bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacology of human memory and cognition: illustrations from the effects of benzodiazepines and cholinergic drugs
Authors: Danion J.M. , Weingartner H. , File S.E. , Jaffard R. , Sunderland T. , Tulving E. , Warburton D.M.
Published: March 2007

The current research methods, findings and questions that are being addressed in studies of the pharmacology of human memory and cognition are reviewed. Memory is not a unitary function. Neuropsychological studies of brain-damaged memory-impaired patients, as well as neuroimaging and drug studies in normal individuals indicate that different forms of learning and memory are subserved by different brain systems. Animal drug studies have also provided evidence that, while distinct, memory systems are not independent, but operate in close interaction with one another. Recent human studies of benzodiazepines and of cholinergic drugs demonstrate the value of the psychological models and of the experimental paradigms that are available from cognitive sciences for exploring how drugs alter cognitive and memory functions. They also show how drugs can be used as tools for analyzing the distinct neurochemical mechanisms underlying independent cognitive processes, and so find effective drugs rationally from a knowledge of the neurochemical bases of cognition. This research leads to specific recommendations concerning treatments that may improve memory functioning, for instance in Alzheimer's disease.
Effective treatment of Tourette's syndrome with marijuana
Authors: Hemming Mark , Yellowlees Peter M.
Published: March 2007

A single case report is described where marijuana appears to have been an effective treatment modality for symptoms of Tourette's syndrome. Other possible treatment modalities are excluded. It is concluded that there is a need for further work examining the interactions between marijuana, nicotine and the symptomatology of Tourette's syndrome.
Effects of chlormethiazole on psychological performance under conditions of constant plasma concentrations
Authors: Fagan D. , Scott D.B. , Tiplady B.
Published: March 2007

Chlormethiazole was administered intravenously to six healthy volunteers (four male, two female, aged 20-33 years) using a loading dose followed by a maintenance infusion lasting ∼ 90 min. Doses were individually calculated from previous pharmacokinetic investigations in these subjects to produce a target steady-state plasma concentration of 1.5 μg ml-1. Effects of chlormethiazole were determined using a short battery consisting of digit-symbol substitution, body sway and visual analogue scales, which was performed repeatedly before, during and after the active infusion. A more comprehensive battery of performance tests was performed once before and once during the active infusion. The mean plasma concentration of chlormethiazole obtained was 1.33 μg ml-1. This produced marked sedation, with subjects scoring themselves as much more drowsy on chlormethiazole than on placebo, and global impairment to performance. An analysis of the slopes of scores on the performance tests in the short battery showed no evidence of a diminution of the effects of chlormethiazole over the infusion period. The same was true of the majority of the visual analogue scales, but two scales, rating eye symptoms and nose symptoms, did decline over the period of the infusion. Recovery was rapid, subjects returning to approximately baseline levels of performance within 30 min of discontinuation of the infusion. These results suggest that acute tolerance to the CNS effects of chlormethiazole does not occur over this time scale, but is found for peripheral effects such as eye and nose symptoms.
Nicotine-induced hypothermia through an indirect dopaminergic mechanism
Authors: Zarrindast M.R. , Zarghi A. , Amiri A.
Published: March 2007

The effect of nicotine on core body temperature was studied in mice. Intraperitoneal (i.p.) injection of nicotine (0.5, 1 and 2 mg/kg) induced a dose-dependent hypothermia. The response was inhibited by reserpine (5 mg/kg), the centrally active nicotinic receptor antagonist mecamylamine (0.1-1 mg/kg) and the D-2 dopamine receptor antagonist sulpiride (25-100 mg/kg). The β-adrenoceptor antagonist propranolol (5 and 10 mg/kg) and the serotonergic blocker methysergide (5 and 10 mg/kg) did not inhibit but increased the nicotine response. The α-adrenoceptor antagonist phenoxybenzamine, the antimuscarinic agent atropine, the D-1 dopamine receptor antagonist SCH 23390, the peripheral dopamine antagonist domperidone and the peripheral nicotinic antagonist hexamethonium did not alter the nicotine-induced hypothermia. It is concluded that nicotine may cause a fall in core body temperature through a central dopaminergic mechanism.
5-HT3 receptor antagonism and psychoactivity
Authors: Sullivan John T. , Preston Kenzie L. , Testa Margaret P. , Bell Joanne , Jasinski Donald R.
Published: March 2007

The purpose of this study was to assess the acute psychoactive and physiological properties of 5-HT 3 antagonism using ondansetron as a probe. Ondansetron is used clinically as an anti-emetic but is also under treatment consideration for a range of psychiatric disorders including drug abuse. A 15 min infusion of 40 mg ondansetron, a 1 min infusion of 25 mg of cocaine (positive control) and their respective placebos were tested intravenously in eight volunteers with histories of drug abuse in a blinded cross-over study. Ondansetron responses could not be distinguished from the placebo. Cocaine produced typical subjective and physiological effects. These findings indicate that the prototypic 5-HT 3 receptor antagonist ondansetron does not produce acute psychoactive effects when infused at doses of up to 40 mg and has no rewarding effects with this regime.
Benzodiazepine receptor agonists and inverse agonists yield concordant rather than opposing effects on startle responses
Authors: Berntson G. , Sarter M. , Ruland S. , Hart S. , Ronis V.
Published: March 2007

Benzodiazepine receptor agonists and inverse agonists exert generally opposite actions at both the cellular and behavioural levels. The present study, however, reveals that both the benzodiazepine receptor agonist, chlordiazepoxide and the partial inverse agonist, FG7142, yield a dose-dependent (2-16 mg/kg, i.p) reduction in the amplitude of the acoustic startle response in the rat. The similarity in drug effects on startle was not attributable to congruent effects on basal somatic activity, as chlordiazepoxide resulted in a dose-dependent decrease in activity whereas FG7142 was associated with a small but non-significant increase in activity. As these results contrast with the bidirectional actions of benzodiazepine receptor agonists and inverse agonists in behavioural tests of fear or anxiety, the neuronal mechanisms mediating the effects of benzodiazepine receptor ligands on the acoustic startle response may be distinct from those that underlie the specific fear- attenuating and potentiating actions, respectively, of benzodiazepine receptor agonists and inverse agonists.
Demonstration of clomipramine and venlafaxine occupation at serotonin reuptake sites in man in vivo
Authors: Malizia A.L. , Melichar J.M. , Brown D.J. , Gunn R.N. , Reynolds A. , Jones T. , Nutt D.J.
Published: March 2007

We describe the use of 11CRTI-55 and the Multiple Objects Coincidences Counter (MOCC) to detect in-vivo binding to peripheral serotonin reuptake sites (left chest comprising platelet and lung serotonin reuptake sites) in man. Displacement and preloading experiments with clomipramine and venlafaxine in two healthy volunteers demonstrated that 11CRTI-55 binding is decreased in a dose-dependent fashion by both these drugs which bind to the serotonin transporter. In addition parallel data from the total head curve (representing 11CRTI-55 binding to central serotonin and dopamine (DA) reuptake sites) suggest that prior blockade of the serotonin transporter may be a useful strategy to maximize radioactive counts in the head when measuring the DA transporter. The MOCC is likely to be useful to determine sequential indices of relative serotonin reuptake blockade in patients on treatment.
Limited anxiolytic-like effects of non-benzodiazepine hypnotics in rodents
Authors: Griebel Guy , Perrault Ghislaine , Sanger David J.
Published: March 2007

The present experiments compared the anxiolytic-like effects of the benzodiazepine (BZD) hypnotic triazolam with those of four non-BZD hypnotics including one non-selective (zopiclone) and three ω1-BZD selective (zolpidem, zaleplon and SX-3228) receptor ligands, in classical animal models including conflict tests (punished lever pressing and punished drinking tests in rats) and exploratory models (elevated plus-maze test in rats and light/dark choice test in mice), and a recently developed mouse defence test battery (MDTB) which has been validated for the screening of anxiolytic drugs. Results from both conflict procedures showed that zopiclone (0.3-10 mg/kg) produced anxiolytic-like effects comparable to those of triazolam (0.1-3 mg/kg), whereas the selective ω 1-BZD receptor hypnotics zolpidem (0.3-3 mg/kg), zaleplon (0.1-3 mg/kg) and SX-3228 (0.1-1 mg/kg) displayed weaker and/or non-specific anxiolytic-like effects. Similarly, in the light/dark test in mice, zolpidem (0.1-1 mg/kg), zaleplon (0.3-10 mg/kg) and SX-3228 (0.03-0.3 mg/kg) showed a reduced potential to produce anxiolytic-like effects as compared to the non-selective ω-BZD receptor hypnotics triazolam (0.03-1 mg/kg) and zopiclone (1-30 mg/kg). In the elevated plus-maze test, zopiclone (1-10 mg/kg), zolpidem (0.1-1 mg/kg), zaleplon (0.3-3 mg/kg) and SX-3228 (0.1-1 mg/kg) displayed anxiolytic-like activity at doses close to those producing behavioural impairment, whereas triazolam (0.03-1 mg/kg) exhibited anxiolytic-like effects over a wide dose range in the absence of decreases in general activity. In the MDTB, zaleplon (0.3-10 mg/kg) decreased all defensive responses, a profile which was similar to that of triazolam (0.03-1 mg/kg), while zopiclone (1-30 mg/kg), zolpidem (0.3-10 mg/kg) and SX-3228 (0.03-1 mg/kg) had fewer effects on defensive behaviours with several effects occurring only at motor-impairing doses. Taken together, these results demonstrate that, although selective ω 1-BZD receptor hypnotics display anxiolytic-like activity, the effects are generally weaker than those observed with non-selective ω-BZD receptor selective hypnotics such as triazolam or zopiclone. In particular, the anxiety-reducing potential of the ω1-BZD receptor selective compounds is limited to certain anxiety measures and may be confounded and/or masked by behavioural suppression.
The Co-evolution of Mind and Machine
Authors: Glenn Jerome C.
Published: March 2007

The Post-Information Age will see the merger of humans and their technologies, perhaps creating an entirely new species.
The Authority of the Scientific Rejection of Pseudo-Science
Authors: Dolby R.G.A.
Published: March 2007

[The following three papers (by R.G.A. Dolby, R.N.D. Martin, and A. Thomson) were presented to the Science & Religion Forum at its annual meeting in Liverpool, Britain, in March 1988, under the general theme of Tradition & Authority in Science and Religion. An abbreviated version of the fourth paper given at that meeting re-entitled STS Perspective: Value Systems, by W.F. Williams, is printed on pp. 219-221 of this volume (Vol. 9, No. 4). A copy of the full version is available from either the author or the editorial office.]
Stochastic Thresholds
Authors: Hartz Arthur , McKINNEY W.Paul , Centor Robert , Krieg Arthur , Simms George , Henck Samuel
Published: March 2007

Thresholds have traditionally been represented by a single number; the optimal management of the patient depends on whether his probability of disease is above or below this number. The concept of a threshold as a single number, however, inadequately represents the treat ment approach of a group of physicians who do not all have the same threshold or a single physician who is uncertain about the exact value of the threshold. An alternative to a single valued threshold is to consider the threshold as having a probability distribution: for every probability that the patient has the disease there is a probability that the threshold is exceeded. This "stochastic" threshold model contains information about the uncertainty of the threshold estimation. Stochastic thresholds can be useful for testing the sensitivity of a management decision to the patient's probability of disease. They can also be used for comparing the standards of practice of individual physicians or comparing the practice of an individual physician with that of a group.
A Cost-effectiveness Analysis of Cyclosporine in Cadaveric Kidney Transplantation
Authors: Simon David G.
Published: March 2007

Expected costs and health outcomes associated with cadaveric kidney transplantation using cyclosporine (CsA) plus steroids, azathioprine (Aza) plus steroids, and "dialysis only" were estimated from both a societal perspective and a Medicare perspective. Published data on patient and graft survival and treatment costs were incorporated into a Markov model to predict the ten-year experience of hypothetical cohorts of 1000 35-year-old persons with end-stage renal disease (ESRD) exposed to each treatment option. In the base-case analysis conducted from the societal perspective, ten-year cumulative costs for the "dialysis only," CsA, and Aza cohorts were $181, $147, and $138 million, respectively. Transplantation using CsA rather than Aza would cost an estimated $19,800 per additional life-year and $9,700 per additional graft-year; whereas from Medicare's perspective, CsA would be less costly than Aza. This analysis suggests that under present regulations, widespread use of CsA instead of Aza for cadaveric graft recipients would result in significant cost shifting from Medicare to the private sector; but from a societal perspective, this would result in no, or at worst, relatively inconsequential, additional health expenditures. A policy whereby dollar savings achieved by Medicare from improved graft survival were used to help underwrite the cost of CsA for cadaveric kidney transplants would promote access to this drug and have little impact on the overall cost of care for individuals with ESRD. Key words: cost- effectiveness; cyclosporine; end-stage renal disease; cadaveric kidney transplantation; Med icare. (Med Decis Making 6:199-207, 1986)
Court Viewpoints and Medical Decision Making
Authors: Mazur Dennis J.
Published: March 2007

Twenty-five years of appellate court decisions about informed consent in three influential states were examined to address four issues: 1) the criteria used to define adequate informed consent; 2) trends in court decisions; 3) parallels between court decision making and decision analysis; 4) the contribution of decision analytic concepts to defining "reasonable" medical informed consent. Court standards have evolved in three phases: the "medical community" standard before 1972, the "reasonable person" standard since 1972, and recent inroads toward developing an "individual preference" standard. The latter two standards form the current basis for deciding whether a patient has been adequately informed. Decision analysis offers a framework for communication about medical outcomes and probabilities, and meth ods for assessing preferences. Jurists and physicians should consider whether the legal system should adopt a decision analytic perspective in the doctrine of informed consent. Researchers should address issues raised by use of decision analysis for communication between the physician and the patient. Key words: medical ethics; patient-physician rela tionship; medical informed consent; medical risk; patient preference; legal (court) decision; professional standards; reasonable man; malpractice; negligence. (Med Decis Making 6:224- 230, 1986)
Management Decisions after Nonstress Testing
Authors: Hage Marvin L.
Published: March 2007

Evaluation of patient management after the utilization of a specific diagnostic test has been difficult to interpret from retrospective studies. Specifically, the impact of the interpretation of the diagnostic study, the environment where the test is performed, and the biases of the physician have been difficult to separate. In this study, agreement on first-choice management decisions by a national sample of obstetricians blinded to specific clinical information, based on interpretations of five nonstress tests, was low (kappa = 0.24 ± 0.02). The response "evaluate for delivery" was significantly different between "reactive" and "nonreactive" inter pretations. There was better management agreement among those respondents with more experience with nonstress testing; those from larger hospitals; and those who practiced at universities, HMOs, and military hospitals. The attitudes of individual respondents as mea sured by the first-choice goals of the test did not significantly influence overall management agreement. Reliability of management was less among physicians aged 50-59 years. There was no obvious national consensus regarding management following nonstress testing. Key words: nonstress test; management; reliability; kappa statistic. (Med Decis Making 7:97- 103, 1987)
The Prognostic Value of the Duration of the Ambulatory Electrocardiogram after Myocardial Infarction
Authors: Davis Barry R. , Friedman Lawrence M. , Lichstein Edgar
Published: March 2007

The purpose of this study was to examine the value of various durations of ambulatory ECG recording with regard to providing useful prognostic information. The authors explored a decision theoretic approach to determine the most useful period of monitoring for making a treatment decision based upon postulated benefit-to-risk ratios of antiarrhythmic therapies. They used data collected as part of the Beta-Blocker Heart Attack Trial (BHAT), a randomized clinical trial of propranolol versus placebo in 3,837 post-myocardial-infarction patients. In BHAT, 1,336 placebo-treated patients had a 24-hour ambulatory ECG that had at least 23 readable hours. Sensitivity and specificity were calculated for eight definitions of ventricular arrhythmia using either total mortality or sudden death (death within one hour of symptoms) as an endpoint. These indices were obtained using the first 1, 2, 4, 6, 12, and 24 hours plus a random hour, a random daytime hour, and a random nighttime hour of the 24-hour ECG of 1,336 placebo-treated patients. The study showed that in the case of high-risk, low-benefit therapies, no test is needed to make a treatment decision. No one should be treated. In the case of high-benefit, low-risk therapies, again, no test is required. Everyone should be treated. For therapies in the middle benefit-to-risk ratio range the most appropriate test for a treatment decision changes from the very specific to the most sensitive. Twenty-four hours of ambu latory monitoring is usually not necessary for a treatment decision, since four hours is likely to be sufficient. Key words: benefit-to-risk ratios; sensitivity and specificity; Holter monitor; ventricular arrhythmia. (Med Decis Making 8:9-18, 1988)
Diagnosis of Cholestasis
Authors: Safran Charles , Greenes Robert A. , Bynum Turner E. , Kierstead Mary L.
Published: March 2007

The authors analyzed two invasive procedures used to visualize the biliary tree, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiog raphy (PTC), and also explored the utility of preinvasive workups for patients with suspected cholestasis. For this analysis they used published ranges for success, fatality, complications, diagnostic accuracies of the procedures, and prognostic information about the underlying diseases. The choice between ERCP and PTC was found to be a "close call," but ERCP was generally favored as the first-choice procedure. The results suggest that noninvasive imaging does not help decide between ERCP and PTC. Although noninvasive imaging may identify those patients with common duct dilation, the higher success rate with PTC in these patients is offset by a slightly higher mortality rate. Consequently, the choice between ERCP and PTC remains close even if ultrasound has shown that biliary ducts are dilated. Fur thermore, it is shown that these noninvasive tests are most useful when they can conclusively determine the presence or absence of biliary obstruction. For many patients, noninvasive imaging will not obviate the need for invasive tests. Key words: cholestasis; jaundice; decision analysis; endoscopic retrograde cholangiopancreatography; percutaneous transhepatic cho langiography; abdominal ultrasonography. (Med Decis Making 8:102-109, 1988)
Bayesian Analysis of Diastolic Blood Pressure Measurement
Authors: Schechter Clyde B. , Adler Rhodes S.
Published: March 2007

A mathematical model is presented for measurements that include substantial fluctuation and error. Under the assumptions that the fluctuation-error variance is the same for all subjects, and that the distributions of fluctuation-error variance within subjects and "true" values of the measurements in the population are normal, Bayes' theorem produces a simple estimate of the "true" value of a measurement, and a standard error, conditional on a single observation. The model is easily extended to several observations. Methods for estimating the parameters of the model from a data set are presented, and applied to diastolic blood pressures of patients in the authors' primary care clinic. The test-retest reliability of a single blood pressure measurement for this population is 0.41. Because continuous measurements are often dichotomized into "normal" and "abnormal" ranges by a threshold criterion, the authors present formulas for the positive predictive value when a decision rule based on a given number of observations is used in a population with respect to a threshold criterion for the "true" values. For example, classifying their patients as hypertensive on the basis of the average of two readings exceeding 90 mm Hg diastolic pressure would have a positive predictive value of 52% for the "gold standard" of average diastolic pressure exceeding 90 mm Hg. Formulas to calculate the frequency with which patients will be classified "abnormal" by one decision rule but will be classified "normal" by later application of another rule are provided and used to "predict" the frequency with which this crossover phenomenon should have occurred in the enrollment phase of the Hypertension Detection and Follow-up Pro grams.5,6 The authors' calculation of 36.3% agrees closely with the observed 34.7% crossover rate, enhancing confidence in the validity of their model and generalizability of their parameter estimates. Key words: Bayes' theorem; hypertension; screening tests. (Med Decis Making 8:182-190, 1988)
Hindsight Bias: An Impediment to Accurate Probability Estimation in Clinicopathologic Conferences
Authors: Dawson Neal V. , Arkes Hal R. , Siciliano Carl , Blinkhorn Richard , Lakshmanan Mark , Petrelli Mary
Published: March 2007

Although clinicopathologic conferences (CPCs) have been valued for teaching differential diagnosis, their instructional value may be compromised by hindsight bias. This bias occurs when those who know the actual diagnosis overestimate the likelihood that they would have been able to predict the correct diagnosis had they been asked to do so beforehand. Evidence for the presence of the hindsight bias was sought among 160 physicians and trainees attending four CPCs. Before the correct diagnosis was announced, half of the conference audience estimated the probability that each of five possible diagnoses was correct (foresight subjects). After the correct diagnosis was announced the remaining (hindsight) subjects estimated the probability they would have assigned to each of the five possible diagnoses had they been making the initial differential diagnosis. Only 30% of the foresight subjects ranked the correct diagnosis as first, versus 50% of the hindsight subjects (p < 0.02). Although less experienced physicians consistently demonstrated the hindsight bias, more experienced physicians succumbed only on easier cases. Key words: clinicopathologic conferences; hindsight bias; cognitive bias; debiasing techniques. (Med Decis Making 8:259-264, 1988)
Potential Effectiveness of Comparative Casemis-corrected Adverse Outcome Rates as Quality Monitors in a Simulated Hospital System
Authors: Pine Michael B. , Morgan David D. , Beller Robert H.
Published: March 2007

To facilitate outcome-based medical quality assurance, a screening technique was developed which corrected facility-specific data for casemix using mean outcome rates from pooled data to establish norms for "uniform-risk groups" of patients. A simulated health care system (108 facilities treating over 500,000 annually) was created to evaluate this technique's ability to distinguish between systems whose adverse outcomes were determined solely by casemix and random variations and those with true differences in quality of care. Specificity and sensitivity of quality of care decisions for individual facilities also were assessed. The screen ing technique achieved excellent differentiation between "homogeneous" systems and those with facility-specific variations in quality of care. No more than 3% of facilities without quality of care problems were ever inaccurately labeled, unless systematic or random errors in patient risk classification were introduced. Sensitivity in detecting substandard facilities was 35% when true deviation from standard was 2.5%, and rose to virtually 100% when deviation was 25% or greater. Thus, simulation can serve as an efficient method of testing the potential performance of casemix-corrected quality assurance screening under a wide variety of cir cumstances. Key words: quality assurance; simulation; health care outcomes; casemix cor rection ; risk adjustment; indirect standardization; clinical indicators; provider comparisons; database development; healthcare monitoring. (Med Decis Making 1989;9:104-115)
An Introduction to a Bayesian Method for Meta-analysis
Authors: Eddy David M. , Hasselblad Vic , Shachter Ross
Published: March 2007

The Confidence Profile Method is a new Bayesian method that can be used to assess technologies where the available evidence involves a variety of experimental designs, types of outcomes, and effect measures; a variety of biases; combinations of biases and nested biases; uncertainty about biases; an underlying variability in the parameter of interest; indirect evidence; and technology families. The result of an analysis with the Confidence Profile Method is a posterior distribution for the parameter of interest, posterior distributions for other parameters, and a covariance matrix for all the parameters in the model. The posterior distributions incorporate all the uncertainty the assessor chooses to describe about any of the parameters used in the analysis. Key words: Confidence Profile Method; bias; Bayesian analysis; meta-analysis. (Med Decis Making 1990;10:15-23)
Improvement of Decisions Regarding Hemodialysis Patients by Urea Kinetic Modeling
Authors: Buur Tom , Timpka Toomas
Published: March 2007

The potentials for improving decisions about adequacy of dialysis (AD) and daily protein intake (DPI) by urea kinetic modeling (UKM) were examined. Four nephrologists evaluated AD, DPI, and metabolic stability in 62 patients. UKM was done three times; but the results were not revealed. Clinicians' decisions were then compared with UKM measures of effective dialysis (Kt/V) and protein catabolic rate (pcr). Detection of inadequately treated patients by the clinicians was poor (28%, Kt/V < 1.0; and 40%, Kt/V < 0.9). Specificities of the clinicians' decisions were 0.96 and 0.92, respectively. Combining pcr and consensus decisions, 59 patients could be assigned a probable DPI. Using this as "gold standard," the average clinician detected 77% of 13 low DPls. Single or triple pcr determinations alone detected 77% or 62%, respectively. Specificities were 0.91, 0.85, and 1.0. Simulated decision making suggested that combining pcr with clinical evaluation in a logical way would lead to detection of most patients with low DPI. Qualitative data from individual patient cases causing con troversies are presented and discussed. It is concluded the UKM should be used routinely to assess the adequacy of dialysis and daily protein intake.
Use of Clinical Judgment Analysis to Explain Regional Variations in Physicians' Accuracies in Diagnosing Pneumonia
Authors: Tape Thomas G. , Heckerling Paul S. , Ornato Joseph P. , Wigton Robert S.
Published: March 2007

The authors sought to explain regional differences in physicians' accuracies in diagnosing pneumonia by prospectively studying emergency department patients at three sites and analyzing differences in physicians' diagnostic strategies and patient characteristics. They enrolled 1,119 Illinois patients, 150 Nebraska patients, and 142 Virginia patients presenting with fever or respiratory symptoms for whom physicians ordered a chest radiograph because of suspicion of pneumonia. Emergency department physicians recorded patients' clinical findings and estimated the probability that a chest radiograph would show pneumonia. A measure of accuracy, the correlation between physicians' probability estimates and actual outcomes, was 0.41 (95% Cl 0.36-0.46) at Illinois, 0.66 (95% Cl 0.54-0.75) at Nebraska, and 0.55 (95% Cl 0.42-0.65) at Virginia. Physicians' strategies at the three sites differed markedly in their weightings of asthma, signs of consolidation, cough, tachypnea, age, and gender. These differences in weighting paralleled differences in the optimal clinical strategies derived from patient data at the three sites. Differences in diagnostic accuracy were best explained by differences in the difficulties of diagnosing pneumonia in the populations. Phy sicians at each site used clinical findings in a way that was close to optimal for their location. This type of analysis provides a new tool for understanding the sources of regional variations in clinical practice. Key words: judgment analysis; variation research; pneumonia. (Med Decis Making 1991 ;11 :189-197)
Routine Neonatal Circumcision
Authors: Ganiats Theodore G. , Humphrey Jonathan B.C. , Taras Howard L. , Kaplan Robert M.
Published: March 2007

A cost-utility analysis was performed to evaluate the relative importance of each of the various elements in the current circumcision debate. Elements used in the analysis included the cost of the procedure, the pain associated with the procedure, the risk of urinary tract infections, and the risk of penile cancer. The net, discounted lifetime dollar cost of routine circumcision is $102 per person, while the net, discounted lifetime health cost is 14 hours of healthy life. These results suggest that the financial and medical advantages and dis advantages of routine neonatal circumcision cancel each other and that factors other than cost or health outcomes must be used in decision making. Key words: cost-utility analysis; circumcision; urinary tract infection. (Med Decis Making 1991;11:282-293)
A Method to Describe Physician Decision Thresholds and Its Application in Examining the Diagnosis of Coronary Artery Disease Based on Exercise Treadmill Testing
Authors: Plasencia Carlos M. , Alderman Beth W. , Barón Anna E. , Rolfs Robert T. , Boyko Edward J.
Published: March 2007

The authors developed a method that utilizes logistic regression analysis to 1) calculate the disease probability with confidence intervals at which any specified proportion of physicians reaches a clinical decision, 2) statistically test whether factors other than disease probability affect this clinical decision, and 3) statistically test whether physician decision making in relation to disease probability varies by other factors. They apply the method to analyze the relationship between disease probability and the proportion of physicians who diagnosed coronary artery disease (CAD) in 127 consecutive subjects who completed the treadmill exercise tolerance test (ETT) at two hospitals. Twenty-five percent of the physicians decided that CAD was possible or definite at a post-ETT disease probability of 0.24 (95% CL = 0.07-0.35); 50% at 0.54 (95% CL = 0.43-0.70); and 75% at 0.82 (95% CL = 0.67-1.0). Multivariate logistic regression analysis revealed three factors significantly and independently related to the diagnosis of CAD: post-ETT disease probability, positive ETT result, and cigarette smoking. The proportion of physicians who reached a diagnosis of CAD did not differ by hospital setting (VA versus university), level of training (attending versus housestaff/ fellow), or diagnosing service (cardiology versus other internal medicine). It is concluded that factors other than disease probability may affect physician diagnostic decisions. Key words: medical decision making; decision threshold; logistic regression analysis; stochastic threshold model; exercise treadmill test; ischemic heart disease. (Med Decis Making 1992;12:204-212)
Selection of End Points in Economic Evaluations of Coronary-heart-disease Interventions
Authors: Drummond Michael F. , Heyse Joseph , Cook John , McGuire Alistair
Published: March 2007

Economic evaluations of interventions to lower blood pressure or cholesterol have used different outcome measures, or end points, in the denominator. Some have related the costs of interventions to improvements in physiologic end points such as mm Hg reduction in blood pressure. Some have related costs to avoidance of coronary heart disease (CHD) events or gains in life expectancy. Others have measured improvements in outcome in quality- adjusted life years (QALYs) gained. The different end points imply different analytic per spectives and different data requirements. The more ambitious analyses, though potentially more relevant in certain situations, require more controversial assumptions to be made. This paper illustrates the trade-offs of relevance, accuracy, and precision by reference to an evaluation of drug therapy for hypercholesterolemia undertaken in the United Kingdom. Estimates are given of cost per percentage cholesterol reduction, cost per CHD event avoided, cost per CHD-free year gained, cost per life year gained, and cost per quality-adjusted life year gained. In each case the assumptions required and the potential relevance of the estimate are discussed. The main findings are that: 1) some end points cannot be discounted to present values in a meaningful way and hence the timing of costs and outcomes cannot be reflected in the analysis; 2) the incorporation of quality-of-life adjustments for years on drug therapy and years post-CHD events greatly changes the cost-effectiveness ratios; 3) the rate of discount changes the pretreatment level of cholesterol for which cost per life year gained is equivalent to cost per quality-adjusted life year gained. Key words: economic evaluation; cost-effectiveness analysis; cost-utility analysis; quality of life; risk assessment model; coronary heart disease; drug therapy. (Med Decis Making 1993;13:184-190)
Cost - Effectiveness Analysis, Extended Dominance, and Ethics
Authors: Cantor Scott B.
Published: March 2007

The principle of extended dominance is applied in incremental cost-effectiveness analysis to eliminate from consideration strategies whose costs and benefits are improved by a mixed strategy of two other alternatives. Ethical considerations arise, however, in that equal care is not provided to all of the population. To explore these concerns, the authors establish a theoretical health care example with three diagnostic strategies. They demonstrate, both algebraically and geometrically, how to calculate the set of all possible mixed strategies that dominate the strategy eliminated by extended dominance. With the consideration of budget constraints, they define the "coefficient of inequity" as the minimum proportion of the pop ulation that would receive an inferior health care strategy if a mixed strategy were to be used instead of the dominated strategy. The implications of cost-effectiveness analysis are made explicit, revealing classic economic concerns about the tradeoff of equity and efficiency. Key words: cost-effectiveness analysis; extended dominance; economics; ethics. (Med Decis Making 1994;14:259-265)
The Inverse Kinematics of a Three-Cylindric Robot
Authors: Pennock G.R. , Vierstra B.C.
Published: March 2007

This article presents solutions to the inverse kinematic prob lems of a three-axis robot with three cylindric joints. Since a cylindric joint has two degrees of freedom, the end effector will have six degrees of freedom in general. Therefore, the robot can position and orient the end effector at a specified location within the work space. An important feature of the robot is that the rotational components of the end effector displacement are completely decoupled from the translational components of displacement. This eliminates the need for compensation from the orienting mechanism when position ing the end effector. The inverse of a 3 × 3 dual-Jacobian matrix is introduced and used to obtain closed-form solutions to the inverse velocity and acceleration problems. This is believed to be an original contribution to the robotics litera ture, and it is hoped that the method will provide a meaning ful alternative to existing methods for formulating the inverse kinematic problems of robots. For illustrative purposes, we include a potential application of the three-cylindric robot as a flexible worktable that could be used in a cooperating multiple-robot work cell.
The use of personal experiences as sources of knowledge
Authors: Fortier Anne-Marie
Published: March 2007

It's possible, too, that there is no such thing as one clear line or strand of probability, and that we live on a sort of twisted braid, blurring from one to the other without even knowing it, as long as we keep within the limits of a set of variations that really make no difference to us. (Russ, 1985: 7)
Idem Per Idem: Its Use and Meaning
Authors: Ogden G.S.
Published: March 2007

The article provides a list of 16 known examples of the idem per idem construction, then examines each in its context to determine its meaning and function. The author offers seven concluding points: (a) it may express totality or intensity of the verbal action; (b) an associated adverbial locating phrase (e.g. ba'ašer) stresses the extent of the verbal action; (c) a temporal phrase in the subordinate clause describes an extended period of time; (d) it can be used as a way of expressing the desire for the appointment of an alternative to the speaker; (e) in a conditional context, the speaker is making a personal commitment to a dangerous course of action; (f) terminating an argument is only a secondary function; (g) the traditional thesis that the form refers to freedom of choice is unsubstantiated.
Copyright and AV Materials: An Introduction
Authors: Pinion Catherine F. , de Vries Hanna
Published: March 2007

The following article continues the series of articles on copyright issues of interest to IFLA members. Sandy Norman, appointed by the IFLA Executive Board as IFLA's Copyright Advisor when IFLA's Copyright Committee was disbanded during the Barcelona Conference, invites IFLA members to comment on these articles, to offer advice on activities IFLA should undertake, and to share their experiences, interests or questions on this important professional aspect of IFLA's work.
Cross-Domain Access to Digitized Cultural Resources: The SCRAN Project
Authors: Royan Bruce
Published: March 2007

Bruce Royan has 30 years of experience in the field of electronic cultural and information services, working with British Telecom, the London Borough of Camden, the British Library and the National Library of Scotland before implementing the Singapore Integrated Library Automation Service (SILAS) in the mid-80s. He returned to the UK as Principal Information Systems Consultant with Infologistix Ltd., consulting and lecturing worldwide. After seven years as University Librarian and Director of Information Services at the University of Stirling, he is now the Chief Executive of SCRAN. Mr Royan is Chair of the IFLA Section on Information Technology, a Member of the British Computer Society, a Fellow of the Society of Antiquaries of Scotland, of the Institute of Management and of the Library Association, and a Councillor of the Institute of Information Scientists. He is also Visiting Professor of Publishing and Communication at Napier University, Edinburgh. Mr Royan may be contacted at SCRAN (Scottish Cultural Resources Access Network), Abden House, 1 Marchhall Crescent, Edinburgh EH16 5HW, Scotland, UK (fax: +(44- 131) 6621511; e-mail: bruce@scran.ac.uk).
Industrialization without Family Change? The Extended Family and the Life Cycle in a Dutch Industrial Town, 1880-1920
Authors: Janssens Angelique
Published: March 2007

This article examines the structural evolution over the life-cycle of a cohort group ofparental households in the industrial town of Tilburg during theperiod 1880-1920. The rapid demographic and industrial developments the town had been going through before and during this period did not lead to a destruction of the traditional pattern of extended family households, as structural-functionalist theories would assume. A large majority ofthe Tilburg parents developed a household structure beyond the nuclear family at some point over their cycle. Most household extensions occurred during the first developmental stages, but especially during the last stages of the parental life-cycle. These families continued to react in accordance with the area's traditional family values. They constitute an example of a 'cultural lag'that can exist between family patterns and social structural change. A strong social and economic position seems to be related to an extended household structure, particularly in the case of the migrant families in the Tilburg sample. Moreover socially differentiated ex tension patterns have been established as well. Finally, the Tilburg study confirms the importance of kin for migrants in an industrializing society.
Rural Elderly Household Life-Course Transitions, 1900 and 1980 Compared
Authors: Arcury Thomas A.
Published: March 2007

The changing household status of the elderly has become an important policy and research question. Using the life-course approach this paper compares elderly household status and elderly household composition of a rural community in 1900 and 1980 better to elucidate historical change in a rural context. To show specific rural characteristics, the 1900 and 1980 data are further compared to available national and urban information. The rural elderly household life-course in 1900 differs in several characteristicsfrom its urban and national counterparts; by 1980, however, the situation in the rural community differs little from that in the national population.
The Joint Family Household Revisited: Demographic Constraints and Household Complexity in the European Past
Authors: Kertzer David I.
Published: March 2007

Debates about the nature and geographical distribution of complex family households in the European past continue to animate much of the work of family history. This ar ticle criticizes the common view that demographic constraints prevented the realization of com plex family forms in western Europe. It also takes issue with recent attempts to contrast a Mediterranean household system with those found in northwestern Europe and in eastern Europe. Evidence from Italian sharecroppers in the Bologna area in the period 1861-1921 is presented and comparative evidence from eastern Europe is discussed. The important differences between stem and joint family systems are elucidated.
Delaying the Fertility Decline: German Women in Saginaw County, Michigan, 1850-1880
Authors: Ross G. Alexander
Published: March 2007

Using U.S. manuscript censusesfrom 1850 to 1880, the study examines changes infertility of women in Saginaw County, Michigan, during the period in which the county became a major center of the lumber industry in North America. The German states were an important source of immigration to Saginaw County during this period and the paper focuses particularly on the fertility of German women in contrast to native-born women and those of other nativity. The comparison reveals that, although other groups of women exhibited a marked decline in fertility, German women sustained a high fertility level to the end of the period of study.
The C-Mean: a Methodological Note of Caution
Authors: Lee Christopher F.
Published: March 2007

This note re-examines the C-Mean, a method for calculating averages for in dividuals within units. According to Daniel Scott Smith, the statistic C (here called the C-Mean) "has two important uses—in clarifying the definition of the subject under study, and in describing units from the perspective of the people located in them." The note clarifies some ambiguities about how to calculate the C-Means for grouped data and discusses some potential biases in the results. Moreover, it raises questions about the interpretive value of the statistic and suggests that the C- Mean should be used in conjunction with other descriptive statistics.
Family Building in Paternalistic Proto-Industries: A Cohort Study from Nineteenth-Century Swedish Iron Foundries
Authors: Sundin Jan
Published: March 2007

Family building and household structure in nineteenth-century proto-industrial iron foundries in northern Sweden are examined by comparing the lives of 500 persons born at iron foundries with 600 persons born in an agrarian area. The organization and demands of work, dependence on the business cycle, and paternalism are important factors in explaining the social and demographic patterns at the foundries.
Fatherhood in Eighteenth-Century Holland: the Van Der Muelen Brothers
Authors: Roberts Benjamin
Published: March 2007

Until recently, fatherhood in the Early Modern period has been largely unknown terrain. Books of advice on the physical upbringing of children were addressed to mothers, implying that fathers were not involved in the process. However, iconog raphic evidence presented by Simon Schama suggests that fathers did indeed partici pate in bringing up their children. This research note uses personal documents-the correspondence of two brothers, Jan André (1703-60) and JosephElias ( 1707-81) Van der Muelen-to address the apparent discrepancy. Two themes, the births and sickness of their children, dominated the brothers' letters to each other, and they also wrote about breast feeding, weaning, and the problems of finding godparents for their children. As such, the correspondence provides an insight into fatherhood in the Early Modern period.
Circe in Crinoline: Domestic Poisonings in Victorian England
Authors: Robb George
Published: March 2007

During the Victorian era, about forty women were tried for poisoning their husbands. Despite the small number, the cases loomed large in the public imagi nation and were given widespread and sensational coverage by the press. Evidence presented at poison trials tells us much regarding Victorian ideas about science, domestic routines, patterns of marital conflict, and attitudes toward women in general. Fears of domestic poisonings caused Parliament to restrict poison sales in 1851 and reinforced negative stereotypes of women as secretive and conniving. Some women, however, may have found the image of the poisoner empowering, and the threat to poison appeared to be a common female defense against abusive husbands.