bluuebunny/crossref_metadata_2025_split huggingface dataset:
The ethical problem of false positives: a prospective evaluation of physician reporting in the medical record
Authors: Dresselhaus T R , Luck J , Peabody J W 
Published: September 2002

Objective:To determine if the medical record might overestimate the quality of care through false, and potentially unethical, documentation by physicians.Design:Prospective trial comparing two methods for measuring the quality of care for four common outpatient conditions: (1) structured reports by standardised patients (SPs) who presented unannounced to the physicians’ clinics, and (2) abstraction of the medical records generated during these visits.Setting:The general medicine clinics of two veterans affairs medical centres.Participants:Twenty randomly selected physicians (10 at each site) from among eligible second and third year internal medicine residents and attending physicians.Main measurements:Explicit criteria were used to score the medical records of physicians and the reports of SPs generated during 160 visits (8 cases × 20 physicians). Individual scoring items were categorised into four domains of clinical performance: history, physical examination, treatment, and diagnosis. To determine the false positive rate, physician entries were classified as false positive (documented in the record but not reported by the SP), false negative, true positive, and true negative.Results:False positives were identified in the medical record for 6.4% of measured items. The false positive rate was higher for physical examination (0.330) and diagnosis (0.304) than for history (0.166) and treatment (0.082). For individual physician subjects, the false positive rate ranged from 0.098 to 0.397.Conclusions:These data indicate that the medical record falsely overestimates the quality of important dimensions of care such as the physical examination. Though it is doubtful that most subjects in our study participated in regular, intentional falsification, we cannot exclude the possibility that false positives were in some instances intentional, and therefore fraudulent, misrepresentations. Further research is needed to explore the questions raised but incompletely answered by this research.
Working hours spent on repeated activities and prevalence of back pain
Authors: Guo H-R 
Published: September 2002

Background and Aims:Back pain is the most common reason for filing workers' compensation claims in the United States and affects large numbers of workers in many other countries. To evaluate the associations between working hours spent on repeated activities and back pain, data gathered through the 1988 National Health Interview Survey were analysed. The data were also used to identify high risk occupations.Methods:A total of 30 074 workers participated in the survey. They were asked to provide information on their job, including the time spent on repeated strenuous physical activities (RSPA) and the time spent on repeated bending, twisting, or reaching (RBTR) on a typical job. A case of back pain was defined as a worker who had back pain every day for a week or more during the past 12 months. Each case was asked to report the cause of back pain. Those who attributed their back pain to repeated activities (RA) or a single accident or injury (AI) were asked to recall whether they performed RA or had the AI at work.Results:Whereas the prevalence of back pain increased as the number of working hours spent on RSPA or RBTR increased, the dose–response relations were not linear for either factor, suggesting the involvement of other unmeasured factors. The estimated overall prevalence of RA back pain was 8.9% among male workers and 5.9% among female workers. “Carpenters” had the highest prevalence (19.2%) and most cases (338 000) among the major occupations of men, and “nursing aides, orderlies, and attendants” had the highest prevalence (15.2%) and most cases (217 000) among the major occupations of women.Conclusions:The number of hours spent on repeated activities at work was associated with the prevalence of back pain. This study identified high risk occupations for future research and intervention.
Workers’ understanding of chemical risks: electroplating case study
Authors: Sadhra S , Petts J , McAlpine S , Pattison H , MacRae S 
Published: September 2002

Background:There is limited research concerning how small companies in particular, respond to health and safety messages.Aims:To understand individuals’ knowledge and beliefs about chemical risks and to compare these with those of experts.Methods:The use of chromic acid in particular, and also other chemicals associated with chrome plating were studied. All chromium plating firms were based in the West Midlands. The methodology involved initial face to face interviews (n = 21) with chromium platers, structured questionnaires (n = 84) to test the prevalence of beliefs identified in the interviews, an expert questionnaire, and a workshop to discuss findings. The responses of platers were compared with those of occupational health and safety experts.Results:Although chromium platers appeared to understand the short term adverse effects of the chemicals to which they are exposed, their understanding of long term, or chronic effects appeared to be incomplete. They had good knowledge of acute effects based primarily on experience. Platers were aware of the hazardous nature of the chemicals with which they work, but did not draw distinction between the terms “hazards” and “risks”. They had difficulties articulating the effects of the chemicals and how exposure might occur; although it is inappropriate to equate this with lack of knowledge. A significant minority of platers displayed deficiencies in understanding key technical terms used in Safety Data Sheets.Conclusions:This study provides a method which can be used to gain some understanding of workers’ knowledge and beliefs about risks that they are exposed to in the workplace. The study also identifies gaps between the platers’ knowledge and beliefs and those of experts. New risk information needs to be designed which addresses the information needs of platers using language that they understand.
Effectiveness of the hands-free technique in reducing operating theatre injuries
Authors: Stringer B , Infante-Rivard C , Hanley J A 
Published: September 2002

Background:Operating theatre personnel are at increased risk for transmission of blood borne pathogens when passing sharp instruments. The hands-free technique, whereby a tray or other means are used to eliminate simultaneous handling of sharp instruments, has been recommended.Aims:To prospectively evaluate the effectiveness of the hands-free technique in reducing the incidence of percutaneous injuries, contaminations, and glove tears arising from handling sharp instruments.Methods:For each of 3765 operations carried out in main and surgical day care operating theatres in a large urban hospital, over six months, circulating nurses recorded the proportion of use of the hands-free technique during each operation, as well as other features of the operation. The hands-free technique, considered to be used when 75% or more of the passes in an operation were done in this way, was used in 42% of operations. The relative rate of incidents (percutaneous injuries, contaminations, and glove tears) in operations where the hands-free technique was used and not used, with adjustment via multiple logistic regression for the different risk profiles of the two sets of operations, was calculated.Results:A total of 143 incidents (40 percutaneous injuries, 51 contaminations, and 52 glove tears) were reported. In operations with greater than 100 ml blood loss, the incident rate was 4% (18/486) when the hands-free technique was used and 10% (90/880) when it was not, approximately 60% less. When adjusted for differences in type and duration of surgery, emergency status, noisiness, time of day, and number present for 75% of the operation, the reduction in the rate was 59% (95% CI 23% to 72%). In operations with less than 100 ml blood loss, the corresponding rates were 1.4% (15/1051) when the hands-free technique was used and 1.5% (19/1259) when it was not used. Adjustment for differences in risk factors did not alter the difference.Conclusions:Although not effective in all operations, use of the hands-free technique was effective in operations with more substantial blood loss.
How informed is consent? Understanding of pictorial and verbal probability information by medical inpatients
Authors: Fuller R , Dudley N , Blacktop J 
Published: September 2002

Abstract
Understanding probability information about treatment risks and benefits is a vital component of patients’ decision making capacity. This study demonstrates extensive misunderstanding of verbal descriptions of probability by medical inpatients of all ages, questioning the extent of their capacity for giving informed consent. Pictorial descriptions of probability were well understood, suggesting their adoption into clinical practice.
Transient disappearance of left bundle branch block pattern: an unusual ECG presentation of acute pulmonary embolism
Authors: Athar S M , Chin B S P , Flint E J 
Published: September 2002

Abstract
A 61 year old man developed acute pulmonary embolism while in hospital. His previous and admission electrocardiograms (ECGs) showed a typical left bundle branch block (LBBB) pattern. Immediately after the onset of acute pulmonary embolism, LBBB disappeared from his body surface ECG with sinus bradycardia, normalisation of QRS duration, prolonged QT interval, and marked T abnormalities to the right precordial leads. Recovery from pulmonary embolism resulted in reappearance of his left bundle branch pattern. Delayed conduction of the previously unaffected right bundle branch resulting in roughly equivalent onset of ventricular activation is the most likely reason. Rate dependent LBBB is also discussed.
An unusual case of gestational diabetes mellitus
Authors: Shankar P , Sundarka M K , Sundarka A 
Published: September 2002

Abstract
The case of a woman, who developed gestational diabetes at six weeks in two successive pregnancies, is reported. She was in the high risk group to develop gestational diabetes. The first pregnancy terminated in abortion at 10 weeks. In the second pregnancy, institution of insulin therapy at diagnosis was associated with a successful outcome. This case highlights the need for screening for gestational diabetes at the first antenatal visit in the high risk group.
Enzyme replacement therapy in the management of longstanding skeletal and soft tissue salmonella infection in a patient with Gaucher’s disease
Authors: Margalit M , Ash N , Zimran A , Halkin H 
Published: September 2002

Abstract
A splenectomised patient with Gaucher’s disease who developed multiple foci of osteomyelitis and soft tissue abcesses, after a severe episode of group C salmonella sepsis, is described. Aggressive antibiotic treatment and surgical drainage had little effect and the patient’s condition continued to deteriorate. With initiation of enzyme replacement therapy (ERT) in addition to specific antibiotic treatment, defervescence and gradual healing occurred. Complete resolution of the infection was seen after 15 months. The possible role of ERT in healing bacterial infections in Gaucher’s disease is discussed.
ARITHMETIC KNOTS IN CLOSED 3-MANIFOLDS
Authors: BAKER M. D. , REID A. W. 
Published: September 2002

Let Od denote the ring of integers in [Formula: see text]. An orientable finite volume cusped hyperbolic 3-manifold M is called arithmetic if the faithful discrete representation of π1(M) into PSL(2,C) is conjugate to a group commensurable with some Bianchi group PSL (2,Od). If M is a closed orientable 3-manifold, we say a link L ⊂ M is arithmetic if M\L is arithmetic. In the paper, we show that there exist closed orientable 3-manifolds which do not contain anarithmetic knot. Our methods give much more precise informations for non-hyperbolic 3-manifolds. For certain Lens Spaces, we can give fairly complete statements.
ORIENTED DIVIDES AND PLANE CURVE BRAIDS
Authors: GIBSON WILLIAM 
Published: September 2002

This paper begins with a review of the extension of A'Campo's divides to the more general construction of oriented divides, using the same disk model of S3. It is shown that all links in S3 can be represented by oriented divides (in contrast with divide links) and simple methods are presented for moving between links and their oriented divide presentations. Using the properties of the disk model, oriented divides are extended by three extra equivalence rules, and it is shown that this extended theory of oriented divides is equivalent to knot theory in S3. Fueled by this result, the concept of oriented divide braid is introduced, together with a group construction which parallels the classical braid group representation of geometric braids. This leads to results analagous to Alexander's well-known theorem concerning braid presentations, and also the Markov theorem.
Nucleated red blood cells as a marker in acute and chronic fetal asphyxia
Authors: Saraçoglu F. , Sahin I. , Eser E. , Göl K. , Türkkani B. 
Published: September 2002

AbstractObjective: To investigate the variations of nucleated red blood cell (NRBC) counts in acute and chronic fetal hypoxia and to examine if it could be possible to establish a cutoff value for the number of NRBCs for prediction of fetal acidosis. Method: We prospectively studied 77 pregnant women. Patients were grouped as acute (n=11) and chronic fetal distress (n=21) and controls (n=45). At delivery the umbilical cord was double clamped and blood samples were collected. Results: The mean NRBC counts in chronic fetal distress group was higher than acute fetal distress. NRBC counts were found to be correlated with umbilical cord pH (r=−0.57; P<0.001). The cutoff value predicting fetal acidosis was determined as 14/100 leukocytes (sensitivity 87%, specificity 81%) by using ROC analysis. Conclusion: The duration and the severity of fetal asphyxia may be predicted by the number of NRBCs per leukocyte.
Serum ferritin level as a marker of preterm labor
Authors: Saha C.K , Jain V , Gupta I , Varma N 
Published: September 2002

AbstractObjective: To compare the serum ferritin levels in women with preterm labor (PTL) or preterm premature rupture of membranes with those in normal gravid women. Method: The study group consisted of 50 consecutive subjects with preterm labor and 49 subjects with preterm premature rupture of membranes (PROM). The control group consisted of 50 subjects matched with the study group for hemoglobin (Hb) and gestation who did not have PTL or preterm PROM. Serum ferritin levels were assayed in both the groups. Results: Mean serum ferritin levels in patients with preterm labor and preterm premature rupture of membranes were 23.24±12.13 ng/ml and 29.44±28.41 ng/ml, respectively. The mean serum ferritin in control subjects was 8.69±3.7 ng/ml. The difference was evaluated by Student's t‐test and was found to be statistically significant. Conclusion: The serum ferritin level is significantly raised in pregnant women with preterm labor and preterm PROM.
Maternal mortality in a tertiary center after introduction of free antenatal care
Authors: Daponte A , Guidozzi F , Marineanu A 
Published: September 2002

AbstractObjective: Determination of maternal mortality rate (MMR) and the main causes of maternal death after the implementation of free antenatal care in a tertiary center in South Africa. Methods: Retrospective case study on maternal deaths from 1 January 1993 to 31 July 1997. Results: The maternal mortality rate was 128/100 000 births. Hypertension disorders (18%), hemorrhage (18%) and sepsis (13%) were the most important causes of death; 44% of all deaths were considered preventable. Conclusions: The high percentage (44%) of preventable deaths is a cause of concern and is the result of increased workload, decreased staff numbers and late referrals with low socio‐economic class of the patient. The discrepancy in the mortality rate between patients booked at the tertiary institution (29.8/100 000) and patients booked elsewhere (304.7/100 000) or not booked at all (348.5/100 000) indicates the need for improving antenatal care in the periphery.
Two-dimensional cascades and mixing: a physical space approach
Authors: DUBOS THOMAS , BABIANO ARMANDO 
Published: September 2002

We develop an analysis of the two-dimensional cascade of a tracer (passive or active
Lagrangian-conserved scalar), locally in space and time, and establish connections
with the modelling of turbulent mixing. We define a local scale-to-scale flux of tracer
variance based on the dynamics of tracer increments. This flux reduces at small scales
to the production or destruction rate of tracer gradients by stirring as a function
of their local orientation with respect to the compressional axis of the strain-rate
tensor. The local detailed budget of tracer variance on which this approach is based
is compared to the global statistical budget expressed by Yaglom's equation. The
spatial pattern of the local transfers produced by a numerical simulation as well as
their statistical distribution are discussed.We then address the problem of the parameterization of turbulent mixing. We
consider an anisotropic tensor diffusivity proportional to the velocity gradients. In
this model the tracer dissipation involves the axes of the strain-rate tensor and we
shall refer to it as strain diffusivity. We show analytically that it locally matches the
scale-to-scale flux through the cutoff scale. This matching is studied numerically in
decaying two-dimensional turbulence. A comparison is made with eddy diffusivity
and hyperdiffusivity. The presence of a numerical instability and ways to suppress it
are discussed from numerical and fundamental points of view.We consider the special case of vorticity, an active scalar in two dimensions. When
applied to vorticity, models affect the energy budget. The two-dimensional inverse
energy cascade requires that parameterizations conserve energy and we show that
strain diffusivity conserves energy. We finally study the sensitivity of the large scales
of the flow to the operator used on vorticity in forced stationary simulations. Strain
diffusivity is found to produce more realistic spectral features than hyperviscosity.
Theory of mind deficit in people with schizophrenia during remission
Authors: HEROLD R. , TÉNYI T. , LÉNÁRD K. , TRIXLER M. 
Published: September 2002

Background. The authors' goal was to investigate the presence or absence of theory of mind impairments among people with schizophrenia during remission. Recent research results interpret theory of mind deficits as state rather than trait characteristics, connecting these impairments mainly to the acute episode of psychosis.Methods. Twenty patients with schizophrenia in remission and 20 matched control subjects were evaluated. Participants were presented with one first-order theory of mind task, one second-order theory of mind task, two metaphor and two irony tasks adapted from previous studies.Results. The schizophrenic patients performed a statistically significant impairment in the irony task, as there were no significant differences in the cases of the other evaluated tasks.Conclusions. These preliminary results suggest that theory of mind impairments can be detected not only in the acute phase as found in previous research studies, but also in remission.
Personality disorders and depression
Authors: FAVA M. , FARABAUGH A. H. , SICKINGER A. H. , WRIGHT E. , ALPERT J. E. , SONAWALLA S. , NIERENBERG A. A. , WORTHINGTON III J. J. 
Published: September 2002

Background. Personality disorders (PDs) were assessed among depressed out-patients by clinical interview before and after antidepressant treatment with fluoxetine to assess the degree of stability of PD diagnoses and determine whether changes in PD diagnoses across treatment are related to the degree of improvement in depressive symptoms.Method. Three hundred and eighty-four out-patients (55% women; mean age = 39.9±10.5) with major depressive disorder (MDD) diagnosed with the SCID-P were enrolled into an 8 week trial of open treatment with fluoxetine 20 mg/day. The SCID-II was administered to diagnose PDs at baseline and endpoint.Results. A significant proportion (64%) of our depressed out-patients met criteria for at least one co-morbid personality disorder. Following 8 weeks of fluoxetine treatment, there was a significant reduction in the proportion of patients meeting criteria for avoidant, dependent, passive-aggressive, paranoid and narcissistic PDs. From baseline to endpoint, there was also a significant reduction in the mean number of criteria met for paranoid, schizotypal, narcissistic, borderline, avoidant, dependent, obsessive–compulsive, passive aggressive and self-defeating personality disorders. While changes in cluster diagnoses were not significantly related to improvement in depressive symptoms, there were significant relationships between degree of reduction in depressive symptoms (percentage change in HAM-D-17 scores) and degree of change in the number of criteria met for paranoid, narcissistic, borderline and dependent personality disorders.Conclusions. Personality disorder diagnoses were found to be common among untreated out-patients with major depressive disorder. A significant proportion of these patients no longer met criteria for personality disorders following antidepressant treatment, and changes in personality disorder traits were significantly related to degree of improvement in depressive symptoms in some but not all personality disorders. These findings suggest that the lack of stability of PD diagnoses among patients with current MDD may be attributable in part to a direct effect of antidepressant treatment on behaviours and attitudes that comprise PDs.
Schizophrenia patients' perceptual biases in response to positively and negatively valenced emotion chimeras
Authors: GOODING DIANE C. , TALLENT KATHLEEN A. 
Published: September 2002

Background. In a prior study, we observed that schizophrenia patients display atypical perceptual biases in response to emotional (happy/neutral) facial chimeras.Methods. The present study was an attempt to replicate and extend those findings, using emotional stimuli with negative affective valence (angry/neutral chimeras) as well as positive valence, and including more than one type of non-affective facial comparison task. We compared schizophrenia patients (N = 37) and controls (N = 48) on free-vision tasks that typically yield left spatial field biases indicative of right hemisphere activation. There were six chimera tasks, including two emotion (happy, angry) chimeras, two non-emotion (gender, age) chimeras and two non-face (dots, gradients) chimeras.Results. We observed a Group×Task interaction, with schizophrenia patients displaying significantly less of the expected left spatial perceptual bias in response to the happy/neutral chimeras and the angry/neutral chimeras relative to the controls. In contrast, the patients and controls did not differ in terms of their response to the Gender, Age, Dots, or Gradients tasks.Conclusions. These findings are consistent with the assertion that, compared with healthy controls individuals with schizophrenia perceive emotion differently.