bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of three methods for estimating appropriate tracheal tube depth in children
Authors: MARIANO EDWARD R. , RAMAMOORTHY CHANDRA , CHU LARRY F. , CHEN MICHAEL , HAMMER GREGORY B. 
Published: September 2005

SummaryBackground:  Estimating appropriate tracheal tube (TT) depth following tracheal intubation in infants and children presents a challenge to anesthesia practitioners. We evaluated three methods commonly used by anesthesiologists to determine which one most reliably results in appropriate positioning.Methods:  After IRB approval, 60 infants and children scheduled for fluoroscopic procedures requiring general anesthesia were enrolled. Patients were randomly assigned to one of three groups: (1) deliberate mainstem intubation with subsequent withdrawal of the TT 2 cm above the carina (‘mainstem’ method); (2) alignment of the double black line marker near the TT tip at the vocal cords (‘marker’ method); or (3) placement of the TT at a depth determined by the formula: TT depth (cm) = 3 × TT size (mmID) (‘formula’ method). TT tip position was determined to be ‘appropriate’ if located between the sternoclavicular junction (SCJ) and 0.5 cm above the carina as determined by fluoroscopy. Risk ratios were calculated, and data were analysed by the chi‐square test accepting statistical significance at P < 0.05.Results:  The mainstem method was associated with the highest rate of appropriate TT placement (73%) compared with both the marker method (53%, P = 0.03, RR = 1.56) and the formula method (42%, P = 0.006, RR = 2.016). There was no difference between the marker and formula methods overall (P = 0.2, RR = 1.27). Analysis of age‐stratified data demonstrated higher success with the marker method compared with the formula method for patients 3–12 months (P = 0.0056, RR = 4.0).Conclusions:  Deliberate mainstem intubation most reliably results in appropriate TT depth in infants and children.
Trends in the state of nature and their implications for human well‐being
Authors: Balmford Andrew , Bond William 
Published: September 2005

AbstractTwo major international initiatives – the Convention on Biological Diversity's target to reduce the rate of biodiversity loss by 2010, and the Millennium Ecosystem Assessment – raise the profile of ecological data on the changing state of nature and its implications for human well‐being. This paper is intended to provide a broad overview of current knowledge of these issues. Information on changes in the status of species, size of populations, and extent and condition of habitats is patchy, with little data available for many of the taxa, regions and habitats of greatest importance to the delivery of ecosystem services. However, what we do know strongly suggests that, while exceptions exist, the changes currently underway are for the most part negative, anthropogenic in origin, ominously large and accelerating. The impacts of these changes on human society are idiosyncratic and patchily understood, but for the most part also appear to be negative and substantial. Forecasting future changes is limited by our poor understanding of the cascading impacts of change within communities, of threshold effects, of interactions between the drivers of change, and of linkages between the state of nature and human well‐being. In assessing future science needs, we not only see a strong role for ecological data and theory, but also believe that much closer collaboration with social and earth system scientists is essential if ecology is to have a strong bearing on policy makers.
Screening for peripheral arterial disease by means of the ankle‐brachial index in newly diagnosed Type 2 diabetic patients
Authors: Faglia E. , Caravaggi C. , Marchetti R. , Mingardi R. , Morabito A. , Piaggesi A. , Uccioli L. , Ceriello A. ,   (Coordinator) for the SCAR (SCreening for ARteriopathy) study group
Published: September 2005

AbstractAim  To evaluate the prevalence of peripheral arterial disease (PAD) with the ankle‐brachial index (ABI) in newly diagnosed Type 2 diabetic subjects.Methods  Between autumn 2002 and spring 2003, 2559 newly diagnosed Type 2 diabetic subjects (about 15% of the cases/year in Italy) were enrolled in 265 diabetology centres. Family history of diabetes, smoking, height, weight, waistline, fasting glycaemia, glycosylated haemoglobin, total and HDL‐cholesterol and triglyceride values were collected. Claudication, cyanosis, cold foot, foot hair anomalies, skin thinning and femoral, popliteal, posterior tibial and dorsalis pedis pulses were assessed. The ABI was measured with a portable Doppler continuous‐wave instrument.Results  An ABI < 0.9 was found in 539 (21.1%) patients. Claudication was present in 187 (7.3%). Femoral pulse was absent in 218 (8.5%), popliteal in 316 (12.3%), tibial in 563 (22.0%) and dorsalis pedis in 578 (22.6%). Foot cyanosis was observed in 88 (3.4%), cold foot in 359 (13.9%), skin thinning in 468 (18.3%) and hair anomalies in 857 (33.5%). Multivariate analysis of the variables associated with ABI < 0.9 in the univariate analysis confirmed the independent role of age [relative risk (RR) 1.02, P < 0.001, confidence interval (CI) 1.01, 1.04], claudication (RR 4.53, P < 0.001, CI 2.97, 6.93), absence of tibial pulse (RR 3.45, P ≤ 0.001. CI 2.54, 4.68) and pedis pulse (RR 1.96, P ≤ 0.001, CI 1.4, 2.68).Conclusions  PAD, as represented by ABI < 0.9, is common in newly diagnosed Type 2 diabetic patients.
Ulcer‐free survival following management of foot ulcers in diabetes
Authors: Pound N. , Chipchase S. , Treece K. , Game F. , Jeffcoate W. 
Published: September 2005

AbstractAims  Measures of healing rate may not give a complete indication of the effectiveness of overall management of diabetic foot ulcers. Apart from healing and speed of healing, the outcomes of greatest importance to the patient are avoidance of any amputation and remaining free from any recurrence. We have documented the number of patients presenting with diabetic foot ulcers who become ulcer free and examined the value of documenting ulcer‐free survival.Methods  All referrals to a specialist diabetic foot clinic over a 31‐month period were analysed and outcomes were determined after a minimum follow‐up of 6 months.Results  Three hundred and seventy patients were referred with a total of 1031 ulcers. One hundred and twenty‐one (32.7%) never became ulcer free: 56 (46.3% of 121) remained unhealed, the ulcers of 12 (9.9% of 121) had been resolved by amputation, two remained unhealed after amputation (1.7% of 121) and 51 (13.8% of 370) had died. Two hundred and thirty‐one (62.4% of 370) became ulcer free at some stage. Five of these were excluded because of an earlier amputation. Ninety‐one of the remaining 226 (40.3%) developed a recurrent or new ulcer after a median 126 days. Of the 135 who did not have a recurrence, 133 (58.8% of 226; 35.9% of 370) survived ulcer free and with limbs intact, while two died. Outcome was unknown in 18 (4.9%). Those who never became ulcer free were older (P < 0.001) and with a greater prevalence of ischaemia (P < 0.001). Those who healed but went on to suffer a new ulcer had a greater prevalence of neuropathy (P = 0.027) than those who remained ulcer free.Conclusions  The use of ulcer‐free survival can be used as an indication of the effectiveness of foot ulcer management. It could be adopted as a measure to compare performance between different specialist units.
Early hypoglycaemia after accidental intramuscular injection of insulin glargine
Authors: Karges B. , Boehm B. O. , Karges W. 
Published: September 2005

AbstractAim  Insulin glargine is a long‐acting insulin analogue with favourable clinical characteristics. We studied a slim 24‐year‐old female with Type 1 diabetes who repeatedly experienced severe hypoglycaemia after switching from NPH insulin to insulin glargine at identical daily doses.Methods  Clinical examination and high‐resolution ultrasound.Results  The patient frequently placed her injections into muscle tissue, followed by unexpected rapid insulin action. After correction of her injection technique, hypoglycaemia did not recur.Conclusions  The long‐acting kinetics of insulin glargine require precipitation in the subcutaneous tissue. Therefore, each patient's injection technique should be carefully checked when treatment with insulin glargine is initiated, particularly in young and lean individuals.
Nicotinamide – biologic actions of an emerging cosmetic ingredient
Authors: Otte N. , Borelli C. , Korting H. C. 
Published: September 2005

SynopsisNicotinamide, the water‐soluble amide of nicotinic acid, is a component of the two most important coenzymes – nicotinamide adenine dinucleotide and nicotinamide adenine dinucleotide phosphate. Thus nicotinamide is involved in numerous oxidation–reduction reactions in mammalian biological systems. Nicotinamide essentially acts as an antioxidant. Most effects are exerted via poly‐adenosine diphosphate‐ribose polymerase inhibition. Thus nicotinamide increasingly gains interest in the prevention and treatment of several skin diseases. It is well established in the systemic therapy of pellagra, a deficiency disease linked to nicotinic acid, but with respect to topical use there is still a need for further evidence with respect to its manifold potential uses. Currently, its local use is established in the care of acne‐prone skin.
Quantification of dandruff adherence to hair
Authors: Piérard‐Franchimont C. , Uhoda E. , Piérard G. E. 
Published: September 2005

SummaryDandruff adherence to hair shafts is a visible annoying phenomenon. The aspect can be recorded by different means including the ultraviolet light‐enhanced visualization (ULEV) method and microscopy. We present another quantitative method. Hairs were clipped from the parietal scalp area of 25 volunteers complaining of dandruff. They were firmly applied onto cyanoacrylate‐coated microscopic slides. Hairs were lifted up after 15–20 s leaving a cast in the adhesive coat. Dandruff were thus harvested from the hair shafts and remained attached to the cyanoacrylate coat. After staining, the material was submitted to image analysis to derive the dandruff density per unit length of hairs. In 11/25 subjects, a correlation was found between the width of the hair casts and the dandruff density. This method does not collect all dandruff along hair shafts, but data are likely representative of the whole corneocyte load.
A new method to evaluate lower eyelid sag using three‐dimensional image analysis
Authors: Fukuda Y. , Fujimura T. , Moriwaki S. , Kitahara T. 
Published: September 2005

SynopsisLower eyelid sags as well as wrinkles represent age‐related morphological changes of the skin surface. However, a quantitative method to evaluate lower eyelid sagging has not been previously established. We designed a new quantitative evaluation method that uses non‐invasive skin scanning, which is based on the difference between the superficial dimension of the sagging surface of the lower eyelid and the dimension of its projection area. In 97 females, 2‐D and the 3‐D images were taken. By 3‐D image analysis, the difference between the superficial dimension of the sagging surface of the lower eyelid and the dimension of its virtual projection area was assessed, and was defined as the sag parameter. This parameter was significantly correlated with the sag score (a photographic scale to assess the degree of sagging) and with aging. The accuracy of the sag parameter was confirmed in a clinical test using a sag treatment lotion and a placebo lotion. The sag score decreased in skin treated with the sag treatment lotion, but the change was not significantly different from that of the placebo treated skin. On the contrary, the sag parameter was significantly reduced (P < 0.05) after topical application of the sag treatment lotion compared with the placebo‐treated skin. These results indicate that the sag parameter as proposed herein is useful in clinical studies to evaluate slight changes in lower eyelid sagging.
Putting Smart Money to Work for Quality Improvement
Authors: Beaulieu Nancy Dean , Horrigan Dennis R. 
Published: September 2005

Objective. To investigate the effects of paying physicians for performance on quality measures of diabetes care when combined with other care management tools.Data Sources/Study Setting. In 2001, a managed care organization in upstate New York designed and implemented a pilot program to financially reward doctors for the quality of care delivered to diabetic patients. In addition to paying a performance bonus, physicians were also supplied with a diabetic registry and met in groups to discuss progress in meeting goals for diabetic care. Primary data on diabetes care at the patient level were collected from each physician during the 8‐month period, April 2001–January 2002.Study Design. Physicians were scored on individual process and outcome measures of diabetes care on three separate occasions; these individual scores were combined into a composite score on which the financial reward was allocated. The study design is pre/post for the patients whose physicians participated in the performance pay program. The control group is a large sample of the health plan's diabetic members.Data Collection. Data on patient outcomes were self‐reported by physicians participating in the study. These data were audited with spot checks of medical charts. Data for the control group were collected as part of the health plan's annual HEDIS data collection.Principal Findings. Physicians and patients achieved significant improvement on five out of six process measures, and on two out of three outcome measures (HbA1c control and LDL control). Thirteen out of 21 physicians improved their average composite score enough to earn some level of financial reward. Of the eight physicians not receiving any of the three levels of reward, six improved their composite scores.Conclusions. Financial incentives for physicians, bundled with other care management tools, led to improvement on objectively measured quality of care for diabetic patients. Self‐selection by physicians into the pay pilot and the small sample size of participating physicians limit the generalizability of the results.
Employer Health Insurance Offerings and Employee Enrollment Decisions
Authors: Polsky Daniel , Stein Rebecca , Nicholson Sean , Bundorf M. Kate 
Published: September 2005

Objective. To determine how the characteristics of the health benefits offered by employers affect worker insurance coverage decisions.Data Sources. The 1996–1997 and the 1998–1999 rounds of the nationally representative Community Tracking Study Household Survey.Study Design. We use multinomial logistic regression to analyze the choice between own‐employer coverage, alternative source coverage, and no coverage among employees offered health insurance by their employer. The key explanatory variables are the types of health plans offered and the net premium offered. The models include controls for personal, health plan, and job characteristics.Principal Findings. When an employer offers only a health maintenance organization married employees are more likely to decline coverage from their employer and take‐up another offer (odds ratio (OR)=1.27, p<.001), while singles are more likely to accept the coverage offered by their employer and less likely to be uninsured (OR=0.650, p<.001). Higher net premiums increase the odds of declining the coverage offered by an employer and remaining uninsured for both married (OR=1.023, p<.01) and single (OR=1.035, p<.001) workers.Conclusions. The type of health plan coverage an employer offers affects whether its employees take‐up insurance, but has a smaller effect on overall coverage rates for workers and their families because of the availability of alternative sources of coverage. Relative to offering only a non‐HMO plan, employers offering only an HMO may reduce take‐up among those with alternative sources of coverage, but increase take‐up among those who would otherwise go uninsured. By modeling the possibility of take‐up through the health insurance offers from the employer of the spouse, the decline in coverage rates from higher net premiums is less than previous estimates.
The Effect of Income Question Design in Health Surveys on Family Income, Poverty and Eligibility Estimates
Authors: Davern Michael , Rodin Holly , Beebe Timothy J. , Call Kathleen Thiede 
Published: September 2005

Objective. To compare systematic differences between an “omnibus” income measure that asks for total family income amounts with a central survey item and an aggregated income measure that sums specific amounts of income obtained from multiple income sources from everyone within a family.Data Source. The 2001 Current Population Survey‐Demographic Supplement (CPS‐DS). Data were collected from 78,000 households from February through April 2001.Study Design. First, we compare the omnibus family income to the aggregated family income amounts for each family. Second, we use the various aggregated family income sources to predict whether there is a mismatch between the omnibus and aggregated family income amounts. Finally, we assign a new aggregated amount of income that is restricted to be within the range of the omnibus amount to observe differences in poverty rates.Data Collection. Data were extracted from University of Michigan's ICPSR website.Principal Findings. There is a great deal of variation between the omnibus family income measure and the aggregated family income measure, with the omnibus amount generally being lower than the aggregated. As a result, the percent of people estimated to be in poverty is higher using the omnibus income item.Conclusions. Health surveys generally rely on an omnibus income measure and analysts should be aware that the income estimates derived from it are limited with respect to poverty determination, and the related concept of eligibility estimation. Analysts of health surveys should also consider matching respondents or multiple imputation to improve the usability of the data.
Factors Affecting Plan Choice and Unmet Need among Supplemental Security Income Eligible Children with Disabilities
Authors: Mitchell Jean M. , Gaskin Darrell J. 
Published: September 2005

Objective. To evaluate factors affecting plan choice (partially capitated managed care [MC] option versus the fee‐for‐service [FFS] system) and unmet needs for health care services among children who qualified for supplemental security income (SSI) because of a disability.Data Sources. We conducted telephone interviews during the summer and fall of 2002 with a random sample of close to 1,088 caregivers of SSI eligible children who resided in the District of Columbia.Research Design. We employed a two‐step procedure where we first estimated plan choice and then constructed a selectivity correction to control for the potential selection bias associated with plan choice. We included the selectivity correction, the dummy variable indicating plan choice and other exogenous regressors in the second stage equations predicting unmet need. The dependent variables in the second stage equations include: (1) having an unmet need for any service or equipment; (2) having an unmet need for physician or hospital services; (3) having an unmet need for medical equipment; (4) having an unmet need for prescription drugs; (5) having an unmet need for dental care.Principal Findings. More disabled children (those with birth defects, chronic conditions, and/or more limitations in activities of daily living) were more likely to enroll in FFS. Children of caregivers with some college education were more likely to opt for FFS, whereas children from higher income households were more prone to enroll in the partially capitated MC plan. Children in FFS were 9.9 percentage points more likely than children enrolled in partially capitated MC to experience an unmet need for any type of health care services (p<.01), while FFS children were 4.5 percentage points more likely than partially capitated MC enrollees to incur a medical equipment unmet need (p<.05). FFS children were also more likely than partially capitated MC enrollees to experience unmet needs for prescription drugs and dental care, however these differences were only marginally significant.Conclusions. We speculate that the case management services available under the MC option, low Medicaid FFS reimbursements and provider availability account for some of the differences in unmet need that exist between partially capitated MC and FFS enrollees.
Managed Care and Gender Disparities in Problematic Health Care Experiences
Authors: Mitchell Shannon , Schlesinger Mark 
Published: September 2005

Objective. To determine whether gender differences in reports of problematic health care experiences are associated with characteristics of managed care.Data Sources. The 2002 Yale Consumer Experiences Survey (N=5,000), a nationally representative sample of persons over 18 years of age with private health insurance, Interstudy Competitive Edge HMO Industry Report 2001, Area Resource File 2002, and the American Hospital Association Annual Survey of Hospitals 2002.Study Design. Independent and interactive effects of gender and managed care on reports of problematic health care experiences were modeled using weighted multivariate logistic regression.Principal Findings. Women were significantly more likely to report problems with their health care compared with men, even after controlling for gendered differences in expectations about medical care. Gender disparities in problem reporting were larger in plans that used certain managed care techniques, but smaller in plans using other methods. Some health plan managed care practices, including closed networks of providers and gatekeepers to specialty care, were associated with greater problem reporting among women, while others, such as requirements for primary care providers, were associated with greater problem reporting among men. Markets with higher HMO competition and penetration were associated with greater problem reporting among women, but reduced problem reporting among men. Women reported more problems in states that had enacted regulations governing access to OB/GYNs, while men reported more problems in states with regulations allowing specialists to act as primary care providers in health plans.Conclusions. There are nontrivial gender disparities in reports of problematic health care experiences. The differential consequences of managed care at both the plan and market levels explain a portion of these gender disparities in problem reporting.