bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in grassland ecosystem function due to extreme rainfall events: implications for responses to climate change
Authors: FAY PHILIP A. , KAUFMAN DAWN M. , NIPPERT JESSE B. , CARLISLE JONATHAN D. , HARPER CHRISTOPHER W. 
Published: March 2008

AbstractClimate change is causing measurable changes in rainfall patterns, and will likely cause increases in extreme rainfall events, with uncertain implications for key processes in ecosystem function and carbon cycling. We examined how variation in rainfall total quantity (Q), the interval between rainfall events (I), and individual event size (SE) affected soil water content (SWC) and three aspects of ecosystem function: leaf photosynthetic carbon gain (), aboveground net primary productivity (ANPP), and soil respiration (). We utilized rainout shelter‐covered mesocosms (2.6 m3) containing assemblages of tallgrass prairie grasses and forbs. These were hand watered with 16 I×Q treatment combinations, using event sizes from 4 to 53 mm. Increasing Q by 250% (400–1000 mm yr−1) increased mean soil moisture and all three processes as expected, but only by 20–55% (P≤0.004), suggesting diminishing returns in ecosystem function as Q increased. Increasing I (from 3 to 15 days between rainfall inputs) caused both positive () and negative () changes in ecosystem processes (20–70%, P≤0.01), within and across levels of Q, indicating that I strongly influenced the effects of Q, and shifted the system towards increased net carbon uptake. Variation in SE at shorter I produced greater response in soil moisture and ecosystem processes than did variation in SE at longer I, suggesting greater stability in ecosystem function at longer I and a priming effect at shorter I. Significant differences in ANPP and between treatments differing in I and Q but sharing the same SE showed that the prevailing pattern of rainfall influenced the responses to a given event size. Grassland ecosystem responses to extreme rainfall patterns expected with climate change are, therefore, likely to be variable, depending on how I, Q, and SE combine, but will likely result in changes in ecosystem carbon cycling.
Using quality report cards for reshaping dentist practice patterns: a pre‐play communication approach
Authors: Lin Chinho , Lin Chun‐Mei 
Published: March 2008

AbstractRationale, aims and objectives  Understanding how information disclosure influences dentists’ patterns of practice change is important in developing quality‐improvement policies and cost containment. Thus, using quality report cards is a promising strategy for investigating whether dentists will reshape their patterns of practice because of the influence of peer comparison.Methods  Based on the coordination game, a data warehouse decision support system (DWDSS) was used as a pre‐play communication instrument, along with the disclosure of quality report cards, which allow dentists to search their own service rates of dental restoration and restoration replacement as well as compare those results with others.Results and conclusions  The group using the DWDSS had a greater decrease in two indicators (i.e. service rates of dental restoration and restoration replacement) than the dentists who did not use it, which implies that the DWDSS is a useful facility for helping dentists filter and evaluate information for establishing the maximum utility in their practice management. The disclosure of information makes significant contributions to solving managerial problems associated with dentists’ deviation of practice patterns.
Multilevel factors affecting tuberculosis diagnosis and initial treatment
Authors: Thongraung Wilawan , Chongsuvivatwong Virasakdi , Pungrassamee Petchawan 
Published: March 2008

AbstractObjectives  The study aims to assess provider adherence to national tuberculosis programme guidelines on diagnosis, initial regimens and dosages, and to examine independent effects of factors at patient, staff and hospital levels influencing adherence.Methods  A review of 383 medical records of new tuberculosis (TB) patients and interviews with related staff were carried out. The study was conducted in 16 public hospitals of seven provinces of southern Thailand. The outcome variables were provider adherence to the guidelines on diagnostic procedure, initial regimen and dosage. Independent variables consisted of patient, staff and hospital factors. Multilevel logistic regression was used to identify factors associated with adherence.Results  The proportions of adherence to the diagnostic procedure, initial regimen and initial dosage prescribed were 70.0%, 100.0% and 57.1%, respectively. Most of diagnosis non‐adherence was anti‐TB drugs being prescribed for smear‐negative patients without prior antibiotic trial (12.5%). The anti‐TB drug with the highest percentages of patients receiving non‐adhered dosage was ethambutol (33.6%). In contrast to single‐level analysis, which showed significant influence of up to five factors, multilevel analysis confirmed only strong effect of male patients receiving better adhered diagnosis and of non‐doctors and TB clinics providing better dosage adherence.Conclusions  Adherence to TB diagnostic procedures was not good, and adherence to initial dosage, especially for ethambutol, was poor. TB clinics, the key factor of adherence, should be expanded. Female patients should be reviewed more carefully because they tend to receive poorer diagnosis adherence.
Interaction effects and subgroup analyses in clinical trials: more than meets the eye?
Authors: Sevdalis Nick , Jacklin Rosamond 
Published: March 2008

AbstractIn clinical trials, it is common practice to follow up significant interactions between the factors under investigation with subgroup analyses. Such analyses pose at least two analytical and interpretational challenges. The first challenge is that performing multiple subgroup analyses increases the likelihood of obtaining spuriously significant results. This has been acknowledged and relevant guidance exists in the medical literature. The second challenge is that the effects that are obtained at the level of subgroup are composite. This has yet to be fully acknowledged and discussed in the context of medical research. This paper aims to fill this lacuna. Using a simple additive model, we use recent findings from the CHARISMA trial on the efficacy of clopidogrel in addition to aspirin in the treatment of patients at risk for atherothrombotic events to demonstrate quantitatively the composition of effects at the level of subgroups. In the simplest case of a design involving an interaction (two crossed factors, with two levels each, i.e. a 2 × 2 design), effects at the level of subgroup consist of influences that stem (i) from the incidence of the measured outcome in the study population as a whole; (ii) from the factor of interest (e.g. treatment vs. placebo); (iii) from the second factor (e.g. patient group membership); (iv) from the interaction between the two factors; and (v) from random error in the measured outcome. The value of the approach illustrated here is that it is generalizable to any research design irrespective of its complexity and that it prompts clinicians to consider the multiple causality underlying medical research findings.
General practitioners’ assessment of risk of violence in their practice: results from a qualitative study
Authors: Magin Parker , Adams Jon , Joy Elyssa , Ireland Malcolm , Heaney Susan , Darab Sandra 
Published: March 2008

AbstractRationale, aims and objectives  Clinicians’ means of stratification of risk of violence has been previously studied in health settings, but not in general practice. This study aimed to investigate the means by which general practitioners (GPs) assess risk of violence in their clinical practice.Method  A qualitative design using focus group interviews and written responses on a subsequent questionnaire. Focus group discussions were audiotaped and transcribed. Questionnaires were sent to all members of three Divisions of General Practice offering the opportunity for respondents to make qualitative comments. The focus group transcripts and qualitative questionnaire responses were coded independently by members of the research team and subjected to thematic analysis. The setting was three Urban Divisions of General Practice in New South Wales, Australia. Participants were one hundred and seventy‐two urban GPs – 18 participants in four focus groups and 154 GPs providing written responses.Results  Assessment and stratification of risk by GPs conformed to a schema based on the physical environment of the consultation, individual characteristics of the patient, individual characteristics of the doctor, and characteristics of the doctor–patient relationship. Despite this, risk assessment and risk stratification were often on the basis of ad hoc, subjective decision making. An aspect of the ad hoc nature of risk assessment was the pre‐eminence afforded ‘instinct’ or ‘intuition’ in subjects’ responses.Conclusion  A schema of factors involved in GPs’ assessment of risk of violence is presented. An appreciation of these will be of clinical and policy importance.
The impact of choice of maternity care on psychological health outcomes for women during pregnancy and the postnatal period
Authors: Jomeen Julie , Martin Colin R. 
Published: March 2008

AbstractRationale  Psychological factors are acknowledged to impact on pregnancy, birth, neonatal outcomes and maternal mental health. The importance of psychological well‐being is now recognized within maternity care and UK maternity policy advocates choice and control, equating this to increased quality of experience and improved psychological outcomes. There remains, however, lack of substantive and consistent evidence with regard to the psychological benefits of choice in maternity care. The aim of this study is to investigate the impact of choice of maternity care on psychological health outcomes.Methods  165 antenatal women were recruited and sampled according to their choices for care. Women were assessed utilizing the Hospital Anxiety and Depression Scale (HADS), Edinburgh Postnatal Depression Scale (EPDS), Cambridge Worry Scale (CWS), Multidimensional Health Locus of Control (MHLC), SF‐36, Pittsburgh Sleep Quality Index (PSQI) and Culture Free Self‐esteem Inventory (CFSEI) at 12 and 32 weeks pregnant and 14 days and 6 months postnatal.Results  No significant differences between groups were revealed on any of the scales or subscales measured. Significant and corresponding differences were identified within groups over time for CWS socio‐medical worries, MHLC ‘powerful others’, SF‐36 bodily pain, vitality personal health and change in health, PSQI global sleep. An interaction effect for CFSEI general and social self‐esteem was revealed between birth centre and midwifery‐led care/main unit women at 14 days postnatal.Conclusions  These results demonstrate that pregnancy represents a psychological challenge regardless of care type chosen and choice of no one care option confers greater psychological benefit across the maternity experience as a whole. It is possible, however, that differences in experience or environment at critical times can affect psychological status.
Evaluating the impact of mobile telephone technology on type 2 diabetic patients’ self‐management: the NICHE pilot study
Authors: Faridi Zubaida , Liberti Lauren , Shuval Kerem , Northrup Veronika , Ali Ather , Katz David L. 
Published: March 2008

AbstractRationale, aims and objectives  Utilizing information technology, such as Internet and cellphones, holds great promise in enhancing diabetic care. Yet few studies have examined the impact of cellphone technology on type 2 diabetics’ self‐care. The primary aim of the study is to examine the feasibility of utilizing this technology to assist with diabetes self‐care in a clinic population as well as its impact on clinical outcomes.Methods  Thirty patients with a diagnosis of type 2 diabetes at two Community Health Centers were randomized to intervention or control. Intervention patients participated in a brief intervention and received tailored daily messages via cellphone prompting them to enhance their diabetic self‐care behaviour. Patients at the control site continued with their standard diabetes self‐management.Results  A mean improvement in HbA1c levels was apparent (−0.1, SD = 0.3%; P = 0.1534) in the intervention group, compared with a mean deterioration in the control (0.3, SD = 1.0%; P = 0.3813), yet without statistical significance. Self‐efficacy scores improved significantly in the intervention group (−0.5, SD = 0.6; P = 0.0080) compared with no improvement in the control (0.0, SD = 1.0; P = 0.9060). Participants encountered numerous technological barriers when attempting to adhere to the intervention protocol.Conclusion  The results indicate the intervention had a positive impact on some clinical outcome and self‐efficacy. Although the technology appears feasible in a clinical setting technology must be made more user‐friendly before a larger phase II trial is conducted.
Comparisons of risk‐adjusted clinical outcomes for patients with aneurysmal subarachnoid haemorrhage across eight teaching hospitals in Japan
Authors: Ishizaki Tatsuro , Imanaka Yuichi , Sekimoto Miho , Fukuda Haruhisa , Mihara Hanako ,   Treatment of Subarachnoid Hemorrhage Expert Group
Published: March 2008

AbstractObjectives To assess predictive value of patient characteristics and severity of aneurysmal subarachnoid haemorrhage (SAH) patients for clinical outcomes, and thereby estimate risk‐adjusted clinical outcomes and compare the outcomes across hospitals.Methods We selected 256 aneurysmal SAH patients from eight teaching hospitals in Japan. The clinical outcomes of patients at the time of discharge were assessed by the Glasgow Outcome Scale (GOS). A multiple logistic regression analysis was performed to identify predictors for the GOS status at the time of discharge. The risk‐adjusted proportion of patients with a favourable GOS outcome was then estimated for each facility and compared across hospitals.Results The logistic regression analysis revealed that younger age (P < 0.001), patients with good World Federations of Neurological Surgeons grade at admission (P < 0.001) and absence of chronic renal failure or ischaemic heart disease as a comorbid condition (P < 0.001) were identified as significant predictors for favourable GOS outcome at the time of discharge among aneurysmal SAH patients (Cstatistic = 0.88). We found that one hospital had significantly better outcomes than the others.Conclusion After comparison of risk‐adjusted values across hospitals, the clinical management methods of the hospital that showed the best performance were examined and shared among providers.
Who’s in charge? Challenges in evaluating quality of primary care treatment for low back pain
Authors: Wasiak Radoslaw , Pransky Glenn S. , Atlas Steven J. 
Published: March 2008

AbstractRationale and objectives  Low back pain (LBP) is a common condition with frequent health care visits and work disability. Quality improvement efforts in primary care focused on guidelines adherence, provider selection and education, and feedback on appropriateness of care. Such efforts can only succeed if a health care provider is in charge of care over a substantial period. This study was conducted to provide insights about actual patterns of provider involvement in LBP care and implications for quality evaluation.Methods  Established primary care patients with occupational LBP and health care covered by a workers’ compensation insurer were selected. Primary care physician (PCP) involvement was examined relative to overall health care utilization. Four methods of classifying PCP involvement were used to assess the association between PCP involvement and health care and work disability outcomes over a 2‐year follow‐up period.Results  Primary care physician was rarely the sole provider during episodes of occupational LBP. PCP was the initial non‐emergency room provider in 55% of cases, and was the most prevalent provider during at least one episode of care in 45% of cases. Different methods of classification led to different conclusions about the association between PCP involvement and work disability or number of health care visits. Multiple providers were involved throughout the clinical course of the small number of cases that accounted for most of the health care visits and work disability; in these cases, the role of PCP in care was difficult to determine.Conclusions  Administrative data alone are adequate for provider comparisons only in relatively simple cases. Provider comparisons based on initial treating provider likely overstate the importance of early care, particularly in more complex cases. For LBP, quality improvement models based on PCP‐directed interventions or reinforcing guideline adherence may not impact outcomes. A patient‐centred model may be necessary to achieve outcome improvements.
Experiences of diagnosis and treatment among people with multiple sclerosis
Authors: Edwards Rhiannon G. , Barlow Julie H. , Turner Andrew P. 
Published: March 2008

AbstractRationale, aims and objectives  The aim of this qualitative study was to examine patients’ experiences of being diagnosed with multiple sclerosis (MS), the information that they were given at this time, subsequent treatment and its impact on their lives.Method  Data were collected through semi‐structured interviews with 24 people with MS. The use of interviews allowed participants’ experiences to be explored in depth. Participants were recruited by the MS Society through membership details and through a press release in a local newspaper. Telephone interviews lasted between 30 and 60 minutes, were tape‐recorded and transcribed verbatim. Data were analysed using thematic content analysis.Results  The majority of participants were female (n = 17), with ages ranging from 35 to 72 years. Disease duration ranged from 1 to 37 years. Many participants’ diagnosed before and after 2000 had experienced long delays in diagnosis. At the point of diagnosis, participants had to make sense of and understand their diagnosis often with insufficient support. Some participants expressed anger about the way they had been given their diagnosis. Many felt they had not received sufficient information about their illness at this time and had responded by conducting their own searches for information to satisfy this need.Conclusion  Improving the way in which doctors communicate with patients experiencing diagnostic delay and at the point of diagnosis deserves further study, in order to avoid later adjustment problems.
The use of gastric electrical signals for algorithm for automatic eating detection in dogs
Authors: Aviv R. , Sanmiguel C. P. , Kliger A. , Policker S. , Haddad W. , Hagiike M. , Soffer E. E. 
Published: March 2008

Abstract  Food ingestion increases fundic impedance (FI) and reduces antral slow wave rate (SWR).Our aim was to determine if such changes can be integrated into an algorithm for automatic eating detection (AED). When incorporated in implantable medical devices, AED can time treatment to food intake without need for patient input.Four dogs were implanted with fundic and antral electrodes, connected to an implantable recording device. Changes in FI and SWR induced by fixed meals of different weights were determined, and were used to build an AED algorithm. Its performance was then tested on the same animals given an ad libitum access to food. The effects of gastric balloon distension and nitroglycerin on SWR and FI were also tested.Fixed meals reduced SWR in a weight‐dependant manner, R2 = 0.936, P < 0.05 baseline compared to 50, 100, 200 and 400 g. Meals increased FI above baseline in a weight‐dependant manner; R2 = 0.994, P < 0.05 baseline compared to 200 and 400 g. During ad libitum intake, the AED algorithm detected 86% of all meals ≥15 g. Gastric distension reduced SWR and increased FI. Nitroglycerin reduced SWR.AED, using changes in FI and gastric SWR is feasible. Changes in FI and SWR are induced primarily by the presence of food in the stomach.
Effects of bean rust (Uromyces appendiculatus) epidemics on host dynamics of common bean (Phaseolus vulgaris)
Authors: Mersha Z. , Hau B. 
Published: March 2008

Epidemics of bean rust (Uromyces appendiculatus) and their effects on host dynamics of common bean (Phaseolus vulgaris) were studied in three controlled greenhouse experiments, with and without fungicide sprays, on two susceptible bean cultivars, Dufrix and Duplika. Bean plants were artificially inoculated with a suspension of 105 U. appendiculatus urediniospores mL−1 water and temporal disease progress, as well as host growth dynamics (leaf size and defoliation), were monitored on a leaflet basis in comparison with non‐inoculated plants, which were sprayed with deionized water. Progress curves of bean rust, expressed as the proportion of leaf area occupied by pustules (uredinia), or as the proportion occupied by total lesion area (= halo areas + pustule area), were well described by logistic functions with maximum disease levels clearly lower than 1. Bean rust epidemics substantially affected host growth by reducing the total leaf area formed by 17·4–35·6% and 35·3–46·2% compared with healthy plants for cvs Dufrix and Duplika, respectively. Fungicide sprays mitigated the negative effect of bean rust, leading to a gain in leaf area of 17–21% compared with unsprayed plants in both cultivars in two experiments, while in another experiment, disease control had no effect in Dufrix, but a clear effect in Duplika. In addition to the growth depression, bean rust also led to pronounced losses of leaf area as a result of reduced leaf size (leaf shrivelling) and accelerated defoliation.
Heritable variation and genetic correlation of quantitative traits within and between ecotypes ofAvena barbata
Authors: GARDNER K. M. , LATTA R. G. 
Published: March 2008

AbstractWe examined heritable variation for quantitative traits within and between naturally occurring mesic and xeric ecotypes of the slender wild oat (Avena barbata), and in 188 recombinant inbred lines derived from a cross between the ecotypes. We measured a suite of seedling and adult traits in the greenhouse, as well as performance‐related traits in field sites native to the two ecotypes. Although the ecotypes were genetically diverged for most traits, few traits showed significant heritable variation within either ecotype. In contrast, considerable heritable variation was released in the recombinant progeny of the cross, and transgressive segregation was apparent in all traits. Heritabilities were substantially greater in the greenhouse than in the field, and this was associated with an increase in environmental variance in the field, rather than a decrease in genetic variance. Strong genetic correlations were evident among the recombinants, such that 22 measured traits could be well represented by only seven underlying factors, which accounted for 80% of the total variation. The primary axis of variation in the greenhouse described a trade‐off between vegetative and reproductive allocation, mediated by the date of first flowering, and fitness was strongly correlated with this trade‐off. Other factors in the greenhouse described variation in size and in seedling traits. Lack of correlation among these factors represents the release of multivariate trait variation through recombination. In the field, a separate axis of variation in overall performance was found for each year/site combination. Performance was significantly correlated across field environments, but not significantly correlated between greenhouse and field.