bluuebunny/crossref_metadata_2025 huggingface dataset:
Private sector balance, financial markets, and US cycle: a SVAR analysis
Authors: Casadio Paolo , Paradiso Antonio
Published: October 2012

Purpose

Considering the sectoral balance approach of Godley, and focusing only on the two main components of the private sector balance for the US economy (household and non‐financial corporate balance), the purpose of this paper is to investigate the relationship between these two sectors, the financial variables, and economic cycle. In particular, the paper considers all these relationships endogenously.

Design/methodology/approach

The authors estimate a structural VAR model between household and (non‐financial) corporate financial balances, financial markets, and economic cycle and the authors perform an impulse response analysis. All the variables are expressed as cyclical components applying the Hodrick‐Prescott filter.

Findings

The main result is that: household and corporate balances react to financial markets in the way the authors expected and discussed; the economic cycle influences the two financial balances; the corporate balance has a positive impact on the cycle; the economic cycle and financial balances influence the financial variables. In particular, the point that shows that the corporate balance has a positive impact on the cycle shows that the corporate balance is a leading component of the cycle as suggested by Casadio and Paradiso and accords with Minsky's theory of financial instability.

Research limitations/implications

The analysis does not include the foreign sector (current‐account balance).

Originality/value

This study is an important step forward with respect to the two main contributions in literature which use this approach: the Levy Institute macroeconomic team and Goldman Sachs. Methodologically their models are based on assumptions (such as exogeneity or market clearing price mechanism for the financial markets) that the authors overcome considering all the relationships studied in an endogenous manner.
Perceptions of performance in US financial regulatory programs
Authors: Greitens Thomas J. , Ernita Joaquin M.
Published: October 2012

Purpose

The purpose of this paper is to analyze the accuracy of program performance measurement in US financial regulatory programs.

Design/methodology/approach

This research uses the US Government's Program Assessment Rating Tool (PART) system of output and outcome data collection, performance data from financial regulatory programs were examined to determine: if PART data revealed any degradation in external financial conditions or internal regulatory performance prior to the Great Recession of 2008, and whether output performance influenced outcome performance.

Findings

The results indicate that outcome measures did “capture” some deterioration in the performance of the financial industry before the Great Recession, but these measures were arguably not influenced by program outputs. This represents a potentially problematic use of performance measures in that programs used outcome measures which were not controlled by programmatic actions.

Originality/value

This project adds to a growing body of literature on the challenges of program performance measurement in government. However, this analysis is unique in that it specifically examines the performance of the US Government's financial regulatory programs, as measured by PART, before the Great Recession of 2008.
Retrospective medical record evaluation
Authors: Verelst Sandra , Jacques Jessica , Van den Heede Koen , Gillet Pierre , Kolh Philippe , Vleugels Arthur , Sermeus Walter
Published: October 2012

Purpose

The purpose of this article is to assess the reliability of an in‐depth analysis on causation, preventability, and disability by two separate review teams on five selected adverse events in acute hospitals: pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator‐associated pneumonia and postoperative wound infection.

Design/methodology/approach

The analysis uses a retrospective medical record review of 1,515 patient records by two independent teams in eight acute Belgian hospitals for the year 2005. The Mann‐Whitney U‐test is used to identify significant differences between the two review teams regarding occurrence of adverse events as well as regarding the degree of causation, preventability, and disability of found adverse events.

Findings

Team 1 stated a high probability for health care management causation in 95.5 per cent of adverse events in contrast to 38.9 per cent by Team 2. Likewise, high preventability was considered in 83.1 per cent of cases by Team 1 versus 51.7 per cent by Team 2. Significant differences in degree of disability between the two teams were also found for pressure ulcers, postoperative pulmonary embolism or deep vein thrombosis and postoperative wound infection, but not for postoperative sepsis and ventilator‐associated pneumonia.

Originality/value

New insight on the degree of and reasons for the huge differences in adverse event evaluation is provided.
Patient safety analysis linking claims and administrative data
Authors: Giorgio Lovaglio Pietro
Published: October 2012

Purpose

The purpose of this paper is to provide international data on the occurrence (and rates) of clinical errors, identified by type and consequence in the Lombardy region, and to assess empirically the association between hospital accreditation‐type measures and clinical error rates by merging hospital discharge records and medical malpractice claim data in the Lombardy region (Italy).

Design/methodology/approach

Data were drawn from the regional database collecting claims and demands for reimbursement declared by patients hospitalized in regional healthcare structures and regional archives collecting hospital discharge records. To model the variability of clinical errors rates, binomial negative regression models were applied. For improved interpretation of the results, a regression tree methodology was used.

Findings

The results demonstrated that the rate of readmission for the same major diagnostic category and the rate of discharges against medical advice significantly affect the incidence of errors causing patient death, whereas the rate of unscheduled surgical readmission in the operating room significantly affects the rate of surgical error.

Research limitations/implications

The findings confirm that claims data is problematic in nature because of the limited number of claims generally emerging from administrative sources. The article proposes using proper regression models for count data, taking into account over‐dispersion and excess zeroes and classification tree methods for a better interpretation of empirical evidence.

Practical implications

Health structures where quality outcomes have a significant impact on clinical error rates should be monitored in depth, investigating the medical charts of involved patients to identify quality problems and problematic areas.

Originality/value

As a risk management strategy, the combined use of claims data and clinical administrative data is proposed to shed light on the more problematic, error‐prone areas, allowing regional stakeholders to receive relevant, highly cost‐effective and timely information and an in‐depth understanding of the problematic areas in the assessment of risk.
Implementation of a sustainable business cycle: the case of a tourism project in Puerto Rico
Authors: de los M. Santos‐Corrada María , Figueroa Enid
Published: October 2012

Purpose

The purpose of this paper is to describe an enterprise venture focused on responsible tourism and its social responsibility using the “cycle of sustainable business” concept.

Design/methodology/approach

The study is based on a case study of a tourism business' project in development, tourism and sports in the town of Río Grande, Puerto Rico. Data were collected from unstructured interviews with the vice president of the company and the available documentation.

Findings

This sustainable business cycle can be divided into eight stages: compost treatment system, mangrove conservation, tree planting, plant sewage treatment, energy conservation, construction, hotel and consumers. All of these stages are important for the performance of the cycle.

Research limitations/implications

The results indicate the importance of developing a responsible tourism industry that respects the natural environment, culture and socioeconomic surroundings.

Practical implications

The case illustrates the advantages enjoyed by a business that executes a cycle of sustainable business in a highly competitive market that is dominated by shareholders and developers of high value/capability.

Social implications

Changing consumer behaviour and values that define a community may rely largely on political interventions that promote responsible tourism by implementing sustainable business cycles.

Originality/value

This article seeks to present a detailed case study of a sustainable tourism business. It highlights the areas in which this resort efficiently carries out sustainability. It also illustrates the challenge of creating consumer awareness of added value. In doing so, it demonstrates the concerns faced by tourism developers regarding sustainable development.
Scissors cut paper: purposive and contingent strategies in a conflict situation
Authors: Meyer Christopher J. , McCormick Blaine , Clement Aimee , Woods Rachel , Fifield Chuck
Published: October 2012

Purpose

This paper aims to focus on a little studied but important type of conflict, zero‐sum situations. These conflicts are less likely to take place than those in which participants can come to an integrative agreement, but knowing how to best strategize for zero‐sum conflicts can lead to better outcomes in these situations.

Design/methodology/approach

Participants in the study utilized two specific strategies – purposive or contingent – in a rock‐paper‐scissors elimination tournament. The use of the strategy and the outcome were measured in a controlled setting.

Findings

Results demonstrate that using a strategy in a win‐lose conflict situation significantly predicts success. Further, competitive individuals are more likely to utilize strategies than other personality types.

Originality/value

This paper builds on the theory that individuals in conflict situations have preferences, pursue goals, and behave purposefully. In particular, the paper studies the antecedents to strategies employed in a conflict situation and that strategy's effect on the outcome.
Bringing business education to life: case activities as an innovative approach to get away from “teaching to the test”
Authors: Fee Alistair
Published: October 2012

Purpose

This paper aims to describe interactive approaches to effective business education / skills development.

Design/methodology/approach

The paper answers the questions: How can we effectively develop students in real time business skills when they are not yet working in the real business world? How can we help students to develop creative, flexible mindsets that will enable them to hit the ground running when they take up their first position in an organization?

Findings

The paper explores the techniques that the author has developed from 30 years working in international businesses around the globe. Much of the work is based on case studies. Not the Harvard Business School case studies with which many readers will be familiar, but in shorter, commercially relevant cases where students have to take real action. These are called “Case Activities” and here are some examples together with a note on the lessons students over the years have reported learning.

Originality/value

In this short, observational piece the author shares ideas, which he has been trying out for the last 15 years.
The Little Black Book of Innovation by Scott D. Anthony
Authors: Wollard Karen K.
Published: October 2012

Purpose

Reviews the latest learning and development books across the globe and pinpoints practical implications.

Design/methodology/approach

This briefing is prepared by an independent writer who adds their own impartial comments and places the articles in context.

Findings

Innovation is essential for organizations and individuals to meet the challenges of global change and competition. This is an easy to read, lively book that delivers on its promise to make innovation understandable and accessible. Scott Anthony writes in a conversational style and uses footnotes to add insights and personal thoughts. The book begins by explaining that the ability to innovate can be improved by studying and applying patterns. This idea, adopted from Clayton Christensen, Harvard Business School professor and author of The Innovators's Dilemma, serves as a guide for the book.

Practical implications:

Provides strategic insights and practical thinking that have influenced some of the world's leading organizations.

Originality/value

The briefing saves busy executives and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy‐to digest format.
Strategic management and the economics of the firm
Authors: Hussler Caroline , Pénin Julien , Dietrich Michael , Burger‐Helmchen Thierry
Published: October 2012

Purpose

The purpose of this paper is to argue for the need to reconcile managerial and economic approaches of the firm. Strategic management seems to be the perfect playground for this.

Design/methodology/approach

The paper shows many divergences between the economic and managerial approach of the firm but also highlights many topics where both approaches come in handy.

Findings

The authors underline the topics and theories in strategic management with the greatest benefits of mixing economics and management can be expected and they echo the papers in this special issue.

Practical implications

The paper comes as a warning for those using only managerial perspective without listening to the caveats and ideas put forward by the economic approach of the firm.

Originality/value

The paper offers an agenda of how economics and management could be reunited, and shows the relevance of doing so to both theory and practice.
Technological diversity management of medical device enterprises
Authors: Shimanuki Seiya , Saiki Tomoko
Published: October 2012

Purpose

The purpose of this paper is to examine knowledge creation and technological diversity management by medical device manufacturers, to identify strategic directions for innovation in the medical device field.

Design/methodology/approach

This paper uses two types of data to assess the importance of multiple technologies and technological diversity in product development: patent applications and approvals of medical devices for sale and use in medical treatment. Additional perspective is provided by the results of a survey of management styles.

Findings

While knowledge‐creating innovation frequently combines multiple technologies, the scope of technological diversity, the variety of types of technology combined may be wider in low‐risk than in high‐risk innovation.

Research limitations/implications

The sample size is too small to justify claims of statistical significance. This research should be extended to incorporate more cases and explore the theme in greater depth.

Practical implications

Companies that choose a high‐risk strategy are likely to be more focused on related multiple technologies with which their researchers are already familiar. Conversely, companies that choose a low‐risk strategy may have more room to experiment since, if something goes wrong, the risk to patient health is lower. Innovative medical device enterprise to seek high‐risk device development is proposed to manage optimal diversity for it.

Originality/value

This paper analyses two case studies relevant to growing interest in technological diversity and knowledge management in knowledge‐driven innovation in the medical device industry in Japan.
Immunobiology of Genital Tract Trauma: Endocrine Regulation of HIV Acquisition in Women Following Sexual Assault or Genital Tract Mutilation
Authors: Ghosh Mimi , Rodriguez‐Garcia Marta , Wira Charles R.
Published: October 2012

Studies on HIV acquisition and transmission in women exposed to sexual trauma throughout their life cycle are lacking, but some findings suggest that rates of HIV acquisition through coercive sex are significantly higher than that seen in consensual sex. Sexual trauma can also occur as a result of female genital mutilation, which makes sex extremely painful and can cause increased abrasions, lacerations, and inflammation, which enhances the risk of HIV acquisition. This review presents an overview of the immune system in the human female reproductive tract (FRT) from adolescence, through puberty to pregnancy and menopause. What is clear is that the foundation of information on immune protection in the FRT throughout the life cycle of women is extremely limited and at some stages such as adolescence and menopause are grossly lacking. Against this backdrop, forced or coercive sexual intercourse as well as genital mutilation further complicates our understanding of the biological risk factors that can result in transmission of HIV and other sexually transmitted infections.
Systemic contact dermatitis to corticosteroids
Authors: Baeck M. , Goossens A.
Published: October 2012

Background

Although unexpected and paradoxical, allergic hypersensitivity to corticosteroids is a common finding, delayed‐type reactions being much more frequently encountered than the immediate‐type ones. Although the skin is the main sensitization and elicitation route, other routes, amongst them systemic administration of corticosteroids may exceptionally be involved.

Objective

To determine the frequency, clinical presentation and cross‐reactivity patterns for allergic reactions following systemic administration of corticosteroids amongst patients with identified and investigated ‘contact allergy’ to corticosteroids.

Methods

We reviewed clinical data, patch test results and sensitization sources in patients who reacted positively to corticosteroids tested in the K.U. Leuven Dermatology department during an 18‐year period.

Results

Sixteen subjects (out of 315 with CS delayed‐type hypersensitivity) presented with allergic manifestations due to systemic administration of corticosteroids. Most patients reacted to molecules from the three groups of the recently reappraised classification.

Conclusion

The reactions observed seem to be in most cases ‘systemic contact dermatitis’ due to oral or parenteral re‐exposure of sensitized individuals with the respective corticosteroids previously applied topically. Moreover, most patients seem to be able to react to any corticosteroid molecules and therefore need a systematic individualized evaluation of their sensitization/tolerance profile.
The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity
Authors: BAE HYO SOOK , CHUNG YE WON , KIM TAK , LEE KYU WAN , SONG JAE YUN
Published: October 2012

Objective. To analyse factors associated with endocervical cone margin involvement and suggest appropriate cone depth for the conization procedure. Design. Retrospective cohort study. Setting. Gynecological oncology center. Population. One thousand two hundred and twenty women undergoing conization for cervical intraepithelial neoplasia (CIN) II or III or stage IA1 microinvasive cervical carcinoma. Methods. The following factors were analysed: age, parity, gravida, conization type, margin status, disease severity and specimen depth. Receiver operating characteristic curve analyses were used to determine the best cut‐off points to define appropriate cone depth. Main outcome measures. Cone depth to avoid endecervical margin involvement. Results. Ninety‐one women had endocervical margin involvement (7.5%). This was positively associated with disease severity and age and inversely related to cone depth. In women under 50 years of age, the cut‐off value was achieved at 1.8 cm cone depth, with high sensitivity and relatively low specificity [area under the curve (AUC) 0.64, sensitivity 0.86, specificity 0.27, p= 0.005]. For a subset of CIN II patients aged ≤50 years, the cut‐off value was 1.2 cm (AUC 0.75, sensitivity 0.90, specificity 0.47, p= 0.008). In women <40 years of age, the cut‐off value was 1.8 cm (AUC 0.60, sensitivity 0.88, specificity 0.25, p= 0.036). In a subset of CIN II, the cut‐off value was 0.9 cm (AUC 0.87, sensitivity 0.83, specificity 0.69, p= 0.002). Conclusions. Age, disease severity and cone depth are predictive factors for endocervical margin involvement. In women of reproductive age, the appropriate cone depth to avoid endocervical margin involvement can be changed depending on age and disease severity.
Natural Products as Sources of New Fungicides (I): Synthesis and Antifungal Activity of Acetophenone Derivatives Against Phytopathogenic Fungi
Authors: Ma Ya‐Tuan , Fan Hua‐Fang , Gao Yu‐Qi , Li He , Zhang An‐Ling , Gao Jin‐Ming
Published: October 2012

Several series of 45 acetophenone derivatives bearing various alkyl or benzyl substituents were conveniently synthesized and their structures characterized by 1H and 13C NMR spectroscopy, HRMS and single‐crystal X‐ray analysis. Their in vitro antifungal activities against a panel of phytopathogenic fungi were evaluated by mycelial growth rate assay. Of them, 12 derivatives (e.g., 3a–c, 4c and 4e) exhibited more potent antifungal effects on some phytopathogens than a commercial fungicide hymexazol as positive control. In particular, compound 3b with IC50 values of 10–19 μg/mL was found to be the most active in this series and might be a potential lead structure for further optimization. The preliminary structure–activity relationship (SAR) studies of a series of acetophenones are also discussed.
Effects of Flavone Derivatives on Antigen‐Stimulated Degranulation in RBL‐2H3 Cells
Authors: Hwang Doseok , Park Hye‐Jin , Seo Eun‐Kyung , Oh Joo Y. , Ji Sang Y. , Park Dong K. , Lim Yoongho
Published: October 2012

Mast cells are primarily responsible for IgE‐mediated allergic responses. The activation level of mast cells is reflected in their degree of degranulation. This can in turn be determined by measuring the amount of β‐hexosaminidase release, a key parameter in degranulation. In this study, 40 flavone derivatives, including flavone, 14 methoxyflavones, 13 hydroxyflavones, and 12 hydroxymethoxyflavones, were evaluated for their inhibition of degranulation in rat basophilic leukemia RBL‐2H3 cells. 3′,7‐Dihydroxyflavone inhibited degranulation (IC50 = 13.56 μm), which was comparable to PP2 (3‐(4‐chlorophenyl)‐1‐(1,1‐dimethylethyl)‐1H‐pyrazolo[3,4‐d]pyrimidin‐4‐amine) used as a control. In addition, we report quantitative relationships between the structural properties of flavones and their inhibitory effects on degranulation.
Diet‐dependent modulation of hippocampal expression of endocannabinoid signaling‐related proteins in cannabinoid antagonist‐treated obese rats
Authors: Rivera Patricia , Luque‐Rojas María Jesús , Pastor Antoni , Blanco Eduardo , Pavón Francisco J. , Serrano Antonia , Crespillo Ana , Vida Margarita , Grondona Jesús M. , Cifuentes Manuel , Bermúdez‐Silva Francisco J. , de la Torre Rafael , de Fonseca Fernando Rodríguez , Suárez Juan
Published: October 2012

Diet‐induced obesity produces changes in endocannabinoid signaling (ECS), influencing the regulation of energy homeostasis. Recently, we demonstrated that, in high‐fat‐diet‐fed rats, blockade of CB1 receptor by AM251 not only reduced body weight but also increased adult neurogenesis in the hippocampus, suggesting an influence of diet on hippocampal cannabinoid function. To further explore the role of hippocampal ECS in high‐fat‐diet‐induced obesity, we investigated whether the immunohistochemical expression of the enzymes that produce (diacylglycerol lipase alpha and N‐acyl phosphatidylethanolamine phospholipase D) and degrade (monoacylglycerol lipase and fatty acid amino hydrolase) endocannabinoids may be altered in the hippocampus of AM251 (3 mg/kg)‐treated rats fed three different diets: standard diet (normal chow), high‐carbohydrate diet (70% carbohydrate) and high‐fat diet (60% fat). Results indicated that AM251 reduced caloric intake and body weight gain, and induced a modulation of the expression of ECS‐related proteins in the hippocampus of animals exposed to hypercaloric diets. These effects were differentially restricted to either the 2‐arachinodoyl glycerol or anandamide signaling pathways, in a diet‐dependent manner. AM251‐treated rats fed the high‐carbohydrate diet showed a reduction of the diacylglycerol lipase alpha : monoacylglycerol lipase ratio, whereas AM251‐treated rats fed the high‐fat diet showed a decrease of the N‐acyl phosphatidylethanolamine phospholipase D : fatty acid amino hydrolase ratio. These results are consistent with the reduced levels of hippocampal endocannabinoids found after food restriction. Regarding the CB1 expression, AM251 induced specific changes focused in the CA1 stratum pyramidale of high‐fat‐diet‐fed rats. These findings indicated that the cannabinoid antagonist AM251 modulates ECS‐related proteins in the rat hippocampus in a diet‐specific manner. Overall, these results suggest that the hippocampal ECS participates in the physiological adaptations to different caloric diets.
Time‐shift experiments and patterns of adaptation across time and space
Authors: Blanquart François , Gandon Sylvain
Published: October 2012

Time‐shift experiments provide measures of the mean fitness of a population in environments of different points in time. Here, we show how to use this type of data to decompose mean fitness into (1) the effect of the environment in which the population is transplanted, (2) the effect of the genetic composition of the population and (3) ‘temporal adaptation’, which measures how the population fits the environment at that time. We derive analytical results for the pattern of ‘temporal adaptation’ and show that it is in general maximal in the recent past. The link between ‘temporal adaptation’ and ‘local adaptation’ is discussed, and we show when patterns of adaptation in time and space are expected to be similar. Finally, we illustrate the potential use of this approach using a data set measuring the adaptation of HIV to the immune response of several recently infected patients.
Climate change reduces offspring fitness in littoral spawners: a study integrating organismic response and long‐term time‐series
Authors: Bartolini Fabrizio , Barausse Alberto , Pörtner Hans‐Otto , Giomi Folco
Published: October 2012

Integrating long‐term ecological observations with experimental findings on species response and tolerance to environmental stress supports an understanding of climate effects on population dynamics. Here, we combine the two approaches, laboratory experiments and analysis of multi‐decadal time‐series, to understand the consequences of climate anomalies and ongoing change for the population dynamics of a eurythermal littoral species,Carcinus aestuarii. For the generation of cause and effect hypotheses we investigated the thermal response of crab embryos at four developmental stages. We first measured metabolic rate variations in embryos following acute warming (16–24 °C) and after incubation at 20 and 24 °C for limited periods. All experiments consistently revealed differential thermal responses depending on the developmental stage. Temperature‐induced changes in metabolic activity of early embryonic stages of blastula and gastrula suggested the onset of abnormal development. In contrast, later developmental stages, characterized by tissue and organ differentiation, were marginally affected by temperature anomalies, indicating enhanced resilience to thermal stress. Then, we extended these findings to a larger, population scale, by analyzing a time‐series ofC. aestuariilandings in the Venice lagoon from 1945 to 2010 (ripe crabs were recorded separately) in relation to temperature. Landings and extreme climatic events showed marked long‐term and short‐term variations. We found negative relationships between landings and thermal stress indices on both timescales, with time lags consistent with an impact on crab early life stages. When quantitatively evaluating the influence of thermal stress on population dynamics, we found that it has a comparable effect to that of the biomass of spawners. This work provides strong evidence that physiological responses to climatic anomalies translate into population‐level changes and that apparently tolerant species may be impacted before the ontogeny of eurythermy. These ontogenetic bottlenecks markedly shape population dynamics and require study to assess the effects of global change.
Influence of tip wear of piezoelectric ultrasonic scalers on root surface roughness at different working parameters. A profilometric and atomic force microscopy study
Authors: Arabaci T , Cicek Y , Dilsiz A , Erdogan İY , Kose O , Kizildağ A
Published: October 2012

Roughness on tooth surfaces is reported to facilitate the reestablishment of microbial dental plaque. Hence, the main goal of dental scaling is to remove bacterial plaque and obtain smoother tooth surfaces. This study was aimed to assess the influence of tip wear of ultrasonic scaler inserts on root surface roughness at different working parameters. Twenty piezoelectric ultrasonic scaler inserts (10 worn/10 new) were selected to examine the erosion ratio (ER) on the scaler tips and to assess the influence of tip wear on root surface roughness. Erosion on the tip surfaces was evaluated under atomic force microscopy (AFM). Root samples were prepared and instrumented by new (Group I) and worn (Group II) inserts at different working parameters. Roughness change (Rc) on root surfaces after instrumentation was examined under profilometer and compared between and within the groups. Statistically significant differences were found between the mean ERs of new and worn tips (P < 0.01). The results of this study showed that tip angulation and instrument power strongly influenced the Rc values on instrumented samples (P < 0.05). It was also revealed that tip wear influenced the Rc values on root surfaces especially at 45° tip angulation (P < 0.05). Therefore, tip wear should also be considered as much as the other parameters to minimize the surface roughness during ultrasonic treatment.
Erythrocyte and reticulocyte indices in the assessment of erythropoiesis activity and iron availability
Authors: Urrechaga E. , Borque L. , Escanero J. F.
Published: October 2012

Introduction

Consequence of the imbalance between the erythroid marrow iron requirements and the actual supply is a reduction in red cell hemoglobin content, which causes hypochromic mature red cells and reticulocytes. Sysmex XE 5000 analyzer (Sysmex Corporation, Kobe, Japan) reports reticulocyte hemoglobin equivalent (Ret‐He) and the percentages of erythrocyte subsets, including the hypochromic fraction (%Hypo‐He). We study the value of these parameters of hemoglobinization in the evaluation of erythropoiesis and iron availability.

Methods

Ninety healthy subjects, 85 patients with chronic kidney disease (CKD) and 65 patients on dialysis (HD) receiving therapy and 91 patients with iron deficiency (IDA) were analyzed. Pearson's correlation, t‐test for independent, and receiver operating characteristic (ROC) curve analysis were utilized.

Results

The results in the IDA group reflected the state of iron depletion (low ferritin), low iron availability (low MCH and high percentage of hypochromic red cells (%Hypo‐He)), and iron‐restricted erythropoiesis (low Ret‐He). In the HD and CKD, the reticulocyte percentage showed the increased erythropoiesis, maintained due to treatment (Ret‐He over 30 pg) and good iron availability, MCH within reference range and %Hypo‐He slightly increased. The results of ROC curves analysis for the diagnosis of iron deficiency (gold standard sTfR > 21 nm) were as follows: Ret‐He area under curve (AUC) 0.935 cutoff 29.8 pg, sensitivity 90.7%, specificity 83.1%. % Hypo‐He AUC 0.925 cutoff 3.5%, sensitivity 87.3%, specificity 88.0%.

Conclusions

Percentage of hypochromic red cells and Ret‐He provide information about individual cell characteristics, so the hypochromic cells are detected and quantitated improving the evaluation of erythropoiesis and iron status.
Effects of Seeing and Hearing Vowels on Neonatal Facial Imitation
Authors: Coulon Marion , Hemimou Cherhazad , Streri Arlette
Published: October 2012

For several decades, many authors have claimed the existence, early in life, of a tight link between perceptual and productive systems in speech. However, the question whether this link is acquired or is already present at birth remains open. This study aimed at investigating this question by employing the paradigm of neonatal facial imitation. We compared imitative responses of newborn infants presented either visual‐only, audiovisual congruent, or audiovisual incongruent models. Our results revealed that the newborns imitated significantly more quickly the movements of the model's mouth when this model was audiovisual congruent rather than visual‐only. Moreover, when observing an audiovisual incongruent model, the newborns did not produce imitative behavior. These findings, by highlighting the influence of speech perception on newborns' imitative responses, suggest that the neural architecture for perception–production is already in place at birth. The implications of these results are discussed in terms of a link between language and neonatal imitation, which could represent a precursor of more mature forms of vocal imitation and speech development in general.
Double balloon enteroscopy can be safely done in elderly patients with significant co‐morbidities
Authors: Byeon Jeong‐Sik , Mann Neel K. , Jamil Laith H. , Lo Simon K.
Published: October 2012

Background and Aim

Performance of double balloon enteroscopy (DBE) on older patients with comorbidities is a matter of safety. We aimed to investigate the utility and safety of DBE in older patients.

Methods

We retrospectively reviewed the medical records of patients 75 years or older who underwent DBE in our open‐access endoscopy unit in a tertiary center. We analyzed the diagnostic yield, therapeutic intervention, and safety including complications of DBE.

Results

Four scheduled DBEs were canceled because of poor conditions. Two hundred and fourteen DBEs were performed in 167 elderly patients. All DBEs were performed under monitored anesthesia care using intravenous propofol administered by anesthesiologists. One half of the patients were male (female : male = 80:87). The mean age of patients was 80.1 ± 3.7 years. Co‐morbidity of significant chronic diseases was noted in 208 (97.2%) DBEs. Fifty‐one (23.8%) DBEs were performed in patients with American Society of Anesthesiologists (ASA) physical status II, 151 (70.6%) DBEs with ASA class III, and 12 (5.6%) DBEs with ASA class IV. The most common indication was obscure gastrointestinal bleeding. The mean DBE procedure time was 131 ± 51 min. Abnormalities were detected in 129 (60.3%) DBEs with therapeutic interventions performed in 83 (38.8%) cases. Pancreatitis, hypoxia, and aspiration pneumonia developed after three (1.4%), three (1.4%), and two (0.9%) DBEs, respectively, all of which resolved with conservative care.

Conclusions

Double balloon enteroscopy can be done with acceptable safety in the elderly with high ASA class. DBE shows a high diagnostic yield and can deliver many therapeutic applications.
Identification of a high risk gastric cancer group using serum pepsinogen after successful eradication of Helicobacter pylori
Authors: Haneda Masahira , Kato Mototsugu , Ishigaki Saori , Suzuki Mio , Takahashi Masakazu , Nakagawa Manabu , Ono Shouko , Mori Yasuaki , Mabe Katsuhiro , Nakagawa Shouichi , Kudo Takahiko , Shimizu Yuichi , Asaka Masahiko
Published: October 2012

Background and Aim

Pepsinogen (PG) method is widely used to identify high risk groups of gastric cancer. It is very useful before Helicobacter pylori eradication, but after eradication the method becomes useless because the PGI, PGII, PGI/II ratios change. Therefore, we aimed to identify a high risk group for gastric cancer using serum pepsinogen after successful eradication of H. pylori.

Methods

A total of 261 participants were enrolled after successful eradication of H. pylori in Hokkaido University Hospital from 1995 to 2010. Participants with renal failure, taking proton pump inhibitors, and those with advanced gastric cancer were excluded. Serum levels of PGI and II were measured using chemiluminescent immunoassay method.

Results

Receiver operating characteristic curves using cancerous and non‐cancerous data in post‐eradication determined the optimal cut‐off value of PGI/II as 4.5. The sensitivity and the specificity were 65.9% and 79.3%, respectively. The usual PG method includes 48.9% of cancer cases, and the PGI/II ≤ 4.5 in post‐eradication includes 65.9% of them, and it includes approximately half of the high risk group of diffuse type cancer. PGI/II ≤ 4.5 in post‐eradication included many gastric cancer cases detected after eradication (12/16 = 75%).

Conclusion

In the identification of a high risk group for gastric cancer, we suggest that the optimal cut‐off value of PGI/II after successful eradication of H. pylori is 4.5. PGI/II ≤ 4.5 in post‐eradication includes more gastric cancer cases compared with the traditional PG method, and 75% of gastric cancer cases detected after eradication.
Alternative investigations for irritable bowel syndrome
Authors: Philpott Hamish , Nandurkar Sanjay , Lubel John , Gibson Peter R
Published: October 2012

Background and Aim

Alternative and complementary medical practitioners have long advocated alternative treatments for irritable bowel syndrome. A more recent development has been the use of alternative investigations by these practitioners and, in the era of internet advertising, directly by patients themselves. The aim of the present study was to examine the alternative investigations that are advocated for the assessment of gastrointestinal disease and that are available through mainstream laboratories in Australia.

Methods

A comprehensive literature review was undertaken for each investigation, which was then evaluated on the basis of ACCE criteria for diagnostic tests. The ACCE criteria consider the analytical and clinical validity, clinical utility and ethical implications of the test.

Results

Serum immunoglobulin G (IgG) to food antigens, salivary IgA, intestinal permeability, fecal short‐chain fatty acids and fecal microbial analysis were identified as readily available. None of the investigations satisfied the ACCE criteria. The tests were deficient in one or more areas of analytical validity, clinical application, validity and ethical usage standards.

Conclusion

Alternative investigations lack reliability and direct clinical applications, and should not be recommended for the investigation of gastrointestinal symptoms.
Clinical features of autoimmune hepatitis and comparison of two diagnostic criteria in Korea: A nationwide, multicenter study
Authors: Kim Bo Hyun , Kim Yoon Jun , Jeong Sook‐Hyang , Tak Won Young , Ahn Sang Hoon , Lee Youn Jae , Jung Eun Uk , Lee Jung Il , Yeon Jong Eun , Hwang Jae Seok , Um Soon Ho , Seo Yeon Seok , Kim Young Seok , Song Byung Cheol , Kim Ju Hyun , Jung Young Kul , Park Choong Kee , Kim Kyung‐Ah , Min Hyun Ju , Cho Eun Young , Lee Eom Seok , Kwon So Young , Chae Hee Bok , Kim Dong Joon , Shin Su Rin
Published: October 2012

Background and Aim

As a rare liver disease, little is known about autoimmune hepatitis (AIH). This study investigated the clinical features and compared two diagnostic criteria of AIH in Korea.

Methods

A nationwide, multicenter, retrospective analysis was done of data of adult patients diagnosed with AIH from January 2005 to December 2009.

Results

The enrolled patients (n = 343; mean age, 52.8 years; range, 19–87 years; 12% male, 88% female) met diagnostic criteria of AIH according to the revised original criteria (n = 311) or the simplified criteria (n = 250). At diagnosis, 30.6% were asymptomatic, 22.7% were cirrhotic, and 4.3% displayed hepatic decompensation. The positive results for anti‐nuclear antibody, smooth muscle antibody, and anti‐liver/kidney microsomal antibody were 94.2%, 23.0%, and 2.9%, respectively. Definite AIH and probable AIH according to the revised original criteria were 24.8% and 65.3%, respectively, while those according to the simplified criteria were 34.4% and 38.5%, respectively. The diagnostic sensitivity and positive predictive value of simplified criteria in comparison with the revised original criteria were 69.9% and 86.4%, respectively. As an initial therapy, corticosteroid (37.7%) or corticosteroid with azathioprine (36.8%) was administered. Remission, incomplete response, and treatment failure were noted with 85.7%, 10.5%, and 3.9% of patients, respectively.

Conclusions

Autoimmune hepatitis in Korea is mostly type I, showing a mean age of 53 years with comparable clinical features to other countries. The concordant rate of the two diagnostic criteria was rather low with modest sensitivity of the simplified criteria. Further studies on the validation of the diagnostic criteria are warranted.
Autoimmune pulmonary alveolar proteinosis: Treatment options in year 2013
Authors: LETH STEFFEN , BENDSTRUP ELISABETH , VESTERGAARD HANNE , HILBERG OLE
Published: October 2012

Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of a periodic acid Schiff (PAS)‐positive eosinophilic material in the distal airways. For decades, the standard treatment of PAP has been whole lung lavage (WLL), where large quantities of saline are instilled into the lungs to remove the proteinaceous material. However, not all patients respond to this treatment. Thus, new treatment modalities, such as subcutaneous or inhaled granulocyte macrophage colony‐stimulating factor (GM‐CSF), and the CD20 antibody rituximab and plasmapheresis, have been investigated. Based on the current literature, a stepwise treatment plan is suggested starting with WLL, continuing to inhaled GM‐CSF, and then to rituximab if the former treatment regimes are unsuccessful.
The occurrence of ‘what’, ‘where’, ‘what house’ and other repair initiations in the home environment of hearing‐impaired individuals
Authors: Pajo Kati
Published: October 2012

Background

Even though research has increasingly focused on the qualitative features of natural conversations, which have improved the communication therapy for hearing‐impaired individuals (HI) and familiar partners (FP), very little is known about the interactions that occur outside clinical settings.

Aims

This study investigated qualitatively how both HI and FP initiated repair due to misperceptions or to a difficulty in understanding during conversations conducted at home. The HI participant's multimodal production style was adopted in the present analysis, and the frequencies were calculated for the different types of verbal repair initiations.

Methods & Procedures

Participants with acquired hearing loss (43–69 years) and their familiar partners (24–67 years) were video recorded (total time approximately 9 h) in their homes. The data consisted of eight conversational dyads. The transcription and analysis utilized Conversation Analysis.

Outcomes & Results

A total of 209 (HI 164/FP 45) verbal repair initiations were identified. The five major types of initiations found in the data (used by both HI and FP) were: open repair initiation, targeting question word, question word with repetition, repetition, and candidate understanding. HI participants rarely explicitly verbalized their difficulty to hear, but the production style, which included a fast speech rate and ‘trouble posture’, indicated a sensitive routine that was visible particularly in clear misperceptions. Furthermore, the alerting action of overlapping turn taking with the FP participant's turn could be seen to reveal the depth of misperception. The individual differences between HI participants were found predominantly in the frequency of their repair initiations, but also in how they used the different types of repair initiation.

Conclusions & Implications

Through a deeper qualitative analysis, conversational research can provide extended knowledge of the occurrence and style of ordinary repair initiations and highlight their relationship in certain conversational environments. A robust starting point in communication therapy is increasing the awareness of HI individuals’ existing skills.
Acute urinary retention increases the risk of complications after transurethral resection of the prostate: a population‐based study
Authors: Chen Jeng‐Sheng , Chang Chia‐Hsien , Yang Wen‐Horng , Kao Yea‐Huei
Published: October 2012

Study Type – Prognosis (cohort)

Level of Evidence 2a

What's known on the subject? and What does the study add?

Higher mortality and morbidity rates in men presenting with AUR have been reported in previous studies.

This study has comprehensive comparisons of post‐TURP complications between patients with and without AUR. Furthermore, it shows that AUR is associated with increased risk of complications after TURP.

OBJECTIVE

To assess the association between a history of acute urinary retention (AUR) and complications after transurethral resection of prostate (TURP).

PATIENTS AND METHODS

We conducted a retrospective, national, population‐based study using Taiwan's National Health Insurance Research Database.

We included men > 50 years old, diagnosed with benign prostatic hyperplasia (BPH) and divided these into two groups: an AUR+ group – those with AUR who underwent TURP between 2002 and 2004; and an AUR‐ group – those without AUR who underwent TURP between those dates.

Prostate cancer, Parkinsonism and multiple sclerosis were exclusion criteria.

Postoperative complications, e.g. re‐catheterization, haematuria or urinary tract infection (UTI), were compared using crude odds ratios (ORs), 95% confidence intervals (CIs), and Student's t‐test.

A chi‐squared test was used for potential confounding factors: preoperative UTI and anticoagulant use.

Univariate and multivariate analysis on medical expenses were conducted.

RESULTS

The AUR+ group contained 3305 men; the AUR‐ group contained 1062.

Re‐catheterization (13.8%), septicaemia (1.1%) and shock (0.3%) were found only in the AUR+ group.

The AUR+ group had more UTIs (18.9% vs. 15.6%, OR: 1.26, 95% CI: 1.05–1.52), more lower urinary tract symptoms (22.8% vs. 16.9%, OR: 1.45, 95% CI: 1.21–1.73), fewer blood transfusions (3.2% vs. 1.5%, OR: 2.19, 95% CI: 1.29–3.72) and higher medical expenses.

There were no significant differences in haematuria, lower urinary tract stricture, or re‐surgical intervention of the prostate and second‐line antibiotic use.

CONCLUSION

Patients in Taiwan with BPH with AUR who were treated by TURP were associated with a higher risk of complications, longer hospital stay and more comorbidities than those without AUR and a preoperative warning is warranted for these patients.
On the recent mess in Mali (Respond to this article at http://www.therai.org.uk/at/debate)
Authors: Soares Benjamin
Published: October 2012

In this guest editorial, Benjamin Soaris looks at the rapid deterioration of the situation in Mali. He encourages anthropologists to see the bigger picture.