bluuebunny/crossref_metadata_2025 huggingface dataset:
The cuff method: a pilot study of a new method of monitoring neuromuscular function
Authors: Rodiera J. , Serradell A. , Álvarez‐Gómez J. A. , Aliaga L.
Published: November 2005

Background:  A new method of monitoring neuromuscular blockade based on a modified blood pressure cuff that incorporates stimulating electrodes was compared with mechanomyography (MMG) (‘gold standard’).

Methods:  Forty adults and 20 children (ASA I–II) underwent neuromuscular blockade monitoring on the contralateral arms and on the same arm using the new cuff method and MMG. Only train‐of‐four (TOF) ratios > 0.1 and T1 heights > 0 were studied. Supramaximal stimulation was also assessed. A device based on a PC with an analogue‐to‐digital conversion card was used to control and synchronize MMG and the cuff method. The agreement between both methods was assessed using the statistical method of Bland and Altman.

Results:  When TOF ratios were >0.7, the bias between the two methods was −0.04 with the limits of agreement ranging from −0.21 to −0.12 (95% CI −0.06 to −0.02). The T1 > 0 heights bias was −0.01 with the limits of agreement ranging from −0.26 to 0.24 (95% CI −0.02 to −0.003). The sensitivity of the cuff method was 88%, with a specificity of 85% and an accuracy of 86%.

Conclusion:  This pilot study indicates that the cuff method could be useful to monitor neuromuscular blockade according to the bias and limits of agreement compared with MMG, particularly when the degree of blockade was evaluated by TOF ratios > 0.7. The new cuff method is easy and simple to use. However, further studies in a larger number of patients are necessary to confirm these favourable preliminary results.
Desflurane anaesthesia increases sister chromatid exchanges in human lymphocytes
Authors: Akin A. , Ugur F. , Ozkul Y. , Esmaoglu A. , Gunes I. , Ergul H.
Published: November 2005

Background:  We investigated genotoxic effects of desflurane on the frequency of sister chromatid exchange (SCE) in peripheral blood lymphocytes of patients during and after anaesthesia.

Methods:  Fifteen female patients, ASA classification I‐II, aged 26–54 years, undergoing elective surgery were enroled in this study. Anaesthesia was induced by injection of thiopental 5–7 mg/kg and fentanyl 1 µg/kg. Vecuronium 0.1 mg/kg was given to facilitate tracheal intubation. Anaesthesia was maintained with desflurane 5–6% in an oxygen/air mixture (FiO2 0.3). N2O was not used for any patient. Using a heparinized syringe, venous blood was collected in patients before anaesthesia. Additional venous blood samples were taken from all patients at 60 and 120 min after the initiation of anaesthesia. Post‐operative blood samples were taken and first, third, seventh and twelfth day samples were coded.

Results:  Number of SCEs per cell at 60 and 120 min were significantly higher than the number of SCEs per cell before anaesthesia. In addition, number of SCEs per cell at 1, 3 and 7th post‐operative days were significantly higher than pre‐operative levels (P < 0.05). There was no difference between pre‐operative number of SCEs per cell and 12th post‐operative day levels (P > 0.05).

Conclusion:  In the present study, because exposure to desflurane increased sister chromatid exchange in human lymphocytes in our group of patients, we conclude that this agent may be capable of producing genetic damage.
Ethical and practical problems in blood sampling for research purposes during pre‐hospital emergencies
Authors: Vester A. E. , Christensen E. F. , Andersen S. K. , Tønnesen E.
Published: November 2005

Background:  Research in the pre‐hospital phase of emergencies involves certain ethical and practical challenges. Severely ill or injured patients are not able to give informed consent in the immediate stressful situation. The aim of this pilot study was to find an ethically acceptable method to carry out research in acutely ill or injured patients before any treatment was given in order to be able to study the acute and unmodified systemic inflammatory response to trauma.

Methods:  Younger physicians were assigned to the mobile emergency care unit (MECU) on a volunteer basis. They drew blood samples ‘at the scene’ from patients exposed to accidental injury or from patients with acute medical emergencies. The ethical committee accepted that informed consent to blood analyses could be postponed until later or given by relatives. Pro‐ and anti‐inflammatory cytokines, catecholamines and cortisol were measured.

Results:  During 6 months, the study group accompanied the MECU on approximately 500 call‐outs. Blood samples were drawn from 42 patients. Consent to the analysis of blood samples was obtained in 30 cases. In 20 cases, it was not possible to draw the blood sample before medication.

Conclusion:  This pilot study showed that it was possible to conduct blood sampling from acutely ill patients ‘at the scene’. However, the present legislation on informed consent makes this type of research very time consuming. When patients die in hospital and no relatives can be found, consent cannot be obtained, and information from these severely affected patients is lost.
A comparison of the vertical infraclavicular and axillary approaches for brachial plexus anaesthesia
Authors: Rettig H. C. , Gielen M. J. M. , Boersma E. , Klein J.
Published: November 2005

Background:  This prospective, randomized study compared the efficacy of the vertical infraclavicular and axillary approaches using a single injection blockade of the brachial plexus. The primary endpoint was complete blockade in dermatomes C5‐Th1, while secondary endpoints included onset time, motor block, block performance time, surgical success rate, patient satisfaction, and side‐effects/complications.

Methods:  Sixty patients, American Society of Anesthesiologists physical status I or II, scheduled for surgery of the forearm or hand received either a vertical infraclavicular (n = 30) or an axillary block (n = 30). A single injection of 0.5 ml/kg ropivacaine 7.5 mg/ml was made after electrolocalization of nerve fibres corresponding to the median nerve at maximum 0.5 mA (2 Hz, 0.1 ms). Onset and distribution of analgesia and motor block were assessed at 5, 10, 15, 20, 30 and 60 min after the local anaesthetic injection. A complete block was defined as analgesia in all dermatomes (C5‐Th1) at 60 min post‐injection.

Results:  The vertical infraclavicular approach provided complete blockade in 29 patients (97%) and the axillary approach in 23 patients (77%). Analgesia in C5‐C6 dermatomes and corresponding motor block occurred significantly more frequently in the vertical infraclavicular approach, which also had the shortest onset time. Block procedure was quicker in the axillary approach. Side‐effects were similar in both groups, and there were no permanent sequelae. Patient satisfaction was equally high in both groups.

Conclusion:  The vertical infraclavicular approach provides a more complete block than the axillary approach when using a single injection technique and equal volumes/doses of local anaesthetic.
Monitoring urinary bladder volume and detecting post‐operative urinary retention in children with an ultrasound scanner
Authors: Rosseland L. A. , Bentsen G. , Hopp E. , Refsum S. , Breivik H.
Published: November 2005

Background:  Post‐operative urinary retention (PUR) is associated with a risk of over‐distension and permanent detrusor damage. The prevention of PUR by routine catheterization may increase the risk of urinary tract infection. Post‐operative monitoring of the bladder volume is a reliable method in adults, but has not been evaluated for reliability in children.

Methods:  Forty‐eight patients who, according to current clinical guidelines, required urinary bladder emptying were scanned before catheterization using the Bladderscan®. Volumes estimated with ultrasound were compared with volumes measured after emptying the bladder with a catheter. Bladder emptying was controlled by concomitant fluoroscopy in 20 children.

Results:  The mean difference between the ultrasound estimates and the catheter‐emptied urine volumes was 4 ml [standard deviation (SD) = 25 ml] in 26 children above the age of 3 years and −18 ml (SD = 19 ml) in 22 younger children. In the subpopulation in whom complete bladder emptying could be confirmed by fluoroscopy (14 children; median age, 3 years; range, 1–11 years), the mean difference between the ultrasound estimates and the catheter‐emptied volumes was −11 ml (SD = 24 ml).

Conclusions:  This study confirms agreement between the ultrasound scanner estimates of urinary bladder volume and the urine volume measured by emptying the bladder. Reliability was good in children above the age of 3 years. The volume was underestimated in younger children. Thus, routine monitoring of urinary bladder volume with an ultrasound scanner is a non‐invasive, pain‐free and reliable way of preventing over‐distension of the urinary bladder in children after surgery and other procedures under general anaesthesia.
Midazolam depresses carotid body chemoreceptor activity
Authors: Kim C. , Shvarev Y. , Takeda S. , Sakamoto A. , Lindahl S. G. E. , Eriksson L. I.
Published: November 2005

Background:  Although the contribution of the γ‐aminobutyric acid (GABA) receptor system in peripheral chemosensation is unclear, immunohistochemistry has demonstrated the presence of GABA‐ergic receptors in mammalian carotid bodies. We hypothesized that an activation of the carotid body GABA receptors would counteract the depolarizing effect of hypoxia.

Methods:  The carotid body with arterial supply and the carotid sinus nerve was removed en bloc from New Zealand White rabbits and placed in a perfusion chamber. The carotid body preparation was perfused via the cut common carotid artery with a modified Tyrode's solution at a rate of 3.5–4.5 ml/min with a constant pressure of 45 cmH2O. The carotid sinus nerve firing frequency (Hz) was recorded at two different oxygen tension levels during perfusion with midazolam of 1, 10 and 100 µg/l.

Results:  The frequency was decreased by midazolam in a dose‐dependent manner (n = 8). Firing frequencies (mean ± SEM) at the low oxygen tension level decreased from 643.13 ± 67.2 Hz in the control to 554.5 ± 67.7 Hz (P = 0.054 vs. control), 509.01 ± 100.5 Hz (P < 0.012 vs. control) and 422.6 ± 77.3 Hz (P < 0.001 vs. control) during perfusion with midazolam of 1, 10 and 100 µg/l, respectively.

Conclusion:  Midazolam depresses carotid body chemoreceptor activity in a dose‐dependent manner.
Intraspecific variation in the ultraviolet colour proportion of flowers in Brassica rapa L.
Authors: Yoshioka Y. , Horisaki A. , Kobayashi K. , Syafaruddin  , Niikura S. , Ninomiya S. , Ohsawa R.
Published: November 2005

In Brassica rapa L., intraspecific variation in the ultraviolet (UV) colour proportion invisible to humans but visible to insect pollinators, was investigated by UV‐photographing. After digitization of each photograph, the UV‐absorbing area (UVA) and total flower area (FA) were evaluated by means of image analysis. The ratio of UVA to FA represented the UV colour proportion (UVP). Nested anova indicated that the proportion of the variance caused by the genotypic effect was largest for UVP, and anova indicated that the F‐value for UVP was larger than that for FA. These results indicate that UVP is very stable within a genotype. That is, there was almost no additional variation caused by plants and branches. In contrast, UVP varies widely between genotypes with respect to FA. The large differences in the UVP of B. rapa flowers are likely to be distinguishable by insect pollinators, which might use these differences as visual cues in their foraging flight.
Molecular mapping determines that Hessian fly resistance gene H9 is located on chromosome 1A of wheat
Authors: Kong L. , Ohm H. W. , Cambron S. E. , Williams C. E.
Published: November 2005

Hessian fly [Mayetiola destructor (Say)] is one of the major insect pests of wheat (Triticum aestivum L.) worldwide. Hessian fly resistance gene H9 was previously reported to condition resistance to Hessian fly biotype L that is prevalent in many wheat‐growing areas of eastern USA and an RAPD marker, OPO051000, linked to H9 in wheat was developed using wheat near‐isogenic lines (NILs). However, marker‐assisted selection (MAS) with RAPD markers is not always feasible. One of the objectives in this study was to convert an RAPD marker linked to the gene H9 into a sequence characterized amplified region (SCAR) marker to facilitate MAS and to map H9 in the wheat genome. The RAPD fragment from OPO051000 was cloned, sequenced, and converted into a SCAR marker SOPO05909, whose linkage relationship with H9 was subsequently confirmed in two F2 populations segregating for H9. Linkage analysis identified one sequence tagged site (STS) marker, STS‐Pm3, and the eight microsatellite markers Xbarc263, Xcfa2153, Xpsp2999, Xgwm136, Xgdm33, Xcnl76, Xcnl117 and Xwmc24 near the H9 locus on the distal region of the short arm of chromosome 1A, contrary to the previously reported location of H9 on chromosome 5A. Locus Xbarc263 was 1.2 cM distal to H9, which itself was 1.7 cM proximal to loci Xcfa2153, Xpsp2999 and Xgwm136. The loci Xgwm136, Xcfa2153 and SOPO05909 were shown to be specific to H9 and not diagnostic to several other Hessian fly resistance genes, and therefore should be useful for pyramiding H9 with other Hessian fly resistance genes in a single genotype.
Segregation distortion for agronomic traits in doubled haploid lines of barley
Authors: Cistué L. , Echávarri B. , Batlle F. , Soriano M. , Castillo A. , Vallés M. P. , Romagosa I.
Published: November 2005

Four barley doubled haploid populations were produced by anther culture from the reciprocal crosses between two six‐row barley cultivars, ‘Plaisant’ and ‘Orria’; the doubled haploid lines (DHLs) derived from each cross were subsequently assigned to weak or vigorous populations according to the weak or vigorous nature of the originating embryos. Well‐formed embryos at day 25 on the induction medium were considered vigorous, whereas embryos maturing later were considered weak. The classification of vigorous and weak was closely associated with the ratio of green to albino plantlets regenerated. A random set of 25 DHLs from each of the four populations were selected for field testing in a replicated trial. Furthermore, a second set consisting of a total of 454 unreplicated DHLs from the four populations were also field assessed for grain yield. Distortion during in vitro culture may impede regeneration of a random array of microspores from a given cross, and may bias genetic estimates of specific trait/marker association in genetic studies. However, no significant differences were detected in this study among the four populations for days to heading, height, grain yield and thousand‐kernel‐weight when measured on the replicated trial of 100 DHLs, nor for grain yield in the second collection of 454 entries. This suggests that the likelihood of producing improved agronomic pure lines is independent of the direction of crossing and, more importantly, independent of the time when embryos matured in the induction media, at least for these particular six‐row cultivars and for the anther culture method used.
A study of emotional attitude of psychiatric nurses: Reliability and validity of the Nurse Attitude Scale
Authors: Katsuki Fujika , Goto Masahiro , Someya Toshiyuki
Published: November 2005

ABSTRACT:  In psychiatric nursing, the exchange of feelings among nurses and patients is vital. However, expressed emotion (EE) studies that have been performed in family studies of schizophrenia indicate that a high EE score can predict the relapse of schizophrenic patients. In the case of long‐term inpatients at a psychiatric hospital in Japan, the emotional attitude of nurses towards patients is anticipated to have some effect on the course of the illness. In the present study, we revised part of the phrasing of the Japanese version of the Family Attitude Scale, and renamed it the Nurse Attitude Scale (NAS). We tested 189 nurses with this scale, and examined reliability and validity. In a factor analysis of the NAS, three factors were extracted, which we termed criticism, hostility, and positive remarks. These factors are the same as items for assessment on the Camberwell Family Interview, a method of EE assessment. Cronbach's α for individual subscales was 0.848 for criticism, 0.845 for hostility, and 0.685 for positive remarks. With regard to test–retest reliability, there were significant correlations with values of 0.65 for criticism, 0.77 for hostility, and 0.44 for positive remarks. In addition, there was a significant correlation between the NAS and Pines’ Burnout scores. These facts, thus suggested that the NAS represents an approximation of the EE of psychiatric nurses. In addition, these findings indicated that the state of burnout in psychiatric nurses resulted in a critical attitude towards patients.
Wound healing ability of Xenopus laevis embryos. I. Rapid wound closure achieved by bisectional half embryos
Authors: Yoshii Yasuko , Noda Masahiro , Matsuzaki Takashi , Ihara Setsunosuke
Published: November 2005

We examined wound closure in ‘half embryos’ produced by the transverse bisection of Xenopus laevis embryos at the primary eye vesicle stage. Both the anterior‐ and posterior‐half embryos survived for more than 6 days, and grew into ‘half tadpoles’. Histology and videomicroscopy revealed that the open wound in the half embryo was rapidly closed by an epithelial sheet movement in the wound marginal zone. The time‐course of wound closure showed a downward convex curve: the wound area decreased to one‐fifth of the original area within 30 min, and the wound continued to contract slowly thereafter. The rapidity of closure of the epidermis as well as the absence of inflammatory cells are typical features of an embryonic type of wound healing. There was a dorso‐ventral polarity in the motility of the epidermis: the wound was predominantly closed by the ventral and lateral epidermis. The change in the contour of the wound edge with time suggested a complex mechanism involved in the wound closure that could not be explained only by the purse‐string theory. The present experimental system would be a unique and useful model for analyses of cellular movements in the embryonic epithelia.
Wound healing ability of Xenopus laevis embryos. II. Morphological analysis of wound marginal epidermis
Authors: Yoshii Yasuko , Matsuzaki Takashi , Ishida Hideki , Ihara Setsunosuke
Published: November 2005

We previously showed that bisectional wounds made in Xenopus laevis embryos at the primary eye vesicle stage were rapidly closed. In this study, microscopic analyses, including scanning electron microscopy, on the morphology of the epidermis were conducted during wound closure in the half embryos. Bright fluorescence of Texas red‐phalloidin showing actin filaments started to be visualized at the cut edge 10 min after wounding. It increased with time, forming a distinguished, though discontinuous, bundle along the wound margin. The wound closure was completely inhibited by 20 µm cytochalasin B, and almost completely by 50 mm 2,3‐butanedione 2‐monoxime, an inhibitor to myosin ATPase activity. Scanning electron microscopy revealed that the outer epidermal cells became extensively elongated in the radial direction, and the contour of the closing wound edge did not become smoother but remained ragged. Thus, a representative embryonic type of wound closure may be driven in Xenopus embryos by a complex mechanism, involving not only the actin ‘purse‐string’ but also an inward movement of individual cells. Anyhow, the wound closure is a movement of the epidermal sheet maintaining cell–cell contact, and not involving locomotion of single cells separated from the wound edge.
Simultaneous imaging of membrane antigen and the corresponding chromosomal locus in pathology archives
Authors: Igarashi Hisaki , Yamashita Kimihiro , Suzuki Masaya , Kitayama Yasuhiko , Isogaki Jun , Maruyama Keiji , Sunayama Ken‐ichi , Tsuda Hitoshi , Ozawa Takachika , Kiyose Shinichiro , Sugimura Haruhiko
Published: November 2005

A new procedure for the simultaneous staining of membranous antigens, such as tyrosine kinase‐type cell surface receptor HER2 (c‐erbB2), and the corresponding chromosome (chromosome 17 for c‐erbB2) in the same cell for use in examining pathology archives is presented. A multistep procedure involving microwave‐assisted fluorescence in situ hybridization and immunofluorescence yielded cell images having c‐erbB2 on the membrane and genomic signals from the chromosome 17 centromere and the c‐erbB2 locus. Furthermore, a combination of microwave‐assisted chromogenic in situ hybridization and immunohistochemistry found colorized signals from both chromosome 17 centromere in the nuclei and c‐erbB2 on the membranes of individual cells. Quantitative image analysis further confirmed the presence of a significantly stronger c‐erbB2 immunoreactivity on cells containing three or more signals from chromosome 17 than from those with less than three signals. It was possible to extend the constellation of cell surface markers and corresponding chromosomes or locus‐specific makers to several other genes including CDH1. In this case, the disappearances of CDH1 expression, a CDH1 locus signal, and a centromere enumeration probe (CEP) 16 signal were simultaneously demonstrated in the less‐adhesive tumor cells. Thus, it is believed that this procedure might pave the way for exploiting pathology archives for the genotype–phenotype analysis of individual cells.
Laparoscopic management of complicated urachal remnants
Authors: Cutting Colin W.M. , Hindley Richard G. , Poulsen Johan
Published: November 2005

OBJECTIVE

To report our experience with a laparoscopic approach to managing symptomatic urachal anomalies.

PATIENTS AND METHODS

Five patients (median age 19 years, range 2–43) had a laparoscopic excision of a complicated urachal remnant between 2001 and 2004. Three ports were routinely used, although their positioning varied as our technique developed with experience. The urachal remnant was dissected from the umbilicus to the bladder dome and then removed intact.

RESULTS

All five operations had no serious immediate complications and minimal blood loss. One patient developed a small peri‐umbilical haematoma after surgery and another had a persistent umbilical discharge at follow‐up, and required open excision of residual remnant tissue.

CONCLUSIONS

The laparoscopic approach appears to be a safe and effective alternative to open surgery for this condition. Despite the slight risk of incomplete excision, the reduced morbidity of this procedure and better cosmetic result would appear advantageous.
Hegemony and Autonomy
Authors: Lentner Howard H.
Published: November 2005

This article analyzes the concept of hegemony and examines its relationship to power and autonomy. Refuting the conventional belief that it is ideology that distinguishes hegemony, the article argues that it is autonomy that constitutes the distinguishing characteristic. Although hegemons tend to evolve into imperialists, hegemony involves leadership of an alliance, not domination by coercion. It is impossible to conceptualize hegemony without also including autonomy. In this conceptualization, the primary source of autonomy lies in a specific hegemonic system of domination that itself embodies the notion of autonomy for both the polity and its citizenry, a limiting construction that hinders the tendency toward imperialism. Such a system includes one type of autonomy that can be designated as autonomy within hegemony. In addition, the article discusses two other types of autonomy: counterhegemony and a largely power-based opposed hegemony. Thus, the article concludes, hegemony is a complex concept, with several types of manifestation, that can more usefully be understood in connection with autonomy and power than as a stand-alone concept.
John Stuart Mill and Unassimilated Subjects
Authors: Tunick Mark
Published: November 2005

Mill's harm principle declares that one's liberty of action may be interfered with by the state only if one has caused harm to others. Cases of culture clash involve unassimilated subjects, be they citizens, aliens, immigrants or national minorities, who violate the law while engaging in a practice that is a prevalent and legitimate part of their native culture or religion and which they do not regard as harmful. A Millian approach to the punishment of unassimilated subjects is explored by examining Mill's views on whether there is an objective standard of harm and Mill's discussions of free will, moral responsibility and the respect due to native cultures.
FELLOW CITIZENS AND IMPERIAL SUBJECTS: CONQUEST AND SOVEREIGNTY IN EUROPE'S OVERSEAS EMPIRES
Authors: PAGDEN ANTHONY
Published: November 2005

This article traces the association between the European overseas empires and the concept of sovereignty, arguing that, ever since the days of Cicero—if not earlier—Europeans had clung to the idea that there was a close association between a people and the territory it happened to occupy. This made it necessary to think of an “empire” as a unity—an “immense body,” to use Tacitus's phrase—that would embrace all its subjects under a single sovereign. By the end of the eighteenth century it had become possible, in this way, to speak of “empires of liberty” that would operate for the ultimate benefit of all their “citizens,” freeing them from previous tyrannical rulers and bringing them under the protection of more benign regimes. In such empires sovereignty could only ever be, as it had become in Europe, undivided. The collapse of Europe's “first” empires in the Americas, however, was followed rapidly by Napoleon's attempt to create a new kind of Empire in Europe. The ultimate, and costly, failure of this project led many, Benjamin Constant among them, to believe that the age of empires was now over and had been replaced by the age of commerce. But what in fact succeeded Napoleon was the modern European state system, which attempted not to replace empire by trade, as Constant had hoped, but to create a new kind of empire, one that sought to minimize domination and settlement, and to make a sharp distinction between imperial ruler and imperial subject. In this kind of empire, sovereignty could only be “divided.” Various kinds of divided rule were thus devised in the nineteenth century. Far, however, from being an improvement on the past, this ultimately resulted in—or at least contributed greatly to—the emergence of the largely fictional and inevitably unstable societies that after the final collapse of the European empires became the new states of the “developing world.”
ILLUSIONS OF POWER AND EMPIRE1
Authors: ROSENAU JAMES N.
Published: November 2005

Subsequent to the end of the Cold War, analysts groped for an understanding of the overall structures of world politics that marked the emergence of a new epoch. As a result, the concept of empire became a major preoccupation, with the economic and military power of the United States considered sufficient for regarding it as an empire. Due to the proliferation of new microelectronic technologies and for a variety of other specified reasons, however, the constraints inherent in the new epoch make it seem highly unlikely that the U.S. or any other country can ever achieve the status of an empire. In effect, the substantial shrinkage of time and distance in the current period has led to the replacement of the age of the nation‐state that originated with the Treaty of Westphalia in 1648 with the age of the networked individual. It is an age that has developed on a global scale and that has brought an end to the history of empires.
Out‐of‐Pocket Financial Burden for Low‐Income Families with Children: Socioeconomic Disparities and Effects of Insurance
Authors: Galbraith Alison A. , Wong Sabrina T. , Kim Sue E. , Newacheck Paul W.
Published: November 2005

Objective. To determine whether socioeconomic disparities exist in the financial burden of out‐of‐pocket (OOP) health care expenditures for families with children, and whether health insurance coverage decreases financial burden for low‐income families.

Data Source. The Household Component of the 2001 Medical Expenditure Panel Survey.

Study Design. Cross‐sectional family‐level analysis. We used bivariate statistics to examine whether financial burden varied by poverty level. Multivariate regression models were used to assess whether family insurance coverage was associated with level of financial burden for low‐income families. The main outcome was financial burden, defined as the proportion of family income spent on OOP health care expenditures, including premiums, for all family members.

Data Collection/Extraction. We aggregated annual OOP expenditures for all members of 4,531 families with a child <18 years old. Family insurance coverage was categorized as follows: (1) all members publicly insured all year, (2) all members privately insured all year, (3) all members uninsured all year, (4) partial coverage, or (5) mix of public and private with no uninsured periods.

Principal Findings. A regressive gradient was noted for financial burden across income groups, with families with incomes <100 percent of the Federal Poverty Level (FPL) spending a mean of $119.66 OOP per $1,000 of family income and families with incomes 100–199 percent FPL spending $66.30 OOP per $1,000, compared with $37.75 for families with incomes >400 percent FPL. For low‐income families (<200 percent FPL), there was a 785 percent decrease in financial burden for those with full‐year public coverage compared with those with full‐year private insurance (p<.001).

Conclusions. Socioeconomic disparities exist in the financial burden of OOP health care expenditures for families with children. For low‐income families, full‐year public coverage provides significantly greater protection from financial burden than full‐year private coverage.
Patient and Provider Assessments of Adherence and the Sources of Disparities: Evidence from Diabetes Care
Authors: Lutfey Karen E. , Ketcham Jonathan D.
Published: November 2005

Objective. To (1) compare diabetes patients' self‐assessments of adherence with their providers' assessments; (2) determine whether there are systematic differences between the two for certain types of patients; and (3) consider how the cognitive processing that providers use to assess adherence might explain these differences.

Data Sources/Study Setting. Primary survey data were collected in 1998 from 156 patient provider pairs in two subspecialty endocrinology clinics in a large Midwestern city.

Study Design. Data were collected in a cross‐sectional survey study design. Providers were surveyed immediately after seeing each diabetes patient, and patients were surveyed via telephone within 1 week of clinic visits.

Data Collection/Extraction Methods. Bivariate descriptive results and multivariate regression analyses are used to examine how patient characteristics relate to four measures of overall adherence assessments: (1) patients' self‐assessments; (2) providers' assessments of patient adherence; (3) differences between those assessments; and (4) absolute values of those differences.

Principal Findings. Patient self‐assessments are almost entirely independent of observable characteristics such as sex, race, and age. Provider assessments vary with observable characteristics such as patient race and age but not with less readily observable factors such as education and income. For black patients, we observe that relative to white patients, providers' assessments are significantly farther away from—although not systematically farther above or below—patients' self‐assessments.

Conclusions. Providers appear to rely on observable cues, particularly age and race, to make inferences about an individual patient's adherence. These findings point to a need for further research of various types of provider cognitive processing, particularly in terms of distinguishing between prejudice and uncertainty. If disparities in assessment stem more from information and communication problems than from provider prejudice, policy interventions should facilitate providers' systematic acquisition and processing of information, particularly for some types of patients.
What Happens When Hospital‐Based Skilled Nursing Facilities Close? A Propensity Score Analysis
Authors: White Chapin , Seagrave Susanne
Published: November 2005

Objective. To assess the effects of hospital‐based skilled nursing facility (HBSNF) closures on health care utilization, spending, and outcomes among Medicare fee‐for‐service beneficiaries.

Data Sources. One hundred percent Medicare fee‐for‐service claims files for 1997–2002 were merged with Medicare Provider of Services files and beneficiary‐level enrollment records.

Study Design. Medicare spending, the use of postacute care, and health outcomes, were compared among hospitals that did and did not close their HBSNFs between 1997 and 2001. Hospitals were stratified according to propensity scores (i.e., predicted probability of closure from a logistic regression) and analyses were conducted within these strata.

Principal Findings. HBSNF closures were associated with increased utilization of alternative postacute care settings, and longer acute care hospital stays. Because of increased use of alternative settings, HBSNF closures were associated with a slight increase in total Medicare spending. There are no statistically robust associations between HBSNF closures and changes in either mortality or rehospitalization.

Conclusions. HBSNF closures altered utilization patterns, but there is no indication that closures adversely affect beneficiaries' health outcomes.
Practice‐Level Effects of Interventions to Improve Asthma Care in Primary Care Settings: The Pediatric Asthma Care Patient Outcomes Research Team
Authors: Finkelstein Jonathan A. , Lozano Paula , Fuhlbrigge Anne L. , Carey Vincent J. , Inui Thomas S. , Soumerai Stephen B. , Sullivan Sean D. , Wagner Edward H. , Weiss Scott T. , Weiss Kevin B.
Published: November 2005

Objective. To assess the practice‐level effects of (1) a physician peer leader intervention and (2) peer leaders in combination with the introduction of asthma education nurses to facilitate care improvement. And, to compare findings with previously reported patient‐level outcomes of trial enrollees.

Study Setting. Data were included on children 5–17 years old with asthma in 40 primary care practices, affiliated with managed health care plans enrolled in the Pediatric Asthma Care Patient Outcomes Research Team (PORT) randomized trial.

Study Design. Primary care practices were randomly assigned to one of two care improvement arms or to usual care. Automated claims data were analyzed for 12‐month periods using a repeated cross‐sectional design. The primary outcome was evidence of at least one controller medication dispensed among patients with persistent asthma. Secondary outcomes included controller dispensing among all identified asthmatics, evidence of chronic controller use, and the dispensing of oral steroids. Health service utilization outcomes included numbers of ambulatory visits and hospital‐based events.

Principal Findings. The proportion of children with persistent asthma prescribed controllers increased in all study arms. No effect of the interventions on the proportion receiving controllers was detected (peer leader intervention effect 0.01, 95 percent confidence interval [CI]: −0.07, 0.08; planned care intervention effect −0.03, 95 percent CI: −0.09, 0.02). A statistical trend was seen toward an increased number of oral corticosteroid bursts dispensed in intervention practices. Significant adjusted increases in ambulatory visits of 0.08–0.10 visits per child per year were seen in the first intervention year, but only a statistical trend in these outcomes persisted into the second year of follow‐up. No differences in hospital‐based events were detected.

Conclusions. This analysis showed a slight increase in ambulatory asthma visits as a result of asthma care improvement interventions, using automated data. The absence of detectable impact on medication use at the practice level differs from the positive intervention effect observed in patient self‐reported data from trial enrollees. Analysis of automated data on nonenrollees adds information about practice‐level impact of care improvement strategies. Benefits of practice‐level interventions may accrue disproportionately to the subgroup of trial enrollees. The effect of such interventions may be less apparent at the level of practices or health plans.
An Episode‐Based Framework for Analyzing Health Care Expenditures: An Application of Reward Renewal Models
Authors: Foster E. Michael , Xuan Fengjuan
Published: November 2005

Objective. To illustrate an episode‐based framework for analyzing health care expenditures based on reward renewal models, a stochastic process used in engineering for describing processes that cycle on and off with “rewards” (or costs) occurring at the end of each cycle.

Data Sources/Study Setting. Data used in the illustration were collected as part of an evaluation of a national initiative to improve mental health services for children and youth. Participants were enrolled in a longitudinal study at a demonstration site and in a comparison community between 1997 and 1999. The illustration involves analyses of mental health expenditures at the two sites and of the dynamics of service use behind those expenditures.

Data Collection/Extraction Methods. Services data were derived from management information systems as well as patient records at inpatient facilities in the two communities. These data cover services received between 1997 and 2003. The analysis focuses on the year following study entry.

Principal Findings. Between‐site differences in expenditures reflect complex between‐site differences in the timing of service use. In particular, children at the demonstration stayed in treatment longer but were less likely to return for treatment later. In contrast, children at the comparison site experienced substantially less continuity of care. Costs per day of treatment within an episode were comparable at the two sites.

Conclusions. Reward renewal models offer a promising means for integrating research on service episodes and the dynamics of service use with that on health care expenditures.
Assessment of the Equivalence of the Spanish and English Versions of the CAHPS® Hospital Survey on the Quality of Inpatient Care
Authors: Hurtado Margarita P. , Angeles January , Blahut Steven A. , Hays Ron D.
Published: November 2005

Objective. To describe translation and cultural adaptation procedures, and examine the degree of equivalence between the Spanish and English versions of the Agency for Healthcare Research and Quality's (AHRQ) Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Hospital Survey (H‐CAHPS®) of patient experiences with care.

Data Sources. Cognitive interviews on survey comprehension with 12 Spanish‐speaking and 31 English‐speaking subjects. Psychometric analyses of 586 responses to the Spanish version and 19,134 responses to the English version of the H‐CAHPS survey tested in Arizona, Maryland, and New York in 2003.

Study Design. A forward/backward translation procedure followed by committee review and cognitive testing was used to ensure a translation that was both culturally and linguistically appropriate. Responses to the two language versions were compared to evaluate equivalence and assess the reliability and validity of both versions.

Data Collection/Extraction Methods. Comparative analyses were carried out on the 32 items of the shortened survey version, focusing on 16 items that comprise seven composites representing different aspects of hospital care quality (communication with nurses, communication with doctors, communication about medicines, nursing services, discharge information, pain control, and physical environment); three items that rate the quality of the nursing staff, physician staff, and the hospital overall; one item on intention to recommend the hospital. The other 12 items used in the analyses addressed mainly respondent characteristics. Analyses included item descriptives, correlations, internal consistency reliability of composites, factor analysis, and regression analysis to examine construct validity.

Principal Findings. Responses to both language versions exhibit similar patterns with respect to item–scale correlations, factor structure, content validity, and the association between each of the seven qualities of care composites with both the hospital rating and intention to recommend the hospital. Internal consistency reliability was slightly, yet significantly lower for the Spanish‐language respondents for five of the seven composites, but overall the composites were generally equivalent across language versions.

Conclusions. The results provide preliminary evidence of the equivalence between the Spanish and English versions of H‐CAHPS. The translated Spanish version can be used to assess hospital quality of care for Spanish speakers, and compare results across these two language groups.
Role of Cognitive Testing in the Development of the CAHPS® Hospital Survey
Authors: Levine Roger E. , Fowler Floyd J. , Brown Julie A.
Published: November 2005

Objective. To describe how cognitive testing results were used to inform the modification and selection of items for the Consumer Assessment of Health Providers and Systems (CAHPS®) Hospital Survey pilot test instrument.

Data Sources. Cognitive interviews were conducted on 31 subjects in two rounds of testing: in December 2002–January 2003 and in February 2003. In both rounds, interviews were conducted in northern California, southern California, Massachusetts, and North Carolina.

Study Design. A common protocol served as the basis for cognitive testing activities in each round. This protocol was modified to enable testing of the items as interviewer‐administered and self‐administered items and to allow members of each of three research teams to use their preferred cognitive research tools.

Data Collection/Extraction Methods. Each research team independently summarized, documented, and reported their findings. Item‐specific and general issues were noted. The results were reviewed and discussed by senior staff from each research team after each round of testing, to inform the acceptance, modification, or elimination of candidate items.

Principal Findings. Many candidate items required modification because respondents lacked the information required to answer them, respondents failed to understand them consistently, the items were not measuring the constructs they were intended to measure, the items were based on erroneous assumptions about what respondents wanted or experienced during their hospitalization, or the items were asking respondents to make distinctions that were too fine for them to make. Cognitive interviewing enabled the detection of these problems; an understanding of the etiology of the problem informed item revisions. However, for some constructs, the revisions proved to be inadequate. Accordingly, items could not be developed to provide acceptable measures of certain constructs such as shared decision making, coordination of care, and delays in the admissions process.

Conclusions. Cognitive testing is the most direct way of finding out whether respondents understand questions consistently, have the information needed to answer the questions, and can use the response alternatives provided to describe their experiences or their opinions accurately. Many of the candidate questions failed to meet these standards. Cognitive testing only evaluates the way in which respondents understand and answer questions. Although it does not directly assess the validity of the answers, it is a reasonable premise that cognitive problems will seriously compromise validity and reliability.
Alterations in carbohydrate metabolism in critically ill cats
Authors: Chan Daniel L. , Freeman Lisa M. , Rozanski Elizabeth A. , Rush John E.
Published: November 2005

Objective:To characterize the alterations in carbohydrate metabolism as they relate to the development of hyperglycemia in critically ill cats.

Design:Prospective, observational, controlled study.

Setting:Intensive care unit at a university veterinary teaching hospital.

Animals:Twenty‐six non‐diabetic cats admitted into the intensive care unit for a variety of diseases and 21 healthy control cats.

Interventions:

Blood samples were obtained from critically ill cats upon admission to the intensive care unit. Blood was similarly obtained from control cats.

Measurements and main results:For all cats, venous blood glucose, lactate, cortisol, insulin, glucagon, epinephrine, norepinephrine, and non‐esterified fatty acid concentrations were determined and compared between the 2 groups of cats. Compared with controls, critically ill cats had significantly higher median concentrations of glucose [183 (range 51–321) mg/dLversus110 (91–165) mg/dL;P<0.001], lactate [2.5 (0.6–11.1) mmol/Lversus1.8 (0.4–4.1) mmol/L;P=0.01], cortisol [7.8 (0.3–53.7) μg/dLversus4.4 (1.5–8.3) μg/dL;P=0.005], glucagon [186 (46–3128) pg/mLversus97 (30–252) pg/mL;P=0.001], and norepinephrine [1.5 (0.2–16.4) pg/mLversus0.63 (0.21–3.61) pg/mL;P=0.003]. Compared with controls, critically ill cats also had a significantly lower median plasma insulin concentration [9 (2–52) μU/mLversus17 (3–35) μU/mL;P=0.04]. The presence or degree of hyperglycemia in critically ill cats was not related to any single measured variable.

Conclusions:Similar to critically ill human patients, alterations in carbohydrate metabolism are present in critically ill cats and likely contribute to the hyperglycemia commonly observed in this population.
Do Users Ignore Spatial Data Quality? A Decision‐Theoretic Perspective
Authors: Van Oort P. A. J. , Bregt A. K.
Published: November 2005

Risk analysis (RA) has been proposed as a means of assessing fitness for use of spatial data but is only rarely adopted. The proposal is that better decisions can be made by accounting for risks due to errors in spatial data. Why is RA so rarely adopted? Most geographical information science (GISc) literature stresses educational and technical constraints. In this article we propose, based on decision theory, a number of hypotheses for why the user would be more or less willing to spend resources on RA. The hypotheses were tested with a questionnaire, which showed that the willingness to spend resources on RA depends on the presence of feedback mechanisms in the decision‐making process, on how much is at stake, and to a minor extent on how well the decision‐making process can be modeled.