bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of a Microfinance Program on Client Perceptions of the Quality of Care Provided by Private Sector Midwives in Uganda
Authors: Agha Sohail , Balal Asma , Ogojo‐Okello Francis 
Published: November 2004

Objective. To assess the impact of a microfinance program that provided business skills training and revolving loans to private sector midwives on perceived quality of services and client loyalty.Study Design. A quasi‐experimental study with a pretest, posttest design was used to evaluate the impact of the intervention. Exit interviews were conducted at 15 clinics that received the intervention and 7 clinics that did not. Baseline exit interviews were conducted between November and December 2000. Five days of business skills training were provided to midwives, and loans (averaging $454) were given during January and February 2001. A follow‐up clinic visit was made to assess whether midwives were implementing what was emphasized during the training. The loans were to be repaid with interest within 6 to 12 months, at an interest rate that is standard within the local commercial market. For those who repaid the first set of loans (11 clinics), a second set of loans (averaging $742) was provided after June 2001. Follow‐up exit interviews were conducted at the same clinics between February and March 2002. We assessed the effect of the intervention at both clinic and client levels. T‐tests, the analysis of variance, and multivariate logistic regression analysis were conducted.Principal Findings. These findings should be interpreted cautiously since secular trends were observed during the study period. The intervention was associated with improvement in clients' perceptions of the quality of care received at intervention clinics. The intervention was also associated with a higher level of client loyalty.Conclusions. The enthusiastic response of midwives and the high loan repayment rate indicate that midwives were very receptive to the microfinance program. Overall, these findings suggest that microfinance may have an important role in strengthening private sector health services by increasing private providers' business skills and clients' satisfaction with services.
Capacity in Thai Public Hospitals and the Production of Care for Poor and Nonpoor Patients
Authors: Valdmanis Vivian , Kumanarayake Lilani , Lertiendumrong Jongkol 
Published: November 2004

Objective. To assess the capacity of Thai public hospitals to proportionately expand services to both the poor and the nonpoor. This is accomplished by measuring the production of services provided to poor, relative to nonpoor, patients and the plant capacity of individual public hospitals to care for the patient load.Study Setting. Thai public hospitals operating in 1999, following the economic crisis when public hospitals were required to treat all patients irrespective of ability to pay.Study Design and Data Collection. Input and output data for 68 hospitals were collected using databases and questionnaire surveys. A distinction was made between inpatient and outpatient services to both poor and nonpoor patients and the data were assessed statistically.Data Analysis. Congestion and capacity indices to measure poor/nonpoor service trade‐offs and capacity utilization were estimated. The analysis was undertaken by data envelopment analysis (DEA), a nonparametric linear programming approach used to derive efficiency and productivity estimates.Principal Findings. Increases in the amount of services provided to poor patients did not reduce the amount of services to nonpoor patients. Overall, hospitals are producing services relatively close to their capacity given fixed inputs. Possible increases in capacity utilization amounted to 5 percent of capacity.Conclusions. Results suggest that some increased public hospital care can be accomplished by reallocation of resources to less highly utilized hospitals, given the budgetary constraints. However, further expansion and increase in access to health services will require plant investments. The study illustrates how DEA methodologies can be used in planning health services in data constrained settings.
Effects of Global Budgeting on the Distribution of Dentists and Use of Dental Care in Taiwan
Authors: Hsueh Ya‐Seng A. , Lee Shoou‐Yih D. , Huang Yu‐Tung A. 
Published: November 2004

Objective. To examine the effects of global budgeting on the distribution of dentists and the use and cost of dental care in Taiwan.Data Sources. (1) Monthly dental claim data from January 1996 to December 2001 for the entire insured population in Taiwan. (2) The 1996–2001 population information for the cities, counties and townships in Taiwan, abstracted from the Taiwan‐Fukien Demographic Fact Book.Study Design. Longitudinal, using the autocorrelation model.Principal Findings. Results indicated decline in dental care utilization, particularly after the implementation of dental global budgeting. With few exceptions, dental global budgeting did not improve the distribution of dental care and dentist supply.Conclusions. The experience of the dental global budget program in Taiwan suggested that dental global budgeting might contain dental care utilization and that several conditions might have to be met in order for the reimbursement system to have effective redistributive impact on dental care and dentist supply.
Effect of Educational Expansion on Educational Inequality in Post‐industrialized Societies: A Cross‐cultural Comparison of Japan and the United States of America
Authors: Kikkawa Toru 
Published: November 2004

Abstract:  This paper analyzes the relationship between educational expansion and educational inequality. I first reconsider the conceptual basis of educational expansion, noting that in post‐industrialized societies, people's educational attainment is no longer measurable in a simple temporal increase because of the recent leveling‐off in the younger generation. I then review the theoretical framework of educational inequality. After presenting a summary of related studies, I provide a multilevel regression model that examines the macro/cohort influence of educational expansion on educational inequality in Japan and the United States. The following propositions are derived from my analyses:Educational expansion has functioned to dissolve both the socio‐economic and the cultural‐educational reproduction processes in Japan; meanwhile, inequality in terms of micro coefficients remains.In the United States, both the magnitude of gender inequality and the influence of the socio‐economic reproduction process are smaller than in Japan. The macro/cohort effects of educational expansion are generally smaller in the United States. This is true despite the fact that educational expansion significantly dissolves gender inequality in the United States, while educational expansion has little to do with gender equalization in Japan.My comparison of the model's fit concludes that the trajectory of educational equalization follows the two‐fold consequence of educational expansion.In sum, these results show that in conjunction with the non‐linear sequence of educational attainment in the post‐industrialized phase of development, the macro/cohort influence of educational expansion as well as the micro structure of educational inequality undergo gradual transformations.
Genomic Abnormalities in Patients With Migraine and Chronic Migraine: Preliminary Blood Gene Expression Suggests Platelet Abnormalities
Authors: Hershey Andrew D. , Tang Yang , Powers Scott W. , Kabbouche Marielle A. , Gilbert Donald L. , Glauser Tracy A. , Sharp Frank R. 
Published: November 2004

Background.—Migraine has strong genetic and environmental components and may also be a significant contributor to chronic migraine (CM). It is hypothesized that gene expression changes in peripheral blood cells can be used to detect the interaction of these influences.Objective.—Distinct genomic expression patterns for migraine and CM will be present. These genomic profiles will help clarify the interactions of inheritance and environment. This initial study begins to examine the feasibility of peripheral blood cell genomic analysis to assist in the understanding of the pathophysiology of migraine and CM.Methods.—Blood samples from patients were obtained either during an acute migraine or CM. Genomic expression patterns were analyzed using Affymetrix U95A microarrays.Results.—Expression patterns of 7 migraine and 15 CM patients were compared to four distinct control groups (total patients, n = 56) including healthy subjects. A group of platelet genes were upregulated in both migraine and CM samples. Different gene expression patterns were also seen between migraine and CM. A group of immediate early genes including c‐fos and cox‐2 were expressed at higher levels in migraine, whereas specific mitochondrial genes were expressed at higher levels in CM.Conclusions.—Increased expression of platelet genes in patients with migraine and CM suggests similar underlying pathophysiology. The differences seen between migraine and CM in other genes suggest an overlapping but not identical pathophysiology. Further genomic profiling studies will help define these relationships and provide further insights into headache pathogenesis.
Preventing Disturbing Migraine Aura With Lamotrigine: An Open Study
Authors: Pascual Julio , Caminero Ana B. , Mateos Valentín , Roig Carlos , Leira Rogelio , García‐Moncó Carlos , Laínez Miguel J 
Published: November 2004

Background.—Lamotrigine has been suggested as possibly effective for preventing migraine aura.Objective.—To describe our experience with a series of patients with disturbing migraine aura treated with lamotrigine.Methods.—The members of the Headache Group of the Spanish Society of Neurology were sent an ad hoc questionnaire to collect patients treated with lamotrigine due to disturbing migraine aura. The main outcome parameter (“response”) was a >50% reduction in the mean frequency of migraine auras at 3 to 6 months of treatment.Results.—A total of 47 patients had been treated with lamotrigine due to severe migraine aura. Three could not complete the protocol as a result of developing skin rashes. Thirty (68%) patients responded. These were 21 females and 9 males whose ages ranged from 19 to 71 years. Eight suffered from migraine with “prolonged” aura, 8 typical aura with migraine headache (but had frequent episodes including speech symptoms), 6 basilar‐type migraine, 6 typical aura without headache, and 2 hemiplegic migraine. Fifteen had been previously treated, without response, with other preventatives. The mean monthly frequency of migraine auras in these 30 patients changed from 4.2 (range: 1 to 15) to 0.7 (range: 0 to 6). Response was considered as excellent (>75% reduction) in 21 cases (70% of responders). Auras reappeared in 2 months in 9 out of 13 patients where lamotrigine was stopped, and ceased as soon as this drug was reintroduced.Conclusions.—Lamotrigine should be considered in clinical practice for the preventive treatment of selected patients with disturbing migraine auras. Lamotrigine seems worthy of a controlled trial as prophylaxis of migraine aura.
Biaxial Flexural Strength and Microstructure Changes of Two Recycled Pressable Glass Ceramics
Authors: Albakry Mohammad , Guazzato Massimiliano , Vincent Swain Michael 
Published: November 2004

Purpose: This study evaluated the biaxial flexural strength and identified the crystalline phases and the microstructural features of pressed and repressed materials of the glass ceramics, Empress 1 and Empress 2.
Materials and Methods: Twenty pressed and 20 repressed disc specimens measuring 14 mm × 1 mm per material were prepared following the manufacturers' recommendations. Biaxial flexure (piston on 3‐ball method) was used to assess strength. X‐ray diffraction was performed to identify the crystalline phases, and a scanning electron microscope was used to disclose microstructural features.
Results: Biaxial flexural strength, for the pressed and repressed specimens, respectively, were E1 [148 (SD 18) and 149 (SD 35)] and E2 [340 (SD 40), 325 (SD 60)] MPa. There was no significant difference in strength between the pressed and the repressed groups of either material, Empress 1 and Empress 2 (p > 0.05). Weibull modulus values results were E1: (8, 4.7) and E2: (9, 5.8) for the same groups, respectively. X‐ray diffraction revealed that leucite was the main crystalline phase for Empress 1 groups, and lithium disilicate for Empress 2 groups. No further peaks were observed in the X‐ray diffraction patterns of either material after repressing. Dispersed leucite crystals and cracks within the leucite crystals and glass matrix were features observed in Empress 1 for pressed and repressed samples. Similar microstructure features—dense lithium disilicate crystals within a glass matrix—were observed in Empress 2 pressed and repressed materials. However, the repressed material showed larger lithium disilicate crystals than the singly pressed material.
Conclusions: Second pressing had no significant effect on the biaxial flexural strength of Empress 1 or Empress 2; however, higher strength variations among the repressed samples of the materials may indicate less reliability of these materials after second pressing.
The Effects of a Commercial Aluminum Airpolishing Powder on Dental Restorative Materials
Authors: Johnson William W. , Barnes Caren M. , Covey David A. , Walker Mary P. , Ross Judith A. 
Published: November 2004

Introduction: JET‐Fresh™ (Dentsply International, York, PA), a new airpolishing powder that contains aluminum trihydroxide as the abrasive agent, has been introduced for use with Prophy‐Jet™ (Dentsply International).
Purpose: The aim of this study was to investigate the surface effects of aluminum trihydroxide airpolishing powder on a series of restorative materials.
Materials and Methods: A total of 6 Class V preparations with enamel margins were created on the buccal surface of extracted human molars. The preparations were restored with Type III gold, a high copper spherical alloy amalgam, porcelain, a light‐activated hybrid composite material, a light‐activated microfilled composite material, and a light‐activated, resin‐modified glass ionomer material. The distal half of each restoration was covered with fiberglass tape and the mesial half subjected to treatment with the aluminum trihydroxide powder via the Prophy‐Jet™ for 5 seconds. After removal of the protective tape, the buccal surface of each treated tooth was replicated with impression material. Replicas were generated using epoxy resin and prepared for evaluation with scanning electron microscopy.
Results: The aluminum trihydroxide produced surface alterations that were apparent visually and when viewed by a scanning microscope of the hybrid and microfilled composites and the glass ionomer restorations. The surfaces of the amalgam and gold restorations were altered, but not to the extent that the resin‐based materials were. No disruption of the surface characterization of the porcelain was detected; however, with gold and porcelain materials, the aluminum trihydroxide removed notable amounts of the luting cements (the results are consistent with the data gathered with sodium bicarbonate powder).
Conclusion: Aluminum trihydroxide as the abrasive agent in an airpolishing system should be avoided on resin composites, resin‐modified composites, and around the margins of cemented restorations.
Use of an Endoscopic Suturing Device for Laparoscopic Resection of the Apex of the Bladder and Umbilical Structures in Normal Neonatal Calves
Authors: Bouré Ludovic , Foster Robert A. , Palmer Michele , Hathway Amanda 
Published: November 2004

Objective—To develop a laparoscopic technique using an endoscopic suturing device for the resection of the apex of the bladder and the umbilical structures in large‐animal neonates.Study Design—Experimental study.Animals or Sample Population—Seven healthy male Holstein calves.Methods—A laparoscopic technique for resection of the apex of the bladder was developed on 2 calf cadavers, then evaluated on 5 anesthetized calves. The calves were positioned in dorsal recumbency, and 4 ventral abdominal portals were used. The umbilical vessels were double‐ligated using an endoscopic suturing device and subsequently transected. The apex of the bladder was transected between a row of laparoscopic clips applied near the apex and atraumatic laparoscopic forceps applied distally; then, the edges were apposed using an endoscopic suturing device. The dissected umbilical remnants were removed from the abdomen through a small incision centered at the umbilicus. One month later, the calves were euthanatized and a second‐look laparoscopy performed; then, bladders were collected for gross and histologic examination.Results—No major complications occurred during or after surgery. The endoscopic suturing device permitted both effective ligation of the umbilical vessels and closure of the bladder. During second‐look laparoscopy, healing of the peritoneal surface of the bladder and umbilical vessels was assessed to be excellent in 4 calves. A focal adhesion of omentum to the bladder suture line was observed in 1 calf. Focal adhesions of the omentum to the umbilical incision site occurred in 2 calves. The bladder mucosa was completely healed at the surgical sites.Conclusion and Clinical Relevance—Resection of the apex of the bladder and umbilical vessels in calves can be accomplished laparoscopically using an endoscopic suturing device.
Effect of Focused and Radial Extracorporeal Shock Wave Therapy on Equine Bone Microdamage
Authors: Da costa Gömez Támara M. , Radtke Catherine L. , Kalscheur Vicki L. , Swain Carol A. , Scollay Mary C. , Edwards Ryland B. , Santschi Elizabeth M. , Markel Mark D. , Muir Peter 
Published: November 2004

Objectives— To determine whether bone microcracks are altered after application of focused and radial extracorporeal shock wave therapy (ESWT) to the equine distal limb.Study Design— An ex vivo experimental model.Sample Population— A contralateral limb specimen was obtained from 11 Thoroughbred racehorses with a unilateral catastrophic injury. Distal limb specimens were also obtained from 5 non‐racing horses.Methods— Three separate skin‐covered bone segments were obtained from the mid‐diaphysis of the metacarpus (MC3) or metatarsus (MT3). Focused (9,000 shockwaves, 0.15 mJ/mm2, 4 Hz) and radial (9,000 shockwaves, 0.175 mJ/mm2, 4 Hz) ESWT treatments were randomized to the proximal and distal segments and the middle segment was used as a treatment control for pre‐existing microcracks. After treatment, bone specimens were bulk‐stained with basic fuchsin and microcracks were quantified in transverse calcified bone sections.Results— ESWT had small but significant effects on microcracks. Microcrack density (Cr.Dn) and microcrack surface density (Cr.S.Dn) were increased after focused ESWT, whereas Cr.Le was increased after radial ESWT. In racing Thoroughbreds, Cr.Le increased with increased number of races undertaken. Cr.Dn and Cr.S.Dn were not significantly influenced by the number of races undertaken.Conclusion— ESWT has small but significant effects on bone microcracking ex vivo.Clinical Relevance— These preliminary data suggest that ESWT has the potential to increase bone microcracking in equine distal limb bone in vivo. Such effects may be more pronounced in Thoroughbreds that are actively being raced, because in vivo microcracking increases with increased number of races undertaken.
Effect of Petrolatum Coating on the Rate of Occlusion of Ameroid Constrictors in the Peritoneal Cavity
Authors: Adin Christopher A. , Gregory Clare R. , Kyles Andrew E. , Griffey Stephen M. , Kendall Lon 
Published: November 2004

Objective—To document rate of closure and degree of inflammation associated with petrolatum coated (PCA) and non‐coated ameroid constrictors (NCA) in the peritoneal cavity.Study Design—Experimental study.Animals—18 Sprague‐Dawley rats.Methods—Thirty‐six ameroid constrictors (AC; 5 mm) were digitally scanned and luminal area measured. Rats were anesthetized, and 1 PCA and 1 NCA were inserted in the peritoneal cavity by median celiotomy. Rats were euthanatized at 2 weeks (6 rats), 4 weeks (6), or 6 weeks (6) after surgery. AC were harvested, digitally scanned, and luminal area determined. Inflammation associated with the AC was subjectively graded (1–5). The effects of petrolatum coating on luminal area measurements and inflammatory score were statistically analyzed.Results—Closure of AC occurred most rapidly during the first 2 weeks, but luminal area decreased only 32% at 6 weeks after implantation. There was no significant difference in rate of closure for PCA compared to NCA at 2, 4, or 6 weeks. Inflammation scores were not significantly different between PCA and NCA.Conclusions—Petrolatum coating did not slow the rate of closure of AC in the peritoneal cavity.Clinical Relevance—The lack of closure of AC supports the conclusion that vascular attenuation is not dependent on luminal constriction alone. Petrolatum coating did not slow the rate of casein expansion and is unlikely to be clinically useful.
Scanning Electron Microscopic Examination of Third Metacarpal/Third Metatarsal Bone Failure Surfaces in Thoroughbred Racehorses with Condylar Fracture
Authors: Stepnik Matthew W. , Radtke Catherine L. , Scollay Mary C. , Oshel Philip E. , Albrecht Ralph M. , Santschi Elizabeth M. , Markel Mark D. , Muir Peter 
Published: November 2004

Objective—To examine the fracture failure surfaces from Thoroughbred horses that had sustained a catastrophic condylar fracture.Sample Population—Bone specimens from the failure surface were obtained from 12 Thoroughbred racehorses with catastrophic injury and 2 non‐racing horses with accidental long bone fracture.Methods—Bone specimens from the failure surface of each fracture were incubated with gold microspheres to label microcracks before examination at ×50 to ×60,000 using scanning electron microscopy. Microcracking at the failure surface was assessed using a visual analog scale.Results—Branching arrays or clusters of microcracks were seen over a range of magnifications in adapted subchondral bone in the distal end of the MC3/MT3 bone from racing Thoroughbreds with a catastrophic displaced condylar fracture. In the palmar/plantar region, microcracking was associated with the formation of an array of macroscopic cracks in the condylar groove. A different pattern of microcracking was seen in specimens of bone from distal metaphyseal and diaphyseal MC3/MT3 failure surfaces from Thoroughbred racehorses with catastrophic fracture and non‐racing horses with an accidental diaphyseal long bone fracture. Few microcracks were seen and typically did not form branching arrays.Conclusion—These data suggest that propagation of condylar fracture in Thoroughbred racehorses is initiated by the formation of nanoscale microcracks in adapted subchondral bone that form during exercise‐induced bone adaptation.Clinical Relevance—Accumulation and coalescence of branching microcracks into arrays or clusters appears to eventually lead to the development of macroscopic subchondral cracks in the condylar groove and initiation of a condylar fracture.