bluuebunny/crossref_metadata_2025 huggingface dataset:
Fall risk factors in elderly patients with cognitive impairment on rehabilitation wards
Authors: Vassallo Michael , Mallela Santhosh Kumar , Williams Andrew , Kwan Joseph , Allen Steve , Sharma Jagdish C
Published: February 2009

Background:  Confusion and cognitive impairment, are risk factors for falls in hospital. Evidence for reducing falls in cognitively‐impaired patients is limited and to date no intervention has consistently been shown to reduce falls in this group of patients. We explored characteristics associated with falls in cognitively‐impaired patients in a rehabilitation setting.

Methods:  In a prospective observational study, 825 consecutive patients were studied. Patient characteristics were assessed on admission. Factors predisposing to falls in cognitively‐impaired patients were identified.

Results:  Cognitively‐impaired patients were more likely to be fallers or recurrent fallers and more likely to sustain an injury than cognitively intact patients. They had a higher incidence of nursing home discharges and a significantly higher mortality. Logistic regression analysis showed that an unsafe gait (P < 0.001; 95% confidence interval, 0.13–0.57) was the only independent risk factor for falls in this group of patients. There was a cumulative higher risk of falling associated with an unsafe gait demonstrable throughout the patients' stay.

Conclusion:  Unsafe gait was the only significant independent risk factor for falls among cognitively‐impaired patients in a rehabilitation environment. Interventions that improve gait patterns or that enhance safety for patients with abnormal gait are required if fall reduction in this group of patients is to be achieved.
Acute confusional state in type 2 diabetic patient: Non‐convulsive status epilepticus
Authors: Wu Chung‐Jung
Published: February 2009

The etiology of acute confusional state in elderly patients with type 2 diabetes mellitus is broad, including hypoglycemia or hyperglycemia, electrolyte imbalance as hyponatremia or hypercalcemia, cerebrovascular disease and drug intoxication among others. Herein, we present an 80‐year‐old female type 2 diabetic patient in an acute confusional state due to non‐convulsive status epilepticus (NCSE). Timely electroencephalogram at an emergency department when available is the only tool for the diagnosis of NCSE when clinically suspected. All clinicians must consider the possibility of NCSE in the differential diagnosis of acute confusional patients when diagnosis is uncertain.
Risk factors for hip fracture in Japanese elderly women with osteoporosis: Applicability of biochemical markers in bone turnover
Authors: Shiga Toshiki , Tsuji Yoshiro , Fujioka Mikihiro , Kubo Toshikazu
Published: February 2009

Aim: The purpose of this study was to investigate risk factors for hip fracture in 169 Japanese elderly women.

Methods: Patients were divided into three groups: 53 patients had osteoporosis with hip fractures (FX‐G), 59 patients had osteoporosis without hip fractures (NFX‐G) and 57 patients had low back pain with neither osteoporosis nor hip fracture (NOP‐G). Bone mineral density (BMD) of lumbar spine, bone‐specific alkaline phosphatase (BAP) and deoxypyridinoline (DPD) were compared among the three groups.

Results: The mean BMD of FX‐G and NFX‐G was lower than that of NOP‐G, but there was no significant difference between FX‐G and NFX‐G. Although the mean BAP of FX‐G was similar to that of NOP‐G, both were lower than NFX‐G (P < 0.05). However, the mean DPD of FX‐G was higher than the other groups (P < 0.05, vs NFX‐G,P < 0.001, vs NOP‐G). The percentage of patients who showed BAP levels less than 35 IU/L and DPD levels of 7.5 nmoL/mmol‐Cr or more, was highest in FX‐G (72.7%). This percentage was lower for NFX‐G (30.9%) and NOP‐G (16.4%). The odds ratio of hip fracture occurring was 5.77 (95% confidence interval, 2.25−14.66).

Conclusion: Bone turnover consisting of increase in bone resorption and decrease in bone formation apart from BMD of lumbar spine resulted in a higher incidence of hip fracture for Japanese elderly women with osteoporosis.
Longitudinal patterns of unawareness of memory deficits in mild Alzheimer's disease
Authors: Akai Tomotaka , Hanyu Haruo , Sakurai Hirofumi , Sato Tomohiko , Iwamoto Toshihiko
Published: February 2009

Aim:  Patients with Alzheimer's disease (AD) frequently demonstrate impaired awareness of their cognitive difficulties. However, less is known about the longitudinal progression of this phenomenon. We examined the longitudinal evolution of unawareness in patients with mild AD to determine whether impaired awareness progresses with cognitive decline.

Methods:  Based on Mini‐Mental State Examination (MMSE) score changes after a 1‐year follow up, 39 patients were regarded as the stabilized group and 19 patients were regarded as the non‐stabilized group. The unawareness of memory impairment was evaluated with a standardized questionnaire system based on the Everyday Memory Checklist (EMC). The EMC scores for the patient's own rating, the caregivers' rating and the unawareness score, defined as the difference between these (caregiver rating – patient rating), were analyzed.

Results:  Although unawareness scores were similar in the two groups at the initial examination, they were significantly higher in the non‐stabilized group than in the stabilized group at the follow up examination. There was a significant and negative correlation between change in unawareness score and change in MMSE score over time (r = −0.56, P < 0.0001).

Conclusion:  Our results indicated that impaired awareness progressed with cognitive decline. The EMC may be a simple and useful tool for the monitoring of progression in patients with AD.
Acute and transient psychosis in old age and the subsequent risk of dementia: A nationwide register‐based study
Authors: Kørner Alex , Lopez Ana Garcia , Lauritzen Lise , Andersen Per Kragh , Kessing Lars Vedel
Published: February 2009

Aim:  Using the unique Danish psychiatric and somatic health registers, we investigated the rate of subsequent dementia in patients with late‐onset acute and transient psychosis.

Methods:  By linkage of the psychiatric and the somatic nationwide registers of all patients with in‐ or outpatient hospital contact in Denmark, we included all patients with a first ever contact during the period 1 January 1994 to 31 December 2001 with one of the main index diagnoses: late‐onset acute and transient psychosis or osteoarthritis. Data on the general population were also included. The first diagnosis of dementia for each individual at discharge or at outpatient contact was established. Poisson regression models were used to compare the cohorts of patients with dementia as the outcome of interest.

Results:  Using a cut‐off age of 60 years, 8062 individuals were included. Significant associations were found between a subsequent diagnosis of dementia and the index diagnosis, age and calendar time. Overall, the rate ratio for developing dementia in late‐onset acute and transient psychosis compared to osteoarthritis patients was 10.86 (95% confidence intervals, 8.42 and 14.00, respectively), however, the magnitude of the rate ratio varied according to sex, age, duration since diagnosis and calendar time. Compared to the general population, the rate ratio was 8.12 (95% confidence intervals, 6.77 and 9.74, respectively).

Conclusion:  The present study has established that subjects with late‐onset acute and transient psychosis are at 11 times higher risk of subsequently getting a diagnosis of dementia compared to patients with osteoarthritis, and at 8 times higher risk compared to the general population.
Very high cycle fatigue behaviour of 2000‐MPa ultra‐high‐strength spring steel with bainite–martensite duplex microstructure
Authors: NIE Y. H. , FU W. T. , HUI W. J. , DONG H. , WENG Y. Q.
Published: February 2009

The very high cycle fatigue and fatigue crack growth (FCG) behaviours of 2000‐MPa ultra‐high‐strength spring steel with different bainite–martensite duplex microstructures (designated as B‐M1 and B‐M2) obtained through isothermal quenching and fully martensite (designated as M) for comparison were studied in this paper by using ultrasonic fatigue testing and compact‐tension specimens. It was found that for the B‐M1 sample with well‐controlled thin and uniformly distributed bainite, the fatigue crack threshold ΔKth is higher and FCG rate da/dN at an early stage is lower than those of the M sample. Therefore, the former has rather longer fatigue life at high stress amplitude, though both have almost identical fatigue strength. However, the fatigue properties of bainite–martensite duplex microstructure are significantly deteriorated with the formation of large bainite. Furthermore, like that of the M sample, the S–N curves of the B‐M1 and B‐M2 samples also display continuous declining type and fish‐eye marks were always observed on the fracture surface in the case of internal fractures, which were mainly induced by inclusion. A granular bright facet (GBF) was observed in the vicinity around the inclusion. For each of the three samples, the stress intensity factor range at the boundary of inclusion (ΔKinc) decreases with increasing the number of cycles to failure (Nf), while the stress intensity factor range at the front of GBF(ΔKGBF) is almost constant with Nf and equals to its ΔKth. This indicates that ΔKGBF might be the threshold value governing the beginning of stable crack propagation.
‘That which does not kill us only makes us stronger’: the role of carbon monoxide in thermophilic microbial consortia
Authors: Techtmann Stephen M. , Colman Albert S. , Robb Frank T.
Published: February 2009

Carbon monoxide (CO), while a potent toxin, is also a key intermediate in major autotrophic pathways such as methanogenesis and acetogenesis. The ability of purple sulfur bacteria to use CO as an energy source was first described by Uffen in 1976. The prototype extremely thermophilic carboxydotroph Carboxydothermus hydrogenoformans was described in 1991. Eight bacteria and one archaeon that utilize CO have since been isolated and described from diverse geothermal environments. They derive energy from the oxidation of CO with water to form CO2 and H2. Most of these isolates thrive with headspace CO partial pressures around 1 atm, which is grossly elevated relative to CO concentrations in geothermal effluents. To account for this, we suggest that under consortial growth conditions the carboxydotrophs occupy microniches in which biogenic CO accumulates locally to high concentrations. CO oxidizers dissipate these potentially toxic CO hot spots with the production of H2, CO2 and acetate whose subsequent oxidation fuels other thermophiles. The identification of genes related to anaerobic CO oxidation in many metagenomic databases attests to widespread distribution of carboxydotrophs. Current evidence suggests that CO‐oxidizing bacteria and archaea hold a vital niche in thermophilic ecosystems.
Therapeutic options in the management of intermediate‐risk nonmuscle‐invasive bladder cancer
Authors: Horvath Andras , Mostafid Hugh
Published: February 2009

Non‐muscle‐invasive bladder cancers form a heterogeneous group of tumours with varying recurrence and progression rates. Recently low‐, intermediate‐ and high‐risk categories, based on tumour stage and grade, have been used to predict prognosis and guide treatment. Whilst the therapeutic options for the low‐ and high‐risk groups are well defined, the optimal treatment for patients in the intermediate‐risk group is unknown. We review current treatment options, recent advances and future developments in the treatment of patients with intermediate‐risk non‐muscle‐invasive bladder cancer.
Laparoscopic partial nephrectomy with selective control of the renal parenchyma: initial experience with a novel laparoscopic clamp
Authors: Simon Jörg , Bartsch Jr Georg , Finter Florian , Hautmann Richard , De Petriconi Robert
Published: February 2009

OBJECTIVE

To report a laparoscopic device that facilitates regional ischaemia in laparoscopic partial nephrectomy (LPN).

PATIENTS AND METHODS

Mimicking the shape of a clamp successfully applied in open PN, we developed a laparoscopic device that allows selective clamping in LPN. After obtaining transperitoneal access to the renal mass, the laparoscopic clamp was placed around the tumour 1–2 cm proximal to the line of resection. After excising the tumour, haemostasis was mainly achieved by applying a haemostyptic agent.

RESULTS

Three patients with elective indications had LPN using this novel laparoscopic clamp. The tumours were in the upper and lower pole of the kidney in one and two patients, respectively. The tumour diameter was 2.4, 2.6 and 3.2 cm, and the selective clamping time 23, 27 and 38 min. Blood loss was minimal in all three cases, with no complications after LPN. The final pathology showed a papillary and clear cell renal carcinoma in two and one patients, respectively. There were no positive margins on histological assessment.

CONCLUSION

LPN with clamping of the renal parenchyma using this novel device can be used in selected patients with peripheral tumours. Resection of the tumour in a bloodless field is possible. The main advantage is that ischaemia occurs only in the renal parenchyma next to the tumour, facilitating nephron‐sparing surgery without being pressed for time.
The feasibility of establishing a programme of adjuvant autologous vaccination for renal cell carcinoma
Authors: Prestwich Robin J. , Scott Karen J. , Brown Joanne , Harnden Patricia , Whelan Peter , Cartledge Jon , O’Donnell Dearbhaile , Pandha Hardev S. , Selby Peter J. , Banks Rosamund E. , Merrick Alison E. , Melcher Alan A.
Published: February 2009

OBJECTIVE

To report the results of a programme aimed at determining the feasibility of autologous renal cell carcinoma (RCC) tissue collection and vaccine preparation within the setting of a UK National Health Service Cancer Centre.

PATIENTS AND METHODS

Patients undergoing nephrectomy for suspected renal tumours were identified from theatre lists between April 2005 and July 2007. Samples of tumour were freshly cut from nephrectomy specimens. If tissue collection failed the reason was recorded prospectively. Cell viability was assessed after sample sieving. Freeze‐thaw lysates were prepared from viable tumour cells, and the immunogenicity tested by pulsing onto dendritic cells (DC).

RESULTS

Of 84 patients, 83 had a histological diagnosis of RCC; samples were obtained from 29 of these 83 (35%). Reasons for failure in tissue collection included that the tumour was too small or haemorrhagic/necrotic, pre‐surgical embolization, and difficulties with fresh tumour collection out of normal working hours. Viable tumour cells were obtained in 12 of the 29 samples (41%); no factor was able to predict the production of viable cells. Unmodified lysates did not activate DC.

CONCLUSION

An autologous RCC vaccination programme might fail to generate vaccines for a substantial proportion of eligible patients in the setting of a clinical cancer centre.
Incidentally discovered renal masses: oncological and perioperative outcomes in patients with delayed surgical intervention
Authors: Rais‐Bahrami Soroush , Guzzo Thomas J. , Jarrett Thomas W. , Kavoussi Louis R. , Allaf Mohamad E.
Published: February 2009

OBJECTIVE

To evaluate whether a period of surveillance before laparoscopic partial nephrectomy (LPN) affects the pathological and clinical outcomes of patients with a small renal mass, as although the standard treatment for an enhancing renal mass remains surgical extirpation, surveillance of small renal masses has become a potential option in appropriately selected patients.

PATIENTS AND METHODS

The clinical and pathological data of 32 patients who had LPN for a small clinical stage T1a renal mass after a surveillance period of ≥3 months was analysed and compared with those from a matched group of patients who had immediate LPN.

RESULTS

The mean interval between diagnosis and LPN in the surveillance group was 15.8 months. The mean tumour size at presentation was 1.97 cm in the surveillance group with a growth rate of 0.56 cm/year. The proportion of patients upstaged from cT1 to pT3a was no different between the groups. There was no difference between the groups in warm ischaemia time, blood loss, operating room time, complications and length of stay after LPN. At the last follow‐up (mean 60 months) there were no local recurrences or distant metastases.

CONCLUSION

Baseline size does not appear to predict tumour malignant potential, and growth rates of malignant and benign tumours were similar in the two groups. A delay in surgery of >1 year was not associated with added surgical morbidity, nor did it preclude patients from undergoing definitive surgery via a minimally invasive approach with an equally effective early oncological outcome.
Combined low‐dose flutamide plus finasteride vs low‐dose flutamide monotherapy for recurrent prostate cancer: a comparative analysis of two phase II trials with a long‐term follow‐up
Authors: Bañez Lionel L. , Blake Gary W. , McLeod David G. , Crawford E. David , Moul Judd W.
Published: February 2009

OBJECTIVE

To compare the efficacy and tolerability of peripheral androgen blockade using combined low‐dose flutamide plus finasteride vs low‐dose flutamide monotherapy for treating biochemical relapse after the definitive management of prostate adenocarcinoma.

PATIENTS AND METHODS

Fifty‐six men treated for biochemical relapse of prostate cancer were enrolled prospectively in a phase II trial at the Walter Reed Army Medical Center from 1997 to 2001. Thirty‐six men were treated with flutamide (125 mg twice daily) and finasteride (5 mg twice daily), and 20 men received low‐dose flutamide only after biochemical recurrence (prostate‐specific antigen, PSA, level ≥0.4 ng/mL). Cox proportional hazards analyses were used to compare the risk of progression between the groups.

RESULTS

Patients on combined and monotherapy had a median follow‐up of 54 and 43.5 months, respectively. Seven men (19%) in the combined arm remain in the study with no progression, while five (25%) on monotherapy continue and are progression‐free. Men on combined therapy had a greater decrease in their PSA level (P = 0.002). Multivariate analysis showed that men on combined therapy had significantly less risk of progression than men on monotherapy (hazard ratio 0.21, 95% confidence interval 0.07–0.63, P = 0.005). There was no significant difference in the frequency of side‐effects between the groups. Toxicities were reported to be mild.

CONCLUSIONS

Our analysis suggests the therapeutic value of low‐dose flutamide alone or combined with finasteride as first‐line agents in a possible graduated approach for treating PSA‐only recurrent prostate cancer. Due to unwanted metabolic effects associated with traditional hormonal agents, phase III trials comparing both regimens with current therapies are warranted.
Routine surveillance cystoscopy for patients with augmentation and substitution cystoplasty for benign urological conditions: is it necessary?
Authors: Hamid Rizwan , Greenwell Tamsin J. , Nethercliffe Janine M. , Freeman Alexander , Venn Suzie N. , Woodhouse Christopher R.J.
Published: February 2009

OBJECTIVE

To evaluate screening cystoscopy as the long‐term follow up in patients with an enterocystoplasty for ≥10 years.

PATIENTS AND METHODS

We performed a prospective analysis of 92 consecutive patients who attended our endoscopy suite for regular check cystoscopy as per standard follow‐up. This is performed for all patients with cystoplasty performed at our institute after 10 years. The data were recorded on patient demographics, original diagnosis and type of cystoplasty. In all, 53 of these patients consented to undergo bladder biopsies at the same time.

RESULTS

The median (range) follow‐up was 15 (10–33) years. No cancer was identified with either surveillance cystoscopy or on routine biopsies. Chronic inflammation was identified in 25 biopsies (27%). Villous atrophy was present in 12 (55%) ileal patch and three (12.5%) colonic patch biopsies. During this study, the first and only case of malignancy in a cystoplasty at our institution was diagnosed in a symptomatic patient. She had intermittent haematuria and recurrent urinary tract infections (UTIs). She previously had a normal surveillance cystoscopy.

CONCLUSIONS

We feel that it is not necessary to perform yearly check cystoscopies in patients with augmented bladders at least in the first 15 years, as cancer has not yet been detected with surveillance cystoscopy in this patient group. However, if the patient develops haematuria or other worrisome symptoms including suprapubic pain and recurrent unexplained UTIs a full evaluation, including cystoscopy and computerized tomography should be undertaken.
Meta‐analysis: does lidocaine gel before flexible cystoscopy provide pain relief?
Authors: Aaronson David S. , Walsh Thomas J. , Smith James F. , Davies Benjamin J. , Hsieh Michael H. , Konety Badrinath R.
Published: February 2009

OBJECTIVE

To consolidate previous reports and conduct a meta‐analysis to draw further conclusions on the efficacy of the instillation of lidocaine gel before flexible cystoscopy, as it has had varying efficacy in several randomized controlled studies.

METHODS

We reviewed previous reports cited in PubMed, Biosis and the Cochrane Library, identified by a professional librarian searching for English language‐only randomized controlled studies involving the keywords, lidocaine, cystoscopy, gel and pain, yielding 14 studies. Ten studies were excluded as they provided no comparison with appropriate control groups or contained insufficient data for analysis. Attempts to contact the authors of these studies yielded no additional data. A meta‐analysis was conducted using a random‐effects model.

RESULTS

Four studies were included in the analysis, two double‐blind and two single‐blind, totalling 411 male patients. Three of the studies found no statistical improvement and one study found a statistically significant improvement in pain relief using lidocaine gel. Studies varied on the quantity of gel instilled and on the dwell time of gel before cystoscopy. The meta‐analysis found that subjects who received anaesthetic‐impregnated gel were 1.7 times more likely not to experience moderate to severe pain (<2, 3 or 30, based on the scale used; odds ratio 1.7, 95% confidence interval 1.1–2.8) than subjects who did not have intraurethral instillation of gel.

CONCLUSIONS

These data suggest that intraurethral instillation of lidocaine gel vs plain lubricating gel reduces the likelihood of moderate to severe pain during flexible cystoscopy.
Is there a rationale for the chronic use of phosphodiesterase‐5 inhibitors for lower urinary tract symptoms secondary to benign prostatic hyperplasia?
Authors: Roumeguère Thierry , Zouaoui Boudjeltia K. , Hauzeur Claude , Schulman Claude , Vanhaeverbeek Michel , Wespes Eric
Published: February 2009

OBJECTIVES

To critically review the physiological roles of phosphodiesterase‐5 (PDE5), to explain and support the putative impact and clinical significance of PDE5 inhibitors (PDE5‐Is) in the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED), both highly prevalent in men aged ≥50 years, as PDE5‐Is are very effective as a first‐line therapy for ED, and attractive for further physiological functional investigations.

METHODS

We searched Medline for peer‐reviewed articles in English, from 1991 to 2008, to provide a critical contemporary review of PDE5 pertaining to the potential interest of findings supporting a role for PDE5‐Is in LUTS due to BPH. The selection of papers was based on the relevance of subject matter. A critical analysis of available fundamental and clinical data is reported.

RESULTS

Several studies assessed the role of the nitric oxide/cGMP signalling pathway in the regulation of the prostate tone, with the support of clinical observations. PDE5‐Is can also represent a potential mode of action allowing the targeting of transcriptional activity implicated in the regulation of the progression of the inflammatory process involved in BPH. PDE5‐Is can inhibit human stromal cell proliferation of the prostate mediated by cGMP accumulation. New targeting hypotheses of pathophysiological processes are also reported.

CONCLUSIONS

There is evidence that LUTS and ED are strongly linked. This analysis of the regulatory basis of PDE5 biology could indicate several directions of investigation. However, it is necessary to devise well‐designed large prospective studies that would produce significant data before this approach becomes a standard of care.
Outcomes of radical prostatectomy for patients with clinical stage T1a and T1b disease
Authors: Helfand Brian T. , Mongiu Anne K. , Kan Donghui , Kim Dae‐Yun , Loeb Stacy , Roehl Kimberly A. , Meeks Joshua J. , Smith Norm D. , Catalona William J.
Published: February 2009

OBJECTIVE

To compare the outcomes between patients with stage T1a/b with those of patients with T1c cancer of the prostate treated with radical retropubic prostatectomy (RRP), as the appropriate management of clinical stage T1a/b prostate cancer is subject to debate; although many patients are managed expectantly, some have adverse pathological features suggesting that more active treatment might be beneficial.

PATIENTS AND METHODS

From 1983 to 2003, 3478 men had RRP by one surgeon. From this group, we retrospectively identified 29 men with clinical stage T1a and 83 with clinical stage T1b disease. Using statistical analysis we compared the treatment outcomes of these patients with those of 1774 men with clinical stage T1c disease.

RESULTS

Men with T1a/b disease had a significantly lower preoperative prostate‐specific antigen (PSA) level, a greater proportion with organ‐confined disease, and a lower mean/median prostatectomy Gleason score than those with T1c disease. Also, men with T1a/b disease were less likely to be potent before surgery, although the frequency of recovery of potency was similar among all groups. On multivariate analysis with age, year of surgery, PSA level and Gleason score, there was no statistical difference in the rates of biochemical recurrence and the 10‐year overall survival rates. However, patients with T1b disease had a significantly lower cancer‐specific survival.

CONCLUSIONS

T1a and T1b prostate cancer can be associated with aggressive pathological features and have a similar rate of progression as clinical stage T1c disease. That notwithstanding, most patients in the study were cured with RRP and had favourable long‐term functional outcomes.
Acupuncture for treating erectile dysfunction: a systematic review
Authors: Lee Myeong Soo , Shin Byung‐Cheul , Ernst Edzard
Published: February 2009

OBJECTIVE

We evaluated the current evidence for the use of acupuncture to treat erectile dysfunction (ED).

METHODS

Systematic searches were conducted in 15 electronic databases, with no language restrictions. Hand‐searches included conference proceedings and our files. All clinical studies of acupuncture as a treatment for ED were considered for inclusion, and their methodological quality was assessed using the Jadad score.

RESULTS

Of the four studies included, one randomized controlled trial (RCT) showed beneficial effects of acupuncture compared with sham acupuncture in terms of response rate, while another RCT found no effects of acupuncture. The remaining two studies were uncontrolled clinical trials. Collectively these data showed that RCTs of acupuncture for ED are feasible but scarce. Most investigations had methodological flaws, e.g. inadequate study design, poor reporting of results, small sample size, and publication without appropriate peer review process.

CONCLUSION

The evidence is insufficient to suggest that acupuncture is an effective intervention for treating ED. Further research is required to investigate whether there are specific benefits of acupuncture for men with ED.
Total phallic reconstruction after penile amputation for carcinoma
Authors: Garaffa Giulio , Raheem Amr A. , Christopher Nim A. , Ralph David J.
Published: February 2009

OBJECTIVE

To report our experience of total phallic reconstruction (TPR) with the use of the radial‐artery free flap (RAFF) in patients who have had a subtotal penectomy for penile or urethral cancer, as the goal of TPR is the creation of a sensate and cosmetically acceptable phallus with an incorporated neourethra that allows the patient to void while standing, and with the insertion of a penile implant to resume sexual activities, improving quality of life.

PATIENTS AND METHODS

The notes of the 15 patients who had undergone RAFF TPR between January 1998 and May 2008 were reviewed retrospectively. The surgical outcome, cosmesis of the phallus, complications, eventual need for revision surgery and patient satisfaction were recorded during the follow‐up.

RESULTS

This technique allowed the reconstruction of a cosmetically acceptable phallus in all patients. After a median (range) follow‐up of 20 (1–68) months all patients were satisfied with the cosmesis and size of the phallus, and 14 were able to void while standing. Among the seven patients who have subsequently had insertion of a penile prosthesis, five can now engage in sexual intercourse. Urethral strictures and fistulae were the commonest complications in, respectively, three and four cases, and one patient had his penile prosthesis explanted because of infection.

CONCLUSIONS

RAFF phalloplasty is an excellent technique for TPR, giving excellent cosmetic and functional results.
1H‐nuclear magnetic resonance spectroscopy for identifying and quantifying common uropathogens: a metabolic approach to the urinary tract infection
Authors: Gupta Ashish , Dwivedi Mayank , Mahdi Abbas Ali , Gowda G.A. Nagana , Khetrapal Chunni Lal , Bhandari Mahendra
Published: February 2009

OBJECTIVE

To address the shortcomings of urine culture for the diagnosis of urinary tract infection (UTI), we used 1H‐nuclear magnetic resonance (NMR) spectroscopy for identifying and quantifying Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia and Proteus mirabilis.

PATIENTS, SUBJECTS AND METHODS

Urine samples from patients with suspected UTI (617), healthy volunteers (50) and commercially available standard strains of E. coli, K. pneumonia, P. aeruginosa, Enterobacter, Acinobacter, Pr. mirabilis, Citrobacter frundii, Streptococcus saprophyticus and Enterococcus faecalis were assessed between 2003 and 2006. 1H‐NMR spectra were recorded on a 400 MHz spectrophotometer; to quantify the bacteria we estimated the areas under the spectral peaks of the specific metabolic product compared with the known concentration of trimethyl silyl propionic acid. All urine specimens were cultured in addition to an assessment by NMR spectroscopy.

RESULTS

Preliminary urinary spectroscopy of the unprocessed samples showed peaks of nonspecific metabolites such as succinate, acetate, lactate and ethanol, indicating infected samples. Based on the results from processed samples, 93% (240/256) of E. coli, 92% (101/110) of K. pneumoniae, 93% (56/60) of P. aeruginosa and eight of 10 Pr. mirabilis could be diagnosed with NMR (numerator) and urine culture (denominator). The remaining samples were sterile and/or had a bacterial population of <103 colony‐forming units (CFU)/mL. The NMR method diagnosed bacterial densities of >103 CFU.

CONCLUSIONS

The identification of the common uropathogens E. coli, K. pneumoniae, P. aeruginosa and Pr. mirabilis by NMR spectroscopy has a shorter reporting time and can be used to differentiate between infected, contaminated and sterile specimens.
Penile fractures: immediate surgical approach with a midline ventral incision
Authors: Mazaris Evangelos M. , Livadas Konstantinos , Chalikopoulos Dimitrios , Bisas Apostolïs , Deliveliotis Charalambos , Skolarikos Andreas
Published: February 2009

OBJECTIVES

To present our experience with immediate surgical treatment of penile fractures, using a midline ventral incision, as the choice of either immediate surgical or conservative treatment in penile fractures, as well as the type of surgical incision, remains controversial.

PATIENTS AND METHODS

In a period of 5 years (2002–2006) eight patients were treated in our department for a penile fracture. The diagnosis was established by a history and clinical examination. In six patients ultrasonography before surgery located the fracture in the right corpus cavernosum, distally from the penoscrotal junction. All patients had immediate surgery using a midline ventral incision and were followed for a mean of 1 year.

RESULTS

All patients presented with a penile haematoma, while five and two had concomitant scrotal and perineal haematomas, respectively. Penile urethral rupture was associated with corporal cavernosal rupture in one patient. In all patients a 5‐cm midline ventral incision was made at the penile raphe. There was unilateral rupture of the corpus cavernosum in seven patients and bilateral rupture with concomitant urethral rupture in one. The fascial defect was sutured in all patients and an end‐to‐end anastomosis made if there was urethral rupture. The early and late periods after surgery were uneventful. Erectile function was unaffected during the follow‐up.

CONCLUSION

Immediate intervention for penile fractures, using a midline ventral incision, achieves good early and late results. Our technique has the advantage of direct access to both corpora cavernosa and the anterior urethra, with a minimal skin incision.
THEFT DETECTION WITH INVENTORY MEASUREMENT ERROR
Authors: Winsen Joseph K.
Published: February 2009

Measurement errors introduce uncertainty into the inventory determination process. Such errors arise from human and/or instrument deficiencies. When inventories are valuable, this inventory determination uncertainty provides an opportunity for theft to be disguised as measurement error. This vulnerability is of current concern in the nuclear materials industry. This paper, which is essentially exploratory in nature, compares and contrasts classical hypothesis testing and game theory as approaches to theft detection in the presence of measurement error.
TAXATION, BANKRUPTCY COSTS, AND CAPITAL STRUCTURE DECISIONS WITHIN THE CONTEXT OF A MULTI‐PERIOD CAPITAL ASSET PRICING MODEL
Authors: McDougall F. M.
Published: February 2009

In this paper, a multi‐period version of the CAPM is used to establish conditions for an optimal capital structure in the presence of a tax on corporate earnings, and bankruptcy costs. It is shown that the optimal point is reached when the marginal tax advantage arising from an increase in debt, is equal to the marginal increase in expected bankruptcy penalties.
A MODIFIED VERSION OF THE KELLER PLAN IN AN ADVANCED FINANCIAL ACCOUNTING COURSE
Authors: Stewart I. C.
Published: February 2009

This note provides an account of the introduction of a modified version of the Keller Plan in an advanced financial accounting course. The experiment involved (1) issuing detailed study guides which included a specification of behavioural outcomes; (2) abandoning large group lectures in favour of small group discussions and (3) measuring achievement by multiple choice testing. Although the degree of individualised learning was limited, most students felt that the changes made ‐ especially the introduction of discussion groups ‐ were of some improvement in their learning and development.
Restrictive Covenants and Accounting Information in the Market for Convertible Notes: Further Evidence
Authors: Stokes Don , Leong Tay Kok
Published: February 2009

This survey extends Whittred and Zimmer's [1986] survey of the restrictive covenants and accounting rules negotiated in debenture, unsecured and convertible note deeds by analysing the contents of 84% of convertible note deeds issued between 1976 and 1985. The paper also examines negotiated reporting obligations and controls for regulatory effects on the covenants and accounting rules. Conclusions from the survey are compared to those of Whittred and Zimmer [1986].
The Gordon‐Shapiro Dividend Growth Formula and Inflation
Authors: Lally Martin
Published: February 2009

The share valuation model which discounts expected dividends is widely accepted in the finance literature. Beyond some point a constant growth rate in expected ividends is assumed. The accepted specification of this growth rate involves a constant retention rate for earnings, and is valid under no inflation. This paper derives the corresponding nominal formula under inflation using a retention rate defined in terms of inflation accounted earnings, and shows that its real counterpart is the accepted formula. It is also shown under inflation that the nominal formula using a retention rate defined in terms of historic cost earnings is considerably more complicated, and that a major error in share valuation results from mistakenly assuming the accepted formula to be valid in nominal terms with a retention rate defined in terms of inflation accounted earnings.
CV OR NOT CV? THAT IS THE QUESTION
Authors: Patterson Cleveland S.
Published: February 2009

There is considerable confusion and contradiction in the standard finance textbooks regarding the question as to whether investment risks should be estimated using the standard deviation of possible outcomes, or their coefficient of variation. This confusion arises in part from failure to distinguish between the relative risk and the relative attractiveness of alternative projects. It also arises from failure to distinguish between the risk implications of market returns variability and those of accounting returns variability.
MANAGERIAL REMUNERATION AND ACCOUNTING FOR RECURRING EXTRAORDINARY ITEMS
Authors: Hoffman Tony , Zimmer Ian
Published: February 2009

The Australian standard on income statements (AAS 1) was recently amended to require that extraordinary items be non‐recurring. Although the amendment applies from 1990, the Corporations Law requires that comparative financial statements for 1989, complying with the new rule, be included with the 1990 financial statements. Comparison of these with actual financial statements for 1989 indicates how the statements would have differed in 1989 if the standard had then required extraordinary items to be non‐recurring. The differences are investigated to partially explain cross sectional differences in firms' classification criteria. Results imply that managers who are remunerated highly (relative to the magnitude of the earnings of the firm) prefer to classify gains as operating and losses as extraordinary.
Sex differences in obesity and the regulation of energy homeostasis
Authors: Lovejoy J. C. , Sainsbury A. ,   the Stock Conference 2008 Working Group
Published: February 2009

Obesity prevalence is generally higher in women than in men, and there is also a sex difference in body fat distribution. Sex differences in obesity can be explained in part by the influence of gonadal steroids on body composition and appetite; however, behavioural, socio‐cultural and chromosomal factors may also play a role. This review, which evolved from the 2008 Stock Conference on sex differences in obesity, summarizes current research and recommendations related to hormonal and neuroendocrine influences on energy balance and fat distribution. A number of important gaps in the research are identified, including a need for more studies on chromosomal sex effects on energy balance, the role of socio‐cultural (i.e. gender) factors in obesity and the potential deleterious effects of high‐fat diets during pregnancy on the foetus. Furthermore, there is a paucity of clinical trials examining sex‐specific approaches and outcomes of obesity treatment (lifestyle‐based or pharmacological), and research is urgently needed to determine whether current weight loss programmes, largely developed and tested on women, are appropriate for men. Last, it is important that both animal and clinical research on obesity be designed and analysed in such a way that data can be separately examined in both men and women.
How to Use Technical Terms in Ads? An FCB Grid Perspective
Authors: Teng Ching‐I , Huang Li‐Shia , Hsieh Pin‐Chun
Published: February 2009

Research on the optimal use of technical terms in advertising can help sponsors effectively communicate complex technical concepts to consumers. This study therefore examined how technical terms, and the extent to which they are explained, influence advertising effectiveness for four product types in the FCB grid. The sample comprised 436 college students. The analytical results of this study indicate that using two technical terms together with detailed explanation of the terms improves consumer attitudes towards the ad and consumer evaluation of the advertised product for thinking (products meeting consumer utilitarian needs) and high involvement products. For thinking and low involvement products, using two technical terms together with detailed/rough explanation improves consumer attitudes towards the ad and consumer evaluation of the advertised product. Moreover, using two unexplained technical terms improves consumer attitudes towards the ad for feeling (those providing consumer gratification, social acceptance and sensory satisfaction) and high involvement products. Using no technical terms improves consumer attitudes towards the ad for feeling and low involvement products. Finally, theoretical and managerial implications and future research directions are discussed.
A Comparison of Tabular PDF Inversion Methods
Authors: Cline D. , Razdan A. , Wonka P.
Published: February 2009

The most common form of tabular inversion used in computer graphics is to compute the cumulative distribution table of a probability distribution (PDF) and then search within it to transform points, using an O(log n) binary search. Besides the standard inversion method, however, several other discrete inversion algorithms exist that can perform the same transformation inO(1) time per point. In this paper, we examine the performance of three of these alternate methods, two of which are new.
BTF‐CIELab: A Perceptual Difference Measure for Quality Assessment and Compression of BTFs
Authors: Guthe Michael , Müller Gero , Schneider Martin , Klein Reinhard
Published: February 2009

Driven by the advances in lossy compression of bidirectional texture functions (BTFs), there is a growing need for reliable methods to numerically measure the visual quality of the various compressed representations. Based on the CIE ΔE00 colour difference equation and concepts of its spatio‐temporal extension ST‐CIELab for video quality assessment, this paper presents a numerical quality measure for compressed BTF representations. By analysing the BTF in its full six‐dimensional (6D) space, light and view transition effects are integrated into the measure. In addition to the compressed representation, the method only requires the source BTF images as input and thus aids the objective evaluation of different compression techniques by means of a simple numerical comparison. By separating the spatial and angular components of the difference measure and linearizing each of them, the measure can be incorporated into any linear or multi‐linear compression technique. Using a per‐colour‐channel principal component analysis (PCA), compression rates of about 500:1 can be achieved at excellent visual quality.
Visual‐Quality Optimizing Super Resolution
Authors: Liu F. , Wang J. , Zhu S. , Gleicher M. , Gong Y.
Published: February 2009

In this paper, we propose a robust image super‐resolution (SR) algorithm that aims to maximize the overall visual quality of SR results. We consider a good SR algorithm to be fidelity preserving, image detail enhancing and smooth. Accordingly, we define perception‐based measures for these visual qualities. Based on these quality measures, we formulate image SR as an optimization problem aiming to maximize the overall quality. Since the quality measures are quadratic, the optimization can be solved efficiently. Experiments on a large image set and subjective user study demonstrate the effectiveness of the perception‐based quality measures and the robustness and efficiency of the presented method.
Tangential Distance Fields for Mesh Silhouette Problems
Authors: Olson M. , Zhang H.
Published: February 2009

Aabstract

We consider a tangent‐space representation of surfaces that maps each point on a surface to the tangent plane of the surface at that point. Such representations are known to facilitate the solution of several visibility problems, in particular, those involving silhouette analysis. In this paper, we introduce a novel class of distance fields for a given surface defined by its tangent planes. At each point in space, we assign a scalar value which is a weighted sum of distances to these tangent planes. We call the resulting scalar field a ‘tangential distance field’ (TDF). When applied to triangle mesh models, the tangent planes become supporting planes of the mesh triangles. The weighting scheme used to construct a TDF for a given mesh and the way the TDF is utilized can be closely tailored to a specific application. At the same time, the TDFs are continuous, lending themselves to standard optimization techniques such as greedy local search, thus leading to efficient algorithms. In this paper, we use four applications to illustrate the benefit of using TDFs: multi‐origin silhouette extraction in Hough space, silhouette‐based view point selection, camera path planning and light source placement.
Telomeres in a Life-Span Perspective
Authors: Epel Elissa S.
Published: February 2009

In order to more fully understand associations between psychological stress and health, it is helpful for researchers to identify “psychobiomarkers,” or biological measures that are regulated in part by psychological function and that predict longevity. Telomere length appears to be such a measure. Telomeres, the protective caps at the tips of chromosomes, shorten with age, and this shortening predicts disease and longevity. Leukocyte telomere length may be best viewed through a life-span approach, as it reflects in part the cumulative number of cell divisions that have occurred and the long-term biochemical environment. Recently, a critical mass of studies demonstrated that telomeres appear to shorten with chronic stress, although the mechanisms are unknown. This paper reviews what appear to be malleable determinants of rate of telomere attrition, focusing on early life chronic stressors and metabolic adversity (poor nutrition during development, and obesity). The next generation of research will benefit from experimental and longitudinal models integrating genetic variation, social environments, life experience, and health behaviors.
Metacognition in Humans and Animals
Authors: Kornell Nate
Published: February 2009

It has long been assumed that metacognition—thinking about one's own thoughts—is a uniquely human ability. Yet a decade of research suggests that, like humans, other animals can differentiate between what they know and what they do not know. They opt out of difficult trials; they avoid tests they are unlikely to answer correctly; and they make riskier “bets” when their memories are accurate than they do when their memories are inaccurate. These feats are simultaneously impressive and, by human standards, somewhat limited; new evidence suggests, however, that animals can generalize metacognitive judgments to new contexts and seek more information when they are unsure. Metacognition is intriguing, in part, because of parallels with self-reflection and conscious awareness. Consciousness appears to be consistent with, but not required by, the abilities animals have demonstrated thus far.
Current Directions in Mediation Analysis
Authors: MacKinnon David P. , Fairchild Amanda J.
Published: February 2009

Mediating variables continue to play an important role in psychological theory and research. A mediating variable transmits the effect of an antecedent variable on to a dependent variable, thereby providing more detailed understanding of relations among variables. Methods to assess mediation have been an active area of research for the last two decades. This paper describes the current state of methods to investigate mediating variables.