bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of intrapartum Cesarean delivery for non‐reassuring fetal status after a successful external cephalic version by a low pre‐version pulsatility index of the fetal middle cerebral artery
Authors: Leung T. Y. , Fok W. Y. , Chan L. W. , Law L. W. , Lau T. K. 
Published: March 2006

AbstractObjectiveTo determine whether a pre‐version Doppler assessment of fetal cerebral and umbilical blood flow can predict the ultimate need for intrapartum Cesarean delivery after a successful external cephalic version (ECV).MethodsA prospective observational study on women undergoing ECV between 36 and 38 gestational weeks was performed over a 5‐year period. The pulsatility index (PI) of the fetal middle cerebral artery (MCA) and umbilical artery, heart rate and amniotic fluid index were measured before ECV. Women who had successful ECV were then divided into three groups according to the mode of delivery: (1) vaginal delivery, (2) intrapartum Cesarean delivery for poor progress and (3) intrapartum Cesarean delivery for non‐reassuring fetal status. The fetal blood flow parameters were compared between the groups. Potential predictors were further analyzed using receiver‐operating characteristics curves.ResultsOf 174 women with successful ECV, 140 (80.5%) had vaginal delivery, 19 (10.9%) required emergency intrapartum Cesarean delivery for non‐reassuring fetal status and 15 (8.6%) for poor progress. MCA‐PI was significantly lower in the group with non‐reassuring fetal status. MCA‐PI is predictive of intrapartum Cesarean delivery (area under the curve = 0.68, P = 0.021). The sensitivity and specificity at a cut‐off level of 1.4 were 62.5% and 76%, respectively, while at a cut‐off level of 1.5 they were 68.8% and 63.5%, respectively.ConclusionIntrapartum Cesarean delivery for non‐reassuring fetal status after successful ECV is associated with a lower pre‐version fetal MCA‐PI. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.
Which extrauterine pelvic masses are difficult to correctly classify as benign or malignant on the basis of ultrasound findings and is there a way of making a correct diagnosis?
Authors: Valentin L. , Ameye L. , Jurkovic D. , Metzger U. , Lécuru F. , Van Huffel S. , Timmerman D. 
Published: March 2006

AbstractObjectivesTo determine which extrauterine pelvic masses are difficult to correctly classify as benign or malignant on the basis of ultrasound findings, and to determine if the use of logistic regression models for calculation of individual risk of malignancy would improve the diagnostic accuracy in difficult tumors.MethodsIn a prospective, international, European multicenter study involving nine centers, 1066 women with a pelvic mass judged to be of extrauterine origin underwent transvaginal ultrasound examination by an experienced ultrasound examiner before surgery. A standardized examination technique and predefined definitions of ultrasound characteristics were used. On the basis of subjective evaluation of ultrasound findings, the examiner classified each mass as being certainly benign, probably benign, unclassifiable, probably malignant or certainly malignant. Even when the examiner found the mass unclassifiable (i.e. difficult mass) he or she was obliged to state whether the mass was more likely to be benign or malignant. Borderline tumors were classified as malignant.ResultsThere were 90 (8%) unclassifiable masses. Multiple logistic regression analysis showed papillary projections, >10 locules in a cyst without solid components, low‐level echogenicity of cyst fluid, and moderate vascularization as assessed subjectively at color Doppler examination to be ultrasound variables independently associated with unclassifiable mass. Borderline malignant tumors (n = 55) proved to be most difficult to assess with only 47% being correctly classified (i.e. classified as malignant), 29% being incorrectly classified (i.e. classified as benign) and 24% being unclassifiable vs. 90% of non‐borderline tumors being correctly classified, 3% being incorrectly classified and 8% being unclassifiable (P < 0.0001). Papillary cystadeno(fibro)mas, myomas and cases of struma ovarii were also more common among the unclassifiable masses than among the classifiable ones (5.6% vs. 1.1%, P = 0.008; 4.4% vs. 0.9%, P = 0.02; 4.4% vs. 0.2%, P = 0.0006). No ultrasound variable or clinical variable (including CA 125) entered a logistic regression model to predict malignancy in difficult masses. A model could be constructed for difficult masses containing papillary projections but this model performed no better than subjective evaluation of the ultrasound image. Sensitivity and specificity of subjective evaluation with regard to malignancy in the group of unclassifiable masses were 56% (14/25) and 77% (50/65) vs. 91% (220/241) and 97% (712/735) in the classifiable masses.ConclusionsBorderline tumors cause great diagnostic difficulties, but so do papillary cystadeno(fibro)mas, struma ovarii and some myomas. Logistic regression models do not solve the diagnostic problem in difficult pelvic masses. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.
Inter‐ and intraobserver variability in sonographic measurement of the lower uterine segment after a previous Cesarean section
Authors: Jastrow N. , Antonelli E. , Robyr R. , Irion O. , Boulvain M. 
Published: March 2006

AbstractObjectiveTo evaluate the reproducibility of sonographic measurement of the lower uterine segment in pregnant women at term.MethodsTwo independent observers performed transabdominal sonography on 129 women between 36 and 38 weeks of gestation who had had a previous Cesarean section. Sonography was performed when the patients had a full and a half‐full bladder; in 100 patients, the measurements were also performed transvaginally, with the patients having an empty bladder. Agreement was quantified by the intraclass correlation coefficient and, using a cut‐off of 3.5 mm, by the kappa coefficient.ResultsThe intraobserver agreement was generally high (intraclass correlation coefficient > 0.90). The interobserver agreement was higher on transvaginal (intraclass correlation coefficient, 0.94) compared with transabdominal (0.70 and 0.84, with full and half‐full bladder, respectively) ultrasound. The kappa coefficient was 0.75 transvaginally, compared with 0.34 and 0.54 using the transabdominal approach, with full and half‐full bladder, respectively.ConclusionThe agreement between two observers for sonographic transvaginal measurement of the lower uterine segment can be considered good, compared with poor to moderate agreement using the transabdominal approach. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.
Sonographic measurement of cervical length and fetal fibronectin testing in threatened preterm labor
Authors: Tsoi E. , Akmal S. , Geerts L. , Jeffery B. , Nicolaides K. H. 
Published: March 2006

AbstractObjectiveIn women presenting with threatened preterm labor, both fetal fibronectin and sonographic measurement of cervical length have been shown to distinguish between true and false labor. The aim of this study was to determine whether the combination of both tests provides a better prediction than the individual tests alone.MethodsWe examined 195 women with singleton pregnancies presenting at 24–36 (median 31) weeks of gestation with regular and painful uterine contractions, intact membranes and cervical dilatation of less than 3 cm. On admission to the hospital fetal fibronectin positivity in cervicovaginal secretions was determined and transvaginal sonographic measurement of cervical length was carried out. The results were not made available to the attending obstetrician. The primary outcome measure was delivery within 7 days of presentation.ResultsDelivery within 7 days occurred in 51.4% (18 of 35) of those with cervical length below 15 mm and 0.6% (1 of 160) of those with cervical length of 15 mm or more, in 21.2% (18 of 85) of the fibronectin positive group and in 0.9% (1 of 110) of the fibronectin negative group. There was a significant association between cervical length and the incidence of fibronectin positivity (r = −0.921, P = 0.003). Logistic regression analysis demonstrated that the only significant contributor to the prediction of delivery within 7 days was cervical length, with no significant contribution from fibronectin positivity, ethnic origin, maternal age, gestational age, body mass index, parity, previous history of preterm delivery, cigarette smoking, or use of tocolytics.ConclusionsIn women with threatened preterm labor assessment of fetal fibronectin in cervicovaginal secretions does not improve the prediction of delivery within 7 days provided by the sonographic measurement of cervical length. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.
Size and shape analysis of mineral resources in arroyo willow and their relation to sawfly densities
Authors: Boecklen William J. , Mopper Susan , Price Peter W. 
Published: March 2006

AbstractThe association between host‐plant mineral nutrients and insect herbivory is complex, idiosyncratic, and dynamic. Because of this we employed an unusual statistical method to evaluate the relationship between tenthredinid sawfly herbivory and concentrations of foliar nutrients in arroyo willow, Salix lasiolepis. We discovered that among 20 willow clones and between two years arroyo willow varied in the size (absolute concentrations) and shape (relative concentrations) of five mineral nutrients (Ca, Mg, N, P, and K). Similarly, the densities of five sawfly species varied in size and shape among clones and between years. In 1984, relative densities, or shape, of the sawfly community was associated with relative concentrations, or shape, of foliar nutrients in 20 willow clones. In contrast, in 1985 absolute densities, or size, was associated with absolute concentrations, or size, of foliar nutrients. This shift from a shape to a size association between herbivory and foliar mineral nutrients may reflect the large difference in winter precipitation and sawfly densities between years: precipitation and sawfly densities were much greater in 1985 than in 1984.
Vegetative growth and productivity of Eichhornia azurea with special emphasis on leaf dynamics
Authors: Ikusima Isao , Gentil José Geraldo 
Published: March 2006

AbstractThe lifeform and the biological production of pure stands of Eichhornia azurea Kunth in three lakes in tropical Brazil were studied. The lifeform of E. azurea is termed ‘semi‐emergent’, because the plant has well developed trailing stems just under the water, and the aerial lamina emerges with the thick petiole. The density of shoot apices was 9.9, 17.2 and 17.1 m−2 in Lake Dom Helvecio, Lake Jacaré and Lake Carioca, respectively. The mean daily increment of the apical shoot biomass was between 1.8 and 4.8 g m−2 day−1. The mean leaf life‐span in Lake Dom Helvecio, Lake Jacaré and Lake Carioca was estimated to be 78, 49 and 64 days in the wet season and 73, 70 and 73 days in the dry season, respectively. The stem life‐span was estimated to be about 28 months. Starch content in the current years' stem ranged from 24 to 118 mg g−1 dry matter with fluctuations, the amplitude of which decreased with age. The differences for most of the growth parameters, such as density of shoot apices, daily increment of biomass and leaf life‐span, between dry and wet season are smaller than those among the three lakes. Both the decrease in daily dry matter production and the increase in leaf life‐span occurred in order from Lake Dom Helvecio to Lake Jacaré and Lake Carioca. The low productivity of E. azurea is considered to be related to a low leaf area index, a long time interval for the emergence of new leaves, long leaf life‐span and a low capacity for branching.
Intra‐ and interspecific dominance hierarchies and variation in foraging tactics of two species of stream‐dwelling chars
Authors: Nakano Shigeru , Furukawa‐Tanaka Tetsuo 
Published: March 2006

AbstractAggressive interactions, foraging behavior, habitat use and diet were studied in sympatric populations of white‐sported char,Salvelinus leucomaenis, and Dolly Varden,Salvelinus malma, in a Japanese mountain stream. Underwater observations on individuals of both species revealed two distinct behavioral regimes: aggressive drift foragers and non‐aggressive benthos foragers. Aggressive drift foragers defended partial territories around focal points from which they made forays to capture invertebrates drifting in the water column. Non‐aggressive benthos foragers cruised around and beneath cobble in large foraging ranges that overlapped each other. Intra‐ and interspecific, size‐dependent dominance hierarchies were recognized among aggressive drift foragers, whereas non‐aggressive benthos foragers showed no such relationships. Terrestrial invertebrates were the most abundant prey in the diets of drift foragers, whereas a very small proportion of the diet of benthos foragers was made up of these taxa. Benthos foragers showed more complex diet composition than drift foragers. These results suggest that non‐aggressive benthos foragers may avoid not only interference but also exploitative competition by using alternative foraging tactics. The proportion of drift foragers to benthos foragers among white‐spotted char was more than 35 times that among Dolly Varden. The significant difference in the proportion of each species using the two types of foraging strategy results in interspecific food segregation in sympatric populations.
Diagnosis and Treatment of Acute Appendicitis in Children: A Survey Among Dutch Surgeons and Comparison with Evidence‐based Practice
Authors: Tan E.C.T.H. , Severijnen R.S.V.M. , Rosman C. , van der Wilt G.J , van Goor H. 
Published: March 2006

AbstractBackgroundConsiderable variability exists in the surgical approach to acute appendicitis in children, affecting both quality and costs of care. A national survey provides insight into daily surgical practice and enables comparison of practice with the available evidence.MethodsA national survey was conducted in all 121 Dutch hospitals asking detailed information concerning diagnosis and treatment of children suspected of acute appendicitis. An evidence‐based practice (EBP) score was developed on the basis of a critical appraisal of the literature, allowing for classification of reported practices with regard to the level of evidence and identification of hospitals working in accordance with the best available evidence.ResultsThe overall response rate was 93%. For the diagnosis of acute appendicitis, respondents relied predominantly on patient history (29%) and clinical examination (31%), followed by laboratory results (22%). Only 20% of the departments routinely measured total white blood cell count (WBC), C‐reactive protein (CRP) and leukocyte differential count (proportion of polymorphonuclear cells), being part of the triad that provides diagnostic evidence. Although strong evidence exists in favour of routine prophylaxis for suspected appendicitis, only two thirds of surgical departments reported this as part of their routine practice. For a number of issues, reasonably consistent evidence is available (e.g. primarily versus delayed closure, drainage versus lavage, routine peritoneal culturing). Thirty‐eight percent of the departments routinely cultured abdominal fluid despite various reports that it provides no therapeutic advantage. Not more than 22% of the departments closed the skin in perforated appendicitis in spite of clear supportive evidence. Considerable variation exists in cleaning the abdomen in perforated appendicitis, despite evidence favouring lavage. Comparing departments in terms of compliance with available evidence revealed that most paediatric surgery departments worked according to evidence‐based medicine.ConclusionsAvailable evidence on diagnosis and treatment of acute appendicitis in children is only partly applied in a small proportion of hospitals in the Netherlands. It is recommended that national guidelines be published, which could decrease health care costs and increase more uniform policy, improve quality of care for this group of patients and improve training of residents in general surgery in the Netherlands.
Cost/DALY Averted in a Small Hospital in Sierra Leone: What Is the Relative Contribution of Different Services?
Authors: Gosselin Richard A. , Thind Amardeep , Bellardinelli Andrea 
Published: March 2006

AbstractBackgroundA cost‐effective analysis (CEA) can be a useful tool to guide resource allocation decisions. However, there is a dearth of evidence on the cost/disability‐adjusted life year (DALY) averted by health facilities in the developing world.MethodsWe conducted a study to calculate the costs and the DALYs averted by an entire hospital in Sierra Leone, using the method suggested by McCord and Chowdhury (Int J Gynaecol Obstet 2003;81:83–92).ResultsFor the 3‐month study period, total costs were calculated to be $369,774. Using the approach of McCord and Chowdhury, we calculated that 11,282 DALYs were averted during the study period, resulting in a cost/DALY averted of $32.78. This figure compares favorably to other non‐surgical health interventions in developing countries. We found that while surgery accounts for 63% of total caseload, it contributes to 38% of the total DALYs averted.ConclusionsSurgical treatment of some common pathologies in developing countries may be more cost‐effective than previously thought, and our results provide evidence for the inclusion of surgery as part of the basic public health armamentarium in developing countries. However, these results are highly context‐specific, and more research is needed from developing countries to further refine the methodology and analysis.
Dysphoric adolescents’ causal explanations and expectancies for approach and avoidance goals
Authors: Dickson Joanne M. , MacLeod Andrew K. 
Published: March 2006

ABSTRACTRelatively little research has studied emotional disturbance from a motivational perspective. The current study aimed to investigate personal goal systems at different levels of analysis, namely, personal goals, associated causal explanations and goal expectancies, as a function of dysphoria. Dysphoric () and non‐dysphoric () adolescents (16–18‐yr‐olds) selected from a larger school sample completed tasks that measured number of approach goals and avoidance goals, causal explanations for goals, and perceived likelihood and control estimates for idiographic goals. As predicted dysphoric adolescents, relative to controls, generated a combination of more avoidance goals and fewer approach goals, and thought of more reasons that explain why goals would not be achieved and fewer reasons that explain why goals would be achieved (irrespective of goal type), and considered avoidance goal outcomes as more likely to occur and approach goal outcomes as less likely to occur. In addition, dysphoric adolescents anticipated less personal control in implementing their goals than controls. Overall, the data identified distinct personal goal systems that function differently in dysphoric and non‐dysphoric adolescents.
Destabilization and stabilization of proteins
Authors: Schellman John A. 
Published: March 2006

Introduction 351Part I. A succession of concepts 3521. Cooperativity 3522. Cosolvent interaction 3523. Linearity 3544. Solvent exchange 3545. Excluded volume 3566. Summation 357Part II 1. The Kirkwood–Buff approach 357Acknowledgments 360References 360In Part I the history of progress in the stabilization and destabilization of protein conformations by means of cosolvents is outlined in terms of distinct conceptual steps. In Part II it is shown that a straightforward application of the Kirkwood–Buff theory of solutions leads to formulas for the preferential interaction and the free energy of unfolding, which confirm and generalize the results of Part I.
Physical activity, fitness and cardiovascular disease risk in adults: interactions with insulin resistance and obesity
Authors: Gill Jason M. R. , Malkova Dalia 
Published: March 2006

There is a considerable body of evidence gathered from studies over the past half a century indicating that a high level of physical activity and a moderately high or high degree of cardiorespiratory fitness reduces the risk of CVD (cardiovascular disease). Recent data suggest that high levels of physical activity or fitness may be particularly beneficial to individuals with insulin-resistant conditions, such as the metabolic syndrome, Type II diabetes or obesity. These individuals, if unfit and sedentary, exhibit increased CVD risk, but their dose–response relationship for physical activity/fitness appears to be particularly steep such that, when they undertake high levels of activity (or have high fitness), their level of risk becomes closer to that of their normal weight or nondiabetic peers. This may be due to effects of physical activity in normalizing the metabolic dysfunction particularly associated with insulin-resistant conditions.
Is the Hygiene Hypothesis an Example of Hormesis?
Authors: Bukowski John A. , Lewis R. Jeffrey 
Published: March 2006

The “hygiene hypothesis” has been suggested to explain the rising incidence of allergic disorders in developed countries. The postulated mechanism is that infectious and/or microbial agents stimulate the immune system toward Th1 (allergy fighting) rather than Th2 (allergy promoting) response. This paper reviews the evidence related to early life infectious/microbial exposures and subsequent atopic disorders and evaluates whether these data suggest a hormetic effect. Our review indicates an insufficient and contradictory association for bacterial/viral infections, with protective effects being either absent or specific to certain infections and/or populations. Chronic, heavy parasitic burdens appear to confer protection against atopic disorders, but are associated with considerable pathology. Moreover, light parasitic burden may increase allergic responses (i.e., no “low dose” beneficial effect). In contrast, there is consistent evidence that general microbial exposures, particularly gut commensals, may be protective against allergy development, which is consistent with a hormetic effect (i.e., potentially beneficial effects at low doses and detrimental effects at high levels). Conclusion: General microbial exposures in relation to the “hygiene hypothesis” may represent a hormetic effect, although further research with more rigorous study methods (i.e., prospective designs and measurement of exposure timing, dose, route, etc.) are needed.
From ‘Vergangenheitsbewältigung’ to Generational Memory Contests in Günter Grass, Monika Maron and Uwe Timm
Authors: Fuchs Anne 
Published: March 2006

AbstractAgainst the backdrop of the proliferation of trauma theory in public and academic debates, the paper argues that in spite of a recent trend to question the canonised discourse of contrition, German discussions about the legacy of the Nazi past are still largely dominated by the following two paradigms: a first psychoanalytic narrative tells a drama of repression, acting out and repetition compulsion, and a second narrative then restores the Enlightenment paradigm through its story of critical engagement with the past. In order to avoid the pitfall of an unhelpful demonisation of forgetting on the one hand, and the danger of a displaced sacralisation of the Holocaust on the other, the paper introduces the notion of memory contests into the debate. Provisionally defined as retrospective imaginings that simultaneously articulate, question and investigate the normative self‐image of previous generations, this notion accounts for the intergenerational dynamic of recent German identity debates. The dynamic of post‐‘Wende’ memory contests is explored with reference to recent works by Grass, Maron and Timm.