bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic Insurance Contracts and Adverse Selection
Authors: Janssen Maarten C. W. , Karamychev Vladimir A.
Published: February 2005

Abstract

We take a dynamic perspective on insurance markets under adverse selection and study a dynamic version of the Rothschild and Stiglitz model. We investigate the nature of dynamic insurance contracts by considering both conditional and unconditional dynamic contracts. An unconditional dynamic contract has insurance companies offering contracts where the terms of the contract depend on time, but not on the occurrence of past accidents. Conditional dynamic contracts make the actual contract also depend on individual past performance (such as in car insurances). We show that dynamic insurance contracts yield a welfare improvement only if they are conditional on past performance. With conditional contracts, the first‐best can be approximated if the contract lasts long. Moreover, this is true for any fraction of low‐risk agents in the population.
Ownership Structure, Agency Costs, Specialization, and Efficiency: Analysis of Keiretsu and Independent Insurers in the Japanese Nonlife Insurance Industry
Authors: Jeng Vivian , Lai Gene C.
Published: February 2005

Abstract

This article uses the nonparametric frontier method to examine differences in efficiency for three unique organizational forms in the Japanese nonlife insurance industry—keiretsu firms, nonspecialized independent firms (NSIFs), and specialized independent firms (SIFs). It is not possible to reject the null hypothesis that efficiencies are equal, with one exception. Keiretsu firms seem to be more cost‐efficient than NSIFs. The results have important implications for the stakeholders of the NSIFs. An examination of the productivity changes across the different organizational forms reveals deteriorating efficiency for all three types of firms throughout the 1985–1994 sample period. Finally, the evidence also suggests that the value‐added approach and the financial intermediary approach provide different but complementary results.
Insurance in a Market for Credence Goods
Authors: Sülzle Kai , Wambach Achim
Published: February 2005

Abstract

We study the impact of variations in the degree of insurance on the amount of fraud in a physician‐patient relationship. In a market for credence goods, where prices are regulated by an authority, physicians act as experts. Due to their informational advantage, physicians have an incentive to cheat by pretending to perform inappropriately high treatment levels leading to overcharging patients. Our approach aims on the impact on changes in each, patients' and physicians' incentive structure when the proportional degree of coinsurance varies. It is shown that a higher coinsurance rate may lead to either less fraud in the market and a lower probability of patients searching for second opinions or more fraud and more searches.
Asylum nursing in the UK at the end of the Victorian era: Hill End Asylum
Authors: BRIMBLECOMBE N.
Published: February 2005

This paper explores aspects of asylum care at the beginning of the 20th century. Archival materials from Hill End, the Hertford County Asylum, provide a single historical case study. The study focuses on the methods and standards by which asylum nursing was monitored and also examines aspects of the origins and work life of the nursing staff. Standards of care were monitored by a number of official bodies visiting the asylum, whilst the medical superintendent's role focused on the supervision and disciplinary control of nursing staff. Evaluation reports at the time were largely favourable in relation to the care given in Hill End Asylum. However, the reports were based on the relatively limited expectations of the time: primarily relating to the cleanliness, quietness and lack of overt complaints regarding care from patients. Further measures reported related to: death rates, wet beds, numbers of staff dismissed, together with the use of mechanical restraints and seclusion. Nursing staff in the asylum were not normally recruited locally and frequently stayed for only short periods of time. Training provided was very limited at Hill End although a national nurse training scheme was well established by this time. The nursing issues important within the asylum were common to all asylums at the time, and some are still significant today. This paper provides an insight into the historical development of the mental health nursing profession in the UK and its relationship with the medical profession. It also provides evidence that current attempts to monitor the quality of care through clinical governance processes are far from new.
Hope makes a difference
Authors: MOORE S. L.
Published: February 2005

Hope. It is a word that is often used but one which we do not stop to think intentionally about. It may be difficult to define, and frequently many come to know it more by its absence. Nurses espouse the value of hope, but it is a concept that often seems elusive when one is trying to put it into practice. The author suggests that hope is at the heart of psychiatric nursing practice and provides insights and reflections about how it has made a difference in the lives of individuals.
Approaches in the safety evaluations of veterinary antimicrobial agents in food to determine the effects on the human intestinal microflora
Authors: CERNIGLIA C. E. , KOTARSKI S.
Published: February 2005

The administration of antimicrobial agents to livestock creates potential for antibiotic residues to enter the food supply and be consumed by humans. Therefore, as a process of food animal drug registration, national regulatory agencies and international committees evaluate data regarding the chemical, microbiologic, pharmacokinetic, pharmacodynamic, pharmacologic, toxicologic, and antimicrobial properties of veterinary drugs to assess the safety of ingested antimicrobial residues to consumers. Currently, European, Australian and United States guidelines for veterinary drug registration require a safety assessment of microbiologic hazards from consumption of antimicrobial residues taking into account the potentially adverse effects on human intestinal microflora. The main concerns addressed are selection of resistant bacteria in the gastrointestinal tract and disruption of the colonization barrier of the resident intestinal microflora. Current requirements differ among national agencies. Efforts are ongoing internationally to review and harmonize approaches and test methods and protocols for application to these microbiologic safety evaluations of antimicrobial drug residues in food. This review describes the background to current regulatory approaches used in applying in vitro and in vivo methods to set a microbiologic acceptable daily intake for residues in food derived from animals treated with an antimicrobial agent. This paper also examines the current research needs to support these evaluations.
Development of a PCR‐based diagnostic test detecting a nt230(del4) MDR1 mutation in dogs: verification in a moxidectin‐sensitive Australian Shepherd
Authors: GEYER J. , DÖRING B. , GODOY J. R. , MORITZ A. , PETZINGER E.
Published: February 2005

A subpopulation of dogs of the Collie and Australian Shepherd breeds show increased sensitivity to central nervous actions of ivermectin, doramectin, loperamide, and probably several other drugs. The molecular background for this greater sensitivity is a nonsense mutation in the MDR1 efflux pump, which is part of the functional blood–brain barrier and normally limits drug penetration into the brain. This report describes a rapid PCR‐based method for detection of this nt230(del4) MDR1 mutation using a small amount of genomic DNA from blood cells. Thereby, homozygous intact, homozygous mutated, and heterozygous mutated MDR1 genotypes can be clearly differentiated by high resolution polyacrylamide gel electrophoresis. Using this diagnostic test two Collies and one Australian Shepherd were screened for the nt230(del4) MDR1 mutation. The Collies had no history of altered drug sensitivity and showed homozygous intact and heterozygous mutated MDR1 alleles, respectively. However, the Australian Shepherd developed clear signs of neurotoxicity including ataxia, crawling, acoustic and tactile hyperexcitability, and miosis after a single dose of moxidectin (400 μg/kg). For this dog two mutated MDR1 alleles were detected. This report describes for the first time moxidectin neurotoxicosis in a dog with a homozygous MDR1 mutation.
Pharmacokinetics and synovial fluid concentrations of flurbiprofen enantiomers in horses: chiral inversion
Authors: SORACI A. L. , TAPIA O. , GARCIA J.
Published: February 2005

Flurbirpofen (FBP), a member of the 2‐aryl propionate nonsteroidal anti‐inflammatory drug class, has potent anti‐inflammatory and analgesic properties. The commercial preparation is a racemic mixture of the R(−) and S(+) enantiomers of FBP. In this study, R(−) and S(+) FBP were used to investigate the metabolic chiral inversion. Each enantiomer was administered separately (0.25 mg/kg) and in a racemic mixture (0.5 mg/kg) intravenously to horses. Plasma and synovial concentration of each enantiomer was determined and the disposition of each was analyzed. After intravenous administration of R(−) FBP and S(+) FBP to horses no chiral inversion was detected. After the administration of the FBP racemate and individual enantiomers no differences were observed between pharmacokinetic parameters [t1/2β(h),Cl(L/h·kg),AUC(μg·h/mL), Vss(L/kg) and MRT (h)] for R(−) and S(+) FBF. Synovial fluid concentrations of both FBP enantiomers were lower than plasma concentrations and no stereoselective differences were detected. These data indicate that the disposition of FBF in horses is not enantioselective and demonstrate a difference in the pharmacokinetic behavior of the enantiomers as compared with other 2‐aryl‐propionic acids, such as carprofen, ketoprofen and vedaprofen in the horse.
Relationship between plasma concentrations and analgesia after intravenous fentanyl and disposition after other routes of administration in cats1
Authors: ROBERTSON S. A. , TAYLOR P. M. , SEAR J. W. , KEUHNEL G.
Published: February 2005

Data allowing rational use of analgesics in cats are limited. Pharmacokinetics and pharmacodynamics of fentanyl were studied in cats. Plasma fentanyl concentrations were measured using radioimmunoassay in a crossover study in six cats after 10 μg/kg (i.v.) or by application of fentanyl in pluronic lecithin organogel (PLO) to the inner ear pinna. On a separate occasion thermal thresholds were measured after i.v. fentanyl (10 μg/kg) or saline. Plasma fentanyl concentrations reached 4.7–8.31 ng/mL 2 min after i.v. administration and were undetectable after 95 min. Fentanyl was not detected in plasma at any time after PLO use. Thermal thresholds did not change following saline administration but were increased above baseline from 5 to 110 min after i.v. fentanyl. In this model a plasma concentration of >1.07 ng/mL was required to provide analgesia. Plasma concentrations were measured in additional cats after intranasal or oral dosing (2 μg/kg) and after 30 μg/kg in PLO gel. After oral and nasal dosing,Cmaxvalues were 0.96 and 1.48 ng/mL at 5 and 2 min, respectively. Plasma fentanyl was not detected after application of the higher dose of fentanyl in PLO.
Evaluation of the anti‐endotoxic effects of polymyxin‐E (colistin) in dogs with naturally occurred endotoxic shock
Authors: ŞENTÜRK S.
Published: February 2005

Endotoxin is a potent stimulator of the inflammatory response and is believed to initiate the pathology in gram‐negative sepsis. Agents are being searched for that bind and neutralize or block the effects of endotoxin. The aim was to study the anti‐endotoxic effects of polymyxin‐E (colistin) in endotoxaemic dogs. The study included a total of 30 endotoxaemic dogs, which were divided into two groups (control = 15; test = 15) of both sexes, different breeds and ages. Hetastarch colloid solution (Expahes®,10 mL/kg, i.v.) with lactated Ringer's solution (20 mL/kg, i.v., Q12 h) was given to all dogs. While ampicillin was administered (Alfasilin®, 10 mg/kg, i.m., Q12 h) as an antibacterial to the control group, colistin (12 500 IU/kg, i.m., Q12 h) + ampicillin were administered to the test group. The clinical examination (body temperature, pulse and respiration rates, capillary filling times, peripheral pulse qualities, dehydration degrees), hematological and biochemical examinations (WBC, RBC, HGB, HCT, thrombocyte, serum urea, creatinine and TNF‐α) were performed both before the treatment, and 2, 4, 12 and 24 h after the treatment. In comparison with the control group, it was observed that test group had shorter capillary filling time at 24 h (P < 0.001). Moreover, the degree of dehydration in test group, was significantly improved at 24 h (P < 0.01). While the differences in peripheral pulse qualities significantly differed between 0 and 2 h in controls, at 2, 4, 24 h after treatment it was found to be significantly increased when compared with 0 h in the test group. Serum TNF‐αconcentrations were statistically decreased in the test group between 0 h and other times (P < 0.01). When compared with controls, serum TNF‐αconcentrations were lower at 2, 4, 12 and 24 h in test group (P < 0.05). Results of the study indicated that polymyxin‐E (colistin) has an anti‐endotoxic effect and is safe for the dogs with endotoxemia at the dosage used in this study.
Superiority of the gastroduodenal safety profile of licofelone over rofecoxib, a COX‐2 selective inhibitor, in dogs
Authors: MOREAU M. , DAMINET S. , MARTEL‐PELLETIER J. , FERNANDES J. , PELLETIER J.‐P.
Published: February 2005

This study assessed the gastroduodenal safety profile of licofelone, a new nonsteroidal anti‐inflammatory drug with dual inhibitory activity against 5‐lipoxygenase and cyclo‐oxygenase (COX), by using endoscopic evaluations and by comparing licofelone to rofecoxib, a selective COX‐2 inhibitor. Twenty‐one dogs underwent blinded gastroduodenoscopies, during which the mucosa of the gastroduodenal tract was assessed and scored. Blood analyses were monitored on days 0 (baseline), 14, 28, 42, and 56. Examinations to detect fecal occult blood were performed daily. Dogs were randomly assigned to three groups that received either a placebo, licofelone at a dose of 2.5 mg/kg twice daily, or rofecoxib at a dose of 0.5 mg/kg daily, respectively. Significant differences between the groups in gastric (P = 0.003), duodenal (P = 0.009), and gastroduodenal (P = 0.002) endoscopic lesion scores were observed at day 56. Rofecoxib‐treated dogs had more lesions in all areas when compared with placebo‐treated dogs, more duodenal lesions when compared with licofelone‐treated dogs and more lesions than they had at baseline. In contrast to licofelone, rofecoxib was found to induce significant gastric and gastroduodenal lesions in dogs that lacked pre‐existing lesions at baseline. Blood analyses and fecal examinations did not reveal abnormalities in any of the experimental groups. Treatment with licofelone was well tolerated and was shown to be safer than rofecoxib in terms of upper gastrointestinal damage. In this way, this study demonstrates the gastroduodenal safety profile of licofelone for chronic treatment.
Use of a nuclear‐targeted β‐glucuronidase fusion protein to demonstrate vegetative cell‐specific gene expression in developing pollen
Authors: Twell David
Published: February 2005

To examine the site of expression of the tomato anther‐specific gene, LAT52, in the developing male gametophyte, the LAT52 gene promoter was fused to a nuclear‐targeted version of the β‐glucuronidase (GUS) gene and introduced into tobacco. Transformed plants expressing GUS activity showed nuclear localization of the GUS reaction product to the vegetative cell of the pollen grain. No staining or localization was detected in the generative cell, at pollen maturation or during pollen tube growth in vitro. These results clearly demonstrate differential gene expression within the male gametophyte, and highlight regulatory events which determine the differing fates of the vegetative and generative cells following microspore mitosis.
Random sequencing of cDNA libraries reveals a variety of expressed genes in cultured cells of rice (Oryza sativa L.)
Authors: Uchimiya Hirofumi , Kidou Shin‐ichiro , Shimazaki Tetsuo , Aotsuka Satoshi , Takamatsu Susumu , Nishi Ritsuko , Hashimoto Hiroshi , Matsubayashi Yuko , Kidou Naomi , Umeda Masaaki , Kato Atsushi
Published: February 2005

Large scale sequencing of randomly selected cDNA clones was carried out to investigate the feasibility of this method for isolating plant genes. cDNA libraries were made using mRNA prepared from suspension‐cultured cells of rice (Oryza sativa L.). Partial nucleotide sequences of 830 individual cDNA clones have been determined and compared with the GenBank database. Approximately 8% of the cDNA clones could be identified as particular genes. This method provides the opportunity to isolate large numbers of plant genes.
Doctors in vocational training: rural background and rural practice intentions
Authors:   Australian Medical Workforce Advisory Committee (AMWAC)
Published: February 2005

Objective:  To report the findings of a national survey of Australian doctors in vocational training about their rural practice intentions and their plans to work full time or part time.

Design:  A self‐administered mailed survey.

Setting:  Vocational training: general practice and other medical college training programs.

Subjects:  Australian doctors (i.e. Australian citizens and permanent residents) registered with one of Australia's 17 medical college vocational training programs in September 2002.

Main outcome measures:  Intention to practise in a rural area on completion of vocational training; full‐time or part‐time practice plans; views about rural practice.

Results:  Of the 7899 doctors who met the criteria for inclusion in the study, 4259 (54%) responded. In total:14% indicated a preference for rural practice on completion of vocational training; 17% were GP trainees of which 31% preferred rural practice; 83% were registered with one of the other 16 specialist training programs (e.g. adult medicine, paediatric medicine and surgery) of which 10% preferred rural practice; 50% of general practice trainees and 23% of trainees in other specialist training programs with a rural background indicated a preference for rural practice in the long term, compared with 25% and 7%, respectively, of doctors with an urban background; 46% of general practice trainees with intentions to practise in a rural area plan to practise part time.

A positive association was observed between rural background and preference for rural practice (odds ratio (OR) 2.9) and between preference for rural practice and enrolment in the rural general practice training pathway (OR 3.1) and involvement in rural education and training activities (OR 5.1).

Conclusions:  The findings of this study support initiatives to increase the number of rural background students entering medical school and rural education and vocational training initiatives. Australia's rural doctor shortage is not likely to be addressed by this cohort of doctors in vocational training. General practice workforce plans, rural and urban, need to take note of the high proportion of doctors who plan to practise part time.
Masculine interest behind high prevalence of female contraceptive methods in rural Nepal
Authors: Chapagain Matrika
Published: February 2005

Objective:  This article explores the nexus between intraspousal power relations and couples’ participation in contraceptive decision‐making. Further, it discloses whether perceived gender roles and privilege influence couples’ contraceptive behaviour in rural Nepal.

Methods:  Two hundred and twenty‐three couples from 197 randomly selected households from two rural population clusters in eastern Nepal were interviewed. Additionally, 40 key informants were included to collect in‐depth qualitative information. The conclusion provides the essence of the results from quantitative and qualitative analyses.

Results:  Out of 10 independent variables regarding the social power status of the wives and husbands (education, age, occupation, personal income, household headship, political participation, social participation, access to mass media, exposure to psychological assault and physical assault from husband), four variables, namely education, personal income, exposure to psychological assault and physical assault demonstrated significant influence on wives’ participation, while no one variable showed association with husbands’ participation in contraceptive decision‐making. Despite the husband's domination, husband–wife joint involvement in making contraceptive decisions was common. However, stereotyped gender roles and privilege appeared to be influential in deciding the types of methods to use, to shift the methods, and to terminate using contraception.

Conclusion:  As an unequal conjugal relationship is one of the factors responsible for the husband's domination in the decision‐making process, women's empowerment should be an entry‐point for the transformation of gender discriminatory attitudes and behaviour. Women's empowerment enhances an equal conjugal relationship, and thereby helps in achieving equal partnership in reproductive health decision‐making.
Do rural consumers expect a prescription from their GP visit? Investigation of patients’ expectations for a prescription and doctors’ prescribing decisions in rural Australia
Authors: Cutts Christopher , Tett Susan E.
Published: February 2005

Objective:  To assess patients’ expectation for receiving a prescription and GPs’ perceptions of patient expectation for a prescription.

Design:  Matched questionnaire study completed by patients and GPs.

Setting:  Seven general practices in rural Queensland, Australia.

Subjects:  The subjects were 481 patients consulting 17 GPs.

Main outcome measures:  Patients’ expectation for receiving a prescription and GPs’ perceptions of patients’ expectation.

Results:  Ideal expectation (hope) for a prescription was expressed by 57% (274/481) of patients. Sixty‐six per cent (313/481) thought it was likely that the doctor would actually give them a prescription. Doctors accurately predicted hope or lack of hope for a prescription in 65% (314/481) of consultations, but were inaccurate in 19% (93/481). A prescription was written in 55% of consultations. No increase in patients’ expectation, doctors’ perceptions of expectation, or decision to prescribe were detected for patients living a greater distance from the doctors.

Conclusions:  Rural patients demonstrated similar rates of hope for a prescription to those found in previous urban studies. Rural doctors seem to be similarly ‘accurate’ and ‘inaccurate’ in determining patients’ expectations. Rates of prescribing were comparable to urban rates. Distance was not found to increase the level of patient expectation, affect the doctors’ perception or to influence the decision to prescribe.
Postoperative morbidity and recurrence after local excision of rectal adenomas and rectal cancer by transanal endoscopic microsurgery
Authors: Endreseth B. H. , Wibe A. , Svinsås M. , Mårvik R. , Myrvold H. E.
Published: February 2005

Objective  Tumours in the middle and upper part of the rectum are not easy accessible to local excision. Transanal endoscopic microsurgery (TEM) has been recommended for excision of sessile adenomas in the middle and upper part of the rectum, and for small cancers in patients not fit for major surgery. The purpose of this study was to evaluate postoperative morbidity and local recurrence after TEM.

Material and methods  Seventy‐nine patients were treated by TEM in the period 1994–2001. The median age was 74 years. The indications for TEM were rectal adenoma in 72 patients and rectal cancer in 7 patients. The tumours were located within 18 cm from the dentate line, median 10 cm. There were performed 69 transmural and 10 mucosal excisions. Mean follow up was 24 months (range 1–95 months). Twenty (25%) patients died during the follow up period, two because of metastases and 18 of other causes.

Results  Seven patients had complications. Two (2.5%) patients had peroperative perforation in the intra‐abdominal part of the rectum treated by laparotomy. Five (6%) patients had postoperative cardiopulmonal or surgical complications. Eight patients with benign pre‐operative histopathological examination had cancer. The local recurrence rate (13%) was similar for adenomas and for carcinomas.

Conclusion  TEM is a safe technique well tolerated also by high‐risk patients, and should be the preferred method in patients with benign tumours in the middle and upper part of the rectum, and in selected cases of early rectal cancer. Benign pre‐operative histology does not preclude malignancy and some patients may need further treatment for unexpected malignancy.
Bipolar electrocoagulation vs conventional monopolar hot biopsy forceps in the endoscopic treatment of diminutive rectal adenomas
Authors: Paspatis G. A. , Vardas E. , Charoniti I. , Papanikolaou N. , Barbatzas C. , Zois E.
Published: February 2005

Objective  To assess whether a cold biopsy from a diminutive rectal adenoma followed by destruction with bipolar (gold probe) electrocoagulation using large probes and high power setting would be a safe and efficient alternative to conventional monopolar hot biopsy forceps (MHBF).

Patients and methods  Eligible patients were those undergoing colonoscopy, fulfilling the criteria of additional clearing colonoscopy and having at least one suspected rectal adenoma ≤ 5 mm. At the time of endoscopy patients were randomized to receive treatment for their diminutive rectal adenomas either with cold biopsy followed by repeated gold probe electrocoagulation (Group A) using a 10 Fr catheter with setting 8 (40 W) for 1 second or with MHBF (Group B). These patients were followed up with a colonoscopy at 2–4 months.

Results  A total number of 24 (15 males, 9 females; mean age 56 years) patients were included in group A and 26 (14 males, 12 females; mean age 58 years) in group B. A total number of 38 and 37 diminutive rectal adenomas was detected in patients of Group A and Group B, respectively. At follow up colonoscopy residual adenoma tissue was found in 2 (5.2%) adenomas of 38 in Group A and in 4 (10.8%) of 37 in Group B (P > 0.3). No complications related to colonoscopy or endoscopic treatments in both groups occurred.

Conclusions  Our data suggest that the use of cold biopsy followed by bipolar electrocoagulation using large probes and high power setting for destroying diminutive rectal adenoma seems to be equally effective and safe as MHBF.
An approach to haemorrhoids
Authors: Tang T. , Lim P. B. , Miller R.
Published: February 2005

Objective  Many patients with haemorrhoids are investigated because of the fear of missing colorectal cancer (CRC). The aim of this study was to determine whether a primarily clinical approach regarding the need for investigation was safe and did not miss patients with CRC.

Patients and methods  Data was collected prospectively on 589 consecutive patients with the principle diagnosis of haemorrhoids at first clinic visit. All had clinical assessment including rigid sigmoidoscopy and were treated by phenol injection or banding. They were categorized for (1) no review unless symptoms persisted –‘One Stop SOS’ (2) outpatient review or (3) investigation. To check for the development of CRC they were contacted by postal questionnaire or telephone interview with a minimum of one year from diagnosis and treatment. All 589 patients were cross‐referenced with the Pathology database and the Hospital Information Services System.

Results  Four hundred and sixty‐nine (80%) answered the questionnaire; 352 patients (60% of the total group) fell in the ‘one stop SOS’ outpatient category; 95 (16%) patients were followed up to review response to treatment for large haemorrhoids; 105 (18%) were investigated with barium enema (12%), flexible sigmoidoscopy (4%), colonoscopy (1%) and miscellaneous (1%); 37 (6%) patients were either given a haemorrhoidectomy date or referred on with a different diagnosis. No patients selected for ‘one‐stop’ treatment developed CRC. Five (0.8%) patients were diagnosed with CRC after appropriate investigation was instituted for suspicious symptoms. One patient with distal transverse colon cancer had a delayed diagnosis as she was investigated initially by flexible sigmoidoscopy.

Conclusion  Most patients with the primary diagnosis of symptomatic haemorrhoids do not need investigation.
Long‐term outcome of laparoscopic mesh rectopexy for solitary rectal ulcer syndrome
Authors: Tweedie D. J. , Varma J. S.
Published: February 2005

Objective  To determine the long‐term outcome of laparoscopic mesh rectopexy for solitary rectal ulcer syndrome (SRUS).

Patients and methods  A retrospective review of 11 patients who underwent laparoscopic mesh rectopexy for refractory SRUS between 1993 and 1996. All patients were followed up initially with rigid sigmoidoscopy and seven were involved in long‐term evaluation (follow‐up at 71–106 months, median 89 months) involving a sickness impact profile questionnaire.

Results  Complete endoscopic healing of the ulcer was demonstrated in all 11 patients up to one year postoperatively but one suffered recurrence later. Of seven assessed long‐term, none experienced endoscopic recurrence. Six continued to enjoy a significant reduction in symptoms and an improved quality of life. One had persistent problems and demonstrated little symptomatic improvement.

Conclusion  Laparoscopic mesh rectopexy offers a minimally invasive option for selected patients who remain severely symptomatic despite maximal conservative therapy for SRUS, with demonstrable ulcer healing and long‐term improvement in symptoms and quality of life. Larger studies are required to fully evaluate its efficacy compared to ‘conventional’ surgical options.
Systematic review of thromboprophylaxis in colorectal surgery – an update
Authors: Borly L. , Wille‐Jørgensen Peer , Rasmussen M. S.
Published: February 2005

Objective  The incidence of thromboembolism after colorectal surgery is higher than after general surgery. The aim of this paper is to update a systematic review addressing thrombosis prophylaxis in connection with colorectal surgery.

Methods  MEDLINE, EMBASE, LILACS, abstract books and reference lists from reviews were searched without language restrictions for randomized controlled trials or clinical controlled trials comparing prophylactic interventions and/or placebo up til August 2003. Five hundred and fifty‐eight studies were identified of which 19 fulfilled the inclusion criterias. Data extraction was done by at least two of the authors. Outcome was deep venous thrombosis and/or pulmonary embolism diagnosed by various methods.

Results  Any kind of heparin is better than no treatment or placebo (11 studies) with a Peto Odds ratio (POR) at 0.32 (95% CI 0.20–0.53). Unfractionated heparin and low molecular weight heparin (4 studies) were equally effective POR 1.01 (95% CI 0.67–1.52). The combination of graduated compression stockings and LMWH is better than LMWH alone (2 studies) with a POR at 4.17 (95% CI 1.37–12.70).

Conclusion  The optimal thromboprophylaxis in colorectal surgery is the combination of graduated compression stockings and low‐dose unfractionated heparin or low molecular weight heparin.
Targets and elective colorectal cancer: outcome and symptom delay at surgical resection
Authors: Bharucha S. , Hughes S. , Kenyon V. , Anderson I. D. , Carlson G. L. , Scott N. A.
Published: February 2005

Objective  To determine, for elective patients with colorectal cancer, if associations exist between the length of symptom history at surgical resection and Dukes stage, completeness of the surgical procedure and patient survival.

Patients and methods  A prospective cohort study was undertaken. Five hundred and eighty‐two patients with colorectal cancer, admitted for surgical resection after outpatient consultation, divided into four equal quartiles according to length of symptom history (short: n = 131, 0–103 days; medium: n = 136, 104–177 days; long: n = 136, 178–318 days; very long: n = 137, 319–1997 days). The main outcome measures used were the Extent of tumour (Dukes stage) at resection, completeness of resectional surgery (curative vs palliative), patient survival after resection.

Results  For patients undergoing elective surgical resection of colorectal cancer we did not find an association between Dukes stage and duration of patient history (Dukes stage C tumours were seen in 37% (CI: 26.2%‐48.0%) of patients with a short symptomatic history as opposed to 34% (CI: 32%‐62%) with a very long symptomatic history). Elective curative resection was not associated with a significantly different symptom duration than elective palliative resection (Palliative resections were performed in 24% (CI: 11.7%‐36.4%) of patients with a short symptomatic history as opposed to 16% (CI: 2.4%‐29.9%) with a very long symptomatic history). The median survival time for the four elective colorectal patient groups defined by length of symptomatic history was not significantly different – (short: n = 131, 4.3 years; medium: n = 136, 5.9 years; long: n = 136, 7.1 years; very long: n = 137, 5.0 years).

Conclusion  Tumour extent, completeness of resection and patient outcome after elective colorectal cancer resection was not found to have an association with length of patient history at the time of surgery.
Pathological audit of stapled haemorhoidopexy
Authors: Shanmugam V. , Watson A. J. M. , Chapman A. D. , Binnie N. R. , Loudon M. A.
Published: February 2005

Introduction  Stapled haemorrhoidopexy is increasingly used for the surgical management of prolapsing haemorrhoids. Accurate placement of the staple line is essential to avoid involvement of the internal anal sphincter (IAS) and the pain sensitive squamous epithelium. The aim of this study was to correlate histology with symptomatic outcome after stapled haemorrhoidopexy.

Patients and methods  A single pathologist reviewed one hundred and six consecutive rectal mucosal specimens. Each specimen was assessed for the presence of columnar, transitional and squamous epithelium as well as involvement of smooth and skeletal muscle. In November 2003 all patients were sent a previously validated postal questionnaire about haemorrhoidal symptoms and a Cleveland Clinic continence scale. Symptomatic outcome was compared between patients who did or did not have squamous epithelium involvement in their pathology specimens and were analysed by Mann–Whitney U‐test.

Results  One hundred and six stapled haemorrhoidopexies were performed between June 2001 and September 2003. Eighty‐four patients (79%) returned the questionnaire; 19 patients had squamous epithelium present in the pathology specimens. There was no significant difference between symptom or Cleveland Clinic scores in patients with or without squamous epithelium in their pathology specimens. Some specimens (n = 6) were found to have smooth muscle underlying squamous epithelium; this was interpreted as the presence of internal anal sphincter (IAS) within the specimen. There was no significant difference in Cleveland Clinic scores between this group and those without IAS involvement.

Conclusion  This study has not demonstrated a long‐term difference in symptomatic outcome or continence in patients who have squamous epithelium present in their stapled haemorrhoidopexy specimens.
People, energy and avian species richness
Authors: Evans Karl L. , Gaston Kevin J.
Published: February 2005

Aim  To investigate the inter‐relationships between energy availability, species richness and human population density, particularly whether human population density influences the manner in which species richness responds to energy availability.

Location  British 10‐km grid cells.

Methods  Using regressions, we investigate how human population density varies with energy availability and the nature of relationships between the numbers of species, classified by abundance and threat categories, and human population density. We then assess whether the relationships between these species richness measures and energy availability are altered when accounting for human population density. We conduct analyses using both independent error models and ones that control for spatial autocorrelation.

Results  Human population density was strongly and positively correlated with energy availability. Total species richness, and that of unthreatened, threatened, common and moderately common species, increases in a positive decelerating manner with human density. When human population density was taken into account, these species groups exhibited similar species–energy relationships, but the slopes of these relationships were significantly reduced in independent error models and, in the case of total richness, in spatial models.

Main conclusions  Positive correlations between human density and species richness probably arise as both increase with energy availability. Our data are compatible with the suggestion that high human population densities reduce the rate at which species richness increases with energy availability, but additional research is required before causality can be confirmed.
The distribution and diversity of Chironomidae (Insecta: Diptera) in western Finnish Lapland, with special emphasis on shallow lakes
Authors: Nyman Marjut , Korhola A. , Brooks S. J.
Published: February 2005

Aim  Predictions of aquatic ecosystem change with global warming require basic data that accurately reflect the environmental conditions underlying species distributions. However, in remote arctic areas such baseline data are scarce. We assess the influence of environmental variables on chironomid distribution and taxon richness in shallow, isothermal lakes in a poorly studied arctic region. We pay particular attention to community variation along the treeline ecotonal zone where many environmental variables change abruptly in a relatively small area.

Location  Lake transect in Finnish Lapland spanning from boreal coniferous forest to arctic tundra.

Methods  Chironomid assemblages were determined from surface‐sediment samples of 50 shallow (< 10 m) natural lakes. Abundance and taxon richness data were related to 24 limnological variables using canonical ordination techniques (DCA, CCA, RDA). A Monte Carlo permutation procedure was used to assess the explanatory power of single variables. Between‐vegetation zone differences of richness were tested for statistical significance using one‐way anova.

Results  In total, 7771 chironomid head capsules were identified, consisting of 13 species, 10 species groups, four subgenera, 41 genera, four genus groups, five types and three with uncertain taxonomic affiliation. A hump‐shaped relationship between taxon richness and elevation was noted along the study transect with a peak in taxon richness occurring in mountain birch woodland lakes at middle elevations, decreasing then towards both warmer and colder ends of the elevation/temperature gradient. Of the individual parameters, sediment organic content, total organic carbon, pH, and lake‐specific air temperature accounted for the greatest amount of variation in the chironomid data.

Main conclusions  Maximum taxon richness occurred at mid‐elevations where aquatic algae also reached their maximum diversity. This area coincides with an ecotonal transitional zone, which seems more likely to account for the peak in species richness. Our study demonstrates that the factors most strongly affecting chironomids in Finnish Lapland (i.e. temperature, and ecosystem features) are those that with great probability will also change as a result of future climate change. This will likely have an effect on the distribution of chironomids in subarctic and arctic areas.
Neurobiology of the fruit fly's circadian clock
Authors: Helfrich‐Förster C.
Published: February 2005

Studying the fruit fly Drosophila melanogaster has revealed mechanisms underlying circadian clock function. Rhythmic behavior could be assessed to the function of several clock genes that generate circadian oscillations in certain brain neurons, which finally modulate behavior in a circadian manner. This review outlines how individual circadian pacemaker neurons in the fruit fly's brain control rhythm in locomotor activity and eclosion.
Effects of lorazepam on short latency afferent inhibition and short latency intracortical inhibition in humans
Authors: Di Lazzaro V. , Oliviero A. , Saturno E. , Dileone M. , Pilato F. , Nardone R. , Ranieri F. , Musumeci G. , Fiorilla T. , Tonali P.
Published: February 2005

Experimental studies have demonstrated that the GABAergic system modulates acetylcholine release and, through GABAA receptors, tonically inhibits cholinergic activity. Little is known about the effects of GABA on the cholinergic activity in the human central nervous system. In vivo evaluation of some cholinergic circuits of the human brain has recently been introduced using a transcranial magnetic stimulation (TMS) protocol based on coupling peripheral nerve stimulation with TMS of the motor cortex. Peripheral nerve inputs have an inhibitory effect on motor cortex excitability at short intervals (short latency afferent inhibition, SAI). We investigated whether GABAA activity enhancement by lorazepam modifies SAI. We also evaluated the effects produced by lorazepam on a different TMS protocol of cortical inhibition, the short interval intracortical inhibition (SICI), which is believed to be directly related to GABAA activity. In 10 healthy volunteers, the effects of lorazepam were compared with those produced by quetiapine, a psychotropic drug with sedative effects with no appreciable affinity at cholinergic muscarinic and benzodiazepine receptors, and with those of a placebo using a randomized double‐blind study design. Administration of lorazepam produced a significant increase in SICI (F3,9= 3.19, P= 0.039). In contrast to SICI, SAI was significantly reduced by lorazepam (F3,9= 9.39, P= 0.0002). Our findings demonstrate that GABAA activity enhancement determines a suppression of SAI and an increase of SICI.
Activation of heteroliganded mouse muscle nicotinic receptors
Authors: Akk Gustav , Milescu Lorin S. , Heckmann Manfred
Published: February 2005

The activation of the mouse muscle‐type nicotinic acetylcholine receptor was studied in the presence of carbachol, and in the simultaneous presence of carbachol and choline. The channel currents were recorded under steady‐state conditions using cell‐attached single‐channel patch clamp, and during transient exposures to the agonists using a piezo‐driven fast application system. The presence of choline resulted in inhibition of currents elicited by carbachol. The inhibitory effect of choline manifested as a reduction in the effective opening rate (increase in the mean intracluster closed time duration) in single‐channel recordings. In the fast application experiments, the peak current amplitude was reduced and the current rise time increased when choline was co‐applied with carbachol. The data were analysed according to a model in which receptor interactions with carbachol and choline resulted in three types of ligation: receptors occupied by two carbachol molecules, receptors occupied by two choline molecules, and receptors in which one agonist binding site was occupied by carbachol and the other by choline, i.e. heteroliganded receptors. All three agonist‐bound receptor populations could open albeit with different efficacies. The affinity of the resting receptor to choline was estimated to be 1–2 mm, and heteroliganded receptors opened with an opening rate constant of ∼3000 s−1. The results of the analysis suggest that the presence of choline in the neuromuscular junction in vivo has little effect on the time course of synaptic currents. Nevertheless, the contribution of heteroliganded receptors should be taken into consideration when the receptor is exposed simultaneously to two or more agonists.
Susceptibility of the heart to ischaemia–reperfusion injury and exercise‐induced cardioprotection are sex‐dependent in the rat
Authors: Brown David A. , Lynch Joshua M. , Armstrong Casey J. , Caruso Nicholas M. , Ehlers Lindsay B. , Johnson Micah S. , Moore Russell L.
Published: February 2005

The cardioprotective effects of short‐term exercise against myocardial ischaemia–reperfusion injury in male and female rats were examined. We subjected male and female rats to 0 (Sed; n= 8 males and 8 females), 1 (1 day; n= 10 males and 8 females), or 5 (5 day; n= 6 males and 6 females) days of treadmill running. Langendorff‐perfused hearts underwent 1 h of regional ischaemia and 2 h of reperfusion, and infarct size (expressed as a percentage of the zone at risk; ZAR), left ventricular pressure development, and coronary flow were measured for each heart. Preischaemic pressure development and coronary flow did not differ between the sexes nor were they influenced by exercise. Sed females had significantly smaller infarct sizes (25 ± 3%) than Sed male hearts (37 ± 3%; P < 0.001). Short‐term running significantly reduced infarct size following 1 day (27 ± 3%; P < 0.05) and 5 days (30 ± 4%; P < 0.10) of exercise in males. One day of running did not reduce infarct size in females (19 ± 3%; P= NS), but 5 day females did show a significant reduction in infarct size (13 ± 2%; P < 0.05). There was no relationship between postischaemic coronary vascular hyperaemia and infarct size across sexes or exercise training groups. Hearts from Sed females exhibited significantly higher manganese superoxide dismutase (MnSOD) protein expression than hearts from Sed males, but short‐term exercise (neither 1 nor 5 days) did not alter MnSOD protein in either sex. Increased sarcolemmal ATP‐sensitive K+ (KATP) channel subunit protein expression (SUR2A and/or Kir6.2) correlated closely with sex‐dependent and exercise‐acquired protection against myocardial infarction. These data indicate that: (1) sex‐dependent and exercise‐induced differences in the susceptibility of the heart to ischaemia–reperfusion injury are not associated with improved coronary flow or postischaemic hyperaemia; (2) increased MnSOD protein expression is not necessary for exercise‐induced protection from infarction; and (3) one possible mechanism for sex‐dependent and exercise‐mediated reductions in infarct size involves an increased protein expression of cardiac sarcolemmal KATP channels.