bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term results of artificial bowel sphincter for the treatment of severe faecal incontinence. Are they what we hoped for?
Authors: Ruiz Carmona M. D. , Alós Company R. , Roig Vila J. V. , Solana Bueno A. , Pla Martí V.
Published: July 2008

Objective  This study evaluates the long‐term morbidity, functional results and quality of life (QOL) after treatment of severe faecal incontinence (FI) with the Acticon® Neosphincter (American Medical Systems, Minneapolis, Minnesota, USA).

Method  Between 1996 and 2002, 17 consecutive patients (14 female, 3 male; median age 46) underwent sphincter implantation. Clinical evaluation, incontinence severity and QOL were assessed. Anorectal manometry, endoanal ultrasound and pudendal nerve latency were performed preoperatively and at several stages of follow‐up. The study was completed in December 2007.

Results  Mean follow‐up was 68 months (range: 3–133). Morbidity occurred in 100% of patients from which 65% required at least one re‐operation. After the first implant, 11 devices had to be removed (65%). Seven patients had a new implant. At the final stage, Acticon® was activated in 9 cases (53%). Severity of FI improved from a median of 17.5 preoperatively to 9 (P = 0.005), 5.5 (P = 0.005) and 10 (P = 0.092) at 6, 12 months and at the end of follow‐up, respectively. There was a significant improvement in QOL in all postoperative controls (P < 0.05). Severity of FI did not show a correlation with QOL in the preoperative period, but did at 6, 12 months and at the end of follow‐up. Mean maximum resting pressure significantly increased with the full anal cuff.

Conclusion  There is a high rate of morbidity, surgical re‐interventions and explants after Acticon® implant. Patients should be clearly informed about this before surgery. However, patients who have not had Acticon® Neosphincter explanted, experience a significant improvement in anal continence and QOL.
Role of anorectal manometry in children with severe constipation
Authors: Noviello C. , Cobellis G. , Papparella A. , Amici G. , Martino A.
Published: July 2008

Objective  Constipation is one of the most frequent disorders of the digestive tract in children and it can be an important problem in paediatric and surgical practice. Most of the time, the cause is psychological or because of a slowing of colonic transit, but it can be a sign of organic gastrointestinal outlet obstruction. Some patients with chronic constipation are resistant to a medical approach and they present with a severe form of constipation that needs recurrent hospital admission. Anorectal manometry (ARM) is a noninvasive procedure and it helps to explain the mechanisms of defecation disorders. The aim of the present study was to evaluate the role of ARM in children with severe constipation.

Method  From October 2003 to October 2006, in the Paediatric Surgery Unit, 85 children – aged more than 1 year – with severe constipation were seen. The mean age was 5 years (range, 1–13). At presentation, every child had abdominal and rectal examination in order to identify abdominal distension or faecal masses. Bowel preparation with enemas was performed before ARM in patient with a rectal faecaloma. Myoelectric activity of the internal anal sphincter and resting anal tone was recorded; recto‐anal inhibitory reflex (RAIR) was tested to exclude Hirschsprung’s disease (HD). Anal tone was considered normal until 50 cm H2O. When the RAIR was absent, the patient underwent rectal suction biopsies (RSB) for histology and acetylcholinesterase histochemistry. In cases of normal or high anal tone with the RAIR present, the child had bowel cleaning, medical treatment, 2‐ and 6‐month follow‐up. Children with ineffective treatment at follow‐up underwent RSB. In case of HD, a laparoscopic‐assisted endorectal pull‐through (ERPT) according to Georgeson’s technique was performed.

Results  Seventy per cent of the patients had bowel preparation before ARM. In four patients the ARM was impossible to assess because of crying. In 28 patients, the anal tone result was higher than 50 cm H2O and local treatment with anaesthetic agents was used for 8 weeks. Seventeen patients underwent RSB: 11 patients with RAIR absent/unclear, 4 noncooperative children and 2 patients with ineffective medical treatment at follow‐up. HD was diagnosed in 2 patients and laparoscopic‐assisted ERPT was performed. The remaining patients had good results at 6‐month follow‐up.

Conclusion  ARM is a noninvasive diagnostic tool to study the mechanism of defecation in children with constipation in order to prescribe the appropriate treatment. This procedure can be used in every child – aged more than 1 year – with severe constipation and assessment of the RAIR can select the cases for RSB.
Genital system anatomy and development of Ovatella myosotis by three‐dimensional computer visualization
Authors: Ruthensteiner Bernhard , Stocker Bettina
Published: July 2008

Adult anatomy as well as organogenesis of the genital system of the ellobiid pulmonate Ovatella myosotis is investigated in detail by means of serial sectioning and three‐dimensional computer reconstruction and visualization. From the middle portion of the adult, which has four nidamental glands, a spermoviduct leads to a common genital aperture. From here two separate structures, the vas deferens and a groove on the body surface, lead anteriorly. The latter is termed the egg groove because it carries the egg ribbon anteriorly, a function that is recognized here for the first time in the Ellobiidae. The evolution of this structure is discussed. In development, the organ system arises from four separate anlagen: (1) the ovotestis anlage, (2) the pallial anlage giving rise to the hermaphrodite duct, fertilization pouch–spermatheca complex, nidamental glandular complex and spermoviduct, (3) the bursa copulatrix anlage and (4) the anlage of the copulatory organ, vas deferens and egg groove. This development mode strongly resembles that of the siphonariid Williamia radiata, supporting its interpretation as a plesiomorphy in Pulmonata. Similarities in development of primitive pulmonates and evolution in gastropods lead to the assumption that ontogenesis of this organ system reflects evolution to some degree.
Morphological variation of the five vole species of the genus Microtus (Mammalia, Rodentia, Arvicolinae) occurring in Greece
Authors: Fraguedakis‐Tsolis Stella E. , Chondropoulos Basil P. , Stamatopoulos Costas V. , Giokas Sinos
Published: July 2008

Morphometric data for the five vole species of the genus Microtus living in Greece are old, sparse, poor and insufficiently analysed. This work aims to give the first comprehensive morphometric analysis of body and skull inter‐ and intraspecific variation for M. (M.) guentheri, M. (M.) rossiaemeridionalis, M. (Terricola) subterraneus, M. (T.) felteni and M. (T.) thomasi, applying multivariate statistics to 28 linear morphometric variables. It was based on ample material (202 adult individuals) using samples from localities that adequately cover the entire distributional range of each species in Greece. The five species and the two subgenera (Microtus and Terricola) were morphometrically clearly distinguished and discriminating variables were revealed. However, morphometrics did not provide robust criteria to infer phylogenetic relations among species. Furthermore, three species, M. (M.) guentheri, M. (M.) rossiaemeridionalis and M. (T.) thomasi, exhibited considerable intraspecific size or shape variation, which was mostly random and not associated with geographical proximity. Comparisons with data in the literature, mainly concerning populations of these species from adjacent areas, indicate that the Greek M. (M.) guentheri, M. (M.) rossiaemeridionalis and M. (T.) thomasi tend to be smaller than their conspecifics, while M. (T.) subterraneus and M. (T.) felteni are about equal in size to their Balkan relatives.
Botulinum A toxin in the treatment of neurogenic detrusor overactivity: a consolidated field of application
Authors: Giannantoni Antonella , Mearini Ettore , Del Zingaro Michele , Santaniello Francesco , Porena Massimo
Published: July 2008

Several studies show promising results in terms of both clinical and urodynamic improvements, supporting the efficacy, safety and tolerability of botulinum toxin serotype A (BoNT‐A) for managing neurogenic detrusor overactivity (DO). DO due to spinal cord injuries represents the most frequently treated dysfunction, where the efficacy appears to be high, with beneficial effects on quality of life. Data on the management of DO in patients with multiple sclerosis, cerebrovascular accidents and Parkinson’s disease are scarce or absent; thus, the suitability of BoNT‐A in the treatment neurogenic DO of other diseases of central nervous origin requires further investigation. Indeed, good quality, randomized controlled trials are still needed to identify not only the most appropriate patients to treat, but also the appropriate dose, administration technique, frequency of treatment and any eventual long‐term complications. Thus, the use of intravesical BoNT‐A in the control of neurogenic DO appears to be promising, but the drug is still in phase 3 clinical development, and further high‐quality research is essential.
Botulinum toxin: future developments
Authors: De Ridder Dirk
Published: July 2008

The proposed mechanisms of action of botulinum neurotoxin‐A (BoNT‐A) in the bladder provide new insights that might help to understand better the complex machinery of the bladder wall and the importance of the afferent signalling mechanisms. BoNT‐A might thus become to be considered a small revolution in the understanding and treatment of bladder overactivity. However, substantially more clinical and basic scientific data are needed before we can truly claim to comprehend how it influences lower urinary tract function, or its role in managing urological problems.
Health economics and intradetrusor injections of botulinum for the treatment of detrusor overactivity
Authors: Sangster Philippa , Kalsi Vinay
Published: July 2008

Health economic aspects are crucial in arguing the feasibility of setting up a new service using an unlicensed treatment. Overall, the costs of intradetrusor botulinum neurotoxin‐A treatment appear to be modest relative to the improvement in quality of life. However, in managing the overactive bladder, there is a need for a widely accepted definition of ‘clinical improvement’ or a common outcome measure to direct future clinical and health economic research.
Low‐acrylamide French fries and potato chips
Authors: Rommens Caius M. , Yan Hua , Swords Kathy , Richael Craig , Ye Jingsong
Published: July 2008

Acrylamide is produced in starchy foods that are baked, roasted or fried at high temperatures. Concerns about the potential health issues associated with the dietary intake of this reactive compound led us to reduce the accumulation of asparagine, one of its main precursors, in the tubers of potato (Solanum tuberosum). This metabolic change was accomplished by silencing two asparagine synthetase genes through ‘all‐native DNA’ transformation. Glasshouse‐grown tubers of the transformed intragenic plants contained up to 20‐fold reduced levels of free asparagine. This metabolic change coincided with a small increase in the formation of glutamine and did not affect tuber shape or yield. Heat‐processed products derived from the low‐asparagine tubers were also indistinguishable from their untransformed counterparts in terms of sensory characteristics. However, both French fries and potato chips accumulated as little as 5% of the acrylamide present in wild‐type controls. Given the important role of processed potato products in the modern Western diet, a replacement of current varieties with intragenic potatoes could reduce the average daily intake of acrylamide by almost one‐third.
Psychosocial Precursors and Correlates of Differing Internalizing Trajectories from 3 to 15 Years1
Authors: Letcher Primrose , Smart Diana , Sanson Ann , Toumbourou John W.
Published: July 2008

Psychosocial precursors and correlates of parent‐reported internalizing behavior trajectories across the age span of 3–15 years were explored using a community‐based cohort of Australian children. Six internalizing trajectories had previously been identified for both girls (N = 810) and boys (N = 874) in this sample, comprising stable low, high, decreasing, and increasing pathways. Infancy and toddler temperamental traits (inhibition/shyness, irritability), behavior problems, and parent–child relationship difficulties constituted significant risks for subsequent problematic internalizing profiles. Several gender‐specific trends were evident, with temperamental reactivity and shyness, less optimal parenting, and peer difficulties more salient for girls on increasing trajectories whereas externalizing problems were more prominent among boys on increasing trajectories. Factors associated with recovery from elevated symptoms included higher levels of social competence, better parent and peer relations, and more positive school adjustment. Findings suggest that individual characteristics and relationship experiences may be involved in the development and course of internalizing problems.
Mainland Chinese Adolescents' Judgments and Reasoning about Self‐determination and Nurturance Rights
Authors: Lahat Ayelet , Helwig Charles C. , Yang Shaogang , Tan Dingliang , Liu Chunqiong
Published: July 2008

Younger (13 years) and older (17 years) adolescents (N = 160) from urban and rural China responded to written scenarios in which children's rights to self‐determination and nurturance conflicted with the desires of authorities. They also evaluated scenarios in which children's desire to exercise self‐determination was in conflict with their own welfare interests (nurturance). Older participants and those from urban settings were more likely than younger participants and those from rural settings to endorse self‐determination, both when in conflict with authority and nurturance. When supporting self‐determination, participants appealed to individual rights, autonomy, and personal choice in their justifications. The findings indicate that concepts of diverse types of rights are maintained by adolescents from both modern and traditional settings in China.
THE JOINT CHOICE OF AN INDIVIDUAL'S OCCUPATION AND DESTINATION*
Authors: Christiadi  , Cushing Brian
Published: July 2008

ABSTRACT This study examines the relationship between an individual's occupation choice and destination choice. It portrays the relationship as an interaction between the supply of occupational skills by individuals and demand by different labor‐market regions. The unusual merger of a multinomial logit model of occupational choice and the conditional logit model of destination choice in a simultaneous equation framework requires derivation of a unique variance–covariance matrix. Results indicate strong association between supply of (migration) and demand for (industry mix) an individual's occupational skills. These effects are especially strong for destinations experiencing slow economic growth, while relatively unimportant for high‐growth locations.
LIFE CYCLE AND MIGRATION TO URBAN AND RURAL AREAS: ESTIMATION OF A MIXED LOGIT MODEL ON FRENCH DATA*
Authors: Détang‐Dessendre Cécile , Goffette‐Nagot Florence , Piguet Virginie
Published: July 2008

ABSTRACT This paper examines which types of individuals are attracted to or repelled from rural and urban areas in France. Migration decisions among urban centers, suburbs, and rural areas are examined for three age groups. Differences between locations are assumed to be driven by agglomeration economies and externalities resulting from densities. We therefore stress the role of labor‐market size, land markets, and commuting time in migration decisions. The results from multinomial mixed logits show that large labor markets attract the youngest and in particular educated individuals. Larger family size favors migration from city centers to suburbs, whereas divorce and widowhood increase the probability of moving to an urban center.
SPATIAL ECONOMETRIC MODELING OF ORIGIN‐DESTINATION FLOWS*
Authors: LeSage James P. , Pace R. Kelley
Published: July 2008

ABSTRACT Standard spatial autoregressive models rely on spatial weight structures constructed to model dependence among n regions. Ways of parsimoniously modeling the connectivity among the sample of N=n2 origin‐destination (OD) pairs that arise in a closed system of interregional flows has remained a stumbling block. We overcome this problem by proposing spatial weight structures that model dependence among the N OD pairs in a fashion consistent with standard spatial autoregressive models. This results in a family of spatial OD models introduced here that represent an extension of the spatial regression models described in Anselin (1988).
SPATIAL MOBILITY AND RETURNS TO EDUCATION: SOME EVIDENCE FROM A SAMPLE OF FRENCH YOUTH*
Authors: Lemistre Philippe , Moreau Nicolas
Published: July 2008

ABSTRACT This study re‐evaluates the returns to geographic mobility and to the level of education taking into account the interaction between these two variables, and using the distance covered as a proxy for migration costs. We have at our disposal an original French database that permits precise calculation of the distance between the place of education and the location of first employment. For men, we find decreasing returns to spatial mobility as the distance covered rises and increasing returns to mobility with higher levels of education. The marginal returns to spatial mobility for women are lower across the board.
ENHANCING SPATIAL REPRESENTATION IN PRIMARY AND SECONDARY COVERAGE LOCATION MODELING*
Authors: Kim Kamyoung , Murray Alan T.
Published: July 2008

ABSTRACT An important goal in many planning contexts is maximizing primary and secondary (or backup) coverage while locating a specified number of service facilities. In general, we are interested in providing the greatest level of coverage to demand that is continuously distributed across space. A critical issue is how to represent continuous demand in coverage analysis, reducing or eliminating error and uncertainty. This paper evaluates representation issues in primary and secondary coverage location modeling. To overcome representational limitations, enhancements for spatial coverage abstraction are introduced and incorporated in a mathematical optimization model. In addition to model improvements, this paper introduces a new and novel error assessment approach arising due to the existence of multiple objectives. Surveillance sensor siting in an urban area is utilized to assess enhanced modeling capabilities.
MIGRATION AND SELF‐SELECTION: MEASURED EARNINGS AND LATENT CHARACTERISTICS*
Authors: Nakosteen Robert A. , Westerlund Olle , Zimmer Michael
Published: July 2008

ABSTRACT Research in regional and labor economics has established that economic incentives play a significant role in the process of internal migration. The most common approach is to view migration as a form of human capital investment undertaken by individuals who expect to benefit from the standpoint of increased earnings. One of the central concepts in these models is self‐selection. Individuals who self‐select the option of migration tend to differ from the nonmigrant population in ways that are not measured in most data sets. The contribution of this paper is in its distinction between two aspects of migrant selection. On one hand, some workers possess unmeasured traits that might simultaneously affect their wages and their propensity to engage in risky human capital investment such as migration. On the other hand, measured earnings might exert a direct effect on migration. Based on samples of employed Swedish males and females at two points in time, this study seeks first to examine whether migration between the two periods occurs in the presence of correlation between unmeasured factors present in both earnings during the first period and the subsequent decision to migrate. Second, it looks for an explicit role of earnings per se in the migration decision. Results of the study provide support for selection based on unmeasured traits for both genders. For females, there is also evidence of selection based on measured earnings.
CHANGES IN THE LOCATION OF EMPLOYMENT AND OWNERSHIP: EVIDENCE FROM CALIFORNIA*
Authors: Kolko Jed , Neumark David
Published: July 2008

ABSTRACT We use the National Establishment Time‐Series database to describe shifts in the geographic dispersion of employment and ownership of firms. Focusing on data on business establishments in California, and establishments anywhere in the United States that are owned by firms headquartered in California, we find shifts in the operations of businesses headquartered in California to other states. However, this shift has been offset by increased employment in the state by firms headquartered elsewhere, resulting in California's share of national employment holding quite constant. The evidence points to increasing geographic dispersion of firms' operations, especially in industries with lower communication costs.
HIGHWAY INFRASTRUCTURE INVESTMENT AND COUNTY EMPLOYMENT GROWTH: A DYNAMIC PANEL REGRESSION ANALYSIS*
Authors: Jiwattanakulpaisarn Piyapong , Noland Robert B. , Graham Daniel J. , Polak John W.
Published: July 2008

ABSTRACT This paper uses recent advances in dynamic panel econometrics to examine the impact of highway infrastructure on aggregate county‐level employment using data for all 100 North Carolina counties from 1985 through 1997. Results are compared to models that do not take endogeneity of highway investment and dynamics of employment adjustment into account. Fully specified dynamic models are found to give insignificant results compared to these other models. Thus, when these issues are properly modeled, the results show that improvements in highways have no discernible impact on employment.
JOB CHAINS AND WAGE CURVES: WORKER MOBILITY AND MARSHALLIAN SURPLUSES IN EVALUATING REGIONAL EMPLOYMENT GROWTH*
Authors: Persky Joseph , Felsenstein Daniel
Published: July 2008

ABSTRACT In theory, new regional jobs yield two distinct sources of welfare gains to workers: (1) mobility gains achieved by workers as they move up job chains and (2) traditional Marshallian surpluses enjoyed by all workers as labor markets tighten. In the past, we have argued that the second channel is likely to be small relative to the first. This paper integrates a chain model (using PSID job change data) with a modified‐Marshallian model based on “wage curves” (estimated from CPS data) to formalize and test that argument. High wage jobs with modest wage–unemployment elasticities show Marshallian effects only 10 percent to 20 percent the size of mobility effects. Low wage jobs with somewhat higher elasticities show Marshallian effects from 40 percent to 70 percent the size of mobility effects.
OLS ESTIMATION AND THE t TEST REVISITED IN RANK‐SIZE RULE REGRESSION*
Authors: Nishiyama Yoshihiko , Osada Susumu , Sato Yasuhiro
Published: July 2008

ABSTRACT The rank‐size rule and Zipf's law for city sizes have been traditionally examined by means of OLS estimation and the t test. This paper studies the accurate and approximate properties of the OLS estimator and obtains the distribution of the t statistic under the assumption of Zipf's law (i.e., Pareto distribution). Indeed, we show that the t statistic explodes asymptotically even under the null, indicating that a mechanical application of the t test yields a serious type I error. To overcome this problem, critical regions of the t test are constructed to test the Zipf's law. Using these corrected critical regions, we can conclude that our results are in favor of the Zipf's law for many more countries than in the previous researches such as Rosen and Resnick (1980) or Soo (2005). By using the same database as that used in Soo (2005), we demonstrate that the Zipf law is rejected for only one of 24 countries under our test whereas it is rejected for 23 of 24 countries under the usual t test. We also propose a more efficient estimation procedure and provide empirical applications of the theory for some countries.
Telephone advisory services—nursing between organisational and occupational professionalism
Authors: Fältholm Ylva , Jansson Anna
Published: July 2008

In this paper, we explore how telephone advisory services (TAS) and the implementation of new technology affect nurses and the nursing profession. This study shows that TAS and applied technology embodies ideas of standardisation and efficiency, and promotes an organisational professionalism such that it challenges occupational professionalism. Torn between organisational and occupational professionalism, the nurses develop strategies to deal with their contradictory demands.
Skills shortages are not always what they seem: migration and the Irish software industry
Authors: Wickham James , Bruff Ian
Published: July 2008

This paper argues that the skills shortage in the Irish software industry is socially produced by a range of domestic factors, especially the education and training system. It also contends that immigration reinforces rather than resolves skills shortages.
Gender matters in the global outsourcing of service work
Authors: Howcroft Debra , Richardson Helen
Published: July 2008

This paper provides a gendered analysis of the outsourcing of service work to developing economies taking, as illustration, call centres, shared service centres and the general ICT sector. The paper challenges the suggestion that changes in global capitalism, facilitated by ICT‐enabled employment, offer new opportunities that benefit women, and suggests a degree of caution is needed before assuming a reduction of gender inequalities.
Distributed work: communication in an ‘officeless firm’
Authors: Lai Yi , Burchell Brendan
Published: July 2008

This paper describes and analyses an ‘officeless firm’, where all employees work from their own homes. Drawing upon observations and interviews, the modes of communication and the nature of the interpersonal relationships that have permitted this organisation to succeed are described, along with the challenges that face this organisation in the future as it attempts to grow.
Using IT in work at home: taking a closer look at IT use in home‐located production
Authors: Chalmers Lee
Published: July 2008

Canadian survey data indicate that information technology (IT) use is generally associated with increased odds of participation in home‐located production (HLP), but this relationship is particularly strong for employees in routine (versus knowledge) occupations. Where IT use and HLP are associated with the odds of experiencing time‐related work stress, it is in the direction of increasing the odds.
Cycles of production: from assembly lines to cells to assembly lines in the Volvo Cab Plant
Authors: Wallace Terry
Published: July 2008

This paper analyses changes in work organisation at the Volvo Cab Plant in Umeå, Sweden in order to identify those contingent elements that impact upon the choices made in selecting specific production technologies. It suggests that managerial decision making is not necessarily located within rational or business enhancement paradigms.
A new look at factors influencing total quality management failure: work process control or workforce control?
Authors: Soltani Ebrahim , Lai Pei‐Chun , Phillips Paul
Published: July 2008

By drawing on multi‐case data, there is some evidence to suggest that total quality management (TQM) effectiveness can be viewed as a direct function of the controlling mechanisms that senior managers created prior to TQM implementation. More importantly, control tools of TQM were not used by non‐managerial employees, with which they could reduce variability or achieve uniformity; rather, they were regarded as a weapon used by their managers against them.
CHARACTERIZATION OF CORAL RED SLIPS ON GREEK ATTIC POTTERY*
Authors: WALTON M. S. , DOEHNE E. , TRENTELMAN K. , CHIARI G. , MAISH J. , BUXBAUM A.
Published: July 2008

Samples of red and black gloss from Greek Attic pottery of the late sixth to fifth centuries bc were examined using scanning electron microscopy (SEM and FIB/STEM). The focus of the study was the chemical and microstructural characterization of the red gloss that was first produced during this period. Two groupings of red gloss were revealed. One red was found to be compositionally similar to the black glosses (labelled ‘LCM coral red’). The other red showed more significant chemical differences, such as higher calcium and magnesium, in comparison to the black (labelled ‘HCM coral red’). The existence of two chemically distinct reds—otherwise identical in colour and texture—suggests that there was more than one source of clay available to the Attic potters for producing red.
Access Intervention in an Integrated, Prepaid Group Practice: Effects on Primary Care Physician Productivity
Authors: Conrad Douglas , Fishman Paul , Grembowski David , Ralston James , Reid Robert , Martin Diane , Larson Eric , Anderson Melissa
Published: July 2008

Objective. To estimate the joint effect of a multifaceted access intervention on primary care physician (PCP) productivity in a large, integrated prepaid group practice.

Data Sources. Administrative records of physician characteristics, compensation and full‐time equivalent (FTE) data, linked to enrollee utilization and cost information.

Study Design. Dependent measures per quarter per FTE were office visits, work relative value units (WRVUs), WRVUs per visit, panel size, and total cost per member per quarter (PMPQ), for PCPs employed >0.25 FTE. General estimating equation regression models were included provider and enrollee characteristics.

Principal Findings. Panel size and RVUs per visit rose, while visits per FTE and PMPQ cost declined significantly between baseline and full implementation. Panel size rose and visits per FTE declined from baseline through rollout and full implementation. RVUs per visit and RVUs per FTE first declined, and then increased, for a significant net increase of RVUs per visit and an insignificant rise in RVUs per FTE between baseline and full implementation. PMPQ cost rose between baseline and rollout and then declined, for a significant overall decline between baseline and full implementation.

Conclusions. This organization‐wide access intervention was associated with improvements in several dimensions in PCP productivity and gains in clinical efficiency.
Specialty and Full‐Service Hospitals: A Comparative Cost Analysis
Authors: Carey Kathleen , Burgess James F. , Young Gary J.
Published: July 2008

Objective. To compare the costs of physician‐owned cardiac, orthopedic, and surgical single specialty hospitals with those of full‐service hospital competitors.

Data Sources. The primary data sources are the Medicare Cost Reports for 1998–2004 and hospital inpatient discharge data for three of the states where single specialty hospitals are most prevalent, Texas, California, and Arizona. The latter were obtained from the Texas Department of State Health Services, the California Office of Statewide Health Planning and Development, and the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. Additional data comes from the American Hospital Association Annual Survey Database.

Study Design. We identified all physician‐owned cardiac, orthopedic, and surgical specialty hospitals in these three states as well as all full‐service acute care hospitals serving the same market areas, defined using Dartmouth Hospital Referral Regions. We estimated a hospital cost function using stochastic frontier regression analysis, and generated hospital specific inefficiency measures. Application of t‐tests of significance compared the inefficiency measures of specialty hospitals with those of full‐service hospitals to make general comparisons between these classes of hospitals.

Principal Findings. Results do not provide evidence that specialty hospitals are more efficient than the full‐service hospitals with whom they compete. In particular, orthopedic and surgical specialty hospitals appear to have significantly higher levels of cost inefficiency. Cardiac hospitals, however, do not appear to be different from competitors in this respect.

Conclusions. Policymakers should not embrace the assumption that physician‐owned specialty hospitals produce patient care more efficiently than their full‐service hospital competitors.
Comparing the Performance of Tree Stakes and Seedlings to Restore Abandoned Tropical Pastures
Authors: Zahawi Rakan A. , Holl Karen D.
Published: July 2008

Tree seedlings are commonly planted to restore abandoned agricultural lands, whereas vegetative plantings have received little study. We evaluated the ability of 10 tree species to establish and survive over 3 years by planting 2‐m‐tall vegetative stakes at three sites in southern Costa Rica. We quantified above‐ and belowground stake and seedling biomass for two species (Erythrina poeppigiana and Gliricidia sepium) after 1 year and canopy cover and height of E. poeppigiana stakes and saplings at 3 years. We also compared economic, logistical, and ecological advantages of each methodology. Erythrina poeppigiana and E. berteroana had the highest number of live stakes by the study’s conclusion (>90%) and were among species with largest canopies. Most others ranged between 40 and 70% with highly site‐specific survival and growth rates, whereas three species did poorly. Four species developed fruit by year 3, including Ficus pertusa and Acnistus arborescens, that are consumed by frugivores. Above‐ and belowground biomass was 7–50 times greater in stakes (65–125 g) than seedlings (2–15 g). Stake roots were considerably more extensive and reached lengths more than 6 m. Erythrina poeppigiana stakes had higher canopy cover than saplings after 3 years but not height. Seedlings are 2–10 times more expensive to establish, although transporting stakes is more cumbersome and the suite of species that establish vegetatively is limited. This underused technique should be included in the growing repertoire of tropical forest restoration tools. Given tradeoffs in propagation methods, a combination is likely to be most efficient and successful.
Sawdust Addition Reduces the Productivity of Nitrogen‐Enriched Mountain Grasslands
Authors: Spiegelberger T. , Müller‐Schärer H. , Matthies D. , Schaffner U.
Published: July 2008

Anthropogenic nutrient enrichment of mountain grasslands has boosted grasses and fast‐growing unpalatable plants at the expense of slow‐growing species, resulting in a significant loss in biodiversity. A potential tool to reduce nutrient availability and aboveground productivity without destroying the perennial vegetation is carbon (C) addition. However, little is known about its suitability under severe climatic conditions. Here, we report the results of a 3‐year field study assessing the effects of sawdust addition on soil nutrients, aboveground productivity, and vegetational composition of 10 grazed and ungrazed mountain grasslands. Of particular interest was the effect of C addition on grasses and on the tall unpalatable weed Veratrum album. After 3 years, soil pH, ammonium, and plant‐available phosphorus were not altered by sawdust application, and nitrate concentrations were marginally higher in treatment plots. However, the biomass of grasses and forbs (without V. album) was 20–25% lower in sawdust‐amended plots, whereas the biomass of V. album was marginally higher. Sawdust addition reduced the cover of grasses but did not affect evenness, vegetation diversity, or plant species richness, although species richness generally increased with decreasing biomass at our sites. Our results suggest that sawdust addition is a potent tool to reduce within a relatively short time the aboveground productivity and grass cover in both grazed and ungrazed mountain grasslands as long as they are not dominated by tall unpalatable weeds. The technique has the advantage that it preserves the topsoil and the perennial soil seed bank.
Responses of Plant Communities to Incremental Hydrologic Restoration of a Tide‐Restricted Salt Marsh in Southern New England (Massachusetts, U.S.A.)
Authors: Smith Stephen M. , Roman Charles T. , James‐Pirri Mary‐Jane , Chapman Kelly , Portnoy John , Gwilliam Evan
Published: July 2008

Hydrologic restoration of Hatches Harbor, a tide‐restricted marsh on Cape Cod (Massachusetts), has resulted in significant plant community changes 7 years following the reintroduction of seawater. Since 1999, incremental increases in flow through a tide‐restricting dike have facilitated the rapid decline of salt‐intolerant vegetation, while encouraging the expansion of native salt marsh taxa. These changes show strong spatial gradients and are correlated with marsh surface elevation, distance from the point of seawater entry, and porewater salinity. Common reed (Phragmites australis) has not decreased in abundance but has migrated a considerable distance upslope. In the wake of this retreat native halophytes have proliferated. Now that maximum flow through the existing dike structure has been reached, continued recovery may be limited less by changing physicochemical conditions and more by rates of growth, seed dispersal, and seed germination of salt marsh taxa.
High Dose Transdermal Buprenorphine for Moderate to Severe Pain in Spanish Pain Centres—A Retrospective Multicenter Safety and Efficacy Study
Authors: Barutell Carlos , Camba Alberto , González‐Escalada José‐Ramón , Rodríguez Manuel ,   the Opioid Group of the Spanish Society for the Study of Pain
Published: July 2008

▪ Abstract

Obectives:  To assess the effectiveness of transdermal buprenorphine in patients suffering from moderate to severe pain. Secondary objectives included gathering information about the causes of pain, management of episodic pain, and the safety profile.

Methods:  Retrospective data were collected from 1,465 patients with moderate to severe pain, ie, ≥50 mm on a 0 to 100 mm visual analog scale (VAS), that were switched to transdermal buprenorphine, and received a dose ≥52.5 μg/hour for at least 14 days during the previous 12 months. Pain could have any etiology. Most patients (72.1%) were on tramadol and/or paracetamol (40.7%) before switching to buprenorphine. Using case report forms, efficacy was determined from changes in VAS score compared with 24 hours prior to the first patch application. Safety was evaluated by retrieving information about the nature and incidence of adverse events (AE), whether they were related to the study compound, and the percentage considered being serious.

Results:  An absolute reduction of 25.1 points in VAS score was seen over a median period of 3.7 months treatment. In addition, the VAS score was reduced by at least 10% in 88.4% of patients and the incidence of episodic pain fell significantly. Treatment was rated as “Good” or “Very Good” by 82.5% of patients. Out of 1,465 patients, 50.2% experienced an AE; this was related to the drug in 48.8%, and considered serious in 4.0%.

Conclusions:  Transdermal buprenorphine was an effective and considerably safe drug for relieving chronic moderate to severe pain. ▪
The Fifth Vital Sign—What Does It Mean?
Authors: Walid Mohammad Sami , Donahue Stephen N. , Darmohray Dana M. , Hyer Jr Leon A. , Robinson Jr Joe Sam
Published: July 2008

Acute pain is reported as a presenting symptom in over 80% of physician visits. Chronic pain affects an estimated 76.2 million Americans—more than diabetes, heart disease, and cancer combined. It has been estimated to be undertreated in up to 80% of patients in some settings. Pain costs the American public more than $100 billion each year in health care, compensation, and litigation. That's why pain was officially declared “The Fifth Vital Sign.” Henceforth the evaluation of pain became a requirement of proper patient care as important and basic as the assessment and management of temperature, blood pressure, respiratory rate, and heart rate. The numeric pain scale certainly has a place in care and in pain management; however, it is important to assess the patient's communication and self‐management style and to recognize that patients, like pain, are on a continuum with varied styles of communication and adaptation. It is easy to get lost in the process, even when the process is initiated with the best of intentions. In the quest for individualized medicine, it might be best to keep pain assessment in the individualization arena.
Expert Judgment‐Based Risk Assessment Using Statistical Scenario Analysis: A Case Study—Running the Bulls in Pamplona (Spain)
Authors: Mallor Fermín , García‐Olaverri Carmen , Gómez‐Elvira Sagrario , Mateo‐Collazas Pedro
Published: July 2008

In this article, we present a methodology to assess the risk incurred by a participant in an activity involving danger of injury. The lack of high‐quality historical data for the case considered prevented us from constructing a sufficiently detailed statistical model. It was therefore decided to generate a risk assessment model based on expert judgment. The methodology is illustrated in a real case context: the assessment of risk to participants in a San Fermin bull‐run in Pamplona (Spain). The members of the panel of “experts on the bull‐run” represented very different perspectives on the phenomenon: runners, surgeons and other health care personnel, journalists, civil defense workers, security staff, organizers, herdsmen, authors of books on the bull‐run, etc. We consulted 55 experts. Our methodology includes the design of a survey instrument to elicit the experts' views and the statistical and mathematical procedures used to aggregate their subjective opinions.
Sourcing Research as an Intellectual Network of Ideas*
Authors: Hult G. Tomas M. , Chabowski Brian R.
Published: July 2008

What are the current intellectual clusters in the sourcing literature? How do these clusters relate to each other? How has sourcing‐related research changed over the last 10 years? We respond to these questions by examining the intellectual structure of research in the sourcing literature across 21 journals during the last decade (1998–2007). Multidimensional scaling is used to analyze cocitation data involving 72,003 citations from 1,960 sourcing articles. The results indicate that 10 different sourcing clusters emerged in the 1998–2002 period and 6 sourcing clusters surfaced in the 2003–2007 period. Five of the intellectual clusters in 1998–2002 disappeared in 2003–2007, five clusters remained, and one new cluster materialized in 2003–2007 that did not exist in the earlier period (Managerial Behavior and Upstream Decision Making).
Outsourcing and Performance in Entrepreneurial Firms: Contingent Relationships with Entrepreneurial Configurations*
Authors: Salimath Manjula S. , Cullen John B. , Umesh U. N.
Published: July 2008

This article develops and examines an empirical typology of entrepreneurial firms, based on organizational and life cycle characteristics. Results indicate five entrepreneurial configurations representing the essential contingent features of age, size, innovation, and governance structure (Elders, Giants, Innovators, and Owners) and one configuration representing a mix of all features (Balanced). We found that (i) outsourcing affected financial performance in entrepreneurial firms and (ii) configurations moderated this relationship. Results support the use of salient contingent features of age, size, innovation, and governance structure to predict outsourcing effectiveness in the entrepreneurial configurations. That is, entrepreneurial firms that aligned their configurational characteristics with outsourcing tended to have greater gains in financial performance. From a resource dependency perspective, managing these alignments has important implications for entrepreneurial firm performance.
Valuate Outsourcing Contracts from Vendors' Perspective: A Real Options Approach
Authors: Jiang Bin , Yao Tao , Feng Baichun
Published: July 2008

To date, most applications of real options theory (ROT) in outsourcing literature are modeled from the clients' side. Little attention has been paid to vendors' options in outsourcing. In this article, we study outsourcing from the vendors' perspective by analyzing vendors' value of waiting. The contribution of our research to the literature lies in our analysis of a model that compensates for vendors' loss of option to wait since they have to exercise outsourcing contracts at clients' given timing. Such a compensation‐oriented model yields new insights about the vendors' valuation of outsourcing opportunities, and offers important practical guidance to vendors' decision making.
Strategic Maneuvers for Outsourcing Flexibility: An Empirical Assessment
Authors: Sia Siew K. , Koh Christine , Tan Cheng X.
Published: July 2008

Tan and Sia (2006) conceptualize outsourcing flexibility within a set of four dimensions: robustness, modifiability, new capability, and ease of exit, and propose a portfolio of preemptive, protective, exploitive, and corrective maneuvers to manage flexibility in outsourcing. In this article, we build upon their proposed framework by anchoring the strategic maneuvers through a multitheoretic lens and empirically validate the research propositions. A survey of 171 outsourcing projects in Singapore was conducted. The findings bear evidence that the four proposed dimensions of outsourcing flexibility are conceptually distinct and that different strategic maneuvers contribute differently to the various flexibility dimensions. The empirical findings also affirm the importance of structuring flexibility for outsourcing success, with some flexibility dimensions manifesting different intensity in enabling outsourcing success for IT outsourcing versus business process outsourcing. We conclude by proposing a more holistic approach for effective flexibility management in outsourcing and highlighting research gaps that may need deeper theorizing and empirical extension.
A Path to Successful IT Outsourcing: Interaction Between Service‐Level Agreements and Commitment
Authors: Goo Jahyun , Huang C. Derrick , Hart Paul
Published: July 2008

Although service‐level agreements (SLAs) are important for IT outsourcing management, appropriate mechanisms for constructing effective SLAs are still poorly understood, leading to inadequate or overcomplicated contracts that are ineffective. This study examines the associations among three distinct sets of SLA characteristics and outsourcing success, as well as the role of commitment in these relationships. Analyzing survey data based on a model theorizing the alignment of SLA characteristics with intended outsourcing objectives, we find that different types of benefits attained through IT outsourcing arrangements are associated with the use of specific contractual dimensions. We also find that commitment, in general, moderates the impact of SLAs on outsourcing success, although the nature of the moderation varies with the different benefits IT outsourcing engagement is intended to achieve. Interestingly, in certain cases—change characteristics for achieving technology benefits, in particular—commitment can be a barrier to the effective use of SLAs in achieving intended outsourcing benefits. As such, our study extends the literature on IT outsourcing, contracting and commitment, as well as provides a general guideline for practitioners to structure effective SLAs and to properly use commitment for managing IT outsourcing engagements to successfully achieve intended benefits.