bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vascular Surgical Society operative outcome study: preoperative physiology predicts outcome
Authors: Prytherch D , Beard J D , Ridler B F , Earnshaw J J 
Published: July 2002

Abstract

Background
This was an audit of operative outcome conducted by the Vascular Surgical Society of Great Britain and Ireland (VSSGBI).

Methods
Some 121 surgeons (all members of the VSSGBI) completed data questionnaires on patients undergoing arterial surgery under their care (mean 12, range 1–49) in May and June 1998. A total of 1480 completed data records were available for logistic regression analysis using the Portsmouth modification of the Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (P-POSSUM) methodology. Information collected included all POSSUM data items plus other factors thought to have a significant bearing on patient outcome: VSSGBI ‘extra items’. The main outcome measures were death within hospital admission and major postoperative complications. The data records were checked for consistency and the remaining 1313 were divided into two sets for analysis. The first ‘training’ set was used to obtain logistic regression models that were applied prospectively to the second ‘test’ data set for various combinations of the POSSUM physiological and operative scores and the VSSGBI ‘extra items’ found to be significantly associated with outcome.

Results
Using POSSUM data items alone, it was possible to predict both death and morbidity after vascular reconstruction using P-POSSUM analysis. Addition of the VSSGBI ‘extra items’ found significant in regression analysis did not significantly improve the accuracy of prediction. The most accurate model predicting both death and morbidity was derived from the preoperative physiology components of the POSSUM data items alone.

Conclusion
P-POSSUM methodology can be used to predict outcome after arterial surgery across a range of surgeons in different hospitals and could form the basis of a national outcome audit. The most startling finding was that the preoperative physiology scores alone were predictive of both death and major morbidity after vascular reconstruction.
Prospective multicentre study of acute renal failure in arterial surgical patients
Authors: Brooks M J , Naidoo M L , Wolfe J H N 
Published: July 2002

Abstract

Background
Acute renal failure following vascular surgery is associated with a high risk of death. The aims of this study were to identify the incidence and risk factors for acute renal failure in arterial surgical patients.

Methods
A prospective longitudinal clinical study of consecutive arterial surgical patients, including those undergoing interventional radiological procedures, in 13 UK vascular units was devised. Data were collected locally in each unit using a standard pro forma. Impaired renal function was defined as an admission creatinine level greater than 125 μmol l−1, while a 50 per cent rise in creatinine was defined as acute renal failure.

Results
Some 1566 patients were enrolled by the 13 units in a 6-month interval (January to June 1999); 124 (7·9 per cent) developed postoperative renal failure. The incidence of renal failure varied according to operation type: abdominal aortic aneurysm 17·6 per cent, thoracoabdominal aneurysm 45·4 per cent, carotid endarterectomy 0·8 per cent, aortobifemoral bypass 10·9 per cent, infrainguinal bypass 5·2 per cent, extra-anatomic bypass 5·2 per cent, embolectomy 14·0 per cent, endovascular procedure 5·0 per cent, radiological procedure 4·2 per cent and amputation 4·5 per cent. The in-hospital mortality rate for all patients was 7·2 per cent, which increased to 37·1 per cent in patients who developed acute renal failure. Significant risk factors for the development of renal failure were thoracoabdominal aneurysm repair (45·4 per cent), emergency surgery (19·4 per cent), surgery on the abdominal aorta (17·6 per cent), pre-existing renal impairment (19·4 per cent) and hypertension (8·3 per cent). Diabetes mellitus, hyperlipidaemia, recent angiography, non-steroidal analgesics, metformin or angiotensin converting enzyme inhibitors were not predictive of the development of renal failure. In 21·8 per cent of patients renal failure developed in association with multiple organ failure. No patient who survived developed end-stage renal failure.

Conclusion
The incidence of acute renal failure following arterial surgery was 7·9 per cent associated, as expected, with a significant mortality rate (37·1 per cent). Emergency aortic surgery carried the highest risk. Patients developing acute renal failure required intensive management, including renal support, but no patient survived to develop end-stage renal failure.
Endoluminal repair of abdominal aortic aneurysm causes more perioperative renal dysfunction than open repair
Authors: Jenkins M P , Onwudike M , Singh R , Bomanji J , Adiseshiah M 
Published: July 2002

Abstract

Background
In this prospective case–control study the aim was to compare perioperative renal function in well matched patients undergoing open repair (OR) (group 1) or endoluminal repair (ER) (group 2) of an abdominal aortic aneurysm (AAA) and preoperative renal function in other patients undergoing ER (group 3) with function 1–3 years after surgery.

Methods
Of 73 patients undergoing AAA repair, 45 were recruited to the study as follows: 14 patients (median age 77 years, 12 men) to group 1, 14 patients (median age 76 years, 11 men) to group 2 and 17 patients (median age 76 years, 14 men) to group 3. Serum creatinine, creatinine clearance and/or glomerular filtration rate (GFR) were measured coupled with 99mTc-radiolabelled mercaptoacetyltriglycine (MAG3) renal studies. From the MAG3 renal scans, perfusion, split renal function, mean parenchymal transit time (MPTTI) and outflow pattern were assessed. Groups 1 and 2 underwent scintigraphic evaluation before, and 8 days after operation. Group 3 was assessed before operation and 1–3 years later.

Results
Fifteen of 31 patients undergoing ER had preoperative renal dysfunction (GFR less than 50 ml min−1) compared with two of 14 who had OR. Ten patients from groups 2 and 3 developed severe renal dysfunction. Of these, two died, one required haemodialysis (graft deployed over the renals), two were dialysis-free but developed worsening renal function and five regained their previous renal function. In four patients who had ER, differential function improved, in one with retroperitoneal fibrosis it deteriorated and in nine it was unchanged. See Table below.

Conclusion
ER is associated with a greater degree of perioperative renal dysfunction than OR. In the absence of technical problems with endograft deployment, renal function in ER in the long term is not adversely affected.
Soft tissue sarcoma involving the sciatic nerve
Authors: Brennan M F 
Published: July 2002

Abstract
In the Clinical Dilemma slot the editors pose a question to an acknowledged expert in the field. In this issue we address the problem of a sarcoma in the posterior aspect of the thigh. At operation, despite preoperative magnetic resonance imaging, the lesion is unexpectedly found to involve the sciatic nerve. How should one proceed? Professor Murray Brennan of New York replies.
Effect of surgical subspecialization on breast cancer outcome
Authors: Golledge J , Wiggins J E , Callam M J 
Published: July 2002

Abstract

Background
There is increasing pressure for specialization of medical services. The effect of surgical specialization on the outcome of breast cancer in Bedford has been assessed.

Methods
The Bedford Breast Cancer Registry, which contains prospective diagnostic, treatment and follow-up data on all breast cancers treated in North Bedfordshire, was analysed to compare breast cancer outcome between 1990–1992 and 1993–1996, that is before and after the advent of surgical subspecialization. All 784 patients were analysed, including patients with metastases (4 per cent) and those treated by tamoxifen alone (8 per cent). Outcome was compared in terms of disease-free survival (DFS), locoregional and all (locoregional and metastases) recurrence rates assessed by Cox proportional hazard and Kaplan–Meier analyses.

Results
Overall DFS was 75 per cent and the locoregional recurrence rate was 8 per cent at 3 years. The tumour stage and grade at presentation and the proportion of screen-detected cancers were similar for both intervals. The outcome for patients before specialization (1990–1992; n = 329) was worse: hazard ratio (HR) for DFS 1·5 (95 per cent confidence interval 1·2–2·0) and HR for locoregional recurrence 2·0 (1·2–3·5). After subspecialization (1993–1996, n = 455) DFS improved from 70 to 79 per cent (P = 0·009) and the all recurrence rate fell from 22 to 12 per cent (P = 0·0004) at 3 years. The improvement in outcome was mainly in younger patients (aged less than 70 years), in whom DFS improved from 72 to 81 per cent (P = 0·02) and the all recurrence rate fell from 24 to 12 per cent (P = 0·001) at 3 years. The improvement was associated with increased axillary surgery (47 to 74 per cent; P &lt; 0·0001), and more frequent use of tamoxifen (74 to 84 per cent; P = 0·004) and chemotherapy (10 to 27 per cent; P &lt; 0·0001) in this age group.

Conclusion
There was a significant improvement in outcome for patients with breast cancer after surgical subspecialization in Bedford. This may relate to the more frequent use of appropriate systemic therapy.
The care of students with insulin‐treated diabetes mellitus living in university accommodation: scope for improvement?
Authors: Strachan M. W. J. , MacCuish A. C. , Frier B. M. 
Published: July 2002

SummaryConcern has been expressed about the welfare of young adults with Type 1 diabetes mellitus who leave home to attend university or college for tertiary education. This has been highlighted by the local experience in Edinburgh of two male students with Type 1 diabetes, both of whom died from metabolic complications of diabetes during their first term at universities distant from their homes. One student died following the development of cerebral oedema secondary to diabetic ketoacidosis, which was probably precipitated by prolonged coma after an episode of severe hypoglycaemia. Another student, who was found ‘dead in bed’, had a history of previous severe hypoglycaemia. At a Fatal Accident Inquiry in Edinburgh, held following the death of the first student, recommendations were made to improve the care and personal safety of students with diabetes living in university accommodation. Despite the report being circulated to all Scottish universities, the second student died within three years of the inquiry. Further efforts to protect the welfare of students with Type 1 diabetes who are attending centres for tertiary education away from their home environment may require the more active participation by diabetes healthcare professionals.
A new approach to vision screening in schools
Authors: Thomson W. David , Evans Bruce 
Published: July 2002

Summary Purpose: To determine the prevalence of visual “defects” among a sample of young schoolchildren and evaluate a new system for vision screening in schools. Methods: A new system for vision screening in schools has been developed. The system is based on a computer program which may be run on a low specification personal computer. Information about the child’s symptoms, history and family history is acquired by means of a parental questionnaire and entered into the program prior to the vision screening. Distance visual acuity and stereopsis are measured directly on the computer screen and colour vision is assessed using a reduced Ishihara test. The program carries out an “expert” analysis of the questionnaire data and the vision test results and determines the most likely diagnosis. Reports for parents, teachers, optometrists, doctors can be generated automatically and statistics relating to the overall screening program are available. An evaluation of a prototype version of the system was carried out on 245 schoolchildren aged between 5 and 8 years. Results: Overall, 48 children failed the screening (excluding colour vision deficiencies), 32 of whom were unaware of any problem with their eyes. Comparison of the result of the vision screening with the outcome of a full eye examination gave a sensitivity of 93.8% and a specificity of 96.1%. Conclusion: A significant number of young school children have unsuspected remediable visual defects. The computer‐based vision screener provides an efficient, sensitive and specific method for screening in schools.
Multidimensional hydrogen tunneling dynamics in the ground vibrational state of the ammonia dimer
Authors: Loeser Jennifer G. , Schmuttenmaer C. A. , Cohen R. C. , Elrod M. J. , Steyert D. W. , Saykally R. J. , Bumgarner R. E. , Blake G. A. 
Published: July 2002

We have measured and assigned more than 800 new far-infrared absorption lines and 12 new microwave absorption lines of the ammonia dimer. Our data are analyzed in combination with all previously measured far-infrared and microwave spectra for this cluster. The vibration–rotation–tunneling (VRT) states of the ammonia dimer connected by electric-dipole-allowed transitions are separated into three groups that correspond to different combinations of monomer rotational states: A+A states (states formed from the combination of two ammonia monomers in A states), A+E states, and E+E states. We present complete experimentally determined energy-level diagrams for the Ka=0 and Ka=1 levels of each group in the ground vibrational state of this complex. From these, we deduce that the appropriate molecular symmetry group for the ammonia dimer is G144. This, in turn, implies that three kinds of tunneling motions are feasible for the ammonia dimer: interchange of the ‘‘donor’’ and ‘‘acceptor’’ roles of the monomers, internal rotation of the monomers about their C3 symmetry axes, and quite unexpectedly, ‘‘umbrella’’ inversion tunneling.
In the Ka=0 A+E and E+E states, the measured umbrella inversion tunneling splittings range from 1.1 to 3.3 GHz. In Ka=1, these inversion splittings between two sets of E+E states are 48 and 9 MHz, while all others are completely quenched. Another surprise, in light of previous analyses of tunneling in the ammonia dimer, is our discovery that the interchange tunneling splittings are large. In the A+A and E+E states, they are 16.1 and 19.3 cm−1, respectively. In the A+E states, the measured 20.5 cm−1 splitting can result from a difference in ‘‘donor’’ and ‘‘acceptor’’ internal rotation frequencies that is increased by interchange tunneling. We rule out the possibility that the upper state of the observed far-infrared subbands is the very-low-frequency out-of-plane intermolecular vibration predicted in several theoretical studies [C. E. Dykstra and L. Andrews, J. Chem. Phys. 92, 6043 (1990); M. J. Frisch, J. E. Del Bene, J. S. Binkley, and H. F. Schaefer III, ibid. 84, 2279 (1986)]. In their structure determination, Nelson et al. assumed that monomer umbrella inversion tunneling was completely quenched and that ‘‘donor–acceptor’’ interchange tunneling was nearly quenched in the ammonia dimer [D. D. Nelson, G. T. Fraser, and W. Klemperer, J. Chem. Phys. 83, 6201 (1985); D. D. Nelson, W. Klemperer, G. T. Fraser, F. J. Lovas, and R. D. Suenram, ibid. 87, 6364 (1987)]. Our experimental results, considered together with the results of six-dimensional calculations of the VRT dynamics presented by van Bladel et al. in the accompanying paper [J. Chem. Phys. 97, 4750 (1992)], make it unlikely that the structure proposed by Nelson et al. for the ammonia dimer is the equilibrium structure.
The dissociation kinetics of NO on Rh(111) as studied by temperature programmed static secondary ion mass spectrometry and desorption
Authors: Borg H. J. , Reijerse J. F. C.-J. M. , van Santen R. A. , Niemantsverdriet J. W. 
Published: July 2002

Temperature programmed static secondary ion mass spectrometry (TPSSIMS) and temperature programmed desorption (TPD) have been used to study the kinetics of adsorption, dissociation, and desorption of NO on Rh(111). At 100 K, NO adsorption is molecular and proceeds via mobile precursor state kinetics with a high initial sticking probability. SSIMS indicates the presence of two distinct NO adsorption states, indicative of threefold adsorption at low coverage, and occupation of bridge sites at higher coverages. Three characteristic coverage regimes appear with respect to NO dissociation. At low coverages θNO&lt;0.25 ML, NO dissociates completely at temperatures between 275 and 340 K. If we neglect lateral interactions and assume pure first order dissociation kinetics, we find effective values for the activation barrier and preexponential factor of 40±6 kJ/mol and 106±1 s−1 for the dissociation of 0.15–0.20 ML NO. However, if we assume that a NO molecule needs an ensemble of three to four vacant sites in order to dissociate, the preexponential factor and activation energy are ∼1011 s−1 and 65 kJ/mol, in better agreement with transition state theory expectations. The Nads and Oads dissociation products desorb as N2 and O2, respectively, with desorption parameters Edes=118±10 kJ/mol and νdes=1010.1±1.0 s−1 for N2 in the zero coverage limit.
At higher coverages, the desorption kinetics of N2 is strongly influenced by the presence of coadsorbed oxygen. In the medium coverage range 0.25&lt;θNO&lt;0.50 ML, part of the NO desorbs molecularly, with an estimated desorption barrier of 113±10 kJ/mol and a preexponential of 1013.5±1.0 s−1. Dissociation of NO becomes progressively inhibited due to site blocking, the onset shifting from 275 K at 0.25 ML to 400 K, coinciding with the NO desorption temperature, at a coverage of 0.50 ML. The accumulation of nitrogen and oxygen atoms on the highly covered surface causes a destabilization of the nitrogen atoms, which results in an additional low-temperature desorption state for N2. For high initial NO coverages above 0.50 ML, the dissociation is completely self-inhibited, indicating that all sites required for dissociation are blocked. The desorption of the more weakly bound—presumably bridged—NO does not generate the sites required for dissociation; these become only available after the desorption of—presumably triply coordinated—NO.
Globalization and Localization
Authors: Gibbs David 
Published: July 2002

David Gibbs, Cox, K. R. (ed) 1997 SPACES OF GLOBALIZATION: REASSERTING THE POWER OF THE LOCAL New York: Guilford Press, £17.95 paper, ISBN 1 57230 199 6, pp. 292 Hines, C. 2000 LOCALIZATION: A GLOBAL MANIFESTO London: Earthscan, £10.99 paper, ISBN 1 85383 612 5, pp. 290
The socio‐political context of the development of Reading Recovery in New Zealand and England
Authors: Openshaw Roger , Soler Janet , Wearmouth Janice , Paige‐Smith Alice 
Published: July 2002

ABSTRACTThis article uses the example of Reading Recovery (RR) to argue that those who engage in reading debates should focus not only on which reading programme appears to match desirable goals in children's literacy development but also strive for a more balanced appreciation of the complex socio‐political context of debates within which reading failure and its various remedies remain contestable. In turn this will lead to a more critical and more academically sophisticated scrutiny of literacy and its diverse purposes. The development of Reading Recovery in New Zealand and England illustrates how it is not simply the efficacy of individual programmes, but a combination of that efficacy and the political context at the micro‐ and macro‐levels that establishes, expands and eventually destabilizes new reading initiatives.
Alcohol, hypertension and the cardiovascular system: a critical appraisal
Authors: PUDDEY IAN B. , BEILIN LAWRENCE J. , RAKIC VALENTINA 
Published: July 2002

AbstractAbstract Cross‐sectional and longitudinal population studies have provided a considerable corpus of evidence for an inverse association between light to moderate alcohol intake and both coronary artery disease and stroke. The formulation of balanced public health advice on the basis of such studies, however, needs to take into account the full spectrum of the effects of alcohol on the cardiovascular system, particularly its equally well documented effect to increase level of blood pressure and prevalence of hypertension. In this review, the broader implications of the association of alcohol with hypertension are discussed, principally in the context of the effect of higher levels of alcohol consumption to increase ischaemic and haemorrhagic stroke, left ventricular hypertrophy, congestive cardiomyopathy, cardiac arrhythmia and sudden cardiac death.
Generalization of early metalinguistic skills in a phonological decoding study with first‐graders at risk for reading failure
Authors: Rivers Kenyatta O. , Lombardino Linda J. 
Published: July 2002

AbstractThis training study was designed to examine the effects of training letter‐sound correspondences and phonemic decoding (segmenting and blending skills) on the decoding skills of three first‐grade children identified to be at risk for reading failure. This training study was to examine the degree to which the subjects could readily learn decoding skills necessary for early reading and to determine the degree to which phonemic decoding training on CVC syllable structures generalize to untrained syllable structures. Three experimental subjects served as their own controls in a single‐subject multiple‐baseline design. Experimental subjects were compared to matched control subjects on their ability to decode real‐word and pseudo‐word stimuli and on formal test scores of reading and spelling. Following training, experimental subjects demonstrated substantial increases in their acquisition and generalization of phonological decoding skills, but revealed much smaller changes on pre‐test to post‐test measures of formal reading and spelling when compared to their matched control subjects.
A Bayesian framework for the analysis of microarray expression

data: regularized t -test and statistical inferences of

gene changes
Authors: Baldi Pierre , Long Anthony D. 
Published: July 2002

Abstract
Motivation: DNA microarrays are now capable of providing genome-wide patterns of gene expression across many different conditions. The first level of analysis of these patterns requires determining whether observed differences in expression are significant or not. Current methods are unsatisfactory due to the lack of a systematic framework that can accommodate noise, variability, and low replication often typical of microarray data.
Results: We develop a Bayesian probabilistic framework for microarray data analysis. At the simplest level, we model log-expression values by independent normal distributions, parameterized by corresponding means and variances with hierarchical prior distributions. We derive point estimates for both parameters and hyperparameters, and regularized expressions for the variance of each gene by combining the empirical variance with a local background variance associated with neighboring genes. An additional hyperparameter, inversely related to the number of empirical observations, determines the strength of the background variance. Simulations show that these point estimates, combined with a t -test, provide a systematic inference approach that compares favorably with simple t -test or fold methods, and partly compensate for the lack of replication.
Availability: The approach is implemented in software called Cyber-T accessible through a Web interface at www.genomics.uci.edu/software.html. The code is available as Open Source and is written in the freely available statistical language R.
Contact: pfbaldi@ics.uci.edu; tdlong@uci.edu
* To whom correspondence should be addressed.
3 Also at Department of Biological Chemistry, College of Medicine, University of California, Irvine.