bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rethinking Medical Professionalism: The Role of Information Technology and Practice Innovations
Authors: MECHANIC DAVID 
Published: June 2008

Context:Physician leaders and the public have become increasingly concerned about the erosion of medical professionalism. Changes in the organization, economics, and technology of medical care have made it difficult to maintain competence, meet patients' expectations, escape serious conflicts of interest, and distribute finite resources fairly. Information technology (IT), electronic health records (EHRs), improved models of disease management, and new ways of relating to and sharing responsibility for patients' care can contribute to both professionalism and quality of care.Methods:The potential of IT, EHRs, and other practice facilitators for professionalism is assessed through diverse but relevant literatures, examination of relevant websites, and experience in working with medical leaders on renewing professionalism.Findings:IT and EHRs are the basis of needed efforts to reinforce medical competence, improve relationships with patients, implement disease management programs, and, by increasing transparency and accountability, help reduce some conflicts of interest. Barriers include the misalignment of goals with payment incentives and time pressures in meeting patients' expectations and practice demands. Implementing IT and EHRs in small, dispersed medical practices is particularly challenging because of short‐term financial costs, disruptions in practice caused by learning and adaptation, and the lack of confidence in needed support services. Large organized systems like the VA, Kaiser Permanente, and general practice in the United Kingdom have successfully overcome such challenges.Conclusions:IT and the other tools examined in this article are important adjuncts to professional capacities and aspirations. They have potential to help reverse the decline of primary care and make physicians' practices more effective and rewarding. The cooperation, collaboration, and shared responsibility of government, insurers, medical organizations, and physicians, as well as financial and technical support, are needed to implement these tools in the United States' dispersed and fragmented medical care system.
Birthweights in sickle cell trait pregnancies
Authors: Tan TL , Seed P , Oteng‐Ntim E 
Published: June 2008

Objectives  Available evidence on the effect of sickle cell trait (SCT) on birthweight is conflicting, not gestational age specific, and does not account for maternal and infant factors. The objectives of this study are to determine the contemporary mean birthweight, mean customised birthweight centile, and to analyse the risk of small‐for‐gestational‐age (SGA) and large‐for‐gestational‐age (LGA) babies in SCT pregnancies.Design  Large retrospective cohort study.Setting  London hospital.Population  Singleton pregnancies between 24 and 42 completed weeks delivered between 2000 and 2005 in parturient with body mass index between 18.0 and 35.0 kg/m2.Methods  All qualifying pregnancies were identified on Terra Nova Healthware. Birthweight centiles of these cases were computed with Gardosi customised bulk centile calculator using collected data on maternal height, weight, ethnicity and parity, and the infant’s gender, gestational age and birthweight. Birthweight and birthweight centiles of SCT and pregnancies with no haemoglobinopathy (control) were compared. Statistical analysis was performed using Stata version 9.2.Main outcome measures  Birthweight and birthweight centiles.Results  Five hundred and five SCT and 16 320 controls were analysed. The mean birthweight of SCT pregnancies was 3223 g, 57 g lower than controls (P = 0.024). However, its mean birthweight centile was 49.0% similar to that of controls’ 47.5% (P = 0.320). There is an apparent risk of LGA babies in SCT pregnancies, but logistic regression analysis suggests that the odds are related to being an older non‐white parturient and a male infant rather than SCT status.Conclusions  SCT is not a risk factor for SGA or LGA infants.
Estimates of maternal risks of pregnancy for women with hereditary haemorrhagic telangiectasia (Osler–Weber–Rendu syndrome): suggested approach for obstetric services
Authors: Shovlin CL , Sodhi V , McCarthy A , Lasjaunias P , Jackson JE , Sheppard MN 
Published: June 2008

Objectives  Hereditary haemorrhagic telangiectasia (HHT) affects 1 in 5–8000 individuals. Pregnancy outcomes are rarely reported. The major reason is that most women do not have their HHT diagnosed prior to pregnancy. Using a large well‐characterised series, we studied all pregnancies known to have occurred in HHT‐affected women, whether or not their diagnosis was known at the time of pregnancy. Our aim was to estimate rates and types of major complications of HHT in pregnancy, to guide management decisions.Design  Cohort study, with prospective, retrospective and familial components.Setting/Population  Tertiary referral centre population.Methods  All 262 pregnancies in the 111 women with HHT and pulmonary arteriovenous malformations (PAVMs) reviewed between 1999 and 2005 were studied. Eighty‐two women (74%) did not have a diagnosis of HHT/PAVM at the time of pregnancy. 222 pregnancies in their 86 HHT‐affected relatives were also studied.Main outcome measures  PAVM bleed, stroke and maternal death.Results  Thirteen women experienced life‐threatening events during pregnancy: 1.0% (95% CI 0.1–1.9) of pregnancies resulted in a major PAVM bleed; 1.2% (0.3–2.2%) in stroke (not all were HHT related); and 1.0% (0.13–1.9%) in maternal death. All deaths occurred in women previously considered well. In women experiencing a life‐threatening event, prior awareness of HHT or PAVM diagnosis was associated with improved survival (P = 0.041, Fisher’s exact test).Conclusions  Most HHT pregnancies proceed normally. Rare major complications, and improved survival outcome following prior recognition, means that pregnancy in a woman with HHT should be considered high risk. Recommendations for pregnancy management are provided.
The hidden mortality of transposition of the great arteries and survival advantage provided by prenatal diagnosis
Authors: Blyth M , Howe D , Gnanapragasam J , Wellesley D 
Published: June 2008

Objective  To describe the sensitivity of fetal anomaly scanning at detecting transposition of the great arteries (TGA) and to investigate whether prenatal detection improves survival.Design  Retrospective review of survival by comparing those who had an antenatal diagnosis with those who did not.Setting  Population‐based study in Wessex region over 13 years.Population  Babies with isolated TGA and an intact ventricular septum.Methods  Review of outcomes by comparing those who had an antenatal diagnosis with those who did not.Main outcome measures  Mortality rates in each group.Results  TGA occurred more commonly in boys than in girls. Using the existing national screening policy, the antenatal detection rate of TGA was only 6.9% over the study period, improving to 25% in the last 4 years. This contrasts with a 40% detection rate when TGA was associated with a ventricular septal defect (VSD). All the babies who had TGA diagnosed antenatally survived through surgery. Of those who were not diagnosed antenatally, two were stillborn, five died before the diagnosis was made and four died after surgery. Although the difference in survival rates between those who were antenatally diagnosed and those who were not is not statistically significant (χ2= 3.9; P = 0.11), some of these deaths could have been prevented if a prenatal diagnosis had been made.Conclusions  Improved antenatal diagnosis could lead to a significant reduction in the mortality associated with TGA. The current low detection rate of TGA in the UK could be improved by the inclusion of outflow tract views in routine fetal anomaly scans, and we believe that the extra workload is justified.
Prevalence and Impact of Migraine Among US Army Soldiers Deployed in Support of Operation Iraqi Freedom
Authors: Theeler Brett J. , Mercer Renee , Erickson Jay C. 
Published: June 2008

Objectives.— To assess the prevalence and impact of migraine headaches in US Army soldiers deployed in support of Operation Iraqi Freedom.Methods.— A brigade of US Army soldiers stationed at Ft. Lewis, Washingtion was given a self‐administered headache questionnaire within 10 days of return from a 1‐year combat tour in Iraq. Soldiers who screened positive for migraine were surveyed again by phone 3 months after return from Iraq.Results.— In total, 19% of soldiers screened positive for migraine and 17% for possible migraine. Soldiers with a positive migraine screen had a mean of 3.1 headache days per month, a mean headache duration of 5.2 hours, and a mean of 2.4 impaired duty days per month due to headache. Soldiers with migraine made a total of 490 sick call visits for headache over a 3‐month period compared with 90 sick call visits among those with possible migraine. In all, 75% of the soldiers with migraine used over‐the‐counter analgesics and only 4% used triptans. Soldiers with migraine contacted 3 months after returning from Iraq had a mean of 5.3 headache days per month and 36% had a Migraine Disability Assessment Scale grade of 3 or 4.Conclusions.— Migraine headaches are common in deployed US Army soldiers exceeding the expected prevalence. These headaches result in impaired duty performance and are a frequent cause of sick call visits. Migraine headaches tend to persist after deployment in many soldiers.
Implications of decreased hippocampal neurogenesis in chronic temporal lobe epilepsy
Authors: Hattiangady Bharathi , Shetty Ashok K. 
Published: June 2008

Summary Temporal lobe epilepsy (TLE), characterized by spontaneous recurrent motor seizures (SRMS), learning and memory impairments, and depression, is associated with neurodegeneration, abnormal reorganization of the circuitry, and loss of functional inhibition in the hippocampal and extrahippocampal regions. Over the last decade, abnormal neurogenesis in the dentate gyrus (DG) has emerged as another hallmark of TLE. Increased DG neurogenesis and recruitment of newly born neurons into the epileptogenic hippocampal circuitry is a characteristic phenomenon occurring during the early phase after the initial precipitating injury such as status epilepticus. However, the chronic phase of the disease displays substantially declined DG neurogenesis, which is associated with SRMS, learning and memory impairments, and depression. This review focuses on DG neurogenesis in the chronic phase of TLE and first confers the extent and mechanisms of declined DG neurogenesis in chronic TLE. The available data on production, survival and neuronal fate choice decision of newly born cells, stability of hippocampal stem cell numbers, and changes in the hippocampal microenvironment in chronic TLE are considered. The next section discusses the possible contribution of declined DG neurogenesis to the pathophysiology of chronic TLE, which includes its potential effects on spontaneous recurrent seizures, cognitive dysfunction, and depression. The subsequent section considers strategies that may be useful for augmenting DG neurogenesis in chronic TLE, which encompass stem cell grafting, administration of distinct neurotrophic factors, physical exercise, exposure to enriched environment, and antidepressant therapy. The final section suggests possible ramifications of increasing the DG neurogenesis in chronic epilepsy.
Potential consequences of altered neurogenesis on learning and memory in the epileptic brain
Authors: Wojtowicz Jan Martin 
Published: June 2008

Summary Studies of epilepsy and memory are tied by their common dependence on the hippocampal formation and the adjacent brain structures in the temporal lobe. With the discovery of adult neurogenesis and the consequent revisions of our understanding of how the hippocampus works, the role of neurogenesis in epilepsy needs to be addressed. In this article, we outline two theories describing how neurogenesis contributes to the hippocampus‐dependent learning. We speculate that any drastic changes in neurogenesis will negatively impact the hippocampal memory processing.
Neurogenesis and epilepsy in the developing brain
Authors: Porter Brenda E. 
Published: June 2008

Summary Multiple studies have highlighted how seizures induce different molecular, cellular, and physiologic consequences in an immature brain as compared to a mature brain. In keeping with these studies, seizures early in life alter dentate granule cell birth in different, and even opposing, fashion to adult seizure models (see

Table 1

). During the first week of rodent postnatal life, seizures decrease cell birth in the postictal period, but do not alter the maturation of newborn cells. Seizures during the second week of life have varied effects on dentate granule cell birth, either causing no change or increasing birth, and may promote a mild increase in neuronal survival. During the third and fourth weeks of life, seizures begin to increase cell birth similar to that seen in adult seizure models. Interestingly, animals that experienced seizure during the first month of life have an increase in cell birth during adulthood, opposite to the reported decrease in chronic animals experiencing a prolonged seizure as an adult. Children have more ongoing cell birth in the dentate gyrus than adults, and markers of cell division are further increased in children with refractory temporal lobe epilepsy. There are clear age‐dependent differences in how seizures alter cell birth in the dentate gyrus both acutely and chronically. Future studies need to focus on how these changes in neurogenesis influence dentate gyrus function and what they imply for epileptogenesis and learning and memory impairments, so commonly found in children with temporal lobe epilepsy.

Early seizures alter cell birth in rodent dentate gyrus

Age
Seizure model
Acute and subacute changes in cell birth
Chronic changes in cell birth

1st week of life
Flurothyl
Increased ictala and decreased postictalb
ND

Pilocarpine
Decreased postictalc
Increasedc

Kainate
Decreasedd
ND

2nd week of life
Pilocarpine
Increasede
ND

Kainate
Increasedf
ND

Hyperthermia
No changef,g
Slight increase in newborn cell survivalg (female only)

3rd –4th week of life
Pilocarpine
Increasede,h
Increased in those animals that develop spontaneous seizuresj

Kainate
Increasedi(similar to adults)
ND

ND, not determined.

a

Holmes et al., 2008; bMcCabe et al., 2001; cXiu‐Yu et al., 2007; dLiu et al., 2003; eSankar et al., 2000; fBender et al., 2003; gLemmens et al., 2005; hPorter et al., 2004; iGray et al., 2002; jCha et al., 2004.
Are Elderly Hospitalized Patients Getting Enough Protein?
Authors: Gaillard Cathy , Alix Emmanuel , Boirie Yves , Berrut Gilles , Ritz Patrick 
Published: June 2008

OBJECTIVES: To determine the protein requirements of elderly hospitalized patients.DESIGN: Cross‐sectional evaluation of nitrogen balance.SETTING: Short‐stay geriatric ward or rehabilitation care unit.PARTICIPANTS: Thirty‐six elderly hospitalized patients (aged 65–99) admitted to short‐stay and rehabilitation care units.MEASUREMENTS: Resting energy expenditure and nitrogen balance were determined under usual and spontaneous energy and protein intake after subjects were clinically stable (3–5 days after admission). All items consumed over a 3‐day period were weighed to determine energy and protein intake.RESULTS: Energy (23.5±6.3 kcal/kg per day) and protein (0.99±0.24 g/kg per day) intake were similar in men and women, and nitrogen balance was neutral (0.37±2.6 g/day; P=.41 vs a neutral nitrogen balance, i.e., 0 g/d). Half of the patients had a positive nitrogen balance. Plasma C‐reactive protein, renal function, nutritional status, and initial diagnosis had no influence on nitrogen balance. In contrast, energy and protein intakes correlated positively with nitrogen balance. Linear regression analysis suggested that an elderly hospitalized patient with an energy intake of 1.31 times resting energy expenditure or greater appears to require a minimum protein intake of 1.06±0.28 g/kg per day.CONCLUSION: Mean protein intake to reach a neutral nitrogen balance in elderly hospitalized patients is 1.06±0.28 g/kg per day, which is higher than current recommendations for healthy elderly people. Safe protein intake (that would be adequate to ensure that 95% of patients remain in positive nitrogen balance) is difficult to establish.
Erythrocyte‐magnetized technology: an original and innovative method for blood group serology
Authors: Bouix Olivier , Ferrera Virginie , Delamaire Maryvonne , Redersdorff Jean Claude , Roubinet Francis 
Published: June 2008

BACKGROUND: Erythrocyte‐magnetized technology (EMT) is a new fully automated method for ABO‐RH‐K phenotyping and antibody detection. The magnetization of red cells avoids centrifugation and washing phases. This report describes the results of an evaluation of this new technology on its specific automated system.STUDY DESIGN AND METHODS: ABO‐RH‐K phenotyping was compared between EMT and a semiautomated routine method (liquid microplate for ABO‐D and microcolumn system for RH‐K) on 311 patients' samples. The overall performance of the new method was further assessed in daily routine on a total of 11,022 samples during 3 months in two different laboratories. Antibody detection was evaluated on 624 consecutive patients' samples and on 118 frozen samples containing specific antibodies in comparison with commercial microcolumn systems.RESULTS: Eight of 311 ABO‐RH‐K tests (2.6%) were not interpreted by EMT. Seven of them were weak antigen or reverse grouping reactions showing a negative result with the routine method. On a 3‐month follow‐up, 216 of 11,022 tests (1.96%) were not interpreted by the system, 75 percent of them being due to weak or mixed‐field reactions. EMT was better in detecting ABO‐D mixed‐field reaction than routine microplate method. Detection of clinically significant antibodies was similar between EMT and microcolumn. In contrast, EMT detected a markedly lower rate of presumed nonsignificant antibodies. The system presents an overall high reliability.CONCLUSION: EMT is tailored to meet the needs of the transfusion service and represents an important advance in the field of immunohematology.
Thoracic radiography of pet macaques in Sulawesi, Indonesia
Authors: Schillaci Michael A. , Jones‐Engel Lisa , Heidrich John E. , Benamore R. , Pereira Andre , Paul Narinder 
Published: June 2008

AbstractThis report describes the results from a study of thoracic radiographs taken on a sample (n = 20) of pet macaque monkeys (Macaca) on the Indonesian island of Sulawesi. We present findings relating to general thoracic health, as well as describe our field methods and outline some of the challenges of conducting thoracic radiography in remote areas of the developing world. Examination of the radiographic images identified six possible cases of cardiac enlargement, and one case of minor lung consolidation possibly consistent with tuberculosis. The study did not identify major radiographic evidence of significant respiratory illness in the monkeys as might be expected based on the intense exposure to human respiratory diseases. These largely negative findings may be in part a consequence of image quality which seems to be influenced by power output and incomplete inspiration during film exposure.
Concentration compared with total urinary excretion of 11,17‐DOA in cynomolgus monkey urine
Authors: Hau J. , Royo F. 
Published: June 2008

AbstractStrees sensitive molecules exhibit great variation in concentration in the circulation and it may often be advantageous to quantify these in urine or feces rather than in serum or plasma. We advocate that all urine‐or feces‐should be collected, and that excretion of stress sensitive molecules should be expressed as amounts excreted per time unit per kg body‐weight, rather than being expressed as concentrations in samples. Urine and feces excretion varies significantly within and between animals over time, which may render simple concentration measures of molecules of little biological relevance.
Molecular cloning, gene expression, and tissue distribution of adiponectin and its receptors in the Japanese monkey, Macaca fuscata
Authors: Kang Kyung‐Hwa , Higashino Atsunori , Kim Heui‐Soo , Lee Yong‐Tae , Kageyama Takashi 
Published: June 2008

AbstractBackground  Adiponectin is an adipocyte‐derived hormone that affects regulation of metabolic syndrome such as insulin resistance, type‐2 diabetes, and obesity. It functions via seven transmembrane domain receptors [i.e., adiponectin receptors 1 (AdipoR1) and 2 (AdipoR2)] that have been scarcely investigated in non‐human primates.Methods  Molecular cloning of cDNAs for adiponectin, AdipoR1, and AdipoR2 that included the whole protein‐coding region in the Japanese monkey, Macaca fuscata, was carried out. Tissue‐specific expression of respective genes was analyzed with Northern blot hybridization.Results  The essential Cys36 and four lysine residues in adiponectin, and transmembrane‐spanning domains in AdipoR1 and AdipoR2 appear well conserved. While adiponectin mRNA is expressed only in adipose tissues, AdipoR1 mRNA was found to be expressed in various tissues including the brain.Conclusions  These results significantly add to the understanding of the molecular basis of obesity‐related adipokines and their receptors in non‐human primates.
Posttraumatic stress among children in Kurdistan
Authors: Ahmad A 
Published: June 2008

AbstractAim: To identify a posttraumatic stress disorder profile for the Child Behaviour Checklist.Method: Checklist item scores for 806 school‐aged children in Iraqi Kurdistan (201 randomly selected from the general population, 241 orphans, 199 primary medical care visitors and 165 hospital in‐patients) were analysed against the Posttraumatic Stress Symptom Scale for Children (PTSS‐C) scores, estimating not only stress diagnoses, but also nonstress‐related, child‐specific posttraumatic symptoms.Results: Twenty checklist items, which revealed significant correlations with the stress diagnoses, formed the checklist–stress profile with acceptable reliability and validity, and significant correlation to the PTSS‐C estimates.Conclusion: A child‐specific stress profile for the checklist is recommended for use as a screening instrument.