bluuebunny/crossref_metadata_2025 huggingface dataset:
The Changing Economic Advantage from Private Schools
Authors: Green Francis , Machin Stephen , Murphy Richard , Zhu Yu
Published: September 2011

Private schooling is an important feature of education systems across the world. Despite its relatively small size, the British private school sector has a long history and plays a prominent role in society. We provide evidence showing that private schools have been successful in transforming their ability to generate the academic outputs that are most in demand in the modern economy: the private/state school wage differential has risen significantly over time, and a significant factor has been faster rising educational attainment for privately‐educated individuals.
The Importance of Time-Series Extrapolation for Macroeconomic Expectations
Authors: Roos Michael W. M. , Schmidt Ulrich
Published: September 2011

This article presents a simple experiment on how laypeople form macroeconomic expectations. Subjects have to forecast inflation and gross domestic product growth. By varying the information provided in different treatments, we can assess the importance of historical time-series information vs. information acquired outside the experimental setting such as knowledge of expert forecasts. It turns out that the availability of historical data has a dominant impact on expectations and wipes out the influence of outside-lab information completely. Consequently, backward-looking behavior can be identified unambiguously as a decisive factor in expectation formation.
Thomas Aquinas Holds Fast: Objections to Aquinas within Today's Debate on Divine Action
Authors: Silva Ignacio
Published: September 2011

Various authors within the contemporary debate on divine action in nature and contemporary science argue both for and against a Thomistic account of divine action through the notions of primary and secondary causes. In this paper I argue that those who support a Thomistic account of divine action often fail to explain Aquinas' doctrine in full, while those who argue against it base their objections on an incomplete knowledge of this doctrine, or identify it with Austin Farrer's doctrine of double agency – again failing to do Aquinas justice. I analyse these objections, indicating how they do not address Aquinas' doctrine by offering a brief but full account of the latter.
Generalized graded unfolding model with structural equation for subject parameters
Authors: USAMI SATOSHI
Published: September 2011

The generalized graded unfolding model (GGUM) is capable of analyzing polytomous scored, unfolding data such as agree‐disagree responses to attitude statements. In the present study, we proposed a GGUM with structural equation for subject parameters, which enabled us to evaluate the relation between subject parameters and covariates and/or latent variables simultaneously, in order to avoid the influence of attenuation. Additionally, an algorithm for parameter estimation is newly implemented via the Markov Chain Monte Carlo (MCMC) method, based on Bayesian statistics. In the simulation, we compared the accuracy of estimates of regression coefficients between the proposed model and a conventional method using a GGUM (where regression coefficients are estimated using estimates of θ). As a result, the proposed model performed much better than the conventional method in terms of bias and root mean squared errors of estimates of regression coefficients. The study concluded by verifying the efficacy of the proposed model, using an actual data example of attitude measurement.
Information integration study of Metelli's and Morinaga's theories of achromatic transparency
Authors: MASIN SERGIO CESARE
Published: September 2011

Information integration methodology was used to test Metelli's and Morinaga's theories of achromatic transparency. Stimuli were transparent achromatic disks on a background formed by two adjacent horizontal rectangles. The common border of these rectangles divided each disk in two halves. Let P and Q be the luminances of the left and right halves of a disk and let A and B be those of the left and right rectangles, respectively. Transparency is given by the ratio (P – Q)/(A – B) in Metelli's theory and is given by a weighted average of the ratios (P – Q)/(A – Q) and (P – Q)/(P – B) in Morinaga's theory. Participants rated the transparency of disks with A and B fixed and P and Q combined factorially. Morinaga's theory closely predicted the resulting pattern of curves and Metelli's theory predicted it incorrectly. Morinaga's theory could also account well for individual differences in the ratings of transparency. The results support the general idea that transparency depends on the integration of photometric luminance information rather than on the integration of perceived lightness information.
The stability and causal effects of task‐specific and generalized self‐efficacy in college1
Authors: MIYOSHI AKIKO
Published: September 2011

This research investigated the stability and causal effects of task‐specific self‐efficacy and generalized self‐efficacy in college students. In Study 1, task‐specific self‐efficacy and generalized self‐efficacy scales were administered to university students (N = 237) on two occasions, with an interval of 2 months. In Study 2, task‐specific (care‐work) self‐efficacy and generalized self‐efficacy scales were administered to college students who were studying to be care workers (N = 49) on three occasions (before the first care‐work practicum, after the practicum, and 3 months later). The results of both studies indicated that generalized self‐efficacy was more stable than task‐specific self‐efficacy. In Study 1, both generalized self‐efficacy and task‐specific self‐efficacy affected each other in daily life. Study 2 examined the effects of an ego‐engaged experience (the first care‐work practicum) for task‐specific (care‐work) self‐efficacy and generalized self‐efficacy. The results indicated that changes in care‐work self‐efficacy did not affect generalized self‐efficacy.
Skull mechanics and implications for feeding behaviour in a large marsupial carnivore guild: the thylacine, Tasmanian devil and spotted‐tailed quoll
Authors: Attard M.R.G. , Chamoli U. , Ferrara T.L. , Rogers T.L. , Wroe S.
Published: September 2011

Extinction risk varies across species and is influenced by key ecological parameters, such as diet specialization. For predictive conservation science to be effective, we need to understand extinction risk factors that may have implicated recent species extinctions. Diet and feeding behaviour of the large extinct marsupial carnivore Thylacinus cynocephalus or thylacine have long been debated. Improved understanding of the skull's biomechanical performance and its limitations in a comparative context may yield important insights. Here, we use three‐dimensional (3D) finite element analysis to assess aspects of biomechanical performance in the skull of T. cynocephalus relative to those of two extant marsupial carnivores with known diets that occurred sympatrically with T. cynocephalus: the Tasmanian devil, Sarcophilus harrisii, and spotted‐tailed quoll, Dasyurus maculatus. Together, these three species comprised the large mammalian carnivore guild in Tasmania at the time of European settlement. The bone‐cracking S. harrisii produced high bite forces for its size as expected, but the stresses induced were surprisingly high. A higher proportion of cancellous bone in the skull of this osteophage may act to absorb shock but decrease rigidity and hence raise stress. A relatively high bite force and rigid skull characterized D. maculatus, which may allow them to target prey of variable sizes. Compared with S. harrisii and D. maculatus, we found that the skull of T. cynocephalus was least well adapted to withstand forces driven solely by its jaw‐closing musculature, as well as to simulations of struggling prey. Our findings suggest that T. cynocephalus likely consumed smaller prey relative to its size, which may have had implications for their survival.
The influence of color on emotional perception of natural scenes
Authors: Codispoti Maurizio , De Cesarei Andrea , Ferrari Vera
Published: September 2011

Is color a critical factor when processing the emotional content of natural scenes? Under challenging perceptual conditions, such as when pictures are briefly presented, color might facilitate scene segmentation and/or function as a semantic cue via association with scene‐relevant concepts (e.g., red and blood/injury). To clarify the influence of color on affective picture perception, we compared the late positive potentials (LPP) to color versus grayscale pictures, presented for very brief (24 ms) and longer (6 s) exposure durations. Results indicated that removing color information had no effect on the affective modulation of the LPP, regardless of exposure duration. These findings imply that the recognition of the emotional content of scenes, even when presented very briefly, does not critically rely on color information.
Increasing the number of irrelevant stimuli increases ability to detect countermeasures to the P300‐based Complex Trial Protocol for concealed information detection
Authors: Hu Xiaoqing , Hegeman Daniel , Landry Elizabeth , Rosenfeld J. Peter
Published: September 2011

We previously found that simultaneously executing a mental countermeasure and an explicit required response impairs reaction time (RT)‐based detection of countermeasure use in a P300‐ based concealed information test. To address this issue, we increased the numbers of irrelevant stimuli to eight, and manipulated the proportions of to‐be‐countered irrelevant stimuli from 25% to 50% to 75% in three groups. Results: Based on P300 data, 100% of the simple guilty (no countermeasure use) and 92% of the innocent subjects were correctly identified as having or not having concealed information. In the countermeasure groups, detection rates varied from 71% to 92% across the different groups. Notably, in the present study with eight irrelevant items, simultaneous countermeasure use was indicated by elevated RT in the 50% and 75% countermeasure proportion groups, which it was not, previously, with 50% (two) countermeasures and four irrelevants.
Dual neuroprotective pathways of a pro‐electrophilic compound via HSF‐1‐activated heat‐shock proteins and Nrf2‐activated phase 2 antioxidant response enzymes
Authors: Satoh Takumi , Rezaie Tayebeh , Seki Masaaki , Sunico Carmen R. , Tabuchi Takahito , Kitagawa Tomomi , Yanagitai Mika , Senzaki Mutsumi , Kosegawa Chihiro , Taira Hideharu , McKercher Scott R. , Hoffman Jennifer K. , Roth Gregory P. , Lipton Stuart A.
Published: September 2011

J. Neurochem. (2011) 119, 569–578.

Activation of the Keap1/nuclear factor erythroid 2‐related factor 2 (Nrf2) pathway and consequent induction of phase 2 antioxidant enzymes is known to afford neuroprotection. Here, we present a series of novel electrophilic compounds that protect neurons via this pathway. Natural products, such as carnosic acid (CA), are present in high amounts in the herbs rosemary and sage as ortho‐dihydroquinones, and have attracted particular attention because they are converted by oxidative stress to their active form (ortho‐quinone species) that stimulate the Keap1/Nrf2 transcriptional pathway. Once activated, this pathway leads to the production of a series of antioxidant phase 2 enzymes. Thus, such dihydroquinones function as redox‐activated ‘pro‐electrophiles’. Here, we explored the concept that related para‐dihydroquinones represent even more effective bioactive pro‐electrophiles for the induction of phase 2 enzymes without producing toxic side effects. We synthesized several novel para‐hydroquinone‐type pro‐electrophilic compounds (designated D1 and D2) to analyze their protective mechanism. DNA microarray, PCR, and western blot analyses showed that compound D1 induced expression of heat‐shock proteins (HSPs), including HSP70, HSP27, and DnaJ, in addition to phase 2 enzymes such as hemeoxygenase‐1 (HO‐1), NADP(H) quinine‐oxidoreductase1, and the Na+‐independent cystine/glutamate exchanger (xCT). Treatment with D1 resulted in activation of Nrf2 and heat‐shock transcription factor‐1 (HSF‐1) transcriptional elements, thus inducing phase 2 enzymes and HSPs, respectively. In this manner, D1 protected neuronal cells from both oxidative and endoplasmic reticulum (ER)‐related stress. Additionally, D1 suppressed induction of 78 kDa glucose‐regulated protein (GRP78), an ER chaperone protein, and inhibited hyperoxidation of peroxiredoxin 2 (PRX2), a molecule that is in its reduced state can protect from oxidative stress. These results suggest that D1 is a novel pro‐electrophilic compound that activates both the Nrf2 and HSF‐1 pathways, and may thus offer protection from oxidative and ER stress.
Activation of α‐secretase cleavage
Authors: Postina Rolf
Published: September 2011

J. Neurochem. (2012) 120 (Suppl. 1), 46–54.

Alpha‐secretase‐mediated cleavage of the amyloid precursor protein (APP) releases the neuroprotective APP fragment sαAPP and prevents amyloid β peptide (Aβ) generation. Moreover, α‐secretase‐like cleavage of the Aβ transporter ‘receptor for advanced glycation end products’ counteracts the import of blood Aβ into the brain. Assuming that Aβ is responsible for the development of Alzheimer’s disease (AD), activation of α‐secretase should be preventive. α‐Secretase‐mediated APP cleavage can be activated via several G protein‐coupled receptors and receptor tyrosine kinases. Protein kinase C, mitogen‐activated protein kinases, phosphatidylinositol 3‐kinase, cAMP and calcium are activators of receptor‐induced α‐secretase cleavage. Selective targeting of receptor subtypes expressed in brain regions affected by AD appears reasonable. Therefore, the PACAP receptor PAC1 and possibly the serotonin 5‐HT6 receptor subtype are promising targets. Activation of APP α‐secretase cleavage also occurs upon blockade of cholesterol synthesis by statins or zaragozic acid A. Under physiological statin concentrations, the brain cholesterol content is not influenced. Statins likely inhibit Aβ production in the blood by α‐secretase activation which is possibly sufficient to inhibit AD development. A disintegrin and metalloproteinase 10 (ADAM10) acts as α‐secretase on APP. By targeting the nuclear retinoic acid receptor β, the expression of ADAM10 and non‐amyloidogenic APP processing can be enhanced. Excessive activation of ADAM10 should be avoided because ADAM10 and also ADAM17 are not APP‐specific. Both ADAM proteins cleave various substrates, and therefore have been associated with tumorigenesis and tumor progression.
Abuse in health care: a concept analysis
Authors: Brüggemann Adrianus Jelmer , Wijma Barbro , Swahnberg Katarina
Published: September 2011

Scand J Caring Sci; 2012; 26; 123–132

Abuse in health care: a concept analysis

Aims and objectives:  To analyse the concept of abuse in health care. This analysis also covers how abuse in health care is different from the related concepts of medical error, patient satisfaction and personal identity threat.

Background:  Abuse in health care is an emerging concept in need of a clear analysis and definition. At the same time, boundaries to the related concepts are not demarcated.

Design:  Concept analysis as developed by Walker and Avant.

Method:  The databases Cumulative Index to Nursing and Allied Health Literature, Medline, and Google Scholar were used to obtain articles published between 1997 and 2009. A total of eleven articles are referred to on abuse in health care, four on medical error, six on patient satisfaction and three on personal identity threat.

Results:  Abuse in health care is defined by patients’ subjective experiences of encounters with the health care system, characterized by devoid of care, where patients suffer and feel they lose their value as human beings. The events are most often unintended. We also found differences with the aforementioned related concepts: medical error does not share the patients’ perspective, and patient satisfaction does not offer room for patients’ abusive experiences. The concept of personal identity threat shares all attributes with abuse in health care, but it lacks an antecedent that signifies the social structures underlying the phenomenon.

Conclusions:  Abuse in health care covers a phenomenon that has severe consequences but is invisible if seen from a medical error or patient satisfaction perspective.
Importance of demography and dispersal for the resilience and restoration of a critically endangered tropical conifer Araucaria nemorosa
Authors: Kettle Chris J. , Ennos Richard A. , Jaffré Tanguy , McCoy Stéphane , Le Borgne Thomas , Gardner Martin , Hollingsworth Peter M.
Published: September 2011

Aims  In situ species survival involves persistence at current sites and/or colonization of new locations. Determining the likelihood of these events requires an understanding of population dynamics and dispersal. We address these issues in populations of a critically endangered tropical conifer Araucaria nemorosa and provide conservation recommendations.

Location  Port Boise, island of Grand Terre, New Caledonia, Pacific Ocean.

Methods  We characterize the demographic structure of six populations of A. nemorosa based upon size class frequencies and relative basal area compared to competing angiosperm trees. Using genotype data from 280 adult individuals at seven microsatellite loci, we indirectly estimate dispersal distances and project a maximal dispersal envelope around the extant populations.

Results  Our survey detected marked differences in demographic parameters including the proportion of basal area occupied by A. nemorosa versus angiosperm trees (ranging from 25% to 77%), the size class frequency distributions of A. nemorosa and seedling densities (ranging from 500 to 37300 seedlings ha−1) among some populations. Wright’s genetic neighbourhood ranged from 22 to 876 trees, and historic gene dispersal ranged from 10.8 to 82.4 m, indicating that most seed dispersal is <100 m.

Main conclusions  This study indicates that the risk of recruitment failure in remnant populations of Araucaria nemorosa is low in most of the stands but is high in the inland population Forêt Nord. In situ natural regeneration appears to be constrained in this population, most likely as a consequence of competitive exclusion. Our results also suggest that the majority of seed dispersal is too short to allow A. nemorosa to disperse to new more hospitable sites within an ecologically relevant time‐scale. Our findings have implications not only for this emblematic tree species but also for a wide range of fragmented and degraded plant species populations with limited dispersal that are vulnerable to competitive exclusion.
Taxonomic and functional homogenization of an endemic desert fish fauna
Authors: Pool Thomas K. , Olden Julian D.
Published: September 2011

Aim  The highly endemic fishes of the arid Southwest USA have been heavily impacted by human activities resulting in one of the most threatened fish faunas in the world. The aim of this study was to examine the patterns and drivers of taxonomic and functional beta diversity of freshwater fish in the Lower Colorado River Basin across the 20th century.

Location  Lower Colorado River Basin (LCRB).

Methods  The taxonomic and functional similarities of watersheds were quantified to identify patterns of biotic homogenization or differentiation over the period 1900–1999. Path analysis was used to identify the relative influence of dam density, urban land use, precipitation regimes and non‐native species richness on observed changes in fish faunal composition.

Results  The fish fauna of the LCRB has become increasingly homogenized, both taxonomically (1.1% based on βsim index) and functionally (6.2% based on Bray–Curtis index), over the 20th century. The rate of homogenization varied substantially; range declines of native species initially caused taxonomic differentiation (−7.9% in the 1960s), followed by marginal homogenization (observed in the 1990s) in response to an influx of non‐native species introductions. By contrast, functional homogenization of the basin was evident considerably earlier (in the 1950s) because of the widespread introduction of non‐native species sharing similar suites of biological traits. Path analysis revealed that both taxonomic and functional homogenization were positively related to the direct and indirect (facilitation by dams and urbanization) effects of non‐native species richness.

Main conclusions  Our study simultaneously examines rates of change in multiple dimensions of the homogenization process. For the endemic fish fauna of the LCRB, we found that the processes of taxonomic and functional homogenization are highly dynamic over time, varying both in terms of the magnitude and rate of change over the 20th century.
Calculation of right ventricular stroke volume in short‐axis MR images using the equation of the tricuspid plane
Authors: Jorstig Stina Hellstrandh , Kähäri Anders , Emilsson Kent , Thunberg Per
Published: September 2011

Short‐axis (SA) magnetic resonance (MR) images are commonly planned parallel to the left atrioventricular valve. This orientation leads to oblique slices of the right ventricle (RV) with subsequent difficulties in separating the RV from the right atrium in the SA images. The insertion points of the tricuspid valve (TV) in the myocardium can be clearly identified in the right ventricle long axis (RVLA) and four‐chamber (4CH) views. The purpose of this study was to develop a method that transfers the position of the tricuspid plane, as seen in the RVLA and 4CH views, to the SA images to facilitate the separation of the RV from the atrium. This methodology, termed Dissociating the Right Atrium from the Ventricle Volume (DRAW), was applied in 20 patients for calculations of right ventricular stroke volume (RVSV). The RVSV using DRAW (RVSVDRAW) was compared to left ventricular stroke volumes (LVSV) obtained from flow measurements in the ascending aorta. The RVSV was also determined using the conventional method (RVSVCONV) where the stack of images from the SA views are summarized, and a visual decision is made of the most basal slice to be included in the RV. The mean difference between RVSVDRAW and LVSV was 0·1 ± 12·7 ml, while the mean difference between RVSVCONV and LVSV was 0·33 ± 14·3 ml. Both the intra‐ and interobserver variability were small using the DRAW methodology, 0·6 ± 3·5 and 1·7 ± 2·7 ml, respectively. In conclusion, the DRAW method can be used to facilitate the separation of the RV and the atrium.
Correlation between serum calcium levels and dual‐phase 99mTc‐sestamibi parathyroid scintigraphy in primary hyperparathyroidism
Authors: Mshelia D. S. , Hatutale A. N. , Mokgoro N. P. , Nchabaleng M. E. , Buscombe J. R. , Sathekge M. M.
Published: September 2011

Aim:  The goal of the study is to correlate serum calcium levels with the results of dual‐phase 99mTc‐sestamibi parathyroid scintigraphy to find the best cut‐off level of the serum calcium that correlates with a positive presurgery.

Methods:  In 111 patients, serum calcium and plasma parathormone (PTH) levels were compared with the results of the 99mTc‐MIBI scintigraphy and with this data determined the level of calcium above which the 99mTc‐MIBI scintigraphy was likely to be positive and below which the study was likely to be negative.

Results:  In total, 11 men (18%) and 50 women (82%) had a positive 99mTc‐MIBI study. Overall 67% of those patients with a positive 99mTc‐MIBI study had a PTH >200 ng l−1 compared to only 9% of those with a negative 99mTc‐MIBI scintigraphy; however, for those with a positive study on an early 99mTc‐MIBI scintigraphy, this rose to 85%. Overall a serum calcium of >2·70 mmol l−1 was found in 82% of patients with a positive 99mTc‐MIBI study but only 14% of those with a negative 99mTc‐MIBI study, this is rose to 97% of patients with a parathyroid adenoma identified on early images. It is also shown that patients whose serum total calcium <2·51 mmol l−1 rarely have positive 99mTc‐MIBI scintigraphy.

Conclusion:  99mTc‐MIBI parathyroid scintigraphy is most likely to yield identification and localization of a parathyroid adenoma when both PTH and calcium are elevated; however, although there is no lower limit of PTH which can predict a negative study, we cannot recommend 99mTc‐MIBI parathyroid scintigraphy if the serum calcium is <2·51 mmol l−1.
Balancing urban and peri‐urban exchange: water geography of rural livelihoods in Mexico
Authors: DÍAZ‐CARAVANTES ROLANDO E
Published: September 2011

The peri‐urban area is the region where there is a more dynamic interaction between the urban and rural. The peri‐urban area supplies natural resources, such as land for urban expansion and agricultural products to feed the urban population. In arid and semi‐arid lands, such as northern Mexico, these areas may also be the source of water for the city's domestic demand. In addition, scholars argue that peri‐urban residents may have a more advantageous geographical position for selling their labour and agricultural products in cities and, by doing so, sustaining their livelihoods. A considerable number of studies have examined the peri‐urban to urban natural resources transfer in terms of land annexation, housing construction, and infrastructure issues; however, the study of the effects of the reallocation of peri‐urban water resources to serve urban needs is critical as well because the livelihoods of peri‐urban residents, such as those based on agriculture and livestock, depend on water availability. In the case of Hermosillo there is a tremendous pressure on the water resources of peri‐urban small farm communities orejidosbecause of urban demand. Based on interviews and structured surveys with producers and water managers, this paper examines how peri‐urban livelihoods have been reshaped by the reallocation of the city's natural resources in many cases caused some ejido members orejidatariosto lose livelihoods.
Nursing Home Price and Quality Responses to Publicly Reported Quality Information
Authors: Clement Jan P. , Bazzoli Gloria J. , Zhao Mei
Published: September 2011

Objective

To assess whether the release of Nursing Home Compare (NHC) data affected self‐pay per diem prices and quality of care.

Data Sources

Primary data sources are the Annual Survey of Wisconsin Nursing Homes for 2001–2003, Online Survey and Certification Reporting System, NHC, and Area Resource File.

Study Design

We estimated fixed effects models with robust standard errors of per diem self‐pay charge and quality before and after NHC.

Principal Findings

After NHC, low‐quality nursing homes raised their prices by a small but significant amount and decreased their use of restraints but did not reduce pressure sores. Mid‐level and high‐quality nursing homes did not significantly increase self‐pay prices after NHC nor consistently change quality.

Conclusions

Our findings suggest that the release of quality information affected nursing home behavior, especially pricing and quality decisions among low‐quality facilities. Policy makers should continue to monitor quality and prices for self‐pay residents and scrutinize low‐quality homes over time to see whether they are on a pathway to improve quality. In addition, policy makers should not expect public reporting to result in quick fixes to nursing home quality problems.
Primary Care and Health Outcomes among Older Patients with Diabetes
Authors: Prentice Julia C. , Graeme Fincke B. , Miller Donald R. , Pizer Steven D.
Published: September 2011

Objective

The aim of this study was to measure the relationship between days spent waiting for primary care and health outcomes among patients diagnosed with diabetes, especially among the elderly population.

Data Source

Secondary data from VA administrative databases and Medicare claims.

Study Design

This is a retrospective observational study. Outcome variables include primary care utilization, mortality, heart attack, stroke, and ambulatory‐care sensitive condition (ACSC) hospitalization. The main explanatory variable of interest is VA primary care wait time. Negative binomial models predict utilization and stacked logistic regression models predict the probability of experiencing each health outcome. Models are stratified by the presence of a selected health condition and age.

Principal Findings

Longer wait times were predicted to decrease utilization between 2 and 4 percent. There was no significant relationship between wait times and health outcomes for the overall sample. In stratified analyses, longer waits were associated with undesirable outcomes for those over age 70 with one of the selected health conditions or in certain narrower 5‐year age groups, but the overall pattern of results does not indicate a systematic and significant effect.

Conclusions

There was a modest effect of long wait times on primary care utilization but no robust effect of longer wait times on health outcomes. Waiting for care did not significantly compromise long‐term health outcomes for veterans with diabetes.
Behind‐the‐Counter Statins: A Silver Bullet for Reducing Costs and Increasing Access?
Authors: Sood Neeraj , Sun Eric , Zhuo Xiaohui
Published: September 2011

Objective

To examine how the 2004 introduction of behind‐the‐counter (BTC) simvastatin in the United Kingdom affected utilization, prices, and expenditures.

Data Sources/Study Setting

Secondary data on simvastatin utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries.

Study Design

We used a difference‐in‐differences approach to estimate how the introduction of BTC simvastatin affected utilization, prices, and expenditures. This approach compares outcomes in the United Kingdom before and after the introduction of BTC simvastatin, using outcomes in countries where the drug remained prescription only to control for possible confounders.

Data Collection/Extraction Methods

Data on simvastain utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries were obtained from an outside vendor.

Principal Findings

The introduction of BTC simvastatin in the United Kingdom led to a significant increase in utilization of simvastatin and a significant decline in expenditures for simvastatin purchases. Our results are robust to alternate model specifications.

Conclusions

Behind‐the‐counter statins have the potential to simultaneously increase use of statins and lower expenditures.
Mojave toxin‐type ascending flaccid paralysis after an envenomation by a Southern Pacific Rattlesnake in a dog
Authors: Hoggan Sarah R. , Carr Amy , Sausman Karen A.
Published: September 2011

Objective

To describe the clinical presentation and case management of a dog that developed ascending flaccid paralysis after being envenomated by a Southern Pacific rattlesnake.

Case Summary

A dog was presented after it was bitten by a Southern Pacific rattlesnake. Only mild local edema and a minor coagulapathy developed, which is atypical for the Southern Pacific envenomation where hemotoxic effects are more commonly observed. Instead, a severe, rapidly progressing, ascending flaccid paralysis leading to acute respiratory failure, consistent with Mojave toxin, was seen. The patient was treated with repeated doses of antivenin and supported with mechanical ventilation. Despite clinical improvement of the paralysis over subsequent 3 days and successful weaning off the ventilator, the dog decompensated and succumbed to acute respiratory distress syndrome.

New or Unique Information Provided

The geographic region where this envenomation occurred has a documented population of Southern Pacific rattlesnakes with Mojave toxin in their venom. To the knowledge of the authors, this is the first reported case in the veterinary literature of an ascending flaccid paralysis, consistent with Mojave toxin, developing after an envenomation by a Southern Pacific rattlesnake.
Outcome and medical management in dogs with lower motor neuron disease undergoing mechanical ventilation: 14 cases (2003–2009)
Authors: Rutter Christine R. , Rozanski Elizabeth A. , Sharp Claire R. , Powell Lisa L. , Kent Marc
Published: September 2011

Objective

To describe the application of intermittent positive pressure ventilation (IIPV) in dogs with lower motor neuron disease (LMND).

Design

Multi‐institutional, retrospective study (2003–2009).

Setting

Intensive care units at multiple university teaching hospitals.

Animals

Fourteen dogs withLMNDthat underwentIIPV.

Interventions

None.

Measurements and Main Results

The ventilatory logs of 4 teaching hospitals were searched for dogs undergoingIIPVin association with a diagnosis of acuteLMND. The medical records were evaluated for signalment, specificLMND, ventilatory management and duration, complications associated with ventilation, duration of hospitalization, and outcome. Descriptive statistics were used as indicated. Fifteen records were evaluated, 1 dog was excluded since it experienced cardiopulmonary arrest (CPA) before commencement ofIIPV. The median age was 7.0 years (range 10 mo to 12 y). There were 5 Labrador retrievers, 4 mixed breeds, and 5 other breeds were each represented once. Five dogs were diagnosed with myasthenia gravis, 4 dogs with polyradiculoneuritis, and 5 dogs had an undeterminedLMND. Clinical signs of weakness before ventilation were present for a median of 36 hours (range 6 h to 14 d). Dogs were ventilated for a median of 109 hours (range 5–261 h). Nine dogs had temporary tracheostomies performed, and 8 dogs received nutritional support. Five dogs developed ventilator associated pneumonia. Six dogs were successfully weaned from the ventilator with a median ventilatory time of 49 hours (range 25–192 h). Three dogs survived to discharge. No singleLMNDwas associated with a better outcome.

Conclusions

High euthanasia rates and iatrogenic complications limit the ability to accurately prognosticate for affected dogs in this retrospective study, but in dogs withLMNDthat is severe enough to requireIIPV, support may be required days to weeks.
Autoimmune hepatitis from the paediatric perspective
Authors: Roberts Eve A.
Published: September 2011

Autoimmune hepatitis (AIH) is an important entity within the broad spectrum of autoimmune hepatobiliary disease comprised of AIH, primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). Since the 1960s, AIH has been investigated with extensive clinical research aimed at effective therapeutic intervention. It was one of the first liver diseases where treatment was demonstrated to prolong survival. AIH occurs in children, as well as in adults. Its clinical manifestations in children may differ from classic adult AIH. These differences have elucidated certain aspects of AIH and hepatobiliary disease in general. There are two major patterns of AIH: type 1, with anti‐smooth muscle antibodies and type 2, with anti‐liver/kidney microsomal antibodies. The second type of AIH was first identified in children and is more common in younger patients. AIH often presents as acute disease in children and also in adults: the nomenclature has dropped the allusion to chronicity. Some children who have sclerosing cholangitis present with clinical disease closely resembling AIH; this AIH‐like PSC, termed autoimmune sclerosing cholangitis (ASC), is also found in adults. Children with AIH may have identifiable monogenic disorders of immune regulation such as autoimmune polyendocrinopathy‐candidiasis‐ectodermal dystrophy (APECED). Like adults with AIH, children with AIH usually respond very favourably to immunosuppressive treatment with corticosteroids ± azathioprine. True cures seem to be rare, although many children achieve a stable remission. Nonetheless children with AIH may develop cirrhosis and some require liver transplantation. Early diagnosis and improved treatment strategies may further improve the outlook for children with AIH.
Use of antiviral therapy in surveillance: impact on outcome of hepatitis B‐related hepatocellular carcinoma
Authors: Chan Stephen L. , Mo Frankie K. F. , Wong Vincent W. S. , Liem Giok S. , Wong Grace L. H. , Chan Vicky T. C. , Poon Darren M. C. , Loong Herbert H. F. , Yeo Winnie , Chan Anthony T. C. , Mok Tony S. K. , Chan Henry L. Y.
Published: September 2011

Background

Antiviral therapy for hepatitis B virus (HBV) infection is frequently prescribed for patients with chronic HBV infection during surveillance for hepatocellular carcinoma (HCC). In patients who subsequently develop HCC, the impact of antiviral therapy on the outcome of HCC remains unclear.

Aims

We aimed to study the impact of antiviral therapy on the survival of patients who developed HCC.

Methods

From two prospective surveillance cohorts, the use of antiviral therapy for patients with HCC was retrospectively reviewed. We compared the overall survival, liver function and tumour characteristics between patients with and without antiviral therapy during surveillance. Multivariate analysis was conducted to determine the independent prognostication of antiviral therapy.

Results

During a median follow‐up of 10.1 years of 1429 patients, 148 cases of HCC were diagnosed and followed up for a median of 5.7 years. Twenty‐nine patients were given antiviral therapy during surveillance and continued treatment after diagnosis of HCC. The median survival of this group of patients was better than the rest of cohorts (hazard ratio: 0.472; 95% CI: 0.25–0.89; P = 0.0191). Use of antiviral therapy remained an independent prognostic factor after adjustment for demographic factors and tumour staging on multivariate analysis. Exploratory analysis revealed that patients who commenced antiviral therapy during surveillance had lower HBV DNA, lower serum alanine transaminase, better hepatic reserves and higher rate of local treatment at diagnosis of HCC.

Conclusion

This study provides evidence that commencement of antiviral therapy during the surveillance period is associated with improvement in overall survival in HBV‐related HCC.
A 2‐Year Follow‐Up of a Lifestyle Physical Activity Versus a Structured Exercise Intervention in Older Adults
Authors: Opdenacker Joke , Delecluse Christophe , Boen Filip
Published: September 2011

OBJECTIVES: To evaluate the long‐term effects of a lifestyle intervention and a structured exercise intervention on physical fitness and cardiovascular risk factors in older adults.

DESIGN: Controlled trial with randomization between the intervention groups.

SETTING: Belgium, Vlaams‐Brabant.

PARTICIPANTS: One hundred eighty‐six sedentary but healthy men and women aged 60 to 83.

INTERVENTIONS: Participants in the lifestyle intervention were stimulated to integrate physical activity into their daily routines and received an individualized home‐based program supported by telephone calls. The structured intervention consisted of three weekly supervised sessions in a fitness center. Both interventions lasted 11 months and focused on endurance, strength, flexibility, and postural and balance exercises.

MEASUREMENTS: Cardiorespiratory fitness, muscular strength, functional performance, blood pressure, and body composition were measured before (pretest), at the end (11 months, posttest), and 1 year after the end (23 months, follow‐up) of the interventions.

RESULTS: The results from pretest to posttest have already been published. The current study analyzed the results from posttest to follow‐up. There was a decrease in cardiorespiratory fitness, muscular fitness, and functional performance from posttest to follow‐up in the structured intervention group but not in the control group or the lifestyle intervention group. At 23 months, participants in both groups still showed improvements in cardiorespiratory fitness. In addition, the structured group showed long‐term improvements in muscular fitness, whereas the lifestyle group showed long‐term improvements in functional performance. No long‐term effects were found for blood pressure or body composition.

CONCLUSION: These results highlight the potential of a structured fitness center–based intervention and a home‐based lifestyle intervention in the battle against inactivity in older adults. Lifestyle programs are especially valuable because they require fewer resources and less time from health institutions and health practitioners.
Improving Internal Medicine Residents' Falls Assessment and Evaluation: An Interdisciplinary, Multistrategy Program
Authors: Caton Cathryn , Wiley M. Kathleen , Zhao Yumin , Moran William P. , Zapka Jane
Published: September 2011

Falls are a major problem in older adults, and physicians receive inadequate training in falls evaluation. A multicomponent program (lecture, academic detailing, and case studies) was implemented to enhance medical residents' knowledge, skills, decisions, and interventions made about falls as part of a larger project to improve assessment and care of older adults. Electronic medical record (EMR) template modifications provided cues and reminders, decision support, and documentation into the visit note. Nursing staff and the EMR prompted residents to evaluate patients with a history of falls. Knowledge and confidence were assessed using a pre‐ and postintervention questionnaire, and an attending physician assessed skills by direct observation of the Timed Up and Go Test (TUG). Effect on clinical actions was assessed using the EMR database. Participation in training of faculty and staff was high. Over the 3‐month intervention period, an attending physician reviewed the detailing sheet outlining important points of the training with 86% of residents, and 64% demonstrated a TUG to an attending physician. Of 895 older adults seen, 15% (134) had a positive screen for falls, of whom 92% (123) had an EMR falls template completed, and 42% (56) had a TUG performed. Of the patients evaluated with the TUG, 53% (29) failed. A review of charts for patients who failed the screen or TUG revealed that the majority had special circumstances limiting their participation, even after a physical therapy evaluation. Education and system changes facilitated improvements in resident knowledge, skill, self‐efficacy, and clinical action in screening, evaluating, and managing falls in older adults.
Avoidability of Hospital Transfers of Nursing Home Residents: Perspectives of Frontline Staff
Authors: Lamb Gerri , Tappen Ruth , Diaz Sanya , Herndon Laurie , Ouslander Joseph G.
Published: September 2011

OBJECTIVES: To describe nursing home (NH) staff perceptions of avoidability of hospital transfers of NH residents.

DESIGN: Mixed methods qualitative and quantitative analysis of 1,347 quality improvement (QI) review tools completed by staff at 26 NHs and transcripts of conference calls.

SETTING: Twenty‐six NHs in three states participating in the Interventions to Reduce Acute Care Transfers (INTERACT II) QI project.

PARTICIPANTS: Site coordinators and staff who participated in project orientation and conference calls and completed QI tools.

MEASUREMENTS: NH and hospitalization data collected for the INTERACT II project. An interprofessional team coded and quantified reasons for hospital transfer on 1,347 QI review tools.

RESULTS: Staff rated 76% of the transfers in the QI review tools as not avoidable. Common reasons for transfers rated as unavoidable were acute change in resident status, family insistence, and physician order for transfer. These same reasons were given for transfers rated as avoidable. Avoidable ratings were associated with a broader set of reasons and recommendations for improvement, including earlier identification and management of changes in clinical status, earlier discussion with family members about advance directives, and more‐comprehensive communication with physicians. NHs that were more actively engaged in the INTERACT II interventions rated more transfers as avoidable. Percentage of transfers rated avoidable was not correlated with change in hospitalization rates.

CONCLUSION: NH staff rated fewer hospital transfers as avoidable than published estimates. Greater attention to the complex array of reasons that staff provide for hospital transfer should be considered in strategies to reduce avoidable hospitalizations of NH residents.
Trends in Use of High‐Risk Medications for Older Veterans: 2004 to 2006
Authors: Pugh Mary Jo V. , Hanlon Joseph T. , Wang Chen‐Pin , Semla Todd , Burk Muriel , Amuan Megan E. , Lowery Ashlei , Good Chester B. , Berlowitz Dan R.
Published: September 2011

OBJECTIVES: To examine the change in use of high‐risk medications for the elderly (HRME), as defined by the National Committee on Quality Assurance's Healthcare Effectiveness Data and Information Set (HEDIS) quality measure (HEDIS HRME), by older outpatient veterans over a 3‐year period and to identify risk factors for HEDIS HRME exposure overall and for the most commonly used drug classes.

DESIGN: Longitudinal retrospective database analysis.

SETTING: Outpatient clinics within the Department of Veterans Affairs (VA).

PARTICIPANTS: Veterans aged 65 by October 1, 2003, and who received VA care at least once each year until September 30, 2006.

MEASUREMENTS: Rates of use of HEDIS HRME overall and according to specific drug classes each year from fiscal year 2004 (FY04) to FY06.

RESULTS: In a cohort of 1,567,467, high‐risk medication exposure fell from 13.1% to 12.3% between FY04 and FY06 (P<.001). High‐risk antihistamines (e.g., diphenhydramine), opioid analgesics (e.g., propoxyphene), skeletal muscle relaxants (e.g., cyclobenzaprine), psychotropics (e.g., long half‐life benzodiazepines), endocrine (e.g., estrogen), and cardiac medications (e.g., short‐acting nifedipine) had modest but statistically significant (P<.001) reductions (range −3.8% to −16.0%); nitrofurantoin demonstrated a statistically significant increase (+36.5%; P<.001). Overall HEDIS HRME exposure was more likely for men, Hispanics, those receiving more medications, those with psychiatric comorbidity, and those without prior geriatric care. Exposure was lower for individuals exempt from copayment. Similar associations were seen between ethnicity, polypharmacy, psychiatric comorbidity, access‐to‐care factors, and use of individual HEDIS HRME classes.

CONCLUSION: HEDIS HRME drug exposure decreased slightly in an integrated healthcare system. Risk factors for exposure were not consistent across drug groups. Future studies should examine whether interventions to further reduce HEDIS HRME use improve health outcomes.
Interleukin‐6, C‐Reactive Protein, and Tumor Necrosis Factor‐Alpha as Predictors of Mortality in Frail, Community‐Living Elderly Individuals
Authors: Giovannini Silvia , Onder Graziano , Liperoti Rosa , Russo Andrea , Carter Christy , Capoluongo Ettore , Pahor Marco , Bernabei Roberto , Landi Francesco
Published: September 2011

OBJECTIVES:

To investigate whether interleukin‐6 (IL‐6), C‐reactive protein (CRP) and tumor necrosis factor‐alpha (TNF‐α) protein levels predict all‐cause mortality in older persons living in the community.

DESIGN: Prospective cohort study.

SETTING: Data were from the Aging and Longevity Study in the Sirente Geographic Area, a prospective cohort study.

PARTICIPANTS: Individuals aged 80 and older living in an Italian mountain community (N=362).

MEASUREMENTS: Participants were classified according to the median value of the three inflammation markers (IL‐6, 2.08 pg/mL; TNF‐α, 1.43 pg/mL; CRP, 3.08 mg/L). A composite summary score of inflammation was also created. The main outcome was risk of death after 4 years of follow‐up.

RESULTS: One hundred fifty deaths occurred during 4 years of follow‐up. In the unadjusted model, high levels of each of the three markers were associated with greater mortality. After adjusting for potential confounders, high levels of IL‐6 (hazard ratio (HR)=2.18, 95% confidence interval (CI)=1.29–3.69) and CRP (HR=2.58, 95% CI=1.52–4.40) were associated with a significantly greater risk of death, whereas the association between TNF‐α protein levels and mortality was no longer significant (HR=1.26, 95% CI=0.74–2.15). The composite summary score of inflammation was strongly associated with mortality, with the highest risk estimated for individuals with all three inflammatory markers above the median.

CONCLUSION: Low levels of inflammatory markers are associated with better survival in older adults, independent of age and other clinical and functional variables.