bluuebunny/crossref_metadata_2025 huggingface dataset:
A three‐centre experience of orthotopic neobladder reconstruction after radical cystectomy: revisiting the initial experience, and results in 104 patients
Authors: Meyer Jon‐Paul , Blick Christopher , Arumainayagam Nimalan , Hurley Katrina , Gillatt David , Persad Rajendra , Fawcett Derek
Published: December 2008

OBJECTIVE

To assess, in a retrospective three‐centre series, a second analysis of the initial experience and results of patients undergoing radical cystectomy (RC) and orthotopic neobladder reconstruction (ONR) after an additional 4 years of follow‐up.

PATIENTS AND METHODS

The medical records of 104 suitable consecutive patients undergoing RC and ONR between June 1994 and April 2003 were reviewed retrospectively. The complications, mortality, continence and cancer control rates were all recorded.

RESULTS

The median (range) follow‐up was 88 (52–156) months; 90 patients had reconstruction with a ‘Studer’ neobladder, 12 with a Hautmann W pouch and 2 with a ‘T pouch’ ileal neobladder. There were 24 early complications, and one death after surgery. There were 32 late complications. The daytime continence rate was 98% and the nocturnal continence rate was 76%. Ten patients required intermittent self‐catheterization (ISC). In all, 30 patients had local and/or distant recurrences, all of whom died. Seven patients died from other causes.

CONCLUSIONS

ONR provides excellent long‐term continence rates and both acceptable complication and mortality rates. Suitable patients undergoing RC should be offered ONR.
Two centuries of cystoscopy: the development of imaging, instrumentation and synergistic technologies
Authors: Samplaski Mary K. , Jones J. Stephen
Published: December 2008

The cystoscope used today is the product of centuries of development. The desire to view the cavities of the body was first described several centuries ago. The earliest true prototype was Bozinni’s 1805 urethral viewing tube, on which many others were based. These primitive instruments were challenging to use for the operator, uncomfortable for the patient, and dangerous for both. Patient positioning was based on the method of bladder distension and the goal of the operation, rather than comfort. Images visualized by early models were inverted and backwards, and required the operator to be skilled in correcting this image. Reflected candlelight was used for illumination, and objects appeared small and distant. With the advent of lenses, prisms and the incandescent light, cystoscopy advanced to Nitze’s prototype, a forerunner of the current cystoscope. Once the image quality was improved, instrumentation through the cystoscope was introduced, broadening the scope of urology, from the management of venereal disease to a premier surgical speciality. Finally, the invention of fibre optics and digital imaging provided the cystoscope used by urologists worldwide, giving unparalleled image quality, allowing for educational opportunities and a quality of patient care unimaginable to the early pioneers. An understanding of this past brings not only an appreciation of the technology currently available, but also a glimpse into what the cystoscope has the potential to become. From this past, it is clear that today’s cystoscope is merely a forerunner of that which the future will bring.
Effect of ageing and body mass index on prostate‐specific antigen levels among Chinese men in Singapore from a community‐based study
Authors: Chia Sin‐Eng , Lau Weber K.O. , Chin Chong Min , Tan James , Ho Siew Hong , Lee June , Cheng Christopher
Published: December 2008

OBJECTIVE

To assess the effect of ageing and body mass index (BMI) on prostate‐specific antigen (PSA) among Chinese men from the results of the 2005 Prostate Awareness Week in Singapore.

SUBJECTS AND METHODS

In all, 2714 men participated in the programme, consisting of 2431 Chinese, 114 Malays, 117 Indians and 52 ‘others’. Of these, 2410 Chinese men who had a PSA level of <20 ng/mL and were aged >50 years but <80 years were included in the analysis. Height and weight were used to calculate the BMI. The relationship between age and PSA levels was analysed using linear regression and bivariate correlation, and the associations among different groups of BMI and PSA levels were analysed using analysis of variance and covariance.

RESULTS

PSA levels were significantly correlated with age (correlation coefficient, r = 0.27, P < 0.001). Analyses showed a significant inverse association between PSA level and BMI; mean PSA levels decreased with increasing BMI for both standards (standard classification; geometric mean, GM, PSA of 1.08, 1.06, 0.96, 0.83 ng/mL for a BMI of <18.5, 18.5–24.9, 25–29.9 and ≥30 kg/m2, respectively, P trend <0.01; and for Asian classification, GM PSA 1.08, 1.09, 0.96, 0.91 ng/mL for a BMI of <18.5, 18.5–22.9, 23–27.5 and ≥27.5, respectively, P trend <0.001). There were significant differences (P < 0.05) in the age‐adjusted GM PSA levels for the groups with BMI <25 (1.05 ng/mL) and BMI ≥25 kg/m2 (0.97 ng/mL). Similarly, there were significant differences (P < 0.05) in the age‐adjusted GM PSA levels in those with a BMI of <30 (1.03 ng/mL) and ≥30 kg/m2 (0.85 ng/mL).

CONCLUSION

These data suggest that the BMI in Chinese men in Singapore is significantly associated with PSA levels, especially among the obese men aged 70–79 years.
Bladder outlet obstruction accelerates bladder carcinogenesis
Authors: Matsumoto Seiji , Shimizu Nobutaka , Hanai Tadashi , Uemura Hirotsugu , Levin Robert
Published: December 2008

OBJECTIVE

To examine the correlation between partial bladder outlet obstruction (PBOO) and bladder carcinogenesis.

MATERIALS AND METHODS

Female Wistar rats (6 weeks old) were divided into three groups of 10 each: group 1 was exposed to n‐butyl‐n‐butanol nitrosamine (BBN, a carcinogen) in drinking water for 8 weeks; group 2 had PBOO induced surgically after exposure to BBN for 8 weeks; group 3 had a sham operation and the rats drank normal water (control group). After 20 weeks, all of the rats were killed humanely and their bladders analysed.

RESULTS

There were no significant differences in body weight among the groups. The bladder weight of group 2 was significantly greater than either group 1 or group 3. Histopathologically, bladder smooth muscle hypertrophy was the major cause of the increased bladder weight for group 2. In group 2 there were increases in bladder wall thickness and many nipple‐shaped urothelial tumours. Basic fibroblast growth factor and hypoxia‐inducible factor‐1α expression were significantly greater in group 2 than in groups 1 and 3.

CONCLUSIONS

Exposure of the bladder to carcinogens during bladder hyperplasia and hypertrophy induced by PBOO results in a greater incidence of superficial bladder carcinoma.
Can we avoid surgery in elderly patients with renal masses by using the Charlson comorbidity index?
Authors: O’Connor Kevin M. , Davis Niall , Lennon Gerry M. , Quinlan David M. , Mulvin David W.
Published: December 2008

OBJECTIVE

To determine the safety of surveillance for localized contrast‐enhancing renal masses in elderly patients whose comorbidities precluded invasive management; to provide an insight into the natural history of small enhancing renal masses; and to aid the clinician in identifying those patients who are most suitable for a non‐interventional approach.

PATIENTS AND METHODS

We conducted a retrospective chart review of 26 consecutive patients (16 men and 10 women), who were followed for ≥1 year, with localized solid enhancing renal masses between 1998 and 2006. These patients were unfit or unwilling to undergo radical or partial nephrectomy. None had their tumours surgically removed. Study variables included age, presentation, tumour size, growth rate, Charlson comorbidity index (CMI) and available pathological data.

RESULTS

The mean (range) patient age was 78.14 (63–89) year, with a mean follow‐up of 28.1 (12–72) months. The mean tumour size was 4.25 (2.5–8.7) cm at diagnosis. The tumour growth rate was 0.44 cm/year; among smaller masses (T1a) it was 0.15 cm/year, vs 0.64 cm/year in the larger masses (T1b and T2). The mean CMI was 2.96. There were 11 deaths overall; 10 patients died from unrelated illnesses. One death was directly attributable to metastatic renal cancer; this patient had an initial tumour diameter of 5.4 cm and a CMI of 6. All patients who died had a CMI of ≥3.

CONCLUSIONS

Elderly patients with small renal tumours (T1a) and comorbidity scores of ≥3 were more likely to die as a result of their comorbidities rather than the renal tumour. Surveillance of small renal masses appears to be a safe alternative in elderly patients who are poor surgical candidates, where the overall growth rate appears to be slow.
Spacing Effects in Learning
Authors: Cepeda Nicholas J. , Vul Edward , Rohrer Doug , Wixted John T. , Pashler Harold
Published: December 2008

To achieve enduring retention, people must usually study information on multiple occasions. How does the timing of study events affect retention? Prior research has examined this issue only in a spotty fashion, usually with very short time intervals. In a study aimed at characterizing spacing effects over significant durations, more than 1,350 individuals were taught a set of facts and—after a gap of up to 3.5 months—given a review. A final test was administered at a further delay of up to 1 year. At any given test delay, an increase in the interstudy gap at first increased, and then gradually reduced, final test performance. The optimal gap increased as test delay increased. However, when measured as a proportion of test delay, the optimal gap declined from about 20 to 40% of a 1-week test delay to about 5 to 10% of a 1-year test delay. The interaction of gap and test delay implies that many educational practices are highly inefficient.
Categorical Scaling of Duration Bisection in Pigeons (Columba livia), Mice (Mus musculus), and Humans (Homo sapiens)
Authors: Penney Trevor B. , Gibbon John , Meck Warren H.
Published: December 2008

A fundamental assumption underlying research in translational neuroscience is that animal models represent many of the same neurocognitive mechanisms and decision processes used by humans. Clear demonstrations of such correspondences will be crucial to the discovery of the neurobiological underpinnings of higher-level cognition. One domain likely to support fruitful comparisons is interval timing, because humans and other animals appear to share basic similarities in their ability to discriminate the durations of events in the seconds-to-minutes range. Here, we report that in a duration-bisection procedure using a series of anchor durations ranging from 2 through 5 s, pigeon, mouse, and human subjects classified a given signal duration as subjectively shorter than an adjacent, physically shorter signal duration when the two durations lay on opposite sides of a putative category boundary. These bisection reversals provide strong evidence for continuity of temporal cognition across a wide range of vertebrate species.
Stop the Presses
Authors: Aron Adam R. , Verbruggen Frederick
Published: December 2008

How does one control an inappropriate tendency? Many studies have investigated this question by measuring the speed with which subjects stop an initiated response. Yet the rapid stopping of an initiated response is apparently underpinned by a neurocognitive mechanism that has global effects on multiple tendencies. This limits such studies as models of cognitive control because they do not explain the selectivity of control over particular tendencies that is apparent in everyday life. We hypothesized that subjects employ a selective stopping mechanism when they have foreknowledge of which response to stop, but employ a global stopping mechanism when they do not have such foreknowledge. Comparing foreknowledge and noforeknowledge conditions, we show that when subjects have foreknowledge, stopping is indeed more selective, as evidenced by less of an effect on the concurrent execution of an alternative response; however, stopping is also slower when subjects have foreknowledge. Thus, selective and global mechanisms of stopping can be dissociated. We suggest that the selective mechanism is used when people maintain the goal of controlling particular responses, whereas the global mechanism is used when it is essential to stop quickly.
Features for Identification of Uppercase and Lowercase Letters
Authors: Fiset Daniel , Blais Caroline , Éthier-Majcher Catherine , Arguin Martin , Bub Daniel , Gosselin Frédéric
Published: December 2008

The determination of the visual features mediating letter identification has a long-standing history in cognitive science. Researchers have proposed many sets of letter features as important for letter identification, but no such sets have yet been derived directly from empirical data. In the study reported here, we applied the Bubbles technique to reveal directly which areas at five different spatial scales are efficient for the identification of lowercase and uppercase Arial letters. We provide the first empirical evidence that line terminations are the most important features for letter identification. We propose that these small features, represented at several spatial scales, help readers to discriminate among visually similar letters.
Methylprednisolone does not restore biological response in multiple sclerosis patients with neutralizing antibodies against interferon‐β
Authors: Hesse D. , Frederiksen J. L. , Koch‐Henriksen N. , Schreiber K. , Stenager E. , Heltberg A. , Ravnborg M. , Bendtzen K. , Sellebjerg F. , Sorensen P. S.
Published: December 2008

Background and purpose:  Neutralizing antibodies (NAbs) appearing during treatment with Interferon‐beta (IFN‐β) reduce or abolish bioactivity and therapeutic efficacy. Initial combination therapy with methylprednisolone (MP) may reduce the frequency of NAb positive patients. We hypothesized that MP treatment might also reduce NAb levels and re‐establish IFN‐β bioactivity in patients already NAb+, who discontinue IFN‐β therapy.

Methods:  In a 6‐month open‐label trial, we compared monthly high‐dose pulsed MP treatment in 38 Nab positive patients with 35 NAb+, MP‐untreated control patients discontinuing any therapy or switching to glatiramer acetate. All patients were NAb+ with an absent in vivo response to IFN‐β. NAbs were measured using a cytopathic effect assay and expressed as neutralizing capacity (NC) in percentage of added IFN‐β. Bioactivity was expressed as in vivo Myxovirus Resistance Protein A (MxA) mRNA induction in whole blood using real time PCR.

Results:  At the end of study, median NAb NC was 92% in both groups. Eight patients (21%) in the MP group and four patients (11%) in the control group had regained an in vivo MxA response to IFN‐β (P = 0.35).

Conclusions:  Monthly pulsed MP treatment in NAb positive patients has no beneficial effect on NAb status or IFN‐β bioactivity.
Impairment of short‐term memory and Korsakoff syndrome are common in AIDS patients with cytomegalovirus encephalitis
Authors: Pirskanen‐Matell R. , Grützmeier S. , Nennesmo I. , Sandström E. , Ehrnst A.
Published: December 2008

Background and purpose  The diagnosis of cytomegalovirus encephalitis (CMV‐E) in AIDS patients is challenging as other illnesses may obscure the symptoms. Here, we characterize the clinical symptoms of CMV‐E and link them to post‐mortem findings.

Patients and methods  In 254 homosexual men with AIDS, followed from HIV diagnosis to death before the antiretroviral combination therapy era, CMV‐E was suspected in 93 cases. All were CMV‐positive in blood. Neurological examination, including cognitive testing was performed in 34 of them within 6 months before death. CMV‐E was diagnosed by CMV‐PCR in cerebrospinal fluid (n = 24) or by post‐mortem (n = 24).

Results  The majority complained of forgetfulness (91%), balance difficulties (85%) and impotence (85%). Impaired short‐term memory was present in 29 patients. It was extreme in 17, justifying the diagnosis of Korsakoff’s syndrome. This was often associated with infectious CMV in blood (P = 0.01). Brainstem symptoms were found in 19 patients. Post‐mortem examination often revealed ventriculoencephalitis. CMV was found primarily around the ventricles and in other structures, described in Korsakoff′s syndrome.

Conclusion  The location of CMV in the brain corresponded well to the clinical findings, demonstrating the close relationship between the neurological symptoms and the neuroanatomical lesions.
Profile of health‐related quality of life in Nigerian stroke survivors
Authors: Owolabi M. O. , Ogunniyi A.
Published: December 2008

Background and purpose:  No study using a stroke‐specific measure has been previously conducted to determine the profile of health‐related quality of life (HRQOL) in Nigerian stroke patients. Such a study is pre‐requisite to planning of patient‐centered rehabilitative care aimed at maximizing HRQOL improvement. Our objectives were to develop and validate a stroke‐specific HRQOL measure, and determine the profile of HRQOL using it.

Methods:  The HRQOL in stroke patients (HRQOLISP) questionnaire was developed and administered to 100 stroke patients and a control group of 100 age‐ and gender‐matched healthy adults. The Stroke Levity Score (SLS) and modified Rankin Scale (mRS) were applied to measure stroke severity and disability respectively.

Results:  The HRQOLISP surpassed the Nunnaly’s criterion for reliability and was able to discriminate between stroke (HRQOLsum = 73.5 ± 9.1) and normal subjects (HRQOLsum = 84.4 ± 6.9, P = 0.002). It differentiated strokes of various severities in the physical dimension (physical, psychological, cognitive and social domains). SLS and mRS correlated only to the domains in the physical dimension.

Conclusion:  The HRQOLISP demonstrated good content, construct and discriminant validity and internal consistency reliability. Stroke had a multifaceted effect on HRQOL, which was more pronounced in the physical dimension.
Development of a new semi‐quantitative non‐invasive method for evaluating ventricular stroke work
Authors: Cheng Mu‐Hua , Rao Guo‐Hui , Zhou Han‐Jian , Xu Jie‐Hua , Zhang Feng
Published: December 2008

Background and aim:  Ventricular stroke work (SW) is one of the best indices to evaluate ventricular function, however, the SW monitoring mainly depends on the invasive method with the artery catheter. In this paper, our aim is to develop a new semi‐quantitative non‐invasive method for evaluating ventricular SW.

Methods:  The multiple gated cardiac blood pool imaging was done in 25 patients with coronary artery disease and 12 normal controls. A new parameter, the relative stroke work (RSW) of left ventricle, was calculated using an equation derived from the principle of hydrodynamics. The left ventricular SW was analyzed by stroke volume (SV) and mean arterial pressure. Ejected fraction (EF), peak ejected rate (PER) and peak filling rate (PFR) were gotten with the routine software in imaging device.

Results:  The left ventricular RSW was linearly correlated with the SW. The RSW was related to the SV, EF, PER and PFR of the left ventricle. The RSW had regressive relation with SV and PER. The RSW in patients, same as SW, SV, EF, PFR and PER, was noticeably lower than that in normal controls, P<0·01.

Conclusion:  The RSW is a potential and valuable clinical index for evaluation of the ventricular function.
Cyclic Stress Measurement Method Using Grain Size and Occurrence Rate of Grown Grains in Electrodeposited Copper Foil
Authors: Ono Y. , Kitaoka S.
Published: December 2008

Abstract:  The copper electroplating stress measurement method uses the grain growth in copper foil. The grain growth is a kind of thermal recrystallisation that is affected by the magnitude of pre‐straining. As a lot of grain nucleation occurs at the large pre‐straining, the large shearing stress should also lead to the same effect. On the basis of the above, we investigate the stress dependence of the grown grain size. We confirmed that the size of grown grains is expressed by using the three‐parameter Weibull distribution, and the relationship between scale parameter and arithmetic mean of grain size has a linear relationship until the grown grain density reaches 50%. It is also recognised that the mean grown grain size becomes smaller with increasing shearing stress amplitude. To measure the shearing stress amplitude, the relationship between mean grain size, shearing stress amplitude and the number of cycles is experimentally formulated. Moreover, even if the number of cycles is unknown, measuring both grown grain density and mean grain size enables us to estimate the shearing stress amplitude.
Partner support and marital satisfaction: Support amount, adequacy, provision, and solicitation
Authors: LAWRENCE ERIKA , BUNDE MALI , BARRY ROBIN A. , BROCK REBECCA L. , SULLIVAN KIERAN T. , PASCH LAURI A. , WHITE GRACE A. , DOWD CHRISTINA E. , ADAMS ERIN E.
Published: December 2008

To compare the extent to which (a) amount versus adequacy of received support and (b) support provision versus solicitation behaviors predict marital satisfaction, married couples from the United States (N= 275) provided perceptions of received support and participated in 2 support transactions. Actor–partner interdependence modeling and structural equation modeling techniques were employed. Husbands’ perceptions of support adequacy predicted marital satisfaction more than their perceptions of support amount, whereas the results were generally the opposite for wives. Husbands’ provision and wives’ solicitation behaviors predicted marital satisfaction. Results suggest the need to move beyond simple counts of support received to examining support adequacy—and the various behaviors and roles involved in supportive transactions—to enhance theories of support and relationship functioning.
Gender and Rulership in the Medieval German Empire
Authors: Fößel Amalie
Published: December 2008

This article discusses queens’ and empresses’ powers, and the changing scope of their activities, in the Medieval German Empire. As a consors regni and partner in politics, queens and empresses played prominent roles in public life and influenced political decisions in the tenth, eleventh and twelfth centuries. Then, in the course of subsequent centuries, the idea of the queens’ partnership in ruling the realm increasingly disappeared. Some of their duties lapsed, while other responsibilities were taken over by the nobility. Queens could still participate in decision making by influencing the King, but more and more they had to carve out a sphere of action for and by themselves. By the later Middle Ages, queens held political power and exercised rulership in the royal family's hereditary territories, but not in the Empire as a whole.
Surgical Repair of Mid‐body Proximal Sesamoid Bone Fractures in 25 Horses
Authors: BUSSCHERS EVITA , RICHARDSON DEAN W. , HOGAN PATRICIA M. , LEITCH MIDGE
Published: December 2008

Objective—To describe the characteristics of unilateral mid‐body proximal sesamoid bone (PSB) fractures, to determine factors associated with the outcome of horses after surgical repair, and to describe a technique for arthroscopically assisted screw fixation in lag fashion.

Study Design—Retrospective case series.

Animals—Horses (n=25) with unilateral mid‐body PSB fracture.

Methods—Medical records (1996–2006), radiographs, and arthroscopic videos of horses with surgically repaired unilateral mid‐body PSB fractures were reviewed. Retrieved data included signalment, affected limb and PSB, fracture characteristics, and surgical technique. Outcome was established by radiographic assessment of healing and race records; categorical data were analyzed using Fisher's Exact test.

Results—Medial forelimb PSBs were most commonly affected (80%). Surgical technique and degree of reduction were significantly associated with outcome; 44% of horses with screw repair and none of the horses with wire fixation raced (P=.047). Factors that may have influenced this outcome were differences in fracture reduction (improved reduction in 22% wire repairs and 88% screw repairs,P=.002) and use of external coaptation (22% wire repair and 88% lag screw repair,P=.002). None of the horses with unimproved reduction raced after surgery.

Conclusions—Only 28% of horses with mid‐body PSB fractures raced after surgery. Compared with wire fixation, screw fixation in lag fashion resulted in good reduction and is seemingly a superior repair technique.

Clinical Relevance—For mid‐body PSB fractures, arthroscopically assisted screw fixation in lag fashion and external coaptation for anesthesia recovery and initial support provides the best likelihood of return to athletic use.
Nomenclature and Definitions for Emergency Department Human Immunodeficiency Virus (HIV) Testing: Report from the 2007 Conference of the National Emergency Department HIV Testing Consortium
Authors: Lyons Michael S. , Lindsell Christopher J. , Haukoos Jason S. , Almond Gregory , Brown Jeremy , Calderon Yvette , Couture Eileen , Merchant Roland C. , White Douglas A.E. , Rothman Richard E. ,   on behalf of the National Emergency Department HIV Testing Consortium
Published: December 2008

Early diagnosis of persons infected with human immunodeficiency virus (HIV) through diagnostic testing and screening is a critical priority for individual and public health. Emergency departments (EDs) have an important role in this effort. As EDs gain experience in HIV testing, it is increasingly apparent that implementing testing is conceptually and operationally complex. A wide variety of HIV testing practice and research models have emerged, each reflecting adaptations to site‐specific factors and the needs of local populations. The diversity and complexity inherent in nascent ED HIV testing practice and research are associated with the risk that findings will not be described according to a common lexicon. This article presents a comprehensive set of terms and definitions that can be used to describe ED‐based HIV testing programs, developed by consensus opinion from the inaugural meeting of the National ED HIV Testing Consortium. These definitions are designed to facilitate discussion, increase comparability of future reports, and potentially accelerate wider implementation of ED HIV testing.
Can Patients with Brain Herniation on Cranial Computed Tomography Have a Normal Neurologic Exam?
Authors: Probst Marc A. , Baraff Larry J. , Hoffman Jerome R. , Wolfson Allan B. , Ourian Ariel J. , Mower William R.
Published: December 2008

Objectives:  Herniation of the brain outside of its normal intracranial spaces is assumed to be accompanied by clinically apparent neurologic dysfunction. The authors sought to determine if some patients with brain herniation or significant brain shift diagnosed by cranial computed tomography (CT) might have a normal neurologic examination.

Methods:  This is a secondary analysis of the National Emergency X‐Radiography Utilization Study (NEXUS) II cranial CT database compiled from a multicenter, prospective, observational study of all patients for whom cranial CT scanning was ordered in the emergency department (ED). Clinical information including neurologic examination was prospectively collected on all patients prior to CT scanning. Using the final cranial CT radiology reports from participating centers, all CT scans were classified into three categories: frank herniation, significant shift without frank herniation, and minimal or no shift, based on predetermined explicit criteria. These reports were concatenated with clinical information to form the final study database.

Results:  A total of 161 patients had CT‐diagnosed frank herniation; 3 (1.9%) had no neurologic deficit. Of 91 patients with significant brain shift but no herniation, 4 (4.4%) had no neurologic deficit.

Conclusions:  A small number of patients may have normal neurologic status while harboring significant brain shift or brain herniation on cranial CT.
Ambulance Diversion as a Proxy for Emergency Department Crowding: The Effect on Pediatric Mortality in a Metropolitan Area
Authors: Shenoi Rohit P. , Ma Long , Jones Jennifer , Frost Mary , Seo Munseok , Begley Charles E.
Published: December 2008

Objectives:  The objective was to determine the prevalence of emergency department (ED) ambulance diversion among Houston pediatric hospitals and its association with mortality of pediatric patients.

Methods:  Hospital diversion and patient data between August 2002 and December 2004 were used to examine the impact of diversion on mortality of children under age 18 years. Patients were assumed to be exposed to ED crowding if diversion and admission or ED arrival times overlapped. Univariate and logistic regression were performed to determine if diversion was associated with mortality while controlling for age, illness severity, injury, and transfer status.

Results:  Mean hospital diversion hours as a percentage of operating hours were 10.58 (standard deviation [SD] ± 9). Overall, of 63,780 admissions, there were 4,095 (6.4%) children admitted during diversion. Fewer severely ill patients were admitted during diversion than nondiversion times (odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.66 to 0.78). The presence of diversion was protective for mortality (OR = 0.51; 95% CI = 0.34 to 0.77) in bivariate analysis. Mortality was associated with presence of major or extreme illness (OR = 60.7; 95% CI = 45.2 to 81.5), injury (OR=1.7; 95% CI = 1.4 to 2.1), and transfer status (OR = 6.3; 95% CI = 5.4 to 7.3). Using conditional logistic regression, major or extreme illness (OR = 50.7; 95% CI = 37.7 to 68.3), injury (OR 3.7; 95% CI = 2.9 to 4.7), and transfer (OR = 2.7; 95% CI = 2.2, 3.2) were associated with mortality, but diversion did not show any association with mortality. After combining ED and inpatient deaths, no association between diversion and mortality was observed.

Conclusions:  Hospital diversion due to ED crowding is common in pediatrics. The authors found no evidence of an association between diversion and ED and inpatient pediatric mortality.
A Comparison of Salicylic Acid Levels in Normal Subjects after Rectal versus Oral Dosing
Authors: Maalouf Roger , Mosley Mark , James Kallail K. , Kramer Karen M. , Kumar Gaurav
Published: December 2008

Objectives:  The common practice is to use 162 mg of aspirin orally in the emergency department (ED) for patients presenting with myocardial infarction. If the patient cannot take aspirin orally in the authors’ facility, then 600 mg of aspirin is given rectally. However, no strong evidence exists as to whether the oral and rectal doses provide equivalent risk protection. The authors hypothesized that the salicylic acid levels for orally and rectally administered aspirin will not be similar, because of the different dosages used and the different routes of administration.

Methods:  The study sample consisted of healthy, nonpregnant, adult volunteers without active illness, who did not take any medication regularly. Each subject served as his or her own control to account for any confounding factors. The study was conducted on 2 days, separated by a 1‐week washout period. On the first day, 162 mg of oral aspirin was chewed and swallowed. Salicylic acid levels were obtained at baseline (i.e., before taking the aspirin) and then 30, 60, and 90 minutes after dosing. The 600‐mg aspirin suppository was self‐administered 1 week later with a sample for laboratory measures again drawn at baseline and then 30, 60, and 90 minutes after dosing.

Results:  Twenty‐four subjects completed the study. The rectal suppository provided significantly more salicylic acid into the blood than the oral tablets over 90 minutes (p < 0.001). No statistical difference was noted between oral and rectal administration from baseline to 30 minutes (p > 0.05). However, mean salicylic acid levels from the rectal suppository were statistically higher than from the oral tablets from 30 to 60 minutes (p < 0.001) and from 60 to 90 minutes (p = 0.002). More than 60% of the subjects had an increasing salicylic acid level response over time to the rectal suppository. The salicylic acid level response to the oral administration was more evenly divided between those subjects whose salicylic acid levels peaked quickly and then fell or held steady (33%), those whose salicylic acid levels increased over time (29%), and those whose salicylic acid levels were measureable only after 60 minutes (25%). Although not statistically significant, these differences in group distributions for the type of salicylic acid level response between oral and rectal doses suggested the possibility of a rectal advantage.

Conclusions:  Whether the higher salicylic acid levels and faster absorption of the rectal aspirin translate into better clinical outcomes is unknown and cannot be concluded from our study. Previous evidence, however, has shown that 162 mg of aspirin chewed and swallowed provided lower mortality in patients presenting with myocardial infarction. Our results suggested the rectal administration of a 600‐mg suppository provides sufficient levels of salicylic acid within 90 minutes to meet or exceed that of oral aspirin.
Intrinsic competition between two oligophagous parasitoids, Sturmiopsis parasitica and Cotesia sesamiae, attacking the same life stages of lepidopteran cereal stemborers
Authors: Mucheru O. M. , Jiang N. , Kongoro J. , Bruce A. Y. , Schulthess F.
Published: December 2008

Host acceptability and suitability of four cereal stemborers (Lepidoptera) commonly occurring in eastern Africa, Sesamia calamistis Hampson, Busseola fusca (Fuller) (both Noctuidae), Chilo partellus Swinhoe (Crambidae), and Eldana saccharina Walker (Pyralidae), for a West African strain of Sturmiopsis parasitica (Curran) (Diptera: Tachinidae) were assessed. In addition, the outcome of multi‐parasitism was studied using a local strain of the endoparasitic Cotesia sesamiae Cameron (Hymenoptera: Braconidae) as the competing parasitoid. Various parasitism sequences and time intervals between parasitism were chosen. Parasitism increased linearly with the number of planidia used per larvae and was 80% with eight planidia. All species were accepted for larviposition, but suitability varied greatly; parasitism was 75.2, 37.9, 34.8, and 23.8% with S. calamistis, B. fusca, E. saccharina, and Ch. partellus, respectively. Sturmiopsis parasitica outcompeted Co. sesamiae irrespective of the time interval between parasitism, and whether it was the first or second species to parasitize. This was mainly due to a longer egg‐to‐cocoon development time and a high cocoon‐to‐adult mortality in Co. sesamiae. The implications of these results for expanding the geographic range of the West African strain of the tachinid in Africa are discussed.
Discrimination of the age of conspecific eggs by an ovipositing ectoparasitic wasp
Authors: Lebreton Sébastien , Labarussias Maureen , Chevrier Claude , Darrouzet Eric
Published: December 2008

The recognition and avoidance of already parasitized hosts is a major issue in parasitoid behavioural ecology. A key factor affecting the fitness reward expected from superparasitism is the probability that the second or subsequent egg laid on a host will win the contest with the first‐laid egg. The present study investigated the ability of females of the solitary ecto parasitoid Anisopteromalus calandrae Howard (Hymenoptera: Pteromalidae) to (i) discriminate between unparasitized Callosobruchus maculatus (Fabricius) (Coleoptera: Bruchidae) hosts and those parasitized by a conspecific, and (ii) discriminate between a host parasitized by an egg just laid (2 h) and one parasitized by an egg about to hatch (28 h). However, they did not adjust their offspring sex ratio on already parasitized hosts compared to unparasitized ones. Our results show that A. calandrae females can discriminate between parasitized and unparasitized hosts, as they lay more eggs on the latter. The probability of the second or subsequent egg laid on a host (superparasitism) winning the contest with a conspecific increases as the time between the two ovipositions decreases. Consequently, parasitoid females should lay more eggs on recently parasitized hosts than on those that have been parasitized for a long time (i.e., when the first eggs are about to hatch), and that is indeed what they were found to do. To increase their fitness in spite of the presence of already parasitized hosts, A. calandrae females have developed highly discriminative capacities regarding the parasitism status of hosts.
Fungal loline alkaloids in grass–endophyte associations confer resistance to the rice leaf bug, Trigonotylus caelestialium
Authors: Shiba Takuya , Sugawara Koya
Published: December 2008

Plant symbiotic fungi (endophytes) of the genus Neotyphodium [anamorphs, asexual derivatives of Epichloë (Ascomycota: Clavicipitaceae)] often associate with grass species of the subfamily Pooideae, which includes important forage and turf species. These endophytes are known to produce a range of alkaloids that enhance their host's resistance to insects or are toxic to grazing animals. Among the alkaloids, loline alkaloids (saturated 1‐aminopyrrolizidines) are generally observed in the highest concentrations in many Neotyphodium–grass symbiotic associations, and are known to be toxic to insects but not to mammals. Some Neotyphodium‐infected grasses have enhanced resistance to rice leaf bug, Trigonotylus caelestialium (Kirkaldy) (Heteroptera: Miridae), one of the major pests for rice production in Japan. Our laboratory experiments quantified the effects of purified loline (N‐formylloline) and in planta synthesis of loline alkaloids by meadow fescue [Lolium pratense (Huds.) S.J. Darbyshire (syn. Festuca pratensis Huds.)]–Neotyphodium uncinatum (Gams, Petrini & Schmidt) Glenn, Bacon & Hanlin and Italian ryegrass (Lolium multiflorum Lam.)–Neotyphodium occultans Moon, Scott & Christensen associations on the development and survival of T. caelestialium. No‐choice feeding assays with laboratory populations of the insect revealed that their growth was significantly decreased by the infected grasses, and the effect was greater for N. uncinatum than for N. occultans, in keeping with differences in N‐formylloline concentrations in the plants. Artificial feeding of N‐formylloline through feeding sachets indicated that the chemical has an adverse effect on survival of larvae, even at the lowest concentration tested (50 µg/g), which was considerably lower than the typical concentrations in many Neotyphodium–grass associations. The results confirmed the ability of Neotyphodium‐infected forage grasses to control T. caelestialium propagation in meadows, which may cause damages to nearby rice paddies.
Anatomy of a crisis: the causes and consequences of surging food prices
Authors: Headey Derek , Fan Shenggen
Published: December 2008

Although the potential causes and consequences of recent rising international food prices have attracted widespread attention, many existing appraisals are superficial and/or piecemeal. This article attempts to provide a more comprehensive review of these issues based on the best and most recent research, as well as on fresh theoretical and empirical analysis. We first analyze the causes of the current crisis by considering how well standard explanations hold up against relevant economic theory and important stylized facts. Some explanations turn out to hold up much better than others, especially rising oil prices, the depreciation of the U.S. dollar, biofuels demand, and some commodity‐specific explanations. We then provide an appraisal of the likely macro‐ and microeconomic impacts of the crisis on developing countries. We observe a large gap between macro and micro factors, which, when identifying the most vulnerable countries, often point in different directions. We conclude with a brief discussion of what ought to be learned from this crisis.
Fighting global food price rises in the developing world: the response of China and its effect on domestic and world markets
Authors: Yang Jun , Qiu Huanguang , Huang Jikun , Rozelle Scott
Published: December 2008

This article addresses how China is being affected by and is responding to the world food crisis. So far, Chinese officials have responded to higher world prices by drawing down stocks and limiting exports of major grains. These policy instruments were not available for soybeans, so domestic prices of soy and other oilseeds have risen with international prices. Using a global CGE model, we show that the initial world price rise was largely due to higher world oil prices and demand for biofuels as opposed to other factors, especially in maize and soybeans. China's response to this shock has kept domestic grain prices low relative to world grain markets and to domestic soybean prices. As grain stocks are depleted, however, demand growth will push domestic prices back into alignment. Anticipating this pressure on consumers and accelerating supply response through public investment will facilitate adjustment.
Plumage brightness predicts non‐breeding season territory quality in a long‐distance migratory songbird, the American redstart Setophaga ruticilla
Authors: Reudink Matthew W. , Studds Colin E. , Marra Peter P. , Kurt Kyser T. , Ratcliffe Laurene M.
Published: December 2008

Many species of birds exhibit brilliant ornamental plumage, yet most research on the function and evolution of plumage has been confined to the breeding season. In the American redstart Setophaga ruticilla, a long‐distance Neotropical‐Nearctic migratory bird, the acquisition of a winter territory in high‐quality habitat advances spring departure and subsequent arrival on breeding areas, and increases reproductive success and annual survival. Here, we show that males holding winter territories in high‐quality, black mangrove habitats in Jamaica have brighter yellow‐orange tail feathers than males occupying territories in poor‐quality second‐growth scrub habitats. Moreover, males arriving on the breeding grounds from higher‐quality winter habitats (inferred by stable‐carbon isotopes) also had brighter tail feathers. Because behavioral dominance plays an important role in the acquisition of winter territories, plumage brightness may also be related to fighting ability and the acquisition and maintenance of territories in high‐quality habitat. These results highlight the need for further research on the relationships between plumage coloration, behavior, and the ecology of over‐wintering migratory birds.
Alcohol‐based hand‐disinfection reduced children's absence from Swedish day care centers
Authors: Lennell Anne , Kühlmann‐Berenzon Sharon , Geli Patricia , Hedin Katarina , Petersson Christer , Cars Otto , Mannerquist Kerstin , Burman Lars G , Fredlund Hans ,   the Study Group
Published: December 2008

Aim: To determine if the use of alcohol‐based hand‐disinfection as a complement to regular hand washing at daycare centers (DCCs) can reduce the childhood rate of absenteeism.

Methods: Children aged 0–6 years attending DCC were studied in a cluster randomized controlled trial during 30 weeks. Thirty matched pairs of DCCs were included in the study, where one of the DCCs was randomized to intervention and the other to control within each pair. The intervention consisted in children and staff using alcohol‐based oily disinfectant gel containing 70% ethanol after regular hand washing. The main outcome was the rate of episodes of absence from DCC due to infection. A regression model was fitted at the individual level and controlling several possible confounders for illness. Absences were reported by the parents.

Results: Differences in missing absence reports between the two groups led to only evaluating those 29 DCCs (1431 children) that were able to provide complete reports. In the multivariate regression, the intervention significantly reduced the rate of absenteeism of a child by 12% compared to a child in a control DCC (IRR 95% CI: 0.799–0.965).

Conclusion: Hand‐disinfection used by children and staff significantly decreased childrens absences due to infections in Swedish DCCs.
Serum zinc in small children with coeliac disease
Authors: Högberg Lotta , Danielsson Lars , Jarleman Stefan , Sundqvist Tommy , Stenhammar Lars
Published: December 2008

In coeliac disease (CD) there is a gluten‐induced small bowel enteropathy leading to malabsorption of various nutrients, vitamins and trace elements. Low levels of serum zinc have been reported in adults with untreated CD. In the present study we related the serum concentration of zinc to the morphology of the small bowel mucosa in 58 children, all under 4 years of age and under investigation for coeliac disease. The mean serum concentration of zinc (mean ± SD; μmol/L) was significantly lower in children with untreated CD (9.7 ± 2.0) (n = 11) compared to non‐coeliac children without enteropathy (15.1 ± 2.3) (n = 16) (p < 0.001), coeliac children on a gluten‐free diet without enteropathy (14.2 ± 1.6) (n = 14) (p < 0.001), coeliac children on gluten challenge with enteropathy (14.1 ± 2.1) (n = 12) (p < 0.001) and coeliac children on gluten challenge without enteropathy (13.8 ± 1.9) (n = 6) (p < 0.005).

Conclusion: Serum zinc concentration is decreased in untreated coeliac children with enteropathy and normalizes on gluten‐free diet. A low serum zinc value in a child being investigated for possible CD on clinical grounds can thus be used as a complementary marker for enteropathy indicating further investigation with small bowel biopsy. The hypothetical role of zinc in the pathogenesis of CD is discussed.
Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population‐based register study
Authors: Selling K Ekholm , Carstensen J , Finnström O , Josefsson A , Sydsjö G
Published: December 2008

Aim: To examine the effect of hospitalization during adolescence on the likelihood of giving birth.

Methods: 142 998 women born in 1973–75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio‐economic characteristics and factors related to the studied women's own birth.

Results: The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29–1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20–24 years but a reduced thereafter.

Conclusion: A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.