bluuebunny/crossref_metadata_2025 huggingface dataset:
Jacquet Erosive Diaper Dermatitis After Surgery for Hirschsprung Disease
Authors: Rodriguez‐Poblador Javier , González‐Castro Urbà , Herranz‐Martínez Susana , Luelmo‐Aguilar Jesus
Published: August 2010

Abstract: We report a case of Jacquet erosive diaper dermatitis that occurred as a consequence of severe diarrhea following extensive colectomy and coloanal anastomosis for Hirschsprung disease. Perianal pseudoverrucous papules and nodules and granuloma gluteal infantum have also been seen following this kind of surgery. We propose that these three entities represent variants in a spectrum of skin lesions associated with severe diaper dermatitis.
Cleansers, Moisturizers, and Talcs: Patterns of Use Among Children of Low Socioeconomic Level
Authors: Palacios‐Lopez Carolina G. , Tamayo‐Sánchez Lourdes , Durán‐McKinster Carola , Orozco‐Covarrubias Ma. de la Luz , Ruiz‐Maldonado Ramón
Published: August 2010

Abstract: The use of cosmetics (cleansers, moisturizers, and talcs) was investigated in 200 infants and children of low socioeconomic level with and without skin disease. For children with atopic dermatitis, mothers preferred to use unscented soap. Lubricating or hydrating creams were widely used in children without skin disease. Talc and mineral oil were significantly more frequently used in infants than in children. Both of these products are potentially harmful and represent an unnecessary expense for families with a survival‐level budget. Dermatologists should discourage their use.
Milia en Plaque of the Eyelids in Childhood: Case Report and Review of the Literature
Authors: Bridges Alina G. , Lucky Anne W. , Haney George , Mutasim Diya F.
Published: August 2010

Abstract: Milia en plaque is a rare type of primary milia. Most of the reported cases have occurred around the ears in adults. We report milia en plaque in a 10‐year‐old girl who presented with symmetrical erythematous plaques studded with milia on the eyelids. Histopathology revealed milia surrounded by a dense lymphocytic infiltrate. Administration of minocycline and manual expression of the milia successfully treated this condition.
Generalized Lymphangiomatosis with Chylothorax and Skin Lymphangiomas in a Neonate
Authors: Dutheil P. , Leraillez J. , Guillemette J. , Wallach D.
Published: August 2010

Abstract: Generalized lymphangiomatosis is an extremely rare condition with clinical features depending on the extent of involvement. We report a newborn infant with chylothorax and cutaneous lymphangiomas of unique clinical presentation. The baby required artificial ventilation, pleural drainage, low triglyceride infusions, and diet. The course was favorable, with a complete regression of the cutaneous lymphangiomas.
Epidemiology and Clinical Pattern of Atopic Dermatitis in a North Indian Pediatric Population
Authors: Dhar Sandipan , Kanwar Amrinder J.
Published: August 2010

Abstract: Various epidemiologic factors and clinical patterns of atopic dermatitis (AD) were evaluated in 672 children. Of these, 210 were infants (up to 1 year) and 462 were children. Mean age at onset and mean duration of the disease were 4.2 months and 3.3 months, respectively, in the “infantile AD” group. In the “childhood AD” group the corresponding figures were 4.1 years and 1.9 years. In both groups, patients from urban areas significantly outnumbered those from rural backgrounds. In the infantile AD group, the disease was aggravated in winter in 67.14%, in summer in 23.36% and in spring in 9.51% of patients. The corresponding figures in the childhood AD group were 58% in winter, 32.92% in summer, 7.43% in spring, and 1.74% in the rainy season. In the infantile AD group, personal and family history of atopy were seen in 0.91% and 36.19% of patients, respectively. No patient had a history of drug allergy. In the childhood AD group, 15.35% had a personal history of atopy, 36.44% had a family history of atopy, and 7.36% had both a personal and family history of atopy. A history of drug allergy was reported in 3.16% of children. In the infantile AD group, 79% had facial involvement, 42% had flexors affected, and 5.70% had both flexors and extensors affected. The types of eczema seen were acute in 52.72%, subacute in 23.35%, chronic in 23.35%, and follicular in 0.46%. In the childhood AD group, 74.50% had facial involvement, 35.53% had flexural involvement, 56.32% had extensor involvement, and 8.24% had both flexors and extensors involved. Acute eczema was seen in 28.79%, subacute in 23.38%, chronic in 47.40%, and follicular in 0.43% of the children.
CHILD Syndrome with Linear Eruptions, Hypopigmented Bands, and Verruciform Xanthoma
Authors: Hashimoto Ken , Prada Stella , Lopez Ana P. , Hoyos Juan Guillernio , Escobar Monica
Published: August 2010

Abstract: A Colombian girl was born with linear verrucous lesions of the right forearm and fingers, hypopigmented bands and streaks on the right arm, verrucous plaques on the right labium majus which extended to the right upper inner thigh, a crooked right tibia, nasal septum deviation to the right, lumbar kyphoscoliosis to the right, and other right‐sided abnormalities. Radiographs showed stippled calcification of the tibial epiphysis, hypoplasia of the calcaneus, and astragalus of the right foot and delta phalanges of the right ring finger. Histologic examination demonstrated hyperkeratosis with ortho‐ and parakeratosis of the acanthotic epidermis. Keratinocytes in the lower epidermis and connective tissue cells, Schwann cells, and capillary endothelial cells of the papillary dermis showed marked vacuolization, a picture compatible with verruciform xanthoma. Electron microscopy revealed lipid vacuoles with lamellar contents and occasional crystals, compatible with cholesterol, in the dermal cells. Other abnormalities included a large number of vesicles and vacuoles in the upper epidermal keratinocytes and a lack of typical cement‐somes; the vesicles and vacuoles were thought to represent abnormal cementsomes (lamellar granules).
Lipofibromatous Hamartoma of the Median Nerve Associated with Macrodactyly and Port‐Wine Stains
Authors: Ban Masanori , Kamiya Hideki , Sato Miki , Kitajima Yasuo
Published: August 2010

Abstract: Lipofibromatous hamartoma of the nerve is a very uncommon congenital tumor. An association between this condition and vascular malformations is not well known. We present an 11 ‐year‐old girl with a lipofibromatous hamartoma of the right median nerve with macrodactyly. She had small red macules on her right neck, chest, and arm, which were diagnosed clinically as port‐wine stains. The specimens of the enlarged nerves showed fibrous and fatty growth surrounding the nerve bundles and proliferation of the small veins. We suggest that this disorder can be accompanied by a vascular malformation.
Childhood Pemphigus Vulgaris Treated with Dapsone: A Case Report
Authors: Bjarnason Bolli , Skoglund Curt , Flosadóttir Ellen
Published: August 2010

Abstract:A 5‐year‐old boy developed hemorrhagic mucocutaneous blisters on various parts of the body leading to fetor, dysphagia, dysuria, anal pruritus, pain on defecation, and weight loss. The histopathology showed the classic features of pemphigus vulgaris, and direct immunofluorescence showed intercellular deposition of IgG and C3 in the epidermis. Circulating pemphigus antibodies were also detected. He was treated with a combination of systemic prednisone and dapsone which induced a rapid remission and controlled the disease well. He has been in remission for 1 year and 7 months with no immunosuppressive therapy except for the use of topical agents for the oral lesions. An adjuvant to corticosteroids has been used only once before in children with pemphigus vulgaris under the age of 12 years. This is the third and the youngest child in the literature treated in this fashion.
Cutaneous Manifestations of Henoch‐Schönlein Purpura in Young Children
Authors: Nussinovitch M. , Prais D. , Finkelstein Y. , Varsano I.
Published: August 2010

Abstract: We evaluated the anatomic distribution and pattern of skin involvement in 155 pediatric patients with Henoch‐Schönlein purpura treated in our center over the last 20 years. Of these, 120 (77.4%) presented with cutaneous signs; only 10% of them had no leg involvement. Seven patients (4.5%) had edema of the hands, feet, or face. The mean age of this subgroup was 9.2 ± 2.2 months, compared to 6.8 ± 2.3 years for the entire group (p < 0.05). Skin biopsies were performed in 18 of these patients, including the 7 with edema, to confirm the clinical diagnosis. All biopsy specimens showed leukocytoclastic vasculitis, with IgA deposits in two and C3 deposits in one. It is important that clinicians keep in mind that an atypical presentation of Henoch‐Schönlein purpura is not unusual.
Papulonecrotic Tuberculid in a 2‐Year‐Old Girl: With Emphasis on Extent of Disease and Presence of Leucocytoclastic Vasculitis
Authors: Ramdial Pratistadevi K. , Mosam Anisa , Mallett Renèe , Aboobaker Jamilla
Published: August 2010

Abstract: The clinicopathologic features of childhood papular necrotic tuberculid (PNT) have been detailed in 10 patients. PNT is characterized by symmetric, acral papular lesions that undergo necrosis. Despite widespread cutaneous involvement, the number of lesions is usually sparse. The extensor aspects of the limbs are usually involved and trunk involvement is uncommon. Vasculitis, an integral component of PNT, has been documented only once in childhood PNT. We describe PNT in a 2‐year‐old girl in whom a multitude of lesions were present all over the body, including unusual involvement of flexor surfaces of the limbs, trunk, perineum, and vulva. Biopsied tissue revealed the characteristic features of PNT, including leucocytoclastic vasculitis. There was prompt response to antituberculous therapy. Based on the findings in this patient, we believe that the clinical spectrum of this eminently treatable disease in children must be expanded in terms of distribution and number of lesions to include extensive limb and trunk, perineal, and vulval involvement; the histopathologic spectrum of childhood PNT must include leucocytoclastic vasculitis; and adult and childhood PNT share common histopathologic features, including a common cellular immunohistochemical profile, thereby suggesting a common pathogenesis.
Intussusception in an Infant with Acute Hemorrhagic Edema of Infancy
Authors: Yu Joyce E. , Mancini Anthony J. , Miller Michael L.
Published: August 2010

Abstract:  Acute hemorrhagic edema of infancy typically occurs in infants less than 2 years of age and follows a benign clinical course. Gastrointestinal complications are unusual in this entity, in contrast to children with Henoch–Schönlein purpura, who are predominantly older than 2 years and at risk for potential morbidity from gastrointestinal tract and kidney involvement. We describe an infant with acute hemorrhagic edema of infancy who developed intussusception.
Evaluation of Adrenal Suppression of a Lipid Enhanced, Topical Emollient Cream Formulation of Hydrocortisone Butyrate 0.1% in Treating Children with Atopic Dermatitis
Authors: Eichenfield Lawrence , Ellis Charles N. , Fivenson David , Hebert Adelaide A. , Dromgoole Syd , Piacquadio Daniel
Published: August 2010

Abstract:  Corticosteroids are currently the first line of treatment for patients with atopic dermatitis. In the pediatric population however, the potential impact of adrenal suppression is always an important safety concern. Twenty boys and girls, 5–12 years of age, with normal adrenal function and a history of atopic dermatitis were maximally treated three times daily with a lipid‐rich, moisturizing formulation of hydrocortisone butyrate 0.1% for up to 4 weeks. At the conclusion of the 4‐week treatment period, cosyntropin injection stimulation testing showed no evidence of adrenal suppression. In addition, the therapy was noted to be highly efficacious, with a clinical success rate of 80% (Physician Global Score of (0) clear or (1) almost clear). No local side effects associated with prolonged use of topical corticosteroids were reported. In summary, this study supports the contention that this lipid‐rich, moisturizing formulation of hydrocortisone butyrate 0.1% was a well‐tolerated and beneficial treatment for atopic dermatitis, demonstrating no adrenal suppression in the pediatric population aged 5–12 years. The relevance of these findings for children below 5 years of age, because of difference in body mass/surface area ratios, remains to be determined.
Transport of epidurally applied horseradish peroxidase to the endoneurial space of dorsal root ganglia: A light and electron microscopic study
Authors: Byröd Gunnar , Rydevik Björn , Johansson Bengt R. , Olmarker Kjell
Published: August 2010

Abstract  The route by which an epidurally applied macromolecule might reach the endoneurial space of spinal nerve roots was assessed with light and electron microscopy in a pig model established to explore the pathophysiology of disk herniation. Horseradish peroxidase (HRP) dissolved in saline was infused epidurally. Animals were sacrificed after 5 minutes (n = 5) or 30 minutes (n = 5). Two control animals received only a saline infusion and were sacrificed after 30 minutes. Nerve root specimens were collected, fixed, and exposed to the HRP substrate, 3.3′‐di‐amino‐benzidine (DAB). The distribution of HRP reaction product in the nerve tissue was studied with light and electron microscopy. In 5‐minute specimens, HRP was found in epidural and intradural vessel walls. At the nerve root level, HRP was detected in meningeal membranes but was not seen in periaxonal space. In addition to engaging the outer cell layers of the dorsal root ganglion (DRG) capsule, HRP was detected as a gradient among the peripherally located nerve cell bodies and sometimes among the emerging afferent axons. The 30‐minute group demonstrated similar findings. The results confirm that HRP can reach the periaxonal spaces of lumbar DRG within 5 minutes after epidural application. Although the transport mechanism is not fully understood, the DRG may constitute an anatomical location allowing epidurally applied macromolecules entrance to the endoneurial space, either by direct diffusion or via vascular transport. The demonstrated transport route may have implications in the pathophysiology of sciatica in conjunction with lumbar disc herniation.
Racial Differences in Biological Sensitivity to Ethanol: The Role of Alcohol Dehydrogenase and Aldehyde Dehydrogenase Isozymes
Authors: Agarwal Dharam P. , Harada Shoji , Goedde H. Werner
Published: August 2010

Electrophoretic and kinetic studies of autopsy liver specimens from individuals of different racial groups revealed a polymorphism in alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). About 85% of the Japanese livers had an atypical ADH and 52% of the livers an unusual ALDH. Only 13% of German liver specimens had the atypical ADH and none showed the unusual form of ALDH which lacks in the isozyme with low Km for acetaldehyde. Using hair roots as the source of ADH and ALDH, individuals showing sensitivity to ethanol were examined. Data on the distribution of phenotypes in random European and Japanese population as well as family studies suggest a direct relationship between the lack of low Km isozyme of ALDH and alcohol‐induced biological sensitivity. Our findings suggest that the alcohol sensitivity quite common in individuals of Mongoloid origin might be due to delayed oxidation of acetaldehyde by an unusual type of ALDH.
Disulfiram‐Associated Hypercholesterolemia
Authors: Rogers Elizabeth L. , Naseem Syed M.
Published: August 2010

The rat model is used to verify disulfiram‐associated hypercholesterolemia and to determine a mechanism of action. Administration of disulfiram 15 mg/kg/day for 3 wk is associated with a 25% increase in serum cholesterol which is reversible with discontinuance of the drug. The hypercholesterolemia is due in part to a fourfold increase in activity of hepatic HMG‐CoA reductase, the rate‐limiting step in cholesterol biosyntheses.
Brain Aldehyde Dehydrogenase in Human Alcoholics and Controls
Authors: Pietruszko Regina , Reed Donna M. , Vallari Robert C. , Major L. Franklin , Saini Nirmal , Hawley Rollin J.
Published: August 2010

Human postmortem brain samples from temporal lobe of 23 alcoholics and 19 controls (13 with cancer and six without cancer) were used for determination of low Km (micromolar) and high Km (millimolar) aldehyde dehydrogenase activity. Despite histories of severe alcoholism leading to death through multiple complications, the mean values for either low or high Km activity did not differ significantly from that of controls similarly studied.
Hepatic Microsomal Ethanol‐Oxidizing System (MEOS): Increased Activity Following Propylthiouracil Administration
Authors: Moreno Fernando , Petrides Alexander S. , Heinen Edgar , Strohmeyer Georg , Teschke Rolf
Published: August 2010

Treatment for 7 days with the thyreostatic drug propylthiouracil (5 mg/100 g of body weight) resulted in a hypothyroid hepatic state as shown by the marked decreased hepatic content of thyroxine and triiodothyronine. This regimen led to an enhanced activity of the microsomal ethanol‐oxidizing system, whereas the activities of alcohol dehydrogenase and catalase remained unchanged. Moreover, a hyperthyroid hepatic state achieved following the daily administration of L‐thyroxine (150 jig/100 g of body weight) or L‐3,3′, 5‐triiodothyronine (10 pg/100 g of body weight) for 7 days resulted in a similar increased activity of the microsomal ethanol‐oxidizing system. Under these conditions, a decrease of alcohol dehydrogenase activity and an unaffected catalase activity was observed. These findings, therefore, show that the administration of either propylthiouracil or thyroid hormones results in an increased activity of the microsomal ethanol‐oxidizing system, suggesting that the underlying mechanism for the induction of the microsomal ethanol‐oxidizing system by propylthiouracil is independent of the action of thyroid hormones.
Effects of Acute and Chronic Ethanol Intake on Bile Acid Metabolism
Authors: Monroe Paul , Vlahcevic Z. R. , Swell L.
Published: August 2010

Ethanol has been demonstrated to cause aberrations in lipoprotein metabolism, cholesterol synthesis, biliary secretion, and bile acid synthesis. Although there is interdependency of cholesterol and bile acid metabolism, a role of ethanoMnduced lipid abnormalities in altering bile acid synthesis has not been found. The direct effects of ethanol administration on bile acid metabolism have been studied in animals and vary with the experimental design. Acutely, ethanol causes decreased bile acid secretion and synthesis, but other effects are less well defined. Chronic ethanol use in man may result in cirrhosis, a condition in which abnormalities of bile acid metabolism have been described in detail. Cholic acid synthesis and pool size are markedly depressed In advanced cirrhosis. Che‐nodeoxycholic acid synthesis is effected less than cholic acid synthesis, probably because 12a‐hydrox‐ylase activity is markedly depressed in cirrhosis, although other steps may also be influenced such as 7a‐hydroxylation of cholesterol or availability of cholesterol precursor. The deoxycholic acid pool is depressed probably because of changes in fecal flora. Despite the decrease in total bile acid pool, lithogenicity of bile is not increased in cirrhotic patients because of a concomitant decline in cholesterol and phospholipid secretion. Changes in hepatic blood flow and hepatic extraction cause an increase in plasma bile acid levels which may have clinical relevance.
Prospective Observation of CAD/CAM Titanium‐Ceramic‐Fixed Partial Dentures: 3‐Year Follow‐Up
Authors: Boeckler Arne F. , Lee Heeje , Psoch Andrea , Setz Juergen M.
Published: August 2010

Purpose: There is lack of knowledge about the clinical performance of computer‐aided design/computer‐aided manufacturing (CAD/CAM) titanium‐ceramic‐fixed partial dentures (FPDs). The purpose of this study was to evaluate CAD/CAM titanium‐ceramic FPDs after 3 years in function.

Materials and Methods: Thirty‐one FPDs were fabricated for 23 patients. The Ti frameworks were completely fabricated using CAD/CAM technology, and the low‐fusing porcelain was veneered. After confirming there were no mechanical or biological complications, the FPDs were cemented using zinc phosphate cement. The patients were recalled at 12, 24, and 36 months after cementation to examine for the presence of any mechanical complications, such as fractures of the veneering porcelain or the supportive framework, or biological complications, including caries, gingivitis, or periodontitis. The periodontal condition was measured using probing depth (PD), bleeding on probing (BOP), and plaque index (PI). Success and survival rates were estimated using the Kaplan‐Meier analysis.

Results: There were four cohesive and three adhesive porcelain fractures, but no framework fractured. The Kaplan‐Meier cumulative success rate of the CAD/CAM titanium‐ceramic crown with regard to mechanical complications was 76.4%, and the cumulative survival rate was 96.8% after 3 years of use. One patient developed caries, but the condition was not associated with marginal discrepancy. No other biological complications were reported. The periodontal parameters demonstrated a tendency that slightly increased up to 24 months and was maintained by 36 months. At the end of the follow‐up, PD was 2.86 mm, percentile of surface with BOP was 23.5, and PI was 0.45.

Conclusion: The CAD/CAM titanium‐ceramic FPDs survived in the mouths of patients without major complications for 3 years, although the risk of porcelain fracture appeared to be relatively high.
Retrospective Evaluation of Clinical Characteristics, Pharmacotherapy and Healthcare Resource Use among Patients Prescribed Pregabalin or Duloxetine for Diabetic Peripheral Neuropathy in Usual Care
Authors: Gore Mugdha , Zlateva Gergana , Tai Kei‐Sing , Chandran Arthi Bala , Leslie Douglas
Published: August 2010

Objective:  To evaluate treatment patterns and costs among patients with painful diabetic peripheral neuropathy (pDPN) newly prescribed pregabalin or duloxetine in usual care settings.

Methods:  Using the PharMetrics® Database, patients with pDPN (ICD‐9‐CM codes 357.2 or 250.6x) newly prescribed pregabalin or duloxetine were identified. Patients initiated on duloxetine (n = 713; mean age 55.4 ± 9.5 years) were propensity score‐matched with patients initiated on pregabalin (n = 713; mean age 56.3 ± 9.3 years). Prevalence of comorbidities, pain‐related pharmacotherapy and healthcare resource use/costs (pharmacy, outpatient, inpatient, total) were examined during the 12 months preceding (pre‐index) and following (follow‐up) the date of the first pregabalin or duloxetine prescription.

Results:  Both cohorts had multiple comorbidities and a substantial pain medication burden. Among pregabalin patients, use of other anticonvulsants (35.6% vs. 24.7%) and tricyclic antidepressants significantly decreased (18.2% vs. 13.7%) and serotonin‐norepinephrine reuptake inhibitors (SNRIs) increased (7.9 % vs. 12.9%) in the follow‐up period; all P values < 0.05. Among duloxetine patients, use of other SNRIs (8.7% vs. 5.2%) and selective serotonin reuptake inhibitors decreased significantly (32.1% vs. 18.9%) in the follow‐up period, but there were increases for anticonvulsants (42.1% vs. 48.4%), benzodiazepines (25.5% vs. 32%), and sedative/hypnotics (22.6% vs. 25.8%); all P values < 0.05. Among pregabalin and duloxetine patients there were increases (P < 0.05) in pharmacy, outpatient, and total healthcare costs from the pre‐index to the follow‐up period. Total medication costs in the follow‐up period were significantly higher for duloxetine (median $6,763 [IQR $3,970–$10,914]) relative to pregabalin (median $6,059 [IQR $3,277–$9,865]); P = 0.0017.

Conclusions:  Patients with pDPN prescribed pregabalin and duloxetine were characterized by a substantial comorbidity and pain medication burden. Although there were no differences in total healthcare costs, medication costs were significantly higher in the duloxetine cohort relative to the pregabalin cohort.
Predictive Genetic Testing for Alzheimer's Disease: Impact upon Risk Perception
Authors: Marteau Theresa M. , Roberts Scott , LaRusse Susan , Green Robert C.
Published: August 2010

The aim of this study was to determine the impact on risk perceptions of disclosing genetic test results used to estimate the risk of Alzheimer's disease (AD). Adult children (n= 149) of people with AD were randomized to one of two groups—Intervention group: lifetime risk estimates of AD based on age, gender, family history, and Apolipoprotein E (APOE) genotype; Control group: lifetime risk estimates of AD based on the same risk factors excluding APOE genotype. Perceptions of personal risk (PPR) for AD were assessed six weeks after risk assessments. PPR were correlated with actual lifetime risk estimates (r= 0.501; p < 0.0001). After controlling for lifetime risks communicated to participants, age, and number of affected relatives, PPR scores among those with an ɛ4‐positive test result (the test result associated with increased AD susceptibility) (adjusted mean: 3.4 (SD: 0.7)) were not different from the PPR scores in the Control group (adjusted mean: 3.4 (SD: 0.7) (F(1,91)= 1.98; p= 0.162). Again, controlling for lifetime risk estimates, age, and number of affected relatives, the PPR score of those receiving an ɛ4‐negative test result was significantly lower (adjusted mean: 3.1 (SD: 0.8)) than those in the Control group (adjusted mean: 3.4 (SD: 0.7) (F(1,95)= 6.23; p= 0.014). Perceptions of risk of developing AD are influenced by genetic test disclosure in those receiving ɛ4‐negative, but not those receiving ɛ4‐positive test results. Despite the reduced perceptions of risk in the former group, there was no evidence of false reassurance (i.e., perceiving risks as equal to or lower than population risks of AD), although this possibility should be assessed in other testing contexts.
Using Integrated Geospatial Mapping and Conceptual Site Models to Guide Risk‐Based Environmental Clean‐Up Decisions
Authors: Mayer Henry J. , Greenberg Michael R.
Published: August 2010

Government and private sector organizations are increasingly turning to the use of maps and other visual models to provide a depiction of environmental hazards and the potential risks they represent to humans and ecosystems. Frequently, the graphic presentation is tailored to address a specific contaminant, its location and possible exposure pathways, and potential receptors. Its format is usually driven by the data available, choice of graphics technology, and the audience being served. A format that is effective for displaying one contaminant at one scale at one site, however, may be ineffective in accurately portraying the circumstances surrounding a different contaminant at the same site, or the same contaminant at a different site, because of limitations in available data or the graphics technology being used. This is the daunting challenge facing the U.S. Department of Energy (DOE), which is responsible for the nation's legacy wastes from nuclear weapons research, testing, and production at over 100 sites in the United States. In this article, we discuss the development and use of integrated geospatial mapping and conceptual site models to identify hazards and evaluate alternative long‐term environmental clean‐up strategies at DOE sites located across the United States. While the DOE probably has the greatest need for such information, the Department of Defense and other public and private responsible parties for many large and controversial National Priority List or Superfund sites would benefit from a similar approach.
Combining Quantitative and Qualitative Measures of Uncertainty in Model‐Based Environmental Assessment: The NUSAP System
Authors: Van Der Sluijs Jeroen P. , Craye Matthieu , Funtowicz Silvio , Kloprogge Penny , Ravetz Jerry , Risbey James
Published: August 2010

This article discusses recent experiences with the Numeral Unit Spread Assessment Pedigree (NUSAP) system for multidimensional uncertainty assessment, based on four case studies that vary in complexity. We show that the NUSAP method is applicable not only to relatively simple calculation schemes but also to complex models in a meaningful way and that NUSAP is useful to assess not only parameter uncertainty but also (model) assumptions. A diagnostic diagram can be used to synthesize results of quantitative analysis of parameter sensitivity and qualitative review (pedigree analysis) of parameter strength. It provides an analytic tool to prioritize uncertainties according to quantitative and qualitative insights in the limitations of available knowledge. We show that extension of the pedigree scheme to include societal dimensions of uncertainty, such as problem framing and value‐laden assumptions, further promotes reflexivity and collective learning. When used in a deliberative setting, NUSAP pedigree assessment has the potential to foster a deeper social debate and a negotiated management of complex environmental problems.
Identification of the Characteristics and Risk Factors of the BSE Epidemic in the Netherlands
Authors: Heres Lourens , Elbers Armin R. W. , Van Zijderveld Fred G.
Published: August 2010

It is generally accepted that the bovine spongiform encephalopathy (BSE) epidemic is transmitted by feed contamination with meat and bone meal (MBM). Whether in some cases substances other than MBM have caused the spread of this disease cannot be excluded at present. Detailed knowledge about country‐specific transmission routes and relevant risk factors is important to perform accurate risk analyses and to control BSE. In the present study all possible information of Dutch BSE cases was collected. The general epidemiological data were first used for a comprehensive descriptive analysis of the Dutch BSE epidemic. A case‐control study was performed to identify the risk factors associated with the occurrence of BSE cases in the Netherlands. Sixty‐eight of the 76 BSE cases enrolled in the case‐control study. With an oral questionnaire information was collected about cow and farm management. The same questionnaire was used in interviews at 128 randomly selected control farms. Detailed analysis of the case anamneses showed that all affected cows could have been exposed to MBM from pig or poultry feed as a result of cross‐contamination. In the case‐control study, only feed producer appeared to be a relevant risk factor. Differences in log odds between feed producers were related to the moment of separation of production lines and to the origin of the MBM. The results suggest that there were meaningful differences in the level of infectivity in MBM from different origins at the time that cross‐contamination was still possible. No other risk factors, either farm or cow related, were significantly associated with the occurrence of BSE.
A Framework for Linking Cybersecurity Metrics to the Modeling of Macroeconomic Interdependencies
Authors: Santos Joost R. , Haimes Yacov Y. , Lian Chenyang
Published: August 2010

Hierarchical decision making is a multidimensional process involving management of multiple objectives (with associated metrics and tradeoffs in terms of costs, benefits, and risks), which span various levels of a large‐scale system. The nation is a hierarchical system as it consists multiple classes of decisionmakers and stakeholders ranging from national policymakers to operators of specific critical infrastructure subsystems. Critical infrastructures (e.g., transportation, telecommunications, power, banking, etc.) are highly complex and interconnected. These interconnections take the form of flows of information, shared security, and physical flows of commodities, among others. In recent years, economic and infrastructure sectors have become increasingly dependent on networked information systems for efficient operations and timely delivery of products and services. In order to ensure the stability, sustainability, and operability of our critical economic and infrastructure sectors, it is imperative to understand their inherent physical and economic linkages, in addition to their cyber interdependencies. An interdependency model based on a transformation of the Leontief input‐output (I‐O) model can be used for modeling: (1) the steady‐state economic effects triggered by a consumption shift in a given sector (or set of sectors); and (2) the resulting ripple effects to other sectors. The inoperability metric is calculated for each sector; this is achieved by converting the economic impact (typically in monetary units) into a percentage value relative to the size of the sector. Disruptive events such as terrorist attacks, natural disasters, and large‐scale accidents have historically shown cascading effects on both consumption and production. Hence, a dynamic model extension is necessary to demonstrate the interplay between combined demand and supply effects. The result is a foundational framework for modeling cybersecurity scenarios for the oil and gas sector. A hypothetical case study examines a cyber attack that causes a 5‐week shortfall in the crude oil supply in the Gulf Coast area.
Settled Borders and Regime Type: Democratic Transitions as Consequences of Peaceful Territorial Transfers
Authors: Gibler Douglas M. , Tir Jaroslav
Published: August 2010

Research arguing that external threats determine regime type has generally failed to provide systematic evidence in favor of the peace‐to‐democracy hypothesis. We suspect that the lack of confirmatory findings is likely driven by conflating the concepts of negative (absence of conflict) and positive (mutual trust and cooperation) peace. By focusing on territorial issues and the phenomenon of peaceful state‐to‐state territorial transfers (i.e., peaceful alteration of borders), we are able to observe the effects of replacing territorial threat stemming from negative territorial peace (or territorial rivalry) with the positive territorial peace associated with legitimate, mutually accepted borders. Our findings support the expectations that peaceful territorial transfers remove active and latent territorial threat and lead to demilitarization and democratization. Importantly, peaceful territorial transfers are not endogenous to regime type. Our study therefore supports an alternative explanation for the democratic peace: both democracy and peace may be a function of settling territorial threats.
Where Federalism Didn’t Fail
Authors: Derthick Martha
Published: August 2010

The governmental response to Hurricane Katrina was not the unalloyed failure that is often portrayed. The response was a mixture of success and failure. Successes occurred when a foundation had been laid for intergovernmental cooperation, as with the largely successful pre‐landfall evacuation of Greater New Orleans, the multistate mobilization of the National Guard, and the search and rescue operations of the U.S. Coast Guard and the Louisiana Department of Wildlife and Fisheries. Postmortems should draw lessons from such successes rather than concentrate entirely on the numerous failures.

It is now clear that a challenge on this scale requires greater federal authority and a broader role for the armed forces—the institution of our government most capable of massive logistical operations on a moment’s notice.

—President George W. Bush, September 15, 2005

I can say with certainty that federalizing emergency response to catastrophic events would be a disaster as bad as Hurricane Katrina. The current system works when everyone understands, accepts, and is willing to fulfill their responsibilities…. the bottom‐up approach yields the best results.

—Florida governor Jeb Bush, October 19, 2005
The Role of Nonprofits in Disaster Response: An Expanded Model of Cross‐Sector Collaboration
Authors: Simo Gloria , Bies Angela L.
Published: August 2010

In this study, nonprofit involvement in cross‐sector collaborative efforts for post‐Katrina and Rita relief, recovery, and rebuilding are examined. Using Bryson, Crosby, and Stone’s model as a framework, the collaborative and intermediary roles played by nonprofits in three affected areas, New Orleans, southwest Louisiana, and central Texas, are analyzed. Extensions of the model are introduced to include aspects of organizational capacity and individual and prosocial behaviors resultant of cross‐sector collaboration during extreme events. Implications of the findings for nonprofit practice and policy as well as future research in emergency management are discussed.
Government and Science: A Troubled, Critical Relationship and What Can Be Done about It
Authors: Lambright W. Henry
Published: August 2010

The U.S. government–science relationship, which helped win World War II, put a man on the moon, unravel the human genome, and nurture economic growth, is troubled. Money is one reason. However, far more than funding, the tensions between government and science are about politics and policy management. Many scientists and their allies argue that the Bush administration has crossed the line separating appropriate control of information from political interference. That is, there has been a “politicization of science.” This essay examines the current debate about politicization in historical context; discusses the tensions among scientists, politicians, and administrators; and suggests possible ways to strengthen the government–science partnership in the future.
Presidential Environmental Appointees in Comparative Perspective
Authors: Auer Matthew R.
Published: August 2010

The pathologies of the presidential appointment process are well documented and include appointees’ frequent lack of federal government work experience and their short appointment tenures. Less well understood are whether and to what extent these problems affect different subsets of high‐level appointees, such as administrators in the environmental bureaucracy. Top‐tier environmental appointees tend to stay longer in their appointed positions than do presidential appointees generally, and more than 40 percent have prior federal government management experience. These and other data suggest that key problems ascribed to the presidential appointment process are less salient in the case of high‐level environmental appointees. Appointees in Republican and Democratic administrations have comparable levels of academic training and federal government experience. These similarities notwithstanding, White House expectations for appointees’ political loyalty varies more from administration to administration. The Ronald Reagan and George W. Bush (first term) administrations maintained the highest demands for political loyalty, with consequences for the policy–administration dichotomy in environmental agencies.
The Tiebout Hypothesis 50 Years Later: Lessons and Lingering Challenges for Metropolitan Governance in the 21st Century
Authors: Howell‐Moroney Michael
Published: August 2010

More than five decades have passed since Charles Tiebout wrote his seminal 1956 paper, often cited as the classic apologetic for locally based systems of metropolitan governance. This essay traces the impact of Tiebout’s work and subsequent scholarship in public choice, identifying important lessons and lingering issues. Although public choice has demonstrated that polycentric systems are adept and flexible in producing and providing municipal services and a variety of interlocal agreements, the presence of municipal boundaries gives rise to a host of spillover problems, such as urban sprawl and segregation. These spillovers are particularly nefarious because, unlike the natural cooperation that seems to occur in service provision, municipalities tend to assert narrow self‐interest in the face of these types of externalities. The essay proposes that, commensurate with the growing salience of equity among the pillars of public administration, interjurisdictional spillovers and their attendant equity impacts will be the central challenge for thinkers studying metropolitan governance in the 21st century.
Inside the Presidential Communications Machine: An Interview with Martha Joynt Kumar
Authors: Kosar Kevin R.
Published: August 2010

Martha Joynt Kumar is a professor of political science at Towson University. Her book, Managing the President’s Message: The White House Communications Operation (Johns Hopkins University Press, 2007), examines the media and communications operations of the administrations of Presidents Bill Clinton and George W. Bush. In March 2008, Professor Kumar was interviewed in the White House Press Briefing Room by Kevin R. Kosar on behalf of Public Administration Review. As this interview went to press, the American Political Science Association’s Presidency Research Group announced that it had awarded Managing the President’s Message the Richard E. Neustadt Award for best book on the U.S. presidency published in 2007.
Taken for Granted? Managing for Social Equity in Grant Programs
Authors: Collins Brian K. , Gerber Brian J.
Published: August 2010

Managing for social equity performance has long been a goal without much guidance for public managers. We examine social equity performance in the context of indirect governance through the administration of grant programs and, more specifically, the matching of policy responses (grant funding) to social needs. Grant program managers must allocate funding to match needs while also ensuring accountability, but common administrative models that rely on competition can undermine social equity performance. We develop a unique framework to analyze the relative social equity performance of four models of grant administration in general. These models are defined by whether competitions or formulas are used to select grantees and to allocate funding. We test the implications of the framework in an analysis of funding distributions from the nonentitlement Community Development Block Grant program in four states. Our findings suggest that social equity in grant programs is better served when grantors do not rely solely on competitive grant contracting in the selection and distribution of grant funds, which is typical in grant administration. However, policy makers and managers can design institutional arrangements that utilize competition, but in a manner that does not create a bias against more socially equitable funding decisions.
Market Discipline in the Individual Annuity Market
Authors: Carson James M. , Doran James S. , Dumm Randy E.
Published: August 2010

Abstract

Theoretical expectations related to market discipline generally suggest a positive relationship between firm financial strength and price. We examine market discipline in the individual annuity market by measuring annuity contract yields during the accumulation phase and find that, among other results, firm financial strength is positively related to yield (i.e., negatively related to price). We argue that this apparent anomaly can be viewed as a form of market discipline itself, for at least four related reasons, the foremost reason being that in order to compete in the asset accumulation market, an insurer has an incentive to provide a track record of historically strong credited interest rates within the annuity. In addition, the credited interest rates within an annuity are only revealed ex post over time, thus diminishing consumer ability to impose traditional market discipline relating firm financial strength and price, and also enabling financially weaker insurers to impose higher ex post prices in the form of lower realized annuity yields.
Current of Injury Predicts Acute Performance of Catheter‐Delivered Active Fixation Pacing Leads
Authors: REDFEARN DAMIAN P. , GULA LORNE J. , KRAHN ANDREW D. , SKANES ALLAN C. , KLEIN GEORGE J. , YEE RAYMOND
Published: August 2010

Background:

During pacemaker lead (PPML) implantation, the implanter must assess lead stability (fixation) and pacing threshold adequacy. Implanters rely principally on lead impedance (IMP) and pacing threshold measurements after fixation of the PPML to determine adequacy of pacing sites. Continuously monitoring lead parameters during fixation might better identify predictors of acute lead stability and performance.

Methods:

At the time of PPML implantation with a catheter delivered, fixed screw, 4‐Fr PPML (Medtronic 3830, Minneapolis, MN, USA) patients underwent measurements of R‐wave amplitude, slew rate, and current of injury (COI) (maximum and at 80 ms) during each turn of the helix. Lead stability was tested with traction applied to the lead body.

Results:

Eighteen patients (age 70 ± 9 years, 9 males) were studied. Right ventricular lead positioning was attempted 43 times; 26 positions demonstrated good fixation and 18 had satisfactory threshold. Sites of good fixation consistently showed larger COI (maximum and at 80 ms) compared to poor fixation sites throughout each turn of the helix; R wave, slew rate, and IMP did not differ significantly. When all measures of COI were examined in a stepwise regression model only the final measure of COI at 80 ms proved significantly associated with acute stability (P = 0.032).

Conclusions:

Lead stability and threshold adequacy are predictable from assessment of the magnitude of injury current. Continuous monitoring of lead parameters during fixation does not appear to confer any benefit over assessment of the parameters after final rotation of the lead. A negative COI is associated with poor threshold and/or fixation.
Morphology‐Enhanced Atrial Event Classification Improves Sensing in Pacemakers
Authors: LEWALTER THORSTEN , TUININGA YPE , FRÖHLIG GERD , REMERIE SUSANN , EBERHARDT FRANK , SCHMIDT JÖRG , VAN GROENINGEN CHRIS , WOHLGEMUTH PETER
Published: August 2010

Background:

In atrial‐based pacing, appropriate therapy and reliable diagnostics depend on detection and discrimination of atrial signals. Accurate classification of atrial events is mainly confounded by oversensing of ventricular far‐field R‐wave signals (FFRW), but attempts to reject FFRWs by manipulating atrial sensitivity and/or postventricular atrial blanking period (PVAB) may result in undersensing (especially of atrial fibrillation, AF) or in 2:1 atrial flutter detection. The objective of this study is therefore to evaluate if such methods can be improved by morphology‐enhanced atrial event classification (MORPH).

Methods:

Twenty‐four‐hour ambulatory atrial electrograms were recorded from continuous telemetry of digital pacemakers. Half of the recording was used for collecting two individual morphology parameters that discriminated P‐waves from FFRWs in every patient (learning phase). The other half was used to test the MORPH algorithm against traditional methods (classification phase).

Results:

In 44/48 patients, data were suitable for analysis. Average P and FFRW amplitudes were 1.96 mV versus 0.61 mV (P < 0.001). The interval between ventricular events and FFRW oversensing (VA interval) averaged at 14 ms during sensing and at 118 ms during pacing in the ventricle. Compared to nominal (“Factory”) settings, the MORPH algorithm improved the sensitivity for P‐wave recognition from 97.2% to 99.2%, the specificity from 91.9% to 99.96%, and the accuracy from 95.3% to 99.4% (P < 0.01 for all).

Conclusions:

By improving atrial signal discrimination, morphology analysis of atrial electrograms allows for high atrial sensitivity settings, and potentially improves the reliability of atrial arrhythmia diagnostics in heart rhythm devices.