bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Intrinsic Muscle Atrophy in the Etiology of Claw Toe Deformity in Diabetic Neuropathy May Not Be as Straightforward as Widely Believed
Authors: Bus Sicco A. , Maas Mario , Michels Robert P.J. , Levi Marcel 
Published: March 2009

OBJECTIVE
Clawing of the toes in the diabetic neuropathic foot is believed to be caused by muscle imbalance resulting from intrinsic muscle atrophy. However, experimental data that support this mechanism are lacking. The aim of this study was to evaluate this hypothesis using magnetic resonance imaging (MRI).

RESEARCH DESIGN AND METHODS
In 20 neuropathic diabetic patients, 10 with claw toe deformity and 10 with normally aligned toes, multiple plane images of the foot and lower leg were acquired using T1-weighted spin-echo MRI. Atrophy of the intrinsic and extrinsic muscles controlling the toes was assessed using a semiquantitative 5-point atrophy scale. An intrinsic-to-extrinsic foot muscle imbalance score was derived from these atrophy scores, and correlation coefficients were established.

RESULTS
The mean ± SD intrinsic muscle atrophy score was 3.1 ± 1.1 for the toe deformity group and 2.6 ± 1.2 for the nondeformity group (not significantly different). The intrinsic muscle atrophy score was not significantly correlated with degree of toe deformity (r = −0.18). The muscle imbalance score was not significantly different between study groups and was not significantly correlated with degree of toe deformity (r = −0.14).

CONCLUSIONS
Neither intrinsic muscle atrophy nor muscle imbalance discriminated between neuropathic patients with or without claw toe deformity, suggesting that the role of these muscle factors in claw toe development may not be primary or as straightforward as previously believed. These findings shed new light on the etiology of foot deformity in diabetes and suggest a more complex nature of development, potentially involving anatomical and physiological predisposing factors.
Can a Low–Glycemic Index Diet Reduce the Need for Insulin in Gestational Diabetes Mellitus?
Authors: Moses Robert G. , Barker Megan , Winter Meagan , Petocz Peter , Brand-Miller Jennie C. 
Published: March 2009

OBJECTIVE
A low–glycemic index diet is effective as a treatment for individuals with diabetes and has been shown to improve pregnancy outcomes when used from the first trimester. A low–glycemic index diet is commonly advised as treatment for women with gestational diabetes mellitus (GDM). However, the efficacy of this advice and associated pregnancy outcomes have not been systematically examined. The purpose of this study was to determine whether prescribing a low–glycemic index diet for women with GDM could reduce the number of women requiring insulin without compromise of pregnancy outcomes.

RESEARCH DESIGN AND METHODS
All women with GDM seen over a 12-month period were considered for inclusion in the study. Women (n = 63) were randomly assigned to receive either a low–glycemic index diet or a conventional high-fiber (and higher glycemic index) diet.

RESULTS
Of the 31 women randomly assigned to a low–glycemic index diet, 9 (29%) required insulin. Of the women randomly assigned to a higher–glycemic index diet, a significantly higher proportion, 19 of 32 (59%), met the criteria to commence insulin treatment (P = 0.023). However, 9 of these 19 women were able to avoid insulin use by changing to a low–glycemic index diet. Key obstetric and fetal outcomes were not significantly different.

CONCLUSIONS
Using a low–glycemic index diet for women with GDM effectively halved the number needing to use insulin, with no compromise of obstetric or fetal outcomes.
Effect of a High-Fiber Diet Compared With a Moderate-Fiber Diet on Calcium and Other Mineral Balances in Subjects With Type 2 Diabetes
Authors: Shah Meena , Chandalia Manisha , Adams-Huet Beverley , Brinkley Linda J. , Sakhaee Khashayar , Grundy Scott M. , Garg Abhimanyu 
Published: March 2009

OBJECTIVE
High levels of dietary fiber, especially soluble fiber, are recommended to lower serum cholesterol levels and improve glycemic control in patients with type 2 diabetes. It is not clear, however, how high levels of fiber affect mineral balance.

RESEARCH DESIGN AND METHODS
In a randomized crossover study, 13 patients with type 2 diabetes were fed a high-fiber (50 g total and 25 g soluble fiber) and a moderate-fiber (24 g total and 8 g soluble fiber) diet of the same energy, macronutrient, calcium, magnesium, and phosphorus content for 6 weeks each. Intestinal calcium absorption was determined by fecal recovery of 47Ca. Stool weight and mineral content were assessed during 3 days, and 24-h urinary mineral content and serum chemistry were assessed over 5 days at the end of each phase. The results were compared by repeated-measures ANOVA.

RESULTS
Compared with the moderate-fiber diet, the high-fiber diet increased stool weight (165 ± 53 vs. 216 ± 63 g/day, P = 0.02) and reduced 24-h urinary calcium (3.3 ± 1.7 vs. 2.4 ± 1.2 mmol/day, P = 0.003) and phosphorus (29.2 ± 5.5 vs. 26.0 ± 3.2 mmol/day, P = 0.003) excretion and serum calcium concentration (2.33 ± 0.06 vs. 2.29 ± 0.07 mmol/l, P = 0.04). Calcium absorption, stool calcium, magnesium, and phosphorus content and serum phosphorus concentration were not significantly different with the two diets.

CONCLUSIONS
A high-fiber diet rich in soluble fiber has a small impact on calcium and phosphorus balance in subjects with type 2 diabetes. It may be prudent to ensure adequate intake of calcium and other minerals in individuals consuming a high-fiber diet.
Classification of resolvable balanced incomplete block designs — the unitals on 28 points
Authors: Kaski Petteri , Östergård Patric 
Published: March 2009

Abstract
Approaches for classifying resolvable balanced incomplete block designs (RBIBDs) are surveyed. The main approaches can roughly be divided into two types: those building up a design parallel class by parallel class and those proceeding point by point. With an algorithm of the latter type — and by refining ideas dating back to 1917 and the doctoral thesis by Pieter Mulder — it is shown that the list of seven known resolutions of 2-(28, 4, 1) designs is complete; these objects are also known as the resolutions of unitals on 28 points.
A decomposition of (λK
υ)+ with extended triangles
Authors: Huang Wen-Chung , Rodger C. 
Published: March 2009

Abstract
By an extended triangle, we mean a loop, a loop with an edge attached (known as a lollipop), or a copy of K
3 (known as a triangle). In this paper, we completely solve the problem of decomposing the graph (λK
υ)+ into extended triangles for all possible number of loops.
An introduction to balanced sequential arrays on the square grid
Authors: Street Anne , Nester Marks 
Published: March 2009

Abstract
Plants grown in large numbers for commercial purposes are usually set out on a regular grid, triangular, square or hexagonal, or possibly a rectangular grid. We need to understand their behaviour when they compete with each other for light, water and nutrients. In a greenhouse, there may be a lamp over each plant, half the plants having their lamps on and half off. The intensity of light falling on any particular plant is determined mainly by whether its own lamp is on, next by the number of its nearest neighbours whose lamps are on, and perhaps also by the number of its second-nearest neighbours whose lamps are on.
Such arrays are also used to study competition among different types of plants and, with some extra restrictions, to design field layouts as well. The problem of constructing suitable arrays was introduced in [CORMACK, R. M.: Spatial aspects of competition beween individuals. In: Spatial and Temporal Analysis in Ecology (R. M. Cormack and J. K. Ord, eds.), International Co-operative Publishing House, Fairland, Maryland, USA, 1979] and discussed in [GATES, D. J.: Competition between two types of plants with specified neighbour configurations, Math. Biosci. 48 (1980), 195–209]. Here we consider only the square grid.
Goal-minimally k-elongated graphs
Authors: Gyürki Štefan 
Published: March 2009

Abstract
Let k be an integer. A 2-edge connected graph G is said to be goal-minimally k-elongated (k-GME) if for every edge uv ∈ E(G) the inequality d
G−uv(x, y) > k holds if and only if {u, v} = {x, y}. In particular, if the integer k is equal to the diameter of graph G, we get the goal-minimally k-diametric (k-GMD) graphs. In this paper we construct some infinite families of GME graphs and explore k-GME and k-GMD properties of cages.
Iterative separation in distributive congruence lattices
Authors: Ploščica Miroslav 
Published: March 2009

Abstract
In [PLOŠČICA, M.: Separation in distributive congruence lattices, Algebra Universalis 49 (2003), 1–12] we defined separable sets in algebraic lattices and showed a close connection between the types of non-separable sets in congruence lattices of algebras in a finitely generated congruence distributive variety and the structure of subdirectly irreducible algebras in . Now we generalize these results using the concept of separable mappings (defined on some trees) and apply them to some lattice varieties.
Design, Development and Evaluation of Pictographic Instructions for Medications Used during Humanitarian Missions
Authors: Sorfleet Christopher , Vaillancourt Régis , Groves Susan , Dawson Jane 
Published: March 2009

Objectives: To develop, design and evaluate pictographic instructions for medications used during humanitarian medical missions. Methods: We developed and designed pictographic medication instructions based on the storyboard pictogram concept and then evaluated the pictograms during an itinerant medical mission in Gabon. We evaluated patients' comprehension of both the individual pictograms and the storyboard template at the time of dispensing or at short-term follow-up. Patients were asked questions to assess their comprehension of the indication, dose, route of administration, frequency and auxiliary instructions. Demographic data, including age, sex and mother tongue, were also collected. During the follow-up interview, we assessed the patients' understanding and recall of the pictographic instructions. Results: Pictograms were tested with 525 patients at the time of dispensing; 47 of these patients were also seen at short-term follow-up (the day after dispensing). Most of the pictograms tested achieved the European Commission standard for comprehension of greater than 80%, but were slightly below the American National Standard Institute criterion of greater than 85% comprehension. The use of pictograms caused a moderate increase in workload for the health care providers. Conclusions: The use of a pictographic storyboard was valuable for medication counselling in a humanitarian aid setting; however, the use of pictograms increased the workload of the health care providers who supplied the counselling.
A Qualitative Inquiry into the Practice Experiences of Community Pharmacy Managers
Authors: Perepelkin Jason , Dobson Roy T. 
Published: March 2009

Background: The connection between community pharmacists' dual role as professionals and businesspeople is most profound for community pharmacy managers. A greater understanding for and appreciation of the practice experiences of community pharmacy managers within a continually changing practice environment was the focus of this study. Methods: Semi-structured, one-on-one telephone interviews with self-identified community pharmacy managers were conducted. Results: Seven interviews were conducted, with a total of 9 themes emerging from the interviews: autonomy, pharmacist behaviour, environment, future, human resources, image, incentives, professional standards and role as manager. Discussion: Despite their common bond as pharmacists and pharmacy managers, interviewees showcased the dynamic nature of community pharmacy practice. Some shared similar thoughts and feelings about the profession and other stakeholders, while others presented opposing views. Conclusions: Community pharmacy managers are the link between pharmacy organizations and employees, including staff pharmacists and others. The dynamic perspective shared by each of these unique professionals highlights the fact that many models and cultures exist in practice today. However, a common vision of putting patients first united all interviewees, a vision that must be relayed to all stakeholders, including patients and employing organizations.
Impact of Depression and Cardiovascular Disease
Authors: Ibishi Nazmie F. , Musliu Nebi R. , Kamberi Ahmet , Qirko Spiro , Brokaj Sabit , Lezha Mimoza , Haxhiu Bekim , Masala John 
Published: March 2009

CME Educational Objectives

1.
Assess the impact of depression in cardiovascular disease (CVD) patients.

2.
Determine the relationship of depression and CVD, including biological and behavioral factors.

3.
Explain the significance of early recognition of depression in CVD patients and the role of indirect self-destructive behavior as an independent risk factor for morbidity and mortality in these patients.
Psychosis of Alzheimer's Disease
Authors: Klimstra Sibel , Mahgoub Nahla 
Published: March 2009

CME Educational Objectives

1.
Discuss the etiology and risk factors of psychosis in Alzheimer's disease.

2.
Review the clinical manifestations of psychosis in Alzheimer's disease.

3.
Summarize the treatment recommendations for psychosis in Alzheimer's disease.
The Cognitive Style of Nursing Students: Educational Implications for Teaching and Learning
Authors: Noble Kim A. , Miller Susan M. , Heckman James 
Published: March 2009

As cognitive and kinesthetic demands on nursing students increase, so does the need for optimal learning environments. Witkin's empirically supported measure of field dependent/independent cognitive style assesses the manner in which students perceive and process information and classifies them along a continuum of field dependence to field independence.
Witkin's Groups Embedded Figures Test (GEFT) was administered to 876 students enrolled in 10 health care programs. Statistically significant differences in the GEFT mean scores of students enrolled in the different programs were discovered. The effect size was moderate. Undergraduate nursing students scored higher on the GEFT than did graduate or RN-to-BSN nursing students. However, nursing students were classified as more field dependent than students in other health-related disciplines. Due to their cognitive processing requirements, field-dependent nursing students may be at risk for academic failure. Therefore, instructional strategies tailored to students' needs should be incorporated into the nursing curriculum.
Partnering with Schools: A Win-Win Experience
Authors: Schwartz Misty , Laughlin Ann 
Published: March 2009

In many states, budget cuts have influenced school systems to question whether school nurses are necessary. Consequently, many schools no longer have a nurse to coordinate school health services. Creighton University School of Nursing saw this situation as an opportunity. Using schools as clinical sites for nursing students has resulted in positive outcomes for all involved.
Competencies successfully demonstrated by nursing students have included understanding concepts of health and illness, identification of strategies to promote and protect the school-age population, and the ability to provide population-focused prevention within the community. Faculty think the school population is healthier and school personnel have increased knowledge of health promotion and protection strategies for school-age children as a result of the school health project. The education provided serves to promote the well-being of students, families, and the community and prepares them to make health-related choices. The project has also resulted in health benefits for the community.
Opinions of Adult Learners About Negotiating Syllabi Rules in a Baccalaureate Nursing Program
Authors: Schrader Vivian , Davis Shoni 
Published: March 2009

A baccalaureate nursing (BSN) program is using the philosophy of adult learning as a tenet of curriculum development. This philosophical approach is to support the uniqueness of the adult learner. Are nursing faculty composing course syllabi in a way that allows accommodations for adult learners' complex lives? Which syllabi items, if any, would adult learners negotiate?
This descriptive study was part of a larger study conducted by the same researchers that compared nursing faculty and student expectations of syllabi. One hundred ninety-nine BSN students reported they would ask for syllabi accommodations and identified the rationale for doing so. The most frequently selected accommodation to be negotiated was assignment deadlines (46%), followed by attendance requirements (35%) and testing deadlines (28%). Personal or family issues was identified by more than 80% of students as the reason they would request a change.
Spill Prevention Through Utilization of Preplanning and Inspection Programs
Authors: Fisher Candice , Smith Ken 
Published: March 2009

Abstract
Preplanning activities combined with periodic facility inspections can helpprevent scenarios that result in oil spills, injuries to personnel, or propertydamage. Tools such as preventive maintenance schedules, environmental andsafety audit checklists, response training, and data tracking throughutilization of electronic databases can assist operators towards the ultimategoal of zero incidents. These mechanisms in association with the progressiveprograms espoused by the U.S. Coast Guard, "Prevention Through People", and the Minerals Management Service, "Safety and Environmental Management Program", are key elements in this prevention effort.

Introduction
Planning and preventive maintenance are philosophies that can be applied tomany things in our daily lives. Our vehicles, our homes and even our bodiesrequire preplanning and preventive maintenance measures to help keep themrunning in top condition. The philosophy behind emergency preplanning andpreventive inspection programs for the offshore oil industry is no different. Oil and gas companies who apply preplanning and prevention programs to theirfacilities are proving to be more successful at avoiding pollution and keepingtheir employees safe and healthy. Now more than ever, government agencies likethe Minerals Management Service and the United States Coast Guard areencouraging proactive programs that allow the individual operator considerableleeway in how they utilize their resources to meet regulatory objectives. Somemay ask: Why should lessees or operators spend money to plan for, or preventaccidents or spills that might never happen? If peace of mind is not reasonenough, the following narrative will attempt to explain how these activitiescan help save lives, property, time, and the environment.

Minerals Management Service Pollution Prevention Programs
Minerals Management Service's (MMS) Mission Statement says it strives: "Tomanage mineral resources on the Outer Continental Shelf in an environmentallysound and safe manner." It is a brief statement for a big job that continues togrow in scope as the impetus shifts toward environmental awareness andpersonnel health and safety as they relate to offshore operations. The movetoward operator accountability in the preplanning and prevention arenas hasplaced MMS in an increasingly coach-like role.
Utilization of an Oil Spill Cooperative To Meet Worst Case Discharge Requirements
Authors: Eisterhold James F. , Armstrong R.W. 
Published: March 2009

Abstract
There are over 25 industry-funded major oil spill response organizations(co-ops) in the United States. Each co-op decides the type and quantity ofequipment necessary to not only respond effectively to a spill, but to alsomeet regulatory requirements for worst case discharge scenario planning. Clean Gulf Associates (CGA), a co-op organized by Gulf of Mexico oil and gasproducers was founded in 1972. The initial inventory consisted ofself-contained skimming systems designed for deployment from vessels ofopportunity, a skimming barge converted from a deck cargo barge, shallow waterskimmers and near shore boom. In selecting equipment, the co-op benefited fromexperience gained during major spill events in Main Pass and Bay Marchand. The Participation Area was offshore Louisiana.
CGA contracted with a large service company to purchase, store and maintainthe desired equipment. In the event of a spill, the member utilized CGAequipment and contracted directly with third parties for personnel to operatethe equipment.
The Participation Area has since expanded to include the entire Gulf of Mexico. The spill response inventory now consists of four models of the Fast Response (Skimming) System, a large, purpose-built skimming barge, two designsof shallow water skimmers, three types of containment boom, two ready-to-deployskimming boats, and a large inventory of dispersant. Retainers have beennegotiated with third parties to provide members with aerial dispersantcapability and computer software programs to determine the trajectory of oilspills. In 1997, CGA obtained ownership of the inventory and contracted with anot-for-profit spill response organization to operate, store, and maintain theequipment stockpile.
Since inception, CGA has continued to enhance the response time to spillevents. The Identified Boat program initially consisted of small skimmingpackages installed on members' field boats stationed at offshore facilities. This program has been essentially replaced by a more efficient approachutilizing the two fast, ready-to-deploy skimming boats.
The co-op's working committees continually study ways to improve spillresponse and reduce costs to the membership.
Using Geographic Response Plans and GIS Data Effectively in Incident Management Systems
Authors: Morris David , Barrett Roy 
Published: March 2009

Abstract
Geographic Response Plans (GRP's) are under development by both industry andagencies. The more generic version of these plans is becoming more common inthe Area Contingency Plans. These GRP's often serve as the base for developingmore detailed tactical plans for emergency response and regulatory compliance. These detailed GRP's can effectively identify human and environmental resourcesthreatened by a potential release, as well as displaying what can be done tocontain or mitigate the release. Such plans are being developed by the pipelineindustry, refineries, terminals, and exploration/production operations. Whenthese plans are developed in a Geographic Information System (GIS), they can becombined with newer software tools to become powerful additions to an Incident Management System. The GIS data from these plans can be quickly incorporatedinto an electronic Incident Action Plan and combined with output from newtrajectory models (such as NOAA's GNOME software). The combination createseffective tools to use in response to actual events. Although GIS data andsoftware will not clean up a spill, pre-planning in the proper format can speedup the initial response and greatly improve information flow during anincident.

Introduction
Rapid and effective response is essential to minimize the damage from an oilspill or hazardous substance release. When a spill or release occurs, responders must quickly determine:what resources are threatened;what are the response priorities, or objectives;which plans will best achieve those objectives;what resources are needed to implement those plans; andwhere to get those resources.
This requires that the tedious portion ofdefining detailed response strategies be done in advance of an incident. Thepre-defined strategies must be specific to each geographic area, or sensitivityto be protected (thus the term, Geographic Response Plan). When these areadequately defined in advance, responders can simply choose which strategies toimplement (or modify) based on the conditions present during that incident.
With the proper combination of planning, data, and software, these steps canquickly result in an effective initial response, as well as a good Incident Action Plan for the next response period.