bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the level of healthcare information technology adoption in the United States: a snapshot
Authors: Poon Eric G , Jha Ashish K , Christino Melissa , Honour Melissa M , Fernandopulle Rushika , Middleton Blackford , Newhouse Joseph , Leape Lucian , Bates David W , Blumenthal David , Kaushal Rainu 
Published: January 2006

Abstract

Background
Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap.

Methods
We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages.

Results
Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity.

Conclusion
Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss.
Exploring if day and time of admission is associated with average length of stay among inpatients from a tertiary hospital in Singapore: an analytic study based on routine admission data
Authors: Earnest Arul , Chen Mark IC , Seow Eillyne 
Published: January 2006

Abstract

Background
It has been postulated that patients admitted on weekends or after office hours may experience delays in clinical management and consequently have longer length of stay (LOS). We investigated if day and time of admission is associated with LOS in Tan Tock Seng Hospital (TTSH), a 1,400 bed acute care tertiary hospital serving the central and northern regions of Singapore.

Methods
This was a historical cohort study based on all admissions from TTSH from 1st September 2003 to 31st August 2004. Data was extracted from routinely available computerized hospital information systems for analysis by episode of care. LOS for each episode of care was log-transformed before analysis, and a multivariate linear regression model was used to study if sex, age group, type of admission, admission source, day of week admitted, admission on a public holiday or eve of public holiday, admission on a weekend and admission time were associated with an increased LOS.

Results
In the multivariate analysis, sex, age group, type of admission, source of admission, admission on the eve of public holiday and weekends and time of day admitted were independently and significantly associated with LOS. Patients admitted on Friday, Saturday or Sunday stayed on average 0.3 days longer than those admitted on weekdays, after adjusting for potential confounders; those admitted on the eve of public holidays, and those admitted in the afternoons and after office hours also had a longer LOS (differences of 0.71, 1.14 and 0.65 days respectively).

Conclusion
Cases admitted over a weekend, eve of holiday, in the afternoons, and after office hours, do have an increased LOS. Further research is needed to identify processes contributing to the above phenomenon.
Effects of mothers' socio-economic status on the management of febrile conditions in their under five children in a resource limited setting
Authors: Olaogun Adenike AE , Adebayo Abayomi A , Ayandiran Olufemi E , Olasode Olayinka A 
Published: January 2006

Abstract

Background
Public health research is shifting focus to the role of socioeconomic indicators in the promotion of health. As such an understanding of the roles that socio-economic factors play in improving health and health-seeking behaviour is important for public health policy. This is because the share of resources devoted to different policy options should depend on their relative effectiveness.

Objective
To measure the effect of socio-economic status (age, education, occupation, income, religion and family structure) of mothers on the management of febrile conditions in under-fives children

Method
Two hundred mothers who brought their febrile under-five children to a health facility were interviewed on the treatment they gave to their children before reporting at health facility. Data collected were entered and analyzed using the SPSS software. Binary logistic regression was adopted for the quantitative analysis of the effect of socio-economic variables on the mothers' actions prior to utilizing the health facility.

Results
Results showed that while mothers' age was negatively correlated (-0.13), occupation was positively correlated (0.17) with under-fives mothers' action. Education, religion, income and family structure were however insignificant at 5% level

Conclusion
This poses a lot of challenges to policy makers in the developing nations where women's education and earning capacity is low. There is therefore a need to increase the number of women benefiting from micro credit. This will ensure that more women are engaged in a form of occupation that is profitable and can sustain the economic and health needs of the family.
Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease
Authors: Baker Adam R , da Silva Nancy F , Quinn David W , Harte Alison L , Pagano Domenico , Bonser Robert S , Kumar Sudhesh , McTernan Philip G 
Published: January 2006

Abstract

Introduction
Inflammation contributes to cardiovascular disease and is exacerbated with increased adiposity, particularly omental adiposity; however, the role of epicardial fat is poorly understood.

Methods
For these studies the expression of inflammatory markers was assessed in epicardial fat biopsies from coronary artery bypass grafting (CABG) patients using quantitative RT-PCR. Further, the effects of chronic medications, including statins, as well as peri-operative glucose, insulin and potassium infusion, on gene expression were also assessed. Circulating resistin, CRP, adiponectin and leptin levels were determined to assess inflammation.

Results
The expression of adiponectin, resistin and other adipocytokine mRNAs were comparable to that in omental fat. Epicardial CD45 expression was significantly higher than control depots (p < 0.01) indicating significant infiltration of macrophages. Statin treated patients showed significantly lower epicardial expression of IL-6 mRNA, in comparison with the control abdominal depots (p < 0.001). The serum profile of CABG patients showed significantly higher levels of both CRP (control: 1.28 ± 1.57 μg/mL vs CABG: 9.11 ± 15.7 μg/mL; p < 0.001) and resistin (control: 10.53 ± 0.81 ng/mL vs CABG: 16.8 ± 1.69 ng/mL; p < 0.01) and significantly lower levels of adiponectin (control: 29.1 ± 14.8 μg/mL vs CABG: 11.9 ± 6.0 μg/mL; p < 0.05) when compared to BMI matched controls.

Conclusion
Epicardial and omental fat exhibit a broadly comparable pathogenic mRNA profile, this may arise in part from macrophage infiltration into the epicardial fat. This study highlights that chronic inflammation occurs locally as well as systemically potentially contributing further to the pathogenesis of coronary artery disease.
Enzymes: An integrated view of structure, dynamics and function
Authors: Agarwal Pratul K 
Published: January 2006

Abstract
Microbes utilize enzymes to perform a variety of functions. Enzymes are biocatalysts working as highly efficient machines at the molecular level. In the past, enzymes have been viewed as static entities and their function has been explained on the basis of direct structural interactions between the enzyme and the substrate. A variety of experimental and computational techniques, however, continue to reveal that proteins are dynamically active machines, with various parts exhibiting internal motions at a wide range of time-scales. Increasing evidence also indicates that these internal protein motions play a role in promoting protein function such as enzyme catalysis. Moreover, the thermodynamical fluctuations of the solvent, surrounding the protein, have an impact on internal protein motions and, therefore, on enzyme function. In this review, we describe recent biochemical and theoretical investigations of internal protein dynamics linked to enzyme catalysis. In the enzyme cyclophilin A, investigations have lead to the discovery of a network of protein vibrations promoting catalysis. Cyclophilin A catalyzes peptidyl-prolyl cis/trans isomerization in a variety of peptide and protein substrates. Recent studies of cyclophilin A are discussed in detail and other enzymes (dihydrofolate reductase and liver alcohol dehydrogenase) where similar discoveries have been reported are also briefly discussed. The detailed characterization of the discovered networks indicates that protein dynamics plays a role in rate-enhancement achieved by enzymes. An integrated view of enzyme structure, dynamics and function have wide implications in understanding allosteric and co-operative effects, as well as protein engineering of more efficient enzymes and novel drug design.
Food composition database development for between country comparisons
Authors: Merchant Anwar T , Dehghan Mahshid 
Published: January 2006

AbstractNutritional assessment by diet analysis is a two-stepped process consisting of evaluation of food consumption, and conversion of food into nutrient intake by using a food composition database, which lists the mean nutritional values for a given food portion. Most reports in the literature focus on minimizing errors in estimation of food consumption but the selection of a specific food composition table used in nutrient estimation is also a source of errors. We are conducting a large prospective study internationally and need to compare diet, assessed by food frequency questionnaires, in a comparable manner between different countries. We have prepared a multi-country food composition database for nutrient estimation in all the countries participating in our study. The nutrient database is primarily based on the USDA food composition database, modified appropriately with reference to local food composition tables, and supplemented with recipes of locally eaten mixed dishes. By doing so we have ensured that the units of measurement, method of selection of foods for testing, and assays used for nutrient estimation are consistent and as current as possible, and yet have taken into account some local variations. Using this common metric for nutrient assessment will reduce differential errors in nutrient estimation and improve the validity of between-country comparisons.
Web GIS in practice IV: publishing your health maps and connecting to remote WMS sources using the Open Source UMN MapServer and DM Solutions MapLab
Authors: Boulos Maged N Kamel , Honda Kiyoshi 
Published: January 2006

Abstract
Open Source Web GIS software systems have reached a stage of maturity, sophistication, robustness and stability, and usability and user friendliness rivalling that of commercial, proprietary GIS and Web GIS server products. The Open Source Web GIS community is also actively embracing OGC (Open Geospatial Consortium) standards, including WMS (Web Map Service). WMS enables the creation of Web maps that have layers coming from multiple different remote servers/sources. In this article we present one easy to implement Web GIS server solution that is based on the Open Source University of Minnesota (UMN) MapServer. By following the accompanying step-by-step tutorial instructions, interested readers running mainstream Microsoft® Windows machines and with no prior technical experience in Web GIS or Internet map servers will be able to publish their own health maps on the Web and add to those maps additional layers retrieved from remote WMS servers. The 'digital Asia' and 2004 Indian Ocean tsunami experiences in using free Open Source Web GIS software are also briefly described.
Successful rescue therapy with tenofovir in a patient with hepatic decompensation and adefovir resistant HBV mutant
Authors: Ratziu Vlad , Thibault Vincent , Benhamou Yves , Poynard Thierry 
Published: January 2006

AbstractBackgroundProlonged adefovir therapy exposes to the emergence of adefovir resistant hepatitis B virus mutants. Initial reports of the rtN236T mutation showed preserved sensitivity to lamivudine; however, complex mutations are emerging with reduced susceptibility to lamivudine.Case presentationAfter 2 years of therapy, a cirrhotic patient developed the rtN236T and rtA181T adefovir resistant mutations. He had been previously treated with lamivudine, developed lamivudine resistance and, despite good compliance, had an incomplete response to adefovir. Adefovir resistance resulted in viral breakthrough with hepatitis flare-up and liver decompensation. Tenofovir had an excellent antiviral effect allowing sustained control of viral replication and reversal of hepatic failure.ConclusionIn patients with cirrhosis, adefovir resistance can lead to severe hepatitis. Tenofovir appears to be an effective treatment of adefovir resistant mutants. Incomplete control of viral replication with adefovir requires monitoring for viral resistance and should prompt a change in antiviral treatment.
Quality of life and pain in premenopausal women with major depressive disorder: The POWER Study
Authors: Hartman Jill M , Berger Ann , Baker Karen , Bolle Jacques , Handel Daniel , Mannes Andrew , Pereira Donna , St Germain Diane , Ronsaville Donna , Sonbolian Nina , Torvik Sara , Calis Karim A , Phillips Terry M , Cizza Giovanni ,   the P.O.W.E.R. (Premenopausal, Osteoporosis, Women, Alendronate, Depression) Study Group
Published: January 2006

Abstract

Background
Whereas it is established that organic pain may induce depression, it is unclear whether pain is more common in healthy subjects with depression. We assessed the prevalence of pain in premenopausal women with major depression (MDD). Subjects were 21- to 45-year-old premenopausal women with MDD (N = 70; age: 35.4 +/- 6.6; mean +/- SD) and healthy matched controls (N = 36; age 35.4 +/- 6.4) participating in a study of bone turnover, the P.O.W.E.R. (P remenopausal, O steopenia/Osteoporosis, W omen, Ale ndronate, Depr ession) Study.

Methods
Patients received a clinical assessment by a pain specialist, which included the administration of two standardized forms for pain, the Brief Pain Inventory – Short Form, and the Initial Pain Assessment Tool, and two scales of everyday stressors, the Hassles and Uplifts Scales. In addition, a quality-of-life instrument, the SF-36, was used. The diagnosis of MDD was established by a semi-structured interview, according to the DSM-IV criteria. Substance P (SP) and calcitonin-gene-related-peptide (CGRP), neuropeptides which are known mediators of pain, were measured every hour for 24 h in a subgroup of patients (N = 17) and controls (N = 14).

Results
Approximately one-half of the women with depression reported pain of mild intensity. Pain intensity was significantly correlated with the severity of depression (r2 = 0.076; P = 0.04) and tended to be correlated with the severity of anxiety, (r2 = 0.065; P = 0.07), and the number of depressive episodes (r2 = 0.072; P = 0.09). Women with MDD complained of fatigue, insomnia, and memory problems and experienced everyday negative stressors more frequently than controls. Quality of life was decreased in women with depression, as indicated by lower scores in the emotional and social well-being domains of the SF-36. SP (P < 0.0003) and CGRP (P < 0.0001) were higher in depressed subjects.

Conclusion
Women with depression experienced pain more frequently than controls, had a lower quality of life, and complained more of daily stressors. Assessment of pain may be important in the clinical evaluation of women with MDD. SP and CGRP may be useful biological markers in women with MDD.
Ineffective off-label use of recombinant activated factor VII in a case of bone-marrow transplantation-related gastrointestinal bleeding
Authors: Eller P , Pechlaner C , Wiedermann CJ 
Published: January 2006

Abstract

Background
For patients with a normal coagulation system, who experience serious bleeding, sound evidence for recombinant activated factor VII (rFVIIa) as an effective haemostatic agent is only scarcely available so far from controlled clinical trials. In systematic reviews on the clinical use of rFVIIa, treatment failures were only rarely reported.

Case presentation
We present a 45-year old, Caucasian male with persistent intestinal bleeding due to enterocolitis associated with cytomegalovirus infection and acute graft-versus-host-disease. He had received allogeneic peripheral blood stem cell transplantation from an unrelated HLA-identical donor because of chronic myelogenous leukaemia diagnosed two years earlier. Bleeding started at day 18 after transplantation with bloody diarrhea, which was treated with multiple transfusions of fresh frozen plasma, platelet, and red blood cell concentrates, and continued relentlessly, despite all efforts, including continued transfusions, high-dose prednisolone, broad antibiotic and antiviral coverage, and tranexamic acid. Recombinant FVIIa was started at boluses of 90–120 μg/kg every 4–8 hours. Despite more than 10 doses, recurrent severe bleeding progressed to refractory shock, multiorgan failure and death.

Conclusions
Little can be concluded from single case reports of clinical improvement, because publication bias in favour of positive effects is likely. Our case suggests that rFVIIa is not a panacea, in particular for severe bleeding after bone-marrow transplantation. As long as rigorous, controlled studies or comprehensive registries are lacking, conventional interventions remain the standard of care in non-haemophilic patients with severe bleeding.
The association between diabetes related medical costs and glycemic control: A retrospective analysis
Authors: Oglesby Alan K , Secnik Kristina , Barron John , Al-Zakwani Ibrahim , Lage Maureen J 
Published: January 2006

Abstract

Background
The objective of this research is to quantify the association between direct medical costs attributable to type 2 diabetes and level of glycemic control.

Methods
A longitudinal analysis using a large health plan administrative database was performed. The index date was defined as the first date of diabetes diagnosis and individuals had to have at least two HbA1c values post index date in order to be included in the analyses. A total of 10,780 individuals were included in the analyses. Individuals were stratified into groups of good (N = 6,069), fair (N = 3,586), and poor (N = 1,125) glycemic control based upon mean HbA1c values across the study period. Differences between HbA1c groups were analyzed using a generalized linear model (GLM), with differences between groups tested by utilizing z-statistics. The analyses allowed a wide range of factors to affect costs.

Results
42.1% of those treated only with oral agents, 66.1% of those treated with oral agents and insulin, and 57.2% of those treated with insulin alone were found to have suboptimal control (defined as fair or poor) throughout the study period (average duration of follow-up was 2.95 years). Results show that direct medical costs attributable to type 2 diabetes were 16% lower for individuals with good glycemic control than for those with fair control ($1,505 vs. $1,801, p < 0.05), and 20% lower for those with good glycemic control than for those with poor control ($1,505 vs. $1,871, p < 0.05). Prescription drug costs were also significantly lower for individuals with good glycemic control compared to those with fair ($377 vs. $465, p < 0.05) or poor control ($377 vs. $423, p < 0.05).

Conclusion
Almost half (44%) of all patients diagnosed with type 2 diabetes are at sub-optimal glycemic control. Evidence from this analysis indicates that the direct medical costs of treating type 2 diabetes are significantly higher for individuals who have fair or poor glycemic control than for those who have good glycemic control. Patients under fair control account for a greater proportion of the cost burden associated with antidiabetic prescription drugs.
Adding pharmacogenomics to the development of new marine-derived anticancer agents
Authors: Jimeno José , Aracil Miguel , Tercero Juan Carlos 
Published: January 2006

Abstract
Nature has always been a highly productive tool in the development of anticancer therapies. Renewed interest in the potential of this tool has recently been sparked by the realization that the marine ecosystem can be used for the discovery and development of new compounds with clinical potential in advanced resistant tumors. These compounds can be incorporated into combination approaches in a chronic therapy scenario. Our marine anticancer program is using the sea to develop new agents with activity in resistant solid tumors and to identify new cellular targets for therapeutic intervention. This review describes the integration of different pharmacogenomic tools in the development of Yondelis™, Aplidin® and Kahalalide F, three marine-derived compounds currently in Phase II or III development. Our results are reinforcing the targeted selectivity of these agents and opening the gates for customized therapies in cancer patients in the near future.
Chromosomal imbalances in nasopharyngeal carcinoma: a meta-analysis of comparative genomic hybridization results
Authors: Li Xin , Wang Ena , Zhao Ying-dong , Ren Jia-Qiang , Jin Ping , Yao Kai-Tai , Marincola Francesco M 
Published: January 2006

Abstract
Nasopharyngeal carcinoma (NPC) is a highly prevalent disease in Southeast Asia and its prevalence is clearly affected by genetic background. Various theories have been suggested for its high incidence in this geographical region but to these days no conclusive explanation has been identified. Chromosomal imbalances identifiable through comparative genomic hybridization may shed some light on common genetic alterations that may be of relevance to the onset and progression of NPC. Review of the literature, however, reveals contradictory results among reported findings possibly related to factors associated with patient selection, stage of disease, differences in methodological details etc. To increase the power of the analysis and attempt to identify commonalities among the reported findings, we performed a meta-analysis of results described in NPC tissues based on chromosomal comparative genomic hybridization (CGH). This meta-analysis revealed consistent patters in chromosomal abnormalities that appeared to cluster in specific "hot spots" along the genome following a stage-dependent progression.