bluuebunny/crossref_metadata_2025_split huggingface dataset:
Falls in the Medicare Population: Incidence, Associated Factors, and Impact on Health Care
Authors: Shumway-Cook Anne , Ciol Marcia A , Hoffman Jeanne , Dudgeon Brian J , Yorkston Kathryn , Chan Leighton 
Published: February 2009

Background and Purpose
Falls are a major health problem in the elderly community; however, questions regarding incidence, risk factors, and provider response to falls exist. The purpose of this study was to examine the incidence of falls, associated factors, health care costs, and provider response to falls among Medicare beneficiaries.

Participants
The participants were 12,669 respondents to the Medicare Current Beneficiaries Survey (MCBS).

Methods
Categories of number of falls (none, one, recurrent) and injury type (medically injurious versus not medically injurious) were created from the falls supplement to the MCBS. Means and proportions for the entire Medicare population were estimated using sampling weights. The association between sociodemographic variables and fall status was modeled using ordinal or binary logistic regression. Aggregate health costs by fall category were estimated from claims data.

Results
Population estimates of falls reported in 2002 ranged from 3.7 million (single fall) to 3.1 million (recurrent falls), with an estimated 2.2 million people having a medically injurious fall. Recurrent falls were more likely with increased age, being female, being nonwhite, reporting fair or poor health, and increased number of limitations in personal activities of daily living and instrumental activities of daily living and comorbidities. Although estimates of the actual costs of falls could not be determined, “fallers” consistently had larger utilization costs than “nonfallers” for the year 2002. Fewer than half (48%) of the beneficiaries reported talking to a health care provider following a fall, and 60% of those beneficiaries reported receiving fall prevention information.

Discussion and Conclusions
Falls are common and may be associated with significant health care costs. Most importantly, health care providers may be missing many opportunities to provide fall prevention information to older people.
Modern Veterinary Graduates Are Outstanding, But Can They Get Better?
Authors: May Stephen A. 
Published: February 2009

Despite periodic debate implying that modern veterinary graduates are less competent than their predecessors, analysis of educational inputs and learning outcomes suggests that they continue to qualify with an excellent knowledge and skill set. However, increased public expectations of veterinarians have led to the need for better-designed, more integrated curricula with increased attention to communication and other professional skills and to elements of individual specialization. The need for revision of curricular content will continue. A more overriding reason for reducing content, however, is the effect this has on students’ learning. Content overload in all disciplines leads to a superficial acquisition of facts, which overwhelms any drive toward understanding and extracting meaning. Unfortunately, many modern assessment methods permit replication to masquerade as problem solving, leading to short-term gains in grades at the cost of the development of information sourcing and application and other lifelong learning skills. All involved in education must be clear that our task is to develop the independent professional person. Such a person is much more than the possessor of a collection of facts and a set of individual competences. To facilitate the development of this overall capability, educators must pay as much attention to students’ engagement in the learning process, and to how they understand and make meaning of our discipline, as to the specific scientific and species content of their school's individual degree programs.
I’ll Show You Mine If You Show Me Yours! Portfolio Design in Two UK Veterinary Schools
Authors: Mossop Liz H. , Senior Avril 
Published: February 2009

Portfolios are an attractive addition to the veterinary curriculum because they add to the assessment of competencies, are flexible, and encourage the development of reflective and lifelong learning skills. Veterinary schools at the University of Liverpool and the University of Nottingham, UK, have both recently introduced portfolios for year 1 undergraduate students. The key difference between the two institutions is that one uses the portfolio as a summative assessment, while the other allows formative assessment only. Advantages of assessing the portfolio include engagement in the process and the ability to examine the key professional skill of reflection. Advantages of using the portfolio for formative assessment only are a facilitation of honest self-criticism and that this approach encourages students to view the portfolio as a valuable professional and personal activity. Both portfolio systems will need to be closely analyzed in order to assess these perceived advantages, and the two institutions are learning from each other's experiences. Whether or not the portfolio is summatively assessed, student and tutor training and support are essential. Feedback from these stakeholders must also be analyzed and used to support and shape the portfolios as they become a central part of both veterinary curricula.
Correlation of Doppler echocardiography with cardiac catheterization in estimating pulmonary capillary wedge pressure: A tertiary level hospital finding in Bangladesh
Authors: Tamanna Rownak Jahan , Jahan Rowshan , Zaher Abduz , Akhanda Abdul Kader 
Published: February 2009

This prospective cross sectional study was conducted in the department of cardiology in National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period of January 2002 to December 2002.Atotal of 50 patients with coronary artery disease subjected to diagnostic cardiac catheterization for evaluation of CAD were studied and the patients were grouped into two groups, group I having PCWP â¥12- < 18 mmHg and group II having PCWP â¥18 mmHg. The aims of the study were to correlate the Pulmonary Capillary Wedge Pressure (PCWP) estimated by Doppler echocardiography with that obtained at cardiac catheterization. Among 2D and M mode echocardiographic indices it was observed that ejection fraction was significantly lower and maximal left atrial volume (MLAV) was significantly higher among patients having PCWP â¥18 mmHg (p < 0.05). Among Doppler derived mitral flow variables deceleration rate was significantly higher (p < 0.05) among patients having PCWP â¥18 mmHg. No statistically significant difference was found between two groups in terms of pulmonary venous flow variables. A statistically significant negative correlation of deceleration time (r=-0.483; p=0.001) and ejection fraction (r=-0.334; p=0.01) and a statistically significant positive correlation of peak E wave (r=0.345; p=0.01) and deceleration rate (r=0.651; p=0.001) was found with catheter derived PCWP. The correlation coefficient between measured and estimated PCWP (from equation 1) was (r=0.678) which was highest. When pulmonary venous flow variables were included with mitral flow variables into multiple linear regression analysis, the resulting correlation coefficients were (r=0.670) for equation 2 and (r=0.652) for equation 3. In all three equations deceleration rate was the most important determinant of PCWP. Therefore in patients with coronary artery disease pulmonary capillary wedge pressure can reliably be estimated by combining Doppler echocardiographic variables of mitral flow and pulmonary venous flow and that mitral flow velocity indexes contribute most significantly to such estimation. Among the mitral flow variables, deceleration rate is the most important determinant of PCWP. Key words: Pulmonary Capillary Wedge Pressure, Cardiac Catheterization, Doppler echocardiography, Bangladesh. Â Â doi:10.3329/uhj.v4i2.2065 University Heart Journal Vol. 4 No. 2 July 2008 p1-8
Changes in plasma brain natriuretic peptide in conventional or direct stenting
Authors: Khan Saidur Rahman , Kurtoglu Nuri , Benli Fehime , Toprak Ahmet , Agirbasli Mehmet , Oktay Ahmet 
Published: February 2009

Direct coronary stenting without balloon predilatation may cause lower postprocedural minor myocardial injury in comparison to conventional stenting with balloon predilatation.Plasma brain natriuretic peptide (BNP) is increased in acute myocardial ischaemia. 40 patients with single vessel and single lesion coronary artey disease who underwent elective stent implantation were divided into Group I (n=20) treated with direct coronary stenting (DS) and Group II (n=20) with conventional stenting (CS). Blood samples for Troponin I and CK-MB measurement were obtained at baseline, just after the intervention procedure, 6 hours after and 12 hours after stenting and for BNP levels at baseline, 6 hours and 12 hours after stenting. In Group II there was a significant increase in Troponin I level 12 hours after the procedure (baseline 0.033 Â± 0.028 ng/ml vs. 0.084 Â± 0.085 ng/ml; p < 0.05).Plasma BNP level in Group I decreased significantly both in base line vs. 6 hours after procedure and baseline vs. 12 hours after procedure (105.2 Â± 73.7 pg/ml vs. 81.3Â± 67.1 pg/ml; p < 0.05 and 105.2 Â± 73.7 pg/ml vs. 89.9 Â± 62.3pg/ml ; p < 0.05 respectively). With direct stenting BNP levels decreased significantly with no change in Troponin I level, while with conventional stenting Troponin I levels increased significantly. Key words: Brain natriuretic peptide, Direct stenting, Conventional stenting. Â doi:10.3329/uhj.v4i2.2066 University Heart Journal Vol. 4 No. 2 July 2008 p9-15 Â
Trends of permanent pacemaker implantation in University Cardiac Center, BSMMU
Authors: Rahman Fazlur , Ahsan Syed Ali , Ahmed Chaudhury Meshkat , Safiuddin Md , Haque KMHS Sirajul , Banerjee Sajal Krishna , Siddique Md Abu , Mahmood Manzoor , Anam Khairul , Rahman Md Mukhlesur , Zaman SM Mostafa , Ahmed Md Khurshed , Habib SM Ahsan , Salim MA , Uddin Mir J , Faruque Mohammed , Khalil MA , Patauri MA , Rashid Md Abdur , Hafiz G 
Published: February 2009

The purpose of the study was to investigate the trends of permanent pacemaker implantations in the University Cardiac Center (UCC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. This retrospective study conducted in the department of Cardiology, UCC, BSMMU, Dhaka to evaluate demographic distribution, indications, complications of the permanent pacemaker (PPM) implantation and its hospital outcome. Data of this retrospective study was collected from hospital registry and patient's record files. Total 98 patients were studied. Among them male were 64.28% (n=63) and female were 35.71% (n=35). Most of them were elderly patients (58%). Complete heart block was the most common cause for PPM implantation, which was 67.35% (n=66). Single chamber multiprogrammable PPM (VVI) was implanted in 86.73% (n=85) and Dual chamber PPM (DDI) was implanted in 13.26% (n=13) cases. No Major complications occurred during the procedure and short term in-hospital outcome was good for all the cases. This study showed that PPM implantation is rapidly increasing modality of treatment for patients with cardiac bradyarrhythmias as effective technique with good in-hospital outcome. Â doi:10.3329/uhj.v4i2.2072 University Heart Journal Vol. 4 No. 2 July 2008 p16-18
A Note on Estimating Treatment Effect for Time-to-event Data in a Literature-based Meta-analysis
Authors: Hamada C. , Yoshimura I. , Hirooka T. 
Published: February 2009

Summary
Objectives: In a literature-based meta-analysis for time-to-event data, the hazard ratio in each trial is often estimated from the summary statistics described in the article. Several methods have been proposed: the direct method (Peto method); the indirect method using a p-value by the log-rank test and the number of total events; and the survival curve method using the Kaplan-Meier estimate. However, there has been no published report on a detailed investigation of these methods. We evaluated the performance of these methods by simulation.
Methods: In a set of simulation experiments, performance of five methods was evaluated by the bias of estimated log hazard ratio and coverage probability of the confidence interval. The methods evaluated were: 1) Cox regression analysis, 2) direct method, 3) indirect method, 4) survival curve method, and 5) modified survival curve method with an alternative weighting scheme.
Results: The direct method was confirmed to have a high degree of accuracy. Although the indirect method was also highly accurate, it tended to underestimate effect size when there was a strong effect. The survival curve method tended to underestimate effect size when event numbers were small and effect size was large. The modified survival curve method could alleviate this tendency toward underestimation of effect size found with the original survival curve method.
Conclusions: When the Kaplan-Meier curve is used to estimate hazard ratios in trials with small sample size in the literature-based meta-analysis, we should check critically whether those trials’ hazard ratios and overall hazard ratio are underestimated or not.
Comparative Evaluation of Balancing Properties of Stratified Randomization Procedures
Authors: Kundt G. 
Published: February 2009

Summary
Objectives: If in a clinical trial prognostic factors are known in advance to be associated with the outcome of a patient it is often recommended that the randomization for a clinical trial should be stratified on these factors, particularly in a multicenter trial. Unfortunately, stratified or covariate-adaptive randomization does not always promote greater balance between the numbers of treatment assignments to A and B within each stratum and thus overall. Because such designs have numerous parameters that must be specified, simulation is a good tool to investigate the impact of these parameters on balance.
Methods: We investigate and discuss in more detail the difference in balancing performance of three stratified randomization procedures. The permuted-block randomization within strata, the “minimization” method and “self-adjusting” design are assessed overall, within levels of prognostic factors, and within strata.
Results: We show the superior performance of “self-adjusting” design and the extent of balancing losses occurring with permuted-block randomization within levels of factors and with “minimization” within strata. A summary of principal conclusions regarding the balancing properties of stratified randomization procedures is presented and general recommendations are offered.
Conclusions: The relative merits of each procedure should be weighted carefully in relation to the characteristics of the trial. Considering the likelihood of imbalances, the sample size and values of parameters of stratified randomization procedures (number of prognostic factors, number of factor levels, block size) are important when choosing a randomization procedure.
Reproducible Extraction of Local and Global Parameters for Functional Analysis of the Left Ventricle in 4D MR Image Data
Authors: Relan J. , Ehrhardt J. , Müllerleile K. , Bahrmeyer A. , Groth M. , Handels H. , Säring D. 
Published: February 2009

Summary
Objectives: Left ventricle (LV) segmentation is required to quantify LV volume and mass parameters. Therefore, spatiotemporal Cine MR sequences in the short and long axis of the heart are acquired. Generally, LV segmentation methods consider short-axis sequences only. The reduced resolution in long-axis direction is one of the main reasons for inaccurate parameter extraction in the apical and basal area. The segmentation approach presented combines short- and long-axis information as well as motion tracking to enable the functional LV analysis in 4D MR Image Data.
Methods: First, anatomical landmarks like the mitral valve and the apex are defined in long-axis views in diastolic and systolic phase in order to specify the upper and lower boundary of the LV. Second, motion field approximation using non-linear registration enables the automatic contour propagation to all time points. Third, intersection planes are defined parallel to the mitral valve plane covering the whole ventricle. Finally, the 4D LV surface model is generated appending all in-plane contours. The segmentation results in short-axis images are checked and adjusted interactively and quantitative parameters are extracted.
Results: For evaluation the contours of 19 different datasets were traced by two medical experts using a contour drawing tool and the new segmentation tool. The results were compared to evaluate automatic contour propagation, robustness of the segmentation as well as interaction time.
Conclusion: The automatic contour propagation enables the fast and reproducible generation of a 4D model for the functional analysis of the heart. The interaction time is decreased from approx. 60 minutes to 10 minutes per case. Inter- and intraobserver differences of the extracted parameters are decreased significantly.
Enhanced Semantic Interoperability by Profiling Health Informatics Standards
Authors: Blobel B. , Lopez D. M. 
Published: February 2009

Summary
Objectives: Several standards applied to the healthcare domain support semantic inter-operability. These standards are far from being completely adopted in health information system development, however. The objective of this paper is to provide a method and suggest the necessary tooling for reusing standard health information models, by that way supporting the development of semantically interoperable systems and components.
Methods: The approach is based on the definition of UML Profiles. UML profiling is a formal modeling mechanism to specialize reference meta-models in such a way that it is possible to adapt those meta-models to specific platforms or domains. A health information model can be considered as such a meta-model.
Results: The first step of the introduced method identifies the standard health information models and tasks in the software development process in which healthcare information models can be reused. Then, the selected information model is formalized as a UML Profile. That Profile is finally applied to system models, annotating them with the semantics of the information model. The approach is supported on Eclipse-based UML modeling tools. The method is integrated into a comprehensive framework for health information systems development, and the feasibility of the approach is demonstrated in the analysis, design, and implementation of a public health surveillance system, reusing HL7 RIM and DIMs specifications.
Conclusions: The paper describes a method and the necessary tooling for reusing standard healthcare information models. UML offers several advantages such as tooling support, graphical notation, exchangeability, extensibility, semi-automatic code generation, etc. The approach presented is also applicable for harmonizing different standard specifications.
Test Turnaround Times and Mortality Rates 12 and 24 Months after the Introduction of a Computerised Provider Order Entry System
Authors: Georgiou A. , Rob M. I. , Westbrook J. I. 
Published: February 2009

Summary
Objectives: Few studies have measured the long-term effects of computerised provider order entry systems on pathology test turnaround time. Further, a recent study has raised the possibility that such systems, which require significant work practice change, may be associated with an increase in mortality rates. Our study answered two questions in relation to system introduction in a major Australian teaching hospital: i) are improvements in turnaround times achieved in the first 12 months after system introduction sustained 24 months post-implementation; and ii) do mortality rates change following the introduction of an order entry system?
Methods: Turnaround time and mortality rates 5 months before and 12 and 24 months after implementation of a computerised order entry system were measured. Turnaround time was defined as the time from receipt of a specimen and order in a laboratory to availability of a result.
Results: Improvements in turnaround time achieved in the first 12 months were sustained with a further significant 12.6% reduction at 24 months post-implementation, with no change in average number of tests per patient. The mortality rate significantly increased in the year following system introduction but returned to the pre-system rate in the second year of system use. Review of the excess deaths demonstrated these were most likely attributable to a coincidental influenza outbreak and not to system introduction.
Conclusions: The computerised provider order entry system produced sustained and continuing improvements in laboratory efficiency over a two-year period. Associations between increased mortality rates and system introduction should be investigated carefully to ascertain any likely association.
Granularity Issues in the Alignment of Upper Ontologies
Authors: Boeker M. , Stenzhorn H. , Niggemann J. , Schulz S. 
Published: February 2009

Summary
Objectives: The application of upper ontologies has been repeatedly advocated for to support the interoperability between different domain ontologies for facilitating the shared use of data within and across disciplines. BioTop is an upper domain ontology that aims at aligning more specialized biomolecular and biomedical ontologies. The integration of BioTop and the upper ontology Basic Formal Ontology (BFO) is the objective of this study.
Methods: BFO was manually integrated into BioTop, observing both its free text and formal definitions. BioTop classes were attached to BFO classes as children and BFO classes were reused in the formal definitions of BioTop classes. A description logics reasoner was used to check the logical consistency of this integration. The domain adequacy was checked manually by domain experts.
Results: Logical inconsistencies were found by the reasoner when applying the BFO classes for fiat and aggregated objects in some of the BioTop class definitions. We discovered that the definition of those particular classes in BFO was dependent on the notion of physical connectedness. Hence we suggest ignoring a BFO subbranch in order not to hinder cross-granularity integration.
Conclusion: Without introducing a more sophisticated theory of granularity, the described problems cannot be properly dealt with. Whereas we argue that an upper ontology should be granularity-independent, we illustrate how granularity-dependent domain ontologies can still be embedded into the framework of BioTop in combination with BFO.