bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of graded leg cycling on postischaemic forearm blood flow in healthy subjects
Authors: Charles Marc , Pichot Vincent , Dauphinot Virginie , Barthelemy Jean‐Claude , Denis Christian , Roche Frédéric , Costes Frédéric
Published: November 2007

This study assessed in healthy subjects, the effect of leg cycling on the forearm vascular responses to ischaemia to confirm previous results showing that exercise‐induced sympathetic activation during leg cycling reduced postischaemic forearm hyperaemia. Seven young healthy subjects performed two bouts of cycling exercises at 50% and 80% of their maximal aerobic capacity (Ex50, Ex80 respectively) during which forearm arterial blood flow was successively occluded for 40, 90 and 180 s. Control forearm blood flow (FBF) and postischaemic forearm blood flow (pi‐FBF) measured at the release of arterial occlusions were assessed using plethysmography. Digital arterial pressure was continuously monitored allowing calculation of control and postischaemic forearm conductance (FC and pi‐FC respectively). At rest, pi‐FBF increased with the duration of ischaemia (5 ± 1, 19 ± 3, 29 ± 3, 31 ± 4 ml min−1 100 ml−1 after 0, 40, 90 and 180 s of ischaemia respectively). During Ex50, FBF and pi‐FBF did not change significantly although pi‐FC was significantly reduced (Δpi‐FC = −39%, −33%, −27% for 40, 90, 180 s of ischaemia respectively). During Ex80, there was a further dramatic decrease in pi‐FC (−53%, −66%, −62% from rest) and pi‐FBF were largely blunted (13 ± 4 versus 19 ± 3, 14 ± 4 versus 29 ± 3, 17 ± 5 versus 31 ± 4 ml min−1 100 ml−1). These results demonstrated that forearm responses to ischaemia depended on leg activities. It was suggested that exercise‐induced sympathetic activation may have interfered on local vasodilatation because of ischaemia.
Randomized controlled trial of supervised exercise to evaluate changes in cardiac function in patients with peripheral atherosclerotic disease
Authors: Hodges L. D. , Sandercock G. R. H. , Das S. K. , Brodie D. A.
Published: November 2007

Introduction:  Peripheral atherosclerotic disease (PAD) is a condition characterized by low functional capacity which is associated with impaired free living, ambulation and low exercise tolerance. The purpose of this randomized controlled study was to evaluate whether changes in maximal walking time are associated with adaptations in cardiovascular function following supervised exercise.

Methods:  After ethics approval, 28 patients (63 ± 11 years) completed a graded treadmill test (2 min stages, 3·2 km h−1, with gradient increasing 2% every 2 min) until they reached level three or four on the claudication pain scale. Peak oxygen consumption was assessed on a breath‐by‐breath basis, by online expiratory gas analysis. Following a 40‐min recovery period, peak cardiac output was measured using the non‐invasive carbon dioxide rebreathing method described by Defares (J Appl Physiol, 13, 1958, 159). Peak cardiac power output was then computed using the equation described by Cooke et al. (Heart, 1998, 79, 289). Patients were randomly assigned to one of two groups: supervised, who exercised at the hospital twice weekly for 12 weeks or control, who received normal treatment which included encouragement to walk regularly.

Results:  After 12 weeks, there were no significant changes in body mass, peak oxygen consumption, peak cardiac output, peak heart rate, peak cardiac power output, respiratory exchange ratio or rating of perceived exertion in both the supervised and control group. There was a significant improvement (91%) in maximal walking distance following the supervised exercise programme. Although patients’ peak cardiovascular measurements were unchanged, the patients in the supervised exercise group were able to complete a higher workload at the end of the 12 weeks of exercise, for the equivalent demands on the circulation system.

Conclusions:  The findings from this study suggest that a short‐term period of supervised exercise training results in an improved walking time in patients with limiting claudication because of PAD. It also demonstrated that the cardiovascular system becomes more efficient in meeting the demands of exercise. It is recommended that individuals with PAD should undertake exercise as a form of treatment.
Introduction to geopolitics by Colin Flint
Authors: Campbell David
Published: November 2007

Statement  The Editors do not necessarily agree with the statements contained in the book reviews, and neither they nor the RGS‐IBG assume responsibility for the reviewers’ assessments of the books that they evaluate.
AN UNUSUAL NEW NEOSAUROPOD DINOSAUR FROM THE LOWER CRETACEOUS HASTINGS BEDS GROUP OF EAST SUSSEX, ENGLAND
Authors: TAYLOR MICHAEL P. , NAISH DARREN
Published: November 2007

Abstract:  Xenoposeidon proneneukos gen. et sp. nov. is a neosauropod represented by BMNH R2095, a well‐preserved partial mid‐to‐posterior dorsal vertebra from the Berriasian–Valanginian Hastings Beds Group of Ecclesbourne Glen, East Sussex, England. It was briefly described by Lydekker in 1893, but it has subsequently been overlooked. This specimen's concave cotyle, large lateral pneumatic fossae, complex system of bony laminae and camerate internal structure show that it represents a neosauropod dinosaur. However, it differs from all other sauropods in the form of its neural arch, which is taller than the centrum, covers the entire dorsal surface of the centrum, has its posterior margin continuous with that of the cotyle, and slopes forward at 35 degrees relative to the vertical. Also unique is a broad, flat area of featureless bone on the lateral face of the arch; the accessory infraparapophyseal and postzygapophyseal laminae which meet in a V; and the asymmetric neural canal, small and round posteriorly but large and teardrop‐shaped anteriorly, bounded by arched supporting laminae. The specimen cannot be referred to any known sauropod genus, and clearly represents a new genus and possibly a new ‘family’. Other sauropod remains from the Hastings Beds Group represent basal Titanosauriformes, Titanosauria and Diplodocidae; X. proneneukos may bring to four the number of sauropod ‘families’ represented in this unit. Sauropods may in general have been much less morphologically conservative than is usually assumed. Since neurocentral fusion is complete in R2095, it is probably from a mature or nearly mature animal. Nevertheless, size comparisons of R2095 with corresponding vertebrae in the Brachiosaurus brancai holotype HMN SII and Diplodocus carnegii holotype CM 84 suggest a rather small sauropod: perhaps 15 m long and 7600 kg in mass if built like a brachiosaurid, or 20 m and 2800 kg if built like a diplodocid.
Admission of Term Infants to Neonatal Intensive Care: A Population‐Based Study
Authors: Tracy Sally K. , Tracy Mark B. , Sullivan Elizabeth
Published: November 2007

ABSTRACT:  Background:
Neonatal intensive care and special care nurseries provide a level of care that is both high in cost and low in volume. The aim of our study was to determine the rate of admission of term babies to neonatal intensive care in association with each method of giving birth among low‐risk women.
Methods:
We examined the records of 1,001,249 women who gave birth in Australia during 1999 to 2002 using data from the National Perinatal Data Collection. Among low‐risk women, we calculated the adjusted odds of admission to neonatal intensive care at term separated for each week of gestational age between 37 and 41 completed weeks. We also calculated the odds of admission to neonatal intensive care in association with cesarean section before or after the onset of labor, and vacuum or instrumental birth compared with unassisted vaginal birth at 40 weeks’ gestation.
Results:
The overall rate of admission to neonatal intensive care of term babies was 8.9 percent for primiparas and 6.3 percent for multiparas. After a cesarean section before the onset of labor, the adjusted odds of admission among low‐risk primiparas at 37 weeks’ gestation were 12.08 (99% CI 8.64–16.89); at 38 weeks, 7.49 (99% CI 5.54–10.11); and at 39 weeks, 2.80 (99% CI 2.02–3.88). At 41 weeks, the adjusted odds were not significantly higher than those at 40 weeks’ gestation. Among low‐risk multiparas who had a cesarean section before the onset of labor, the adjusted odds of admission to neonatal intensive care at 37 weeks’ gestation were 15.40 (99% CI 12.87–18.43); at 38 weeks, 12.13 (99% CI 10.37–14.19); and at 39 weeks, 5.09 (99% CI 4.31–6.00). At 41 weeks’ gestation, the adjusted odds of admission were significantly lower than those at 40 weeks (AOR 0.64, 99% CI 0.47–0.88). Babies born after any operative method of birth were at increased odds of being admitted to neonatal intensive care compared with those born after unassisted vaginal birth at 40 weeks’ gestation.
Conclusions:
The adjusted odds of admission to neonatal intensive care for babies of low‐risk women were increased after birth at 37 weeks’ gestation. In a climate of rising cesarean sections, this information is important to women who may be considering elective procedures. (BIRTH 34:4 December 2007)
Changing Policies on Vaginal Birth after Cesarean: Impact on Access
Authors: Roberts Richard G. , Deutchman Mark , King Valerie J. , Fryer George E. , Miyoshi Thomas J.
Published: November 2007

ABSTRACT:  Background:
The issue of vaginal birth after cesarean (VBAC) has become highly visible and contentious. In 1999, the American College of Obstetricians and Gynecologists advocated a policy that surgical capability be “immediately available” for women in labor attempting VBAC.
Methods:
Every hospital in Colorado, Montana, Oregon, and Wisconsin was contacted by telephone at least once during the period 2003 to 2005. Using a semistructured interview, respondent hospitals were asked whether and when their policies for VBAC had changed and what was the availability of VBAC services before and after the 1999 policy was issued.
Results:
Of 314 hospitals contacted, 312 responded to the survey (response rate 99.4%). Babies were delivered at 230 (74%) respondent hospitals. Almost one‐third, 68 of 222 (30.6%), of responding delivery hospitals that previously offered VBAC services had stopped doing so; seven hospitals had never allowed VBAC. Of the hospitals that still allowed VBAC, 68 percent had changed their VBAC policies since 1999, with the most frequent changes requiring the in‐house presence of surgery (53%) and anesthesia (44%) personnel when women desiring VBAC presented in labor. Compared with hospitals that stopped allowing VBAC, those that currently permit VBAC were larger (156.6 vs 58.1 beds, t = 7.02, p < 0.001), closer to other delivery hospitals (20.9 vs 39.2 miles, t = 4.33, p < 0.001), annually delivered more babies (1009.9 vs 458.3, t = 4.41, p < 0.001), and annually had more cesarean deliveries (226.7 vs 105.7, t = 3.91, p < 0.001). Conclusions: In the years following advocacy of the 1999 policy, the availability of VBAC services significantly decreased, especially among smaller or more isolated hospitals. (BIRTH 34:4 December 2007)
Self‐Rated “No‐” and “Low‐” Risk Pregnancy: A Comparison of Outcomes for Women in Obstetric‐Led and Midwife‐Led Units in England
Authors: Symon Andrew G. , Paul Jeanette , Butchart Maggie , Carr Val , Dugard Pat
Published: November 2007

ABSTRACT:  Background:
Debate in the United Kingdom about place of birth often concerns obstetric‐led units and midwife‐led units and relates to notions of risk and safety. Outcomes for these two types of unit are often not comparable because of the restricted selection criteria for midwife‐led units. The purpose of this study was to compare outcomes for women intending to give birth in these different types of unit and whose self‐rated pregnancy risk level was “none” or “low.”
Methods:
Self‐completion questionnaires were distributed to mothers 8 days after the birth in 9 units (6 midwife led 3 obstetric led) over a 6‐month period.
Results:
Completed questionnaires were received from 432 women (midwife led = 294, obstetric led = 138). Mothers in midwife‐led units spent shorter times in labor in the unit (p < 0.01), received less analgesia (p < 0.01) and had fewer interventions (p < 0.01), and were more likely to have a normal delivery (p < 0.01) than women in obstetric‐led units. Similar differences were found for both primiparous and multiparous women. In terms of the number of midwives attending each woman, analysis of covariance suggested different models of care depending on type of unit (p < 0.05) and parity (p < 0.01).Conclusions: Since these mothers’ self‐rated risk level was none or low, some comparability of outcomes is permissible. It appears that models of care are significantly different in obstetric‐led units compared with midwife‐led units, leading to greater likelihood of intrapartum intervention, need for analgesia, and assisted or operative delivery. A randomized controlled trial examining such units would permit a conclusive examination of these outcomes. (BIRTH 34:4 December 2007)
Systematic Review of the Literature on Postpartum Care: Effectiveness of Interventions for Smoking Relapse Prevention, Cessation, and Reduction in Postpartum Women
Authors: Levitt Cheryl , Shaw Elizabeth , Wong Sharon , Kaczorowski Janusz ,   The McMaster University Postpartum Research Group
Published: November 2007

ABSTRACT:  Background:
Many women stop smoking during pregnancy and relapse again either later in the pregnancy or in the postpartum period. Smoking is harmful to mothers, and environmental tobacco smoke is harmful for children. This systematic review examined the published evidence for the effectiveness of postpartum interventions that prevent relapse (current persons who have stopped but start smoking again), improve cessation rates (current smokers who stop smoking), and reduce smoking (number of cigarettes smoked per day) in postpartum women.
Methods:
MEDLINE, CINAHL, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postpartum women. The initial literature search was done in 1999 and enhanced in 2003 and 2005. Randomized controlled trials that examined relapse prevention, smoking cessation, or smoking reduction interventions in the postpartum period were reviewed in this report. Data were extracted in a systematic manner, and the quality of each study was reviewed.
Results:
Five papers were published based on three trials for which data were extracted and summarized. Our review of these trials showed no statistically significant benefits of advice materials and counseling interventions in hospital (Vancouver), pediatricians’ offices (Portland), or child health centers (Stockholm) on relapse prevention, cessation rates, or smoking reduction in the postpartum period. Although the interventions had little effect on the major smoking outcomes, some positive attitudinal and knowledge changes were reported.
Conclusion:
This review found no evidence from the randomized controlled trial literature to date to support implementing postpartum smoking cessation interventions, such as providing advice materials and counseling, insofar as they were delivered in the trials reviewed. (BIRTH 34:4 December 2007)
Effect of artificial dermal substitute, cultured keratinocytes and split thickness skin graft on wound contraction
Authors: Reid Michael J. , Currie Lachlan J. , Elizabeth James S. , Sharpe Justin R.
Published: November 2007

In this study, the effect of different wound treatments on contraction was evaluated in an established porcine model. In two separately conducted experiments full thickness wounds treated with artificial dermal substitute, split thickness skin graft (STSG), meshed STSG applied in combination with cultured keratinocytes or meshed STSG alone were compared with untreated wounds. The surface area of all wounds was quantified at regular time intervals. After 20 days wounds from some groups were subjected to histological analysis to establish the degree of epithelialization. Wounds treated with STSG contracted more than with artificial dermal substitute until day 21. From day 21 to day 35 wounds treated with STSG showed the least contraction. Wounds sprayed with cultured keratinocytes demonstrated a slower rate of contraction than those with meshed STSG alone after 20 days. The untreated control wounds showed a greater rate of contraction and had almost closed by day 20. This study demonstrates that there is a significant difference in contraction between wounds treated with artificial dermal substitute and control wounds and between wounds treated with STSG with cultured keratinocytes and meshed STSG alone. STSG with cultured keratinocytes, unmeshed STSG, and artificial dermal substitute all reduced wound contraction significantly.
Comparison of topical iodine and silver sulfadiazine as therapies against sulfur mustard burns in a pig model
Authors: Margulis Alexander , Chaouat Malka , Ben‐Bassat Hannah , Eldad Arieh , Icekson Michael , Breiterman Semion , Neuman Rami
Published: November 2007

Sulfur mustard (SM) is a powerful vesicant used as an agent of chemical warfare. The severity of lesions incurred after exposure to SM reiterated the need for an efficient and rapid neutralizing agent against SM. Previous studies have shown that postexposure treatment with iodine is effective against SM lesions in rodents. In the current study we used the pig model to emulate SM‐induced burn lesions, and observed the immediate effect of a single dose of iodine formulation treatment on these burns. SSD, a common agent recommended for use in both chemical and thermal burns was used as control. Results indicated that 1.27 mg of SM caused deep lesions and histopathological changes in the pig skin as scored in the biopsies obtained. A single application of an iodine formulation 20 minutes from exposure to SM exhibited no protective action on the skin as evident in the biopsies obtained 1, 3, 5, 10, and 21 days after treatment. SSD treatment induced the least protective action. The SSD‐treated wounds also took the longest to heal. Attempts to neutralize the SM action with iodine compounds were not successful in the pig model. Currently, other compounds are being investigated. Attention must be drawn to the adverse effect of SSD on SM‐induced wounds. Further studies must be initiated to elucidate this phenomenon.
Flow Cytometric Assays for Quantifying Activated Ovine Platelets
Authors: Johnson Carl A. , Snyder Trevor A. , Woolley Joshua R. , Wagner William R.
Published: November 2007

Abstract:  Ovines are a common animal model for preclinical evaluation of cardiovascular devices including heart valves, endovascular grafts, and ventricular assist devices. Biocompatibility is essential to the success of these devices; however, tools to assess biocompatibility in ovines are limited. To address this need, antibodies that bind to activated human and bovine platelets and annexin V protein were evaluated for potential cross‐reactivity to activated ovine platelets. These candidate markers were incubated with stimulated and quiescent ovine whole blood, and binding to platelets was quantified by flow cytometry. Several antihuman CD62P antibodies including one polyclonal antibody, three monoclonal antibodies, and annexin V selectively bound to activated ovine platelets. An assay to quantify platelet microaggregates was also developed. The availability of assays to quantify ovine platelet activation can increase the quality of biocompatibility data obtainable during preclinical development of artificial organs in the ovine model, potentially aiding in the evaluation of design refinements to enhance device biocompatibility.
Magnetic Design for the PediaFlow Ventricular Assist Device
Authors: Noh Myounggyu D. , Antaki James F. , Ricci Michael , Gardiner Jeff , Paden Dave , Wu Jingchun , Prem Ed , Borovetz Harvey , Paden Bradley E.
Published: November 2007

Abstract:  This article describes a design process for a new pediatric ventricular assist device, the PediaFlow. The pump is embodied in a magnetically levitated turbodynamic design that was developed explicitly based on the requirements for chronic support of infants and small children. The procedure entailed the consideration of multiple pump topologies, from which an axial mixed‐flow configuration was chosen for further development. The magnetic design includes permanent‐magnet (PM) passive bearings for radial support of the rotor, an actively controlled thrust actuator for axial support, and a brushless direct current (DC) motor for rotation. These components are closely coupled both geometrically and magnetically, and were therefore optimized in parallel, using electromagnetic, rotordynamic models and fluid models, and in consideration of hydrodynamic requirements. Multiple design objectives were considered, including efficiency, size, and margin between critical speeds to operating speed. The former depends upon the radial and yaw stiffnesses of the PM bearings. Analytical expressions for the stiffnesses were derived and verified through finite element analysis (FEA). A toroidally wound motor was designed for high efficiency and minimal additional negative radial stiffness. The design process relies heavily on optimization at the component level and system level. The results of this preliminary design optimization yielded a pump design with an overall stability margin of 15%, based on a pressure rise of 100 mm Hg at 0.5 lpm running at 16 000 rpm.
Tissue Engineering of Urethra Using Human Vascular Endothelial Growth Factor Gene‐Modified Bladder Urothelial Cells
Authors: Guan Yong , Ou Lailiang , Hu Gang , Wang Hongjun , Xu Yong , Chen Jiatong , Zhang Jun , Yu Yaoting , Kong Deling
Published: November 2007

Abstract:  Acquired or congenital abnormalities may lead to urethral damage or loss, often requiring surgical reconstruction. Urethrocutaneous fistula and strictures are common complications, due to inadequate blood supply. Thus, adequate blood supply is a key factor for successful urethral tissue reconstruction. In this study, urethral grafts were prepared by seeding rabbit bladder urothelial cells (UCs) modified with human vascular endothelial growth factor (VEGF165) gene in the decellularized artery matrix. A retroviral pMSCV‐VEGF165‐GFP vector was cloned by insertion of VEGF open reading frame into the vector pMSCV‐GFP (murine stem cell virus [MSCV]; green fluorescent protein [GFP]). Retrovirus was generated using package cell line 293T. Rabbit UCs were expanded ex vivo and modified with either MSCV‐VEGF165‐GFP or control MSCV‐GFP retrovirus. Transduction efficiency was analyzed by fluorescence‐activated cell sorting. The expression of VEGF165 was examined by immunofluorescence, reverse transcript‐polymerase chain reaction, Western blot, and enzyme‐linked immunosorbent assay (ELISA). Decellularized rabbit artery matrix was seeded with genetically modified UCs and was subsequently cultured for 1 week prior to subcutaneous implantation into nude mice. Four weeks after implantation, the implants were harvested and analyzed by fluorescence microscopy, and by histologic and immunohistochemical staining. Ex vivo transduction efficiency of UCs was greater than 50% when concentrated retrovirus was used. The modified cells expressed both VEGF and GFP protein. Furthermore, the VEGF‐modified UCs secreted VEGF in a time‐dependent manner. Scanning electron microscopy and histochemical analysis of cross sections of the cultured urethral grafts showed that the seeded cells were attached and proliferated on the luminal surface of the decellularized artery matrix. In the subcutaneously implanted vessels, VEGF‐modified cells significantly enhanced neovascularization and the formation of a urethral layer compared to GFP‐modified cells. These results indicate that VEGF gene therapy may be a suitable approach to increase the blood supply in tissue engineering for treatment of urethral damage or loss.
Diet and Its Relationship with Grip Strength in Community‐Dwelling Older Men and Women: The Hertfordshire Cohort Study
Authors: Robinson Sian M. , Jameson Karen A. , Batelaan Sue F. , Martin Helen J. , Syddall Holly E. , Dennison Elaine M. , Cooper Cyrus , Sayer Avan Aihie ,   the Hertfordshire Cohort Study Group
Published: November 2007

OBJECTIVES: To examine relationships between diet and grip strength in older men and women and to determine whether prenatal growth modifies these relationships.

DESIGN: Cross‐sectional and retrospective cohort study.

SETTING: Hertfordshire, United Kingdom.

PARTICIPANTS: Two thousand nine hundred eighty‐three men and women aged 59 to 73 who were born and still living in Hertfordshire, United Kingdom.

MEASUREMENTS: Weight at birth recorded in Health Visitor ledgers; current food and nutrient intake assessed using an administered food frequency questionnaire; and grip strength measured using a handheld dynamometer.

RESULTS: Grip strength was positively associated with height and weight at birth and inversely related to age (all P<.001). Of the dietary factors considered in relation to grip strength, the most important was fatty fish consumption. An increase in grip strength of 0.43 kg (95% confidence interval (CI)=0.13–0.74) in men (P=.005) and 0.48 kg (95% CI=0.24–0.72) in women (P<.001) was observed for each additional portion of fatty fish consumed per week. These relationships were independent of adult height, age, and birth weight, each of which had additive effects on grip strength. There was no evidence of interactive effects of weight at birth and adult diet on grip strength.

CONCLUSION: These data suggest that fatty fish consumption can have an important influence on muscle function in older men and women. This raises the possibility that the antiinflammatory actions of omega‐3 fatty acids may play a role in the prevention of sarcopenia.
Rehospitalization After Hip Fracture: Predictors and Prognosis from a National Veterans Study
Authors: French Dustin D. , Bass Elizabeth , Bradham Douglas D. , Campbell Robert R. , Rubenstein And Laurence Z.
Published: November 2007

OBJECTIVES: To estimate the risk and long‐term prognostic significance of 30‐day readmission postdischarge of a 4‐year cohort of elderly veterans first admitted to Medicare hospitals for treatment of hip fractures (HFx), controlling for comorbidities.

DESIGN: Retrospective, national secondary data analysis.

SETTING: National Medicare and Veterans Health Administration (VHA) facilities.

PARTICIPANTS: The study cohort was 41,331 veterans with a HFx first admitted to a Medicare eligible facility during 1999 to 2002.

MEASUREMENTS: HFxs were linked with all other Medicare and VHA inpatient discharge files to capture dual inpatient use. Logistic regression was used to examine the relationship between 30‐day readmission and age, sex, inpatient length of stay, and selected Elixhauser comorbidities.

RESULTS: Approximately 18.3% (7,579/41,331) of HFx patients were readmitted within 30 days. Of those with 30‐day readmissions, 48.5% (3,675/7,579) died within 1 year, compared with 24.9% (8,388/33,752) of those without 30‐day readmissions. Readmission risk was significantly greater in the presence of specific comorbidities, ranging from 11% greater risk for patients with fluid and electrolyte disorders (95% confidence interval (CI)=1.04–1.20) to 43% for renal failure (95% CI=1.29–1.60). For this cohort, cardiac arrhythmias (24%), chronic pulmonary disease (28%), and congestive heart failure (16%) were common comorbidities, and all affected the risk of 30‐day readmission.

CONCLUSION: Patients with HFx with 30‐day readmissions were nearly twice as likely to die within 1 year. Identification of several predictive comorbidities at discharge and examination of reasons for subsequent readmission suggests that readmission was largely due to active comorbid clinical problems. These comorbidity findings have implications for the current Centers for Medicare and Medicaid Services (CMS) pay‐for‐performance initiatives, especially those related to better coordination of care for patients with chronic illnesses. These comorbidity findings for elderly patients with HFx may also provide data to enable CMS and healthcare providers to more accurately differentiate between comorbidities and hospital‐acquired complications under the current CMS initiative related to nonpayment for certain types of medical conditions and hospital acquired infections.
Experience of a network of transfusion coordinators for blood conservation (Ontario Transfusion Coordinators [ONTraC])
Authors: Freedman John , Luke Katherine , Escobar Michael , Vernich Lee , Chiavetta Jo Anne
Published: November 2007

BACKGROUND: The experiences of the development of a provincial program to promote blood conservation are herein reported.

STUDY DESIGN AND METHODS: Transfusion coordinators were placed in 23 Ontario hospitals. Anonymized laboratory and clinical information was collected in a defined number of all consecutive patients admitted for three designated procedures: knee arthroplasty, abdominal aortic aneurysm (AAA), and coronary artery bypass graft (CABG) surgery (n ≈ 1100, 300, and 300 at each time period, respectively).

RESULTS: Considerable interinstitutional variation was observed in the proportion of patients who received transfusions. At 12 months, and over the 24‐month period of the project, most hospitals demonstrated decreased use of allogeneic blood; at 12 months an approximate 24 percent reduction in patients undergoing knee surgery, 14 percent in AAA, and 23 percent in CABG was obtained. In addition, patients who received transfusions received less allogeneic blood. Patients who did not receive allogeneic transfusions had lower postoperative infection rates (p < 0.05) and length of stay (p < 0.0001); allogeneic transfusion was an independent predictor of increased length of stay. The main blood conservation measures employed during this time were education, preoperative autologous donation, erythropoietin, and cell salvage.

CONCLUSION: The implementation of a provincial network of transfusion coordinators was feasible and allogeneic transfusion rates declined over the period the program has been in place.
Changing age distribution of the blood donor population in the United States
Authors: Zou Shimian , Musavi Fatemeh , Notari Edward P. , Fang Chyang T. ,   ARCNET Research Group
Published: November 2007

BACKGROUND: The American Red Cross has been maintaining a research database of all blood donors. Such a database provides a unique opportunity for monitoring changes over time in donor and donation patterns.

STUDY DESIGN AND METHODS: Changes in age distribution among blood donors were analyzed through comparison of the volunteer donor population in 1996, 1999, 2002, and 2005, before and after adjustment for demographic changes of the general population in the United States.

RESULTS: Donations by repeat donors 50 years or older as a proportion of total donations increased from 22.1 percent in 1996 to 34.5 percent in 2005, or 1.4 percent per year, whereas donations from repeat donors of 25 to 49 years decreased from 49.1 percent in 1996 to 37.1 percent in 2005, or 1.3 percent per year. After adjusting for general population trends, the effective number of donors decreased by more than 10 percent in female and male repeat donors of age 20 to 49 years and male first‐time donors of age 25 to 49 years from 1996 to 2005; female and male repeat donors of age 25 to 39 years decreased by greater than 40 percent. Prevalence rates of major infectious disease markers decreased by 3.3 percent or more per year for first‐time donations and by 6.4 percent or more per year for repeat donations.

CONCLUSION: The aging patterns of blood donors suggest the need for improved recruitment and retention in the young adult and middle‐aged groups. A severe shortage of blood and blood components may be forecast in the foreseeable future unless offset by significant increased supply or reduced usage of blood and blood components.
A comparative labor productivity analysis of blood collection centers
Authors: Bell Adam M. , Kemp John D. , Raife Thomas J.
Published: November 2007

BACKGROUND: Blood center labor benchmarking data may be helpful to optimize staffing and to establish productivity targets. Data were gathered and labor productivity was analyzed among blood donor centers of different sizes collecting different product mixes.

STUDY DESIGN AND METHODS: Blood collection volumes and blood center labor data were obtained from eight blood centers: six regional centers, one mobile collection operation, and our hospital‐affiliated center. A total of 2004 annual whole‐blood (WB) collections and apheresis platelet (PLT) collections were captured. Full‐time equivalents (FTEs) associated with blood collection operations were captured. With these data total unit (WB + PLT) collection rates per FTE were calculated. To compare value associated with each center's total unit collections, an indexed monetary value was assigned to WB and PLT and the value was calculated.

RESULTS: Despite a 12‐fold range in the size of operations, there was a strong correlation between total annual products collected and number of FTEs (mean 460 ± 39 units/FTE). As expected, centers that collected relatively more PLTs had higher value per total unit collected. Surprisingly, however, there was no relationship between proportion of PLTs collected and total units collected per FTE. Centers collecting proportionately more PLTs therefore had higher value per FTE.

CONCLUSION: A benchmark scale of labor productivity among blood donor centers of different sizes and product mixes was established. Product mix is not a major determinant of total unit collections per FTE but is an important determinant of value per FTE. Correlating collection targets with benchmark data from this survey may help determine optimal blood center labor allocation strategies.
Factors influencing donor return
Authors: Schlumpf Karen S. , Glynn Simone A. , Schreiber George B. , Wright David J. , Randolph Steele Whitney , Tu Yongling , Hermansen Sigurd , Higgins Martha J. , Garratty George , Murphy Edward L. ,   National Heart, Lung, and Blood Institute Retrovirus Epidemiology Donor Study
Published: November 2007

BACKGROUND: To predict future blood donation behavior and improve donor retention, it is important to understand the determinants of donor return.

STUDY DESIGN AND METHODS: A self‐administered questionnaire was completed in 2003 by 7905 current donors. With data mining methods, all factors measured by the survey were ranked as possible predictors of actual return within 12 months. Significant factors were analyzed with logistic regression to determine predictors of intention and of actual return.

RESULTS: Younger and minority donors were less likely to return in 12 months. Predictors of donor return were higher prior donation frequency, higher intention to return, a convenient place to donate, and having a good donation experience. Most factors associated with actual donor return were also associated with a high intention to return. Although not significant for actual return, feeling a responsibility to help others, higher empathetic concern, and a feeling that being a blood donor means more than just donating blood were related to high intention to return.

CONCLUSION: Prior donation frequency, intention to return, donation experience, and having a convenient location appear to significantly predict donor return. Clearly, donor behavior is dependent on more than one factor alone. Altruistic behavior, empathy, and social responsibility items did not enter our model to predict actual return. A donor's stated intention to give again is positively related to actual return and, while not a perfect measure, might be a useful proxy when donor return cannot be determined.
First‐Best Equilibrium in Insurance Markets With Transaction Costs and Heterogeneity
Authors: Liu Jerry W. , Browne Mark J.
Published: November 2007

Abstract

We investigate extensions of the classic Rothschild and Stiglitz (1976) (RS) model of adverse selection under asymmetric information. In RS, low‐risk customers are worse off owing to an externality created by high‐risk buyers in the market. We find critical changes in insurance buyers' behavior under the joint assumptions of transaction costs and buyer heterogeneity with respect to either risk aversion or wealth. Combining transaction costs and heterogeneity, we find a separating equilibrium in which neither high‐risk nor low‐risk individuals are penalized due to information asymmetry.
On the Corporate Demand for Insurance: The Case of Korean Nonfinancial Firms
Authors: Regan Laureen , Hur Yeon
Published: November 2007

Abstract

Several theories have been developed to explain the motives for corporate insurance purchases, but there are few empirical tests of these theories. Furthermore, the empirical results are not consistent across studies, suggesting the need for further research. This study uses accounting data for 433 publicly listed nonfinancial firms in Korea to test the determinants of insurance demand for the period 1990 through 2001. Our results support the theory that firm size, tax considerations, and firm ownership are important determinants of insurance demand. Firms that are members of chaebols demand more insurance than unaffiliated firms, all else equal. Contrary to theory, our results also indicate that firms that have higher debt‐to‐equity ratios demand less insurance than less leveraged firms, and that firms that have greater liquidity demand more insurance. This might be related to the overall high debt levels of firms in the period leading up to the Korean financial crisis in 1997, but that investigation is beyond the scope of this study.
The Organizational Structure of Insurance Companies: The Role of Heterogeneous Risks and Guaranty Funds
Authors: Ligon James A. , Thistle Paul D.
Published: November 2007

Abstract

We examine a market with observably heterogeneous risks and a government sponsored guaranty fund and consider whether it is optimal to form a single insurer or separate insurers for each consumer type. Given the economic environment, pooling never dominates the formation of separate insurance companies. This result provides an incentive for the phenomenon of insurance fleets.
Price Performance Following Share‐Repurchase Announcements by Closed‐End Funds
Authors: Akhigbe Aigbe , Kim Doseong , Madura Jeff
Published: November 2007

We investigate the price performance of closed‐end funds that announce share‐repurchase programs. Closed‐end funds experience positive average stock‐price reactions to the announcements. The long‐run buy‐and‐hold abnormal returns of repurchasing funds over the subsequent three years are significantly higher than a nonrepurchasing control sample matched by size, type, investment style and geographic diversification. Funds with larger discounts, international funds, equity funds, and funds that announce larger repurchases or frequently announce repurchases, experience more positive stock‐price reactions. Except for larger repurchases, the same characteristics are associated with more positive long‐run buy‐and‐hold returns.
Effects of Injection‐Drug Injury on Ankle Mobility and Chronic Venous Disorders
Authors: Pieper Barbara , Templin Thomas N. , Birk Thomas J. , Kirsner Robert S.
Published: November 2007

Purpose:
To identify potential confounders and test a causal model of injection‐site risk, chronic venous disorders (CVD), and ankle mobility. The reliability and validity of goniometry measurements of ankle mobility were also of interest because they are seldom performed in people with a history of injection‐drug use.

Design:
The study was a test‐retest design, consisting of 104 participants from a methadone maintenance treatment center.

Methods:
Each participant provided demographic information, health and drug histories, and underwent bilateral ankle goniometric measures of dorsiflexion, plantar flexion, inversion, and eversion. The clinical portion of the Clinical‐Etiology‐Anatomy‐Pathophysiology (CEAP)was used to classify CVD severity.

Findings:
Reliability of goniometry measurements ranged from .70 to .90. Causal modeling supported hypotheses of increased risk from leg injection and reciprocal effects involving ankle mobility and disease progression. Ankle inversion mobility was the strongest indicator of ankle mobility.

Conclusions:
Injury to the lower extremities from IDU affected CVD and mobility. Further research should include assessment of comorbidity and other potential confounders. Ankle inversion should remain part of the goniometry assessment.
Predicting High Physical Function in People With Fibromyalgia
Authors: Rutledge Dana N. , Jones Kim , Jones C. Jessie
Published: November 2007

Purpose:
The purpose of this study was to investigate predictors of high physical function in people with fibromyalgia (FM).

Design:
Cross‐sectional descriptive, correlational study of 2,580 persons with FM who responded to an online survey during fall 2005.

Methods:
The survey indicated self‐reported physical activity levels, functional abilities, symptoms, health care costs, employment status, work productivity, self management strategies. It had adequate validity and reliability. A significant binary logistic regression model of predictors of physical function (individual factors, symptoms, self management strategies) was validated using backwards logistic regression.

Findings:
Significant explanatory variables of high physical function were: men, greater education, younger age, lower intensity fatigue, spasticity, and balance problems, not using prescription pain medications, using aerobic or strength training exercise, and not using relaxation methods.

Conclusions:
People with FM suffer from multiple symptoms and use many modalities to control symptoms to remain functional. Given knowledge of predictors of physical function in FM, health care providers might be able to develop strategies to promote better functioning. Prospective trials are needed to track the natural course of study variables, measuring their effect on function, and to test effects of interventions to maximize function.
Determinants of Self‐Reported Physical Activity Among Jordanian Adults
Authors: Ammouri Ali A. , Neuberger Geri , Nashwan Abdulqadir J. , Al‐Haj Ahmad M.
Published: November 2007

Purpose: To assess health‐promoting behaviors among adult Jordanians and examine relationships among individual characteristics (age, gender, income, and education), perceptual factors (perceived self‐efficacy, perceived benefits, and perceived barriers), competing demands, and self‐reported physical activity.

Design: A cross‐sectional, correlational design with self‐administered questionnaires was conducted in three major cities in Jordan.

Methods: Descriptive statistics and path analysis were used to examine the direct and indirect effects of independent variables on adults' physical activity.

Findings: Men scored higher than did women on physical activity, and women scored higher than did men on health responsibility. Total variance in self‐reported physical activity accounted for by independent variables was 30%. Self‐efficacy had the strongest direct effects, followed by perceived benefits, perceived barriers, and competing demands on physical activity. Age had the strongest indirect effect on physical activity participation via perceptual factors.

Conclusions: Counseling these adults for physical activity should include application of behavior change strategies suitable to age and focused on increasing self‐efficacy, decreasing barriers, increasing perception of benefits, and decreasing sedentary activities.
An Ultrastructural Comparison of the Attachment Sites Between Gregarina steini and Cryptosporidium muris
Authors: VALIGUROVÁ ANDREA , HOFMANNOVÁ LADA , KOUDELA BŘETISLAV , VÁVRA JIŘÍ
Published: November 2007

ABSTRACT. Early developmental stages of Gregarina steini Berndt, 1902 from the intestine of Tenebrio molitor larvae were studied by transmission electron microscopy. The formation and structure of the eugregarine attachment site were compared with comparable features found on the feeder organelle of Cryptosporidium muris Tyzzer, 1907, from the stomach of experimentally infected rodents. The similarity of the attachment strategy between both organisms was revealed. The membrane fusion site in G. steini, formed by the trophozoite plasma membrane, host cell plasma membrane and a membrane‐like structure limiting the cortical zone of the epimerite, resembles the Y‐shaped membrane junction between the host cell plasma membrane, the trophozoite plasma membrane and membrane surrounding the anterior vacuole in C. muris. The anterior vacuole of C. muris appears to be the precursor of the feeder organelle and its structure is very similar to the epimeritic bud and the cortical zone of G. steini trophozoites. In both investigated organisms, the apical complex disappears early during cell invasion. The possibility of the epicellular location of Cryptosporidium on the surface of host cells is discussed.
Redescription of a Poorly Known Marine Ciliate, Leptoamphisiella vermis Gruber, 1888 n. g., n. comb. (Ciliophora, Stichotrichia, Pseudoamphisiellidae), from the Yellow Sea, China
Authors: LI LIQIONG , SONG WEIBO , AL‐RASHEID KHALED A. S. , HU XIAOZHONG , AL‐QURAISHY SALEH A.
Published: November 2007

ABSTRACT. Leptoamphisiella vermis
Gruber, 1888 n. g., n. comb. (basionym Epiclintes vermisGruber, 1888) is an extraordinarily large and worm‐like marine stichotrichous ciliate. Based on a population isolated recently from coastal waters of Qingdao, China, the living morphology and infraciliature are redescribed and its taxonomic position is defined. Accordingly, a new diagnosis for this species is suggested: large, marine Leptoamphisiella with a conspicuous layer of pellicular alveoli; 400–1000 μm × 40–70 μm in vivo; body band‐like, highly flexible; about 40 membranelles; always three frontal and two buccal cirri; 52–80 transverse cirri (TC) extending to the posterior end of the buccal field; 57–79 left midventral and 44–62 right midventral cirri; 62–102 cirri in left and 63–91 cirri in right marginal rows (MR); 9–13 dorsal kineties that extend the full body length; about 100 macronuclear nodules and 5–13 micronuclei. The diagnosis for the new genus is as follows: vermiform Pseudoamphisiellidae with strongly contractile body, differentiated frontal, buccal, and highly developed TC; two remarkably separated midventral rows; one MR on each side of the body; frontoterminal and caudal cirri absent. Leptoamphisiella vermis n. comb. is fixed as the type species of the new genus.
Perimortem or Postmortem Bone Fractures? An Experimental Study of Fracture Patterns in Deer Femora*
Authors: Wheatley Bruce P.
Published: November 2007

Abstract:  The determination of perimortem trauma is important for forensic anthropologists. Characteristics of bone fractures such as sharp edges, presence of fracture lines, the shape of the broken ends, fracture surface morphology, fracture angle on the Z‐axis, and butterfly fractures are said to differentiate perimortem from postmortem trauma. A Drop Weight Impact Test Machine was used to break 76 deer femora of various ages since death. The results of this study suggest that the characteristics listed above are unreliable at differentiating a perimortem fracture from a postmortem fracture in a forensic case. There are, however, statistically significant differences between fresh bones broken less than 4 days old and dry bones broken 44 days or 1 year old after death.