of principle and safety for the treatment of equine periocular squamous cell carcinoma (PSCC) was therefore conducted. We hypothesized that surgical excision with adjunctive local PDT is an effective and safe treatment for equine PSCC.Procedures Nine horses (10 eyes) with PSCC were treated with surgical resection, local infiltration of resulting wound beds with 2‐[1‐hexyloxyethyl]‐2‐devinylpyropheophorbide‐a (HPPH) and irradiation with 665‐nm wavelength diode laser. Regular follow‐up ophthalmic examinations were performed.Results Surgical resection and PDT yielded disease‐free intervals of 25–68 months in our study horses as of January, 2008. These results were obtained following a single treatment in seven horses and two treatments in one horse. In one horse, carcinomain situdeveloped 2.5 months after partial surgical excision and PDT, requiring local excision under standing sedation.Conclusions Preliminary results suggest that surgical resection and adjunctive local PDT is a safe and effective novel treatment for PSCC in horses. More research is needed before PDT for the treatment of equine PSCC can be adequately compared with other current modalities. Important to future investigations regarding PDT, tumor recurrence rate, length of hospitalization, number of treatment episodes required to effect tumor remission, and total treatment costs should be examined in a controlled manner. Our present results and experiences suggest that this treatment may be useful in the treatment of equine PSCC.
Deep lamellar endothelial keratoplasty in 10 horses
Authors: Plummer C. E. , Kallberg M. E. , Ollivier F. J. , Barrie K. P. , Brooks D. E. 
Published: August 2008

AbstractObjective  To describe and evaluate a surgical technique utilized for the therapy of deep corneal stromal abscesses (DSA) in horses. The DSA is excised and replaced with a partial thickness corneal lamellar allograft.Methods  A retrospective clinical study describing the indications for the surgical technique utilized and the outcomes of this procedure in 10 eyes of 10 horses.Results  Each affected eye had a discrete DSA within the posterior stroma. An initial partial thickness semicircular corneal incision was made at the limbus, followed by anterior stromal lamellar dissection over the lesion. After excision of the DSA and replacement with a larger diameter split‐thickness donor button, the anterior stroma was replaced into its original position and the initial corneal incision was repaired. All of the animals that underwent deep lamellar endothelial keratoplasty (DLEK) procedure healed appropriately and with subjectively less postoperative scarring and complications than previously described surgical approaches to DSA.Conclusions  This procedure is an effective technique for surgical removal of DSA in horses and, in most cases, results in a visual and cosmetically acceptable globe. The advantages of this technique compared to other surgical approaches to DSA are the peripheral location of the incision, shortened anesthesia times, the resultant minimal scarring and shorter healing times associated with DLEK.
From Voluntary Participation to Monitored Coordination: why European countries feel increasingly bound by their commitment to the Bologna Process
Authors: RAVINET PAULINE 
Published: August 2008

Beginning in the year 2000, higher education policies all over Europe were transformed by the launching and evolution of the Bologna Process, otherwise known as the process of creating a European Higher Education Area (EHEA). Initially, this process was flexible and informal, which makes the rapidity and scope of the changes it brought about surprising: why did European governments commit themselves to achieving the Bologna Objectives, and why so quickly, when there was no legal obligation to do so?I will argue the following: to understand the development of such a sense of obligation, we must take into account the special interests at stake when Bologna objectives are implemented at a national level. We must also consider the legitimacy lent to the process by the Bologna ideals of a knowledge‐based economy and society. These elements are present in other studies on this topic. However, and this is rarely considered, we also have to take into account the specific dynamics of the process of creating an institutional coordination and monitoring mechanism. This mechanism has a formal institutional structure and tools for evaluation and monitoring. Our analysis of the way in which it was developed and formalised enriches previous research on the topic and also sheds light on how a flexible European process of voluntary participation became a monitored system of coordinated national higher education policies.
Epidemiological study of acute encephalitis in Tottori Prefecture, Japan
Authors: Wada‐Isoe K. , Kusumi M. , Kai T. , Awaki E. , Shimoda M. , Yano H. , Suzuki K. , Nakayasu H. , Oota K. , Kowa H. , Nakashima K. 
Published: August 2008

Background and purpose:  To conduct an epidemiological survey of acute encephalitis focusing on non‐herpetic acute limbic encephalitis (NHALE) in Tottori Prefecture, western area of Japan.Methods:  A questionnaire survey on the annual number of patients aged 16 years or more with acute encephalitis from 2001 to 2005 was undertaken in 2006.Results:  During the study period, 49 patients were diagnosed with acute encephalitis. The subtype of acute encephalitis was as follows: 10 patients with herpes simplex encephalitis (HSE), 12 patients with NHALE, 4 patients with paraneoplastic encephalitis, 2 patients with encephalitis associated with collagen disease, one patient with viral encephalitis other than HSE, 20 patients with encephalitis with unknown causes. The service‐based incidence rate of acute encephalitis was 19.0 per million person‐years. The incidence rate of NHALE subtype was 4.7 per million person‐years.Conclusions:  Our epidemiological survey indicated an estimated 550 patients would develop NHALE per year in Japan, suggesting that NHALE may not be a rare disorder.
Blood pressure is not associated with haematoma enlargement in acute intracerebral haemorrhage
Authors: Martí‐Fàbregas J. , Martínez‐Ramírez S. , Martínez‐Corral M. , Díaz‐Manera J. , Querol L. , Suárez‐Calvet M. , De Juan M. , Santaló M. , Marín R. , Martí‐Vilalta J.‐L. 
Published: August 2008

Background and purpose:  We performed an observational study that compared baseline and subsequent blood pressure (BP) measurements and its association with haematoma enlargement (HE) in patients with intracerebral haemorrhage (ICH).Methods:  We prospectively studied consecutive patients with supratentorial spontaneous ICH within the first 6 h after the onset of symptoms. HE was defined as an increase ≥33% in the volume of haematoma on the CT obtained 24–48 h after the onset of symptoms as compared with the CT at admission. We recorded systolic BP (SBP), diastolic BP (DBP) and mean BP (MBP) at admission and at 6, 12, 18 and 24 h after onset; the maximum SBP, DBP and MBP during the study period; the maximum SBP and DBP within intervals; the mean of all BP readings; administration of antihypertensive agents.Results:  We studied 60 patients whose mean age was 72.1 ± 11.3 years. HE was observed in 27 (45%) patients. No statistically significant differences were observed in any of the analyses that compared BP parameters between the HE and non‐HE groups (two‐way anova).Conclusions:  In an exploratory analysis, we did not find an association between BP and HE within the first 24 h after an acute ICH.