bluuebunny/crossref_metadata_2025 huggingface dataset:
How I treat elderly patients with diffuse large B-cell lymphoma
Authors: Pfreundschuh Michael
Published: August 2010

Enormous progress has been made in the treatment of diffuse large B-cell lymphoma (DLBCL), mostly due to the anti-CD20 antibody rituximab. More than 50% of elderly DLBCL patients can be expected to be cured by modern immunochemotherapy. The standard chemotherapy partner of rituximab is the CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen. Elderly patients need particular attention and thorough evaluation if they are suited for the standard treatment or if they are candidates for palliative treatment. Rigorous supportive care including anti-infectious prophylaxis and growth factor support are mandatory. Whether there is still a role of additive radiotherapy in the R-CHOP era is under debate. While further intensification of chemotherapy might hardly be feasible in elderly patients, dose and schedule of rituximab appear to be optimizable. Patients failing after R-CHOP are a particular challenge as are frail patients who are not fit enough for R-CHOP. Further progress can be expected from novel antibodies and small molecules that interfere with signal transduction pathways essential for the survival of the lymphoma cell. To achieve this goal, prospective trials with large numbers of patients are necessary for which the continuous commitment of patients and physicians is indispensable.
Commitment of chondrogenic precursors of the avian scapula takes place after epithelial-mesenchymal transition of the dermomyotome
Authors: Wang Baigang , Pu Qin , De Raja , Patel Ketan , Christ Bodo , Wilting Jörg , Huang Ruijin
Published: August 2010

Background

Cells of the epithelially organised dermomyotome are traditionally believed to give rise to skeletal muscle and dermis. We have previously shown that the dermomyotome can undergo epithelial-mesenchymal transition (EMT) and give rise to chondrogenic cells, which go on to form the scapula blade in birds. At present we have little understanding regarding the issue of when the chondrogenic fate of dermomyotomal cells is determined. Using quail-chick grafting experiments, we investigated whether scapula precursor cells are committed to a chondrogenic fate while in an epithelial state or whether commitment is established after EMT.

Results

We show that the hypaxial dermomyotome, which normally forms the scapula, does not generate cartilaginous tissue after it is grafted to the epaxial domain. In contrast engraftment of the epaxial dermomyotome to the hypaxial domain gives rise to scapula-like cartilage. However, the hypaxial sub-ectodermal mesenchyme (SEM), which originates from the hypaxial dermomyotome after EMT, generates cartilaginous elements in the epaxial domain, whereas in reciprocal grafting experiments, the epaxial SEM cannot form cartilage in the hypaxial domain.

Conclusions

We suggest that the epithelial cells of the dermomyotome are not committed to the chondrogenic lineage. Commitment to this lineage occurs after it has undergone EMT to form the sub-ectodermal mesenchyme.
EGF regulates survivin stability through the Raf-1/ERK pathway in insulin-secreting pancreatic β-cells
Authors: Wang Haijuan , Gambosova Katarina , Cooper Zachary A , Holloway Michael P , Kassai Andrea , Izquierdo Denisse , Cleveland Kelly , Boney Charlotte M , Altura Rachel A
Published: August 2010

Background

Postnatal expansion of the pancreatic β-cell mass is required to maintain glucose homeostasis immediately after birth. This β-cell expansion is regulated by multiple growth factors, including glucose, insulin, insulin-like growth factor (IGF-1) and epidermal growth factor (EGF). These mitogens signal through several downstream pathways (AKT, ERK, STAT3, and JNK) to regulate the survival and proliferation of β-cells. Survivin, an oncofetal protein with both pro-proliferative and anti-apoptotic properties, is a known transcriptional target of both IGF-1 and EGF in cancer cells. Here, we analyzed the effects of the β-cell mitogens IGF-1 and EGF on survivin regulation in the established pancreatic β-cell model cell lines, MIN6 and INS-1 and in primary mouse islets.

Results

In pancreatic β-cells, treatment with glucose, insulin, or EGF increased survivin protein levels at early time points. By contrast, no significant effects on survivin were observed following IGF-1 treatment. EGF-stimulated increases in survivin protein were abrogated in the presence of downstream inhibitors of the Raf-1/MEK/ERK pathway. EGF had no significant effect on survivin transcription however it prolonged the half-life of the survivin protein and stabilized survivin protein levels by inhibiting surviving ubiquitination.

Conclusions

This study defines a novel mechanism of survivin regulation by EGF through the Raf-1/MEK/ERK pathway in pancreatic β-cells, via prolongation of survivin protein half-life and inhibition of the ubiquitin-mediated proteasomal degradation pathway. This mechanism may be important for regulating β-cell expansion after birth.
Mothers and daughters-in-law: a prospective study of informal care-giving arrangements and survival in Japan
Authors: Nishi Akihiro , Tamiya Nanako , Kashiwagi Masayo , Takahashi Hideto , Sato Mikiya , Kawachi Ichiro
Published: August 2010

Background

Daughters-in-law have played an important role in informal care-giving arrangements within East Asian traditional norms. The aim of this study was to measure the impact of daughter-in-law care-giving on the survival of care recipients. We prospectively examined the associations between different types of kinship relationship between the main family caregiver and the care recipient in relation to survival among care recipients.

Methods

A questionnaire was administered to Japanese community-dwelling seniors who were eligible to receive national long-term care insurance (LTCI) community-based services. Among 191 individuals whose informal care-giving arrangement was definitively determined, we observed 58 care recipients receiving care from spouses, 58 from daughters-in-law, 27 from biological daughters, 25 from other relatives, and 23 care recipients living alone.

Results

During 51 months of follow-up from December 2001, 68 care recipients died, 117 survived, and 6 moved. Hazard ratios of each care-giving arrangement were estimated by Cox proportional hazard models adjusted for care recipients' demographic factors, their care needs level based on their physical and cognitive functioning and their service use, caregivers' demographic factors, and household size. The highest risk of mortality was found for female elders receiving care from daughters-in-law (HR 4.15, 95% CI 1.02-16.90) followed by those receiving care from biological daughters (HR 1.64, 95% CI 0.37-7.21), compared to women receiving spousal care. By contrast, male elders receiving care from daughters-in-law tended to live longer than those receiving care from their spouses.

Conclusions

Our finding suggests that there may be a survival "penalty" for older Japanese women who are cared for by their daughters-in-law.
Development and testing of the BONES physical activity survey for young children
Authors: Economos Christina D , Hennessy Erin , Sacheck Jennifer M , Shea M Kyla , Naumova Elena N
Published: August 2010

Background

Weight-bearing and high intensity physical activities are particularly beneficial for stimulating bone growth in children given that bone responds favorably to mechanical load. While it is important to assess the contribution and impact of weight-bearing physical activity on health outcomes, measurement tools that quantify and provide information on these activities separately from overall physical activity are limited. This study describes the development and evaluation of a pictorial physical activity survey (PAS) that measures children's participation and knowledge of high-intensity, weight-bearing ("bone smart") physical activity.

Methods

To test reliability, two identical sets of the PAS were administered on the same day to 41 children (mean age 7.1 ± 0.8 years; 63% female) and compared. To test validity, accelerometry data from 40 children (mean age 7.7 ± 0.8 years; 50% female) were compared to data provided by the PAS. Agreements between categorical and ordinal items were assessed with Kappa statistics; agreements between continuous indices were assessed with Spearman's correlation tests.

Results

The subjects produced reliable results in all 10 physical activity participation items (κ range: 0.36-0.73, all p < 0.05), but less reliable in answering if the physical activities were "bone smart" (κ range: -0.04-0.66). Physical activity indices, including metabolic equivalent time and weight-bearing factors, were significant in test-retest analyses (Spearman's r range: 0.57-0.74, all p < 0.001). Minutes of very vigorous activity from the accelerometer were associated with the self-reported weight-bearing activity, moderate-high, and high activity scores from the PAS (Spearman's r range: 0.47-0.48, all p < 0.01). However, accelerometer counts, counts per minute, and minutes of moderate-vigorous and vigorous activity were not associated with the PAS scores.

Conclusions

Together, the results of these studies suggest that the PAS has acceptable test-retest reliability, but limited validity for early elementary school children. This survey demonstrates a first step towards developing a questionnaire that measures high intensity, weight-bearing activity in schoolchildren.
Combined vascular endothelial growth factor-A and fibroblast growth factor 4 gene transfer improves wound healing in diabetic mice
Authors: Jazwa Agnieszka , Kucharzewska Paulina , Leja Justyna , Zagorska Anna , Sierpniowska Aleksandra , Stepniewski Jacek , Kozakowska Magdalena , Taha Hevidar , Ochiya Takahiro , Derlacz Rafal , Vahakangas Elisa , Yla-Herttuala Seppo , Jozkowicz Alicja , Dulak Jozef
Published: August 2010

Background

Impaired wound healing in diabetes is related to decreased production of growth factors. Hence, gene therapy is considered as promising treatment modality. So far, efforts concentrated on single gene therapy with particular emphasis on vascular endothelial growth factor-A (VEGF-A). However, as multiple proteins are involved in this process it is rational to test new approaches. Therefore, the aim of this study was to investigate whether single AAV vector-mediated simultaneous transfer of VEGF-A and fibroblast growth factor 4 (FGF4) coding sequences will improve the wound healing over the effect of VEGF-A in diabetic (db/db) mice.

Methods

Leptin receptor-deficient db/db mice were randomized to receive intradermal injections of PBS or AAVs carrying β-galactosidase gene (AAV-LacZ), VEGF-A (AAV-VEGF-A), FGF-4 (AAV-FGF4-IRES-GFP) or both therapeutic genes (AAV-FGF4-IRES-VEGF-A). Wound healing kinetics was analyzed until day 21 when all animals were sacrificed for biochemical and histological examination.

Results

Complete wound closure in animals treated with AAV-VEGF-A was achieved earlier (day 19) than in control mice or animals injected with AAV harboring FGF4 (both on day 21). However, the fastest healing was observed in mice injected with bicistronic AAV-FGF4-IRES-VEGF-A vector (day 17). This was paralleled by significantly increased granulation tissue formation, vascularity and dermal matrix deposition. Mechanistically, as shown in vitro, FGF4 stimulated matrix metalloproteinase-9 (MMP-9) and VEGF receptor-1 expression in mouse dermal fibroblasts and when delivered in combination with VEGF-A, enhanced their migration.

Conclusion

Combined gene transfer of VEGF-A and FGF4 can improve reparative processes in the wounded skin of diabetic mice better than single agent treatment.
Feasibility of breast conservation after neoadjuvant taxene based chemotherapy in locally advanced breast cancer: a Prospective Phase I trial
Authors: El-Sayed Mohamed I , Maximous Doaa W , Aboziada Mohamed A , Abdel-Wanis Mostafa E , Mikhail Nabiel NH
Published: August 2010

Background

Neoadjuvant chemotherapy is the standard care for locally advanced breast cancer. Our study aimed at evaluating the feasibility of breast conversation surgery (BCS) after neoadjuvant chemotherapy.

Patients and methods

Forty five patients had stage IIB (except those with T2N1 disease) and stage IIIA were selected to 3 cycles taxane-based neoadjuvant chemotherapy. Patient who had tumours ≤5 cm underwent a tentative BCS while patients who had tumour size >5 cm underwent radical surgery. Negative margin is essential for BCS. Adjuvant chemotherapy and 3-D radiotherapy ± hormonal treatment were given to all patients.

Results

Thirty four patients had BCS. Response to chemotherapy was the only statistically significant factor which influences the BCS. Incidence of local recurrence was 5.9% for patients who had BCS at a median follow up 24 months.

Conclusion

Breast conservation is feasible in selected cases of locally advanced, non metastatic cancer breast. We recommend that patients who have tumour size ≤4 cm after chemotherapy are the best candidates for BCS.
Editorial: Heat shock proteins: Darwinistic immune modulation on dangerous grounds
Authors: van Wijk Femke , Prakken Berent
Published: August 2010

Making sense of the contradictory biological features attributed to HSPs when taking into account the physiology of an immune response and the requirements of the local environment.
Estimation of primaries by sparse inversion from passive seismic data
Authors: van Groenestijn G. J. , Verschuur D. J.
Published: August 2010

For passive seismic data, surface multiples are used to obtain an estimate of the subsurface responses, usually by a crosscorrelation process. This crosscorrelation process relies on the assumption that the surface has been uniformly illuminated by subsurface sources in terms of incident angles and strengths. If this is not the case, the crosscorrelation process cannot give a true amplitude estimation of the subsurface response. Furthermore, cross terms in the crosscorrelation result are not related to actual subsurface inhomogeneities. We have developed a method that can obtain true amplitude subsurface responses without a uniform surface-illumination assumption. Our methodology goes beyond the crosscorrelation process and estimates primaries only from the surface-related multiples in the available signal. We use the recently introduced estimation of primaries by sparse inversion (EPSI) methodology, in which the primary impulse responses are considered to be the unknowns in a large-scale inversion process. With some modifications, the EPSI method can be used for passive seismic data. The output of this process is primary impulse responses with point sources and receivers at the surface, which can be used directly in traditional imaging schemes. The methodology was tested on 2D synthetic data.
The course of bipolar disorder
Authors: Saunders Kate E. A. , Goodwin Guy M.
Published: August 2010

Bipolar disorder is arguably a pivotal diagnosis in adult psychiatry bounded by schizophrenia on one side and unipolar depression on the other. It represents a wide spectrum of disorders, all sharing common features of elated and depressed mood. The early descriptions of symptom-free euthymia have long been dismissed and the chronic and enduring deficits associated with the disorder are beginning to be better understood. We review the current literature with regard to the course of the disorder, factors that may influence prognosis and common comorbidities.
Diagnosis and classification of personality disorder: difficulties, their resolution and implications for practice
Authors: Sarkar Jaydip , Duggan Conor
Published: August 2010

There are many difficulties associated with the diagnostic guidelines for personality disorder in the current international classificatory systems such as ICD–10 and DSM–IV. These lead not only to significant overlap with DSM Axis I disorders, resulting in high rates of diagnoses of comorbidities and multiple personality disorders, but also to lack of adequate capture of core personality pathology. The current classifications are also unhelpful in treatment selection, presumably the prime reason for assessing individuals in the first place. In this article we highlight various deficits and inadequacies related to the nosology of the current systems and suggest some strategies for dealing with these. We offer an integrated model of assessing and diagnosing personality disorders. We attempt to demonstrate how using a more integrated approach minimises or even eliminates some of the key problems highlighted in the current systems.
Personality disorder and mental health legislation in the UK
Authors: Thomson Lindsay D. G.
Published: August 2010

This commentary explores the issue of personality disorder and mental health legislation from a UK perspective, highlighting the differences between its four countries and three mental health acts. It discusses data from Scotland that support the contention that the addition of the term ‘personality disorder’ to mental health legislation is not alone sufficient to change current practice. The legislative criterion of risk to others is discussed and the varying responses in the UK to the contentious issue of preventive detention, highly likely to be relevant to serious offenders with personality disorder, are described, including the indeterminate sentence of imprisonment for public protection and the order of lifelong restriction. It is concluded that, regardless of location, care of patients with a primary diagnosis of personality disorder will be driven forward not by legislation but by service development, research and changing attitudes.
Alcohol-induced psychotic disorder and delirium in the general population
Authors: Perälä Jonna , Kuoppasalmi Kimmo , Pirkola Sami , Härkänen Tommi , Saarni Samuli , Tuulio-Henriksson Annamari , Viertiö Satu , Latvala Antti , Koskinen Seppo , Lönnqvist Jouko , Suvisaari Jaana
Published: August 2010

Background

Epidemiological data on alcohol-induced psychotic disorder and delirium (alcohol-induced psychotic syndrome, AIPS) are scarce.

Aims

To investigate the epidemiology of AIPS, the risk factors for developing AIPS among people with alcohol dependence, and mortality associated with alcohol dependence with or without AIPS, in a sample drawn from the general population of Finland.

Method

A general population sample of 8028 persons were interviewed with the Composite International Diagnostic Interview and screened for psychotic disorders using multiple sources. Best-estimate diagnoses of psychotic disorders were made using the Structured Clinical Interview for DSM–IV Axis I Disorders and case notes. Data on hospital treatments and deaths were collected from national registers.

Results

The lifetime prevalence was 0.5% for AIPS and was highest (1.8%) among men of working age. Younger age at onset of alcohol dependence, low socioeconomic status, father's mental health or alcohol problems and multiple hospital treatments were associated with increased risk of AIPS. Participants with a history of AIPS had considerable medical comorbidity, and 37% of them died during the 8-year follow-up.

Conclusions

Alcohol-induced psychotic disorder is a severe mental disorder with poor outcome.
Examining interactions between risk factors for psychosis
Authors: Zammit Stanley , Lewis Glyn , Dalman Christina , Allebeck Peter
Published: August 2010

Background

For complex multifactorial diseases it seems likely that co-exposure to two risk factors will show a greater than additive relationship on disease risk.

Aims

To test whether greater than additive relationships occur between risk factors for psychosis.

Method

A cohort study of 50 053 Swedish conscripts. Data on IQ, cannabis use, psychiatric diagnoses, disturbed behaviour and social relations assessed at age 18 were linked to admissions with any non-affective psychoses over a 27-year follow-up period. Statistical interactions between risk factors were examined under both additive and multiplicative models.

Results

There was some evidence of interaction for eight of the ten combinations of risk factors under additive models, but for only one combination under multiplicative models.

Conclusions

Multiplicative models describe the joint effect of risk factors more adequately than additive ones do. However, the implications of finding interactions as observed here, or for most interactions reported to date, remain very limited.
Interpretation of interactions: guide for the perplexed
Authors: Kendler Kenneth S. , Gardner Charles O.
Published: August 2010

In this issue, Zammit et al explore how five dichotomised risk factors work together to predict risk for non-affective psychosis in a large Swedish cohort. In this editorial, we review these findings, and comment on both the nature of additive v. multiplicative models and the meaning of statistical interactions.
Culture and complex interventions: lessons for evidence, policy and practice
Authors: Bhui Kamaldeep
Published: August 2010

Evidence-based mental healthcare is evolving rapidly. There is a need for well-tested and effective interventions that are suited to culturally diverse populations. This editorial considers the findings from the SITARA study. There are a substantial number of implications for research, policy and practice.
Monitoring the metabolic side-effects of atypical antipsychotics
Authors: Gumber Rohit , Abbas Mizrab , Minajagi Manjunath
Published: August 2010

Aims and method

National clinical guidance states that patients on antipsychotics should have their metabolic profile regularly monitored. The aim of this study was to assess whether we are effectively monitoring metabolic profiles and to improve the detection, communication and intervention of metabolic abnormalities among patients on atypical antipsychotics. We describe a full audit cycle.

Results

The audit resulted in a 24% increase in the number of patients on atypical antipsychotics being referred to the metabolic clinic. The number of abnormal results communicated to primary care showed a significant improvement of 25% (P<0.001), and ultimately the number of patients who received intervention improved by 17% (P= 0.001).

Clinical implications

Audit feedback has been effective in changing clinical practice. The audit demonstrated the potential value of a metabolic clinic and shared care between primary and secondary practitioners for this group of high-risk patients.
The dog that failed to bark
Authors: Burns Tom
Published: August 2010

UK mental healh services have been distinguished by their continuity of care but recently there has been a move to separating consultant responsibility for in-patient and out-patient care. Local examples of the success of this approach have been published but there has been remarkably little careful thought about its longer-term impacts. International comparisons would suggest that there are significant potential disadvantages, including increased bed pressures. Some disadvantages, such as the poor fit with the Mental Health Act and patient dissatisfaction with structural discontinuity are already obvious. A more considered debate is called for.
Prognostic Factors in Patients With Advanced Cancer: Use of the Patient-Generated Subjective Global Assessment in Survival Prediction
Authors: Martin Lisa , Watanabe Sharon , Fainsinger Robin , Lau Francis , Ghosh Sunita , Quan Hue , Atkins Marlis , Fassbender Konrad , Downing G. Michael , Baracos Vickie
Published: August 2010

Purpose

To determine whether elements of a standard nutritional screening assessment are independently prognostic of survival in patients with advanced cancer.

Patients and Methods

A prospective nested cohort of patients with metastatic cancer were accrued from different units of a Regional Palliative Care Program. Patients completed a nutritional screen on admission. Data included age, sex, cancer site, height, weight history, dietary intake, 13 nutrition impact symptoms, and patient- and physician-reported performance status (PS). Univariate and multivariate survival analyses were conducted. Concordance statistics (c-statistics) were used to test the predictive accuracy of models based on training and validation sets; a c-statistic of 0.5 indicates the model predicts the outcome as well as chance; perfect prediction has a c-statistic of 1.0.

Results

A training set of patients in palliative home care (n = 1,164) was used to identify prognostic variables. Primary disease site, PS, short-term weight change (either gain or loss), dietary intake, and dysphagia predicted survival in multivariate analysis (P < .05). A model including only patients separated by disease site and PS with high c-statistics between predicted and observed responses for survival in the training set (0.90) and validation set (0.88; n = 603). The addition of weight change, dietary intake, and dysphagia did not further improve the c-statistic of the model. The c-statistic was also not altered by substituting physician-rated palliative PS for patient-reported PS.

Conclusion

We demonstrate a high probability of concordance between predicted and observed survival for patients in distinct palliative care settings (home care, tertiary inpatient, ambulatory outpatient) based on patient-reported information.
Molecular Anatomy of Breast Cancer Stroma and Its Prognostic Value in Estrogen Receptor–Positive and –Negative Cancers
Authors: Bianchini Giampaolo , Qi Yuan , Alvarez Ricardo H. , Iwamoto Takayuki , Coutant Charles , Ibrahim Nuhad K. , Valero Vicente , Cristofanilli Massimo , Green Marjorie C. , Radvanyi Laszlo , Hatzis Christos , Hortobagyi Gabriel N. , Andre Fabrice , Gianni Luca , Symmans W. Fraser , Pusztai Lajos
Published: August 2010

Purpose

The purpose of this study was to identify genes enriched in breast cancer stroma, assess the stromal gene expression differences between estrogen receptor (ER) –positive and –negative cancers, and separately determine their prognostic value in these two subtypes of breast cancers.

Methods

We compared gene expression profiles of pairs of fine-needle (stroma-poor) and core-needle (stroma-rich) biopsies from 37 cancers to identify stroma-associated genes. We defined stromal metagenes and tested their prognostic values in 684 node-negative patients who received no systemic adjuvant therapy and 259 tamoxifen-treated patients.

Results

We identified 293 probe sets overexpressed in core biopsies; these included five highly coexpressed gene clusters (metagenes) corresponding to immune functions and extracellular matrix components. These genes showed quantitative and qualitative differences between ER-positive and ER-negative cancers. A B-cell/plasma cell metagene showed strong prognostic value in ER-positive highly proliferative cancers, a lesser prognostic value in ER-negative cancers, and no prognostic value in ER-positive cancers with low proliferation. The hazard ratio for distant relapse in the lowest compared with the highest tertile of the pooled prognostic data set was 4.29 (95% CI, 2.04 to 9.01; P = .001) in ER-positive cancers and 3.34 (95% CI, 1.60 to 6.97; P = .001) in ER-negative cancers. This remained significant in multivariate analysis including routine variables and other genomic prognostic scores. As a result of quantitative differences in this metagene between ER-positive and ER-negative cancers, different thresholds apply in the two subgroups. Other stromal metagenes had inconsistent prognostic value.

Conclusion

Among ER-negative and ER-positive highly proliferative cancers, a subset of tumors with high expression of a B-cell/plasma cell metagene carries a favorable prognosis.
Delivering regional thrombolysis via a hub-and-spoke model
Authors: Moynihan Barry , Davis Daniel , Pereira Anthony , Cloud Geoffrey , Markus Hugh S
Published: August 2010

Summary

Objectives

Audits in the United Kingdom and other countries show that only a small proportion of eligible stroke patients receive thrombolysis. Providing 24-hour thrombolysis cover presents major challenges in both infrastructure and staffing. One model for improving access is to provide out-of-hours cover in a regional centre but this may present problems including greater delays to hospital admissions.

Design

Evaluation of the introduction of a ‘hub-and-spoke’ model of thrombolysis to increase access to thrombolysis for patients in south west London. One-year data are presented.

Setting

A network in south-west London comprised of a hub hospital and three district ‘spoke’ hospitals.

Participants

All suspected stroke admissions to a regional stroke centre. Main outcome measures Thrombolysis rates for acute stroke.

Results

Increased out-of-hours thrombolysis rates were achieved with only a small increase in stroke admissions (approximately 10%) in the hub hospital. Thrombolysis rates increased from 1.2 per 100 stroke admissions for the local daytime service to 6 per 100 admissions for the regional service. Most patients thrombolysed were not local to the hub hospital. Only 1 in 4 patients considered for thrombolysis was thrombolysed, in line with previous data. Ten percent of all thrombolysis calls were not stroke but represented stroke mimics. Median length of stay was 6 days (target was 3 days). Fifty percent of the thrombolysed patients from spoke hospitals were discharged directly home.

Conclusions

In an urban area, a hub-and-spoke thrombolysis model increased access to thrombolysis without resulting in a marked increase in overall stroke admission numbers for the hub hospital. Proactive plans to repatriate patients back to district hospitals are required, and repatriation protocols have to prioritize regional patients over other targets in spoke hospitals to facilitate capacity in the hub hospital.
Real Options and Investment Mode: Evidence from Corporate Venture Capital and Acquisition
Authors: Tong Tony W. , Li Yong
Published: August 2010

Existing research has used real options theory to study corporate venture capital (CVC) investment, yet little work has empirically examined such investment in a comparative setting. In this paper, we begin to address this gap by investigating firms' investment mode choice between CVC and acquisition, which are alternative modes for pursuing external business development and corporate growth. We propose that when exogenous uncertainty elevates the value of real options, firms are more likely to undertake CVC investments rather than acquisitions. Furthermore, we suggest that the value of real options under uncertainty is contingent upon several factors, which may also shape firms' choice between CVC and acquisition. The results indicate that market uncertainty is positively related to firms' choice of CVC versus acquisition. In addition, investment irreversibility strengthens the effect of uncertainty, whereas growth opportunities surrounding the investment weaken the effect. Our empirical findings and the comparative approach we adopt to studying CVC investments and acquisitions have important implications for theory and research.
Practice as the Site of Knowing: Insights from the Field of Telemedicine
Authors: Nicolini Davide
Published: August 2010

This paper aims to shift the unit of analysis in the study of organisational knowledge from individuals and their actions to practices and their relationships. It introduces the concept of “site” to help advance an understanding of the relationship between practice and knowing. The notion of site supports the intuition that knowing is both sustained in practice and manifests itself through practice. It also evokes the idea of knowledge as being rooted in an extended pattern of interconnected activities that only when taken in its living and pulsating entirety constitutes the site of knowing. In this paper, I review the different ways to conceptualise the relationships between knowing and practice, and I show how the idea of site adds to the existing body of work. Building on the results of a longitudinal study in the field of telemedicine, I then offer suggestions on aspects of practice where knowing manifests itself, and I use the concepts of “translation by contact” and “at distance” to explain how dispersed knowings are woven together and the power effect that can derive from these. I conclude by reflecting on the implications of this radical view and the direction for future research.
Agency in Action: Entrepreneurs' Networking Style and Initiation of Economic Exchange
Authors: Vissa Balagopal
Published: August 2010

This multimethod study investigates the effects of entrepreneurs' interpersonal networking style on the initiation of interorganizational exchange ties. I use inductive theorizing to make a distinction between interpersonal networking actions aimed at adding new contacts (network-broadening actions) versus managing existing contacts (network-deepening actions). I reason that because networking actions alter the cost-benefit calculus of using referrals, the extent to which entrepreneurs rely on referrals when searching for new exchange partners should vary with their networking actions. I then propose that entrepreneurs are likely to add fewer new exchange partners when they rely more on referrals to search. The empirical analysis employs a longitudinal design using data coded from the business cards of new contacts formed over a two-month period by a panel of Indian entrepreneurs operating business-to-business ventures. This study makes a theoretical contribution by identifying decision makers' networking style as a distinct mechanism shaping partner selection for their organization. Specifically, the study shows entrepreneurs using more network-deepening actions initiate fewer new economic exchanges, due (in part) to their increased reliance on referral-based search, whereas entrepreneurs using more network-broadening actions initiate more new economic exchanges due (in part) to their decreased reliance on referral-based search.
A (virtual) world without limits: aesthetic expression in Second Life
Authors: Morie Jacquelyn Ford
Published: August 2010

This article describes work by contemporary artists taking advantage of the possibilities for new forms of art creation in the realm of online virtual worlds. The virtual world most conducive to artistic creation is Linden Lab's Second Life (2003-present), which is based primarily
on player-created content. Because of this, Second Life has become a virtual crucible for new concepts and forms of artistic work. Moving swiftly beyond conventional art forms, artists in Second Life are redefining the jurisdictional sphere of art, and creating things not possible
in the physically circumscribed world, from preternatural objects to the creation of one's own self within the virtual space.
A Cross-National and Cross-Cultural Approach to Global Market Segmentation: An Application Using Consumers’ Perceived Service Quality
Authors: Agarwal James , Malhotra Naresh K. , Bolton Ruth N.
Published: August 2010

The spread of global culture is being facilitated by the proliferation of transnational corporations, the rise of global capitalism, widespread aspiration for material possessions, and the homogenization of global consumption. The extent of convergence of cultural values across nations has been debated by international marketing researchers. However, from a practical standpoint, transnational firms require a cross-national, cross-cultural approach to market segmentation that can be used to guide the development of global marketing strategies. In this study, the authors investigate the application of cross-national versus cross-cultural approaches to market segmentation through a rigorous empirical investigation in the context of banking services. Although services constitute the fastest growing sector of the world economy, few studies have examined global market segmentation strategies for them. The authors develop theory-based cross-national hypotheses and test them by estimating a structural model of consumers’ perceived service quality using survey data from two countries: the United States and India. They test cross-cultural hypotheses by estimating the same model on culture-based clusters. They demonstrate that there are distinctive differences between cross-national and cross-cultural models of perceived service quality and highlight the growing relevance of cross-cultural research approaches. More generally, the cross-national, cross-cultural approach to market segmentation can guide the development of global marketing strategies for services and improve business performance.
Validation of the Pediatric Cardiac Quality of Life Inventory
Authors: Marino Bradley S. , Tomlinson Ryan S. , Wernovsky Gil , Drotar Dennis , Newburger Jane W. , Mahony Lynn , Mussatto Kathleen , Tong Elizabeth , Cohen Mitchell , Andersen Charlotte , Shera David , Khoury Philip R. , Wray Jo , Gaynor J. William , Helfaer Mark A. , Kazak Anne E. , Shea Judy A. ,   for the Pediatric Cardiac Quality of Life Inventory Testing Study Consortium
Published: August 2010

OBJECTIVE:

The purpose of this multicenter study was to confirm the validity and reliability of the Pediatric Cardiac Quality of Life Inventory (PCQLI).

METHODS:

Seven centers recruited pediatric patients (8–18 years of age) with heart disease (HD) and their parents to complete the PCQLI and generic health-related quality of life (Pediatric Quality of Life Inventory [PedsQL]) and non–quality of life (Self-Perception Profile for Children [SPPC]/Self-Perception Profile for Adolescents [SPPA] and Youth Self-Report [YSR]/Child Behavior Checklist [CBCL]) tools. PCQLI construct validity was assessed through correlations of PCQLI scores between patients and parents and with severity of congenital HD, medical care utilization, and PedsQL, SPPC/SPPA, and YSR/CBCL scores. PCQLI test-retest reliability was evaluated.

RESULTS:

The study enrolled 1605 patient-parent pairs. Construct validity was substantiated by the association of lower PCQLI scores with Fontan palliation and increased numbers of cardiac operations, hospital admissions, and physician visits (P < .001); moderate to good correlations between patient and parent PCQLI scores (r = 0.41–0.61; P < .001); and fair to good correlations between PCQLI total scores and PedsQL total (r = 0.70–0.76), SPPC/SPPA global self-worth (r = 0.43–0.46), YSR/CBCL total competency (r = 0.28–0.37), and syndrome and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-oriented scale (r = −0.58 to −0.30; P < .001) scores. Test-retest reliability correlations were excellent (r = 0.78–0.90; P < .001).

CONCLUSIONS:

PCQLI scores are valid and reliable for children and adolescents with congenital and acquired HD and may be useful for future research and clinical management.
Emergency Department Visits for Concussion in Young Child Athletes
Authors: Bakhos Lisa L. , Lockhart Gregory R. , Myers Richard , Linakis James G.
Published: August 2010

OBJECTIVES:

The objective of this study was to characterize emergency department (ED) visits for pediatric sport-related concussion (SRC) in pre–high school– versus high school–aged athletes.

METHODS:

A stratified probability sample of US hospitals that provide emergency services in the National Electronic Injury Surveillance System (1997–2007) and All Injury Program (2001–2005) was used. Concussion-related ED visits were analyzed for 8- to 13- and 14- to 19-year-old patients. Population data were obtained from the US Census Bureau; sport participation data were obtained from National Sporting Goods Association.

RESULTS:

From 2001 to 2005, US children who were aged 8 to 19 years had an estimated 502 000 ED visits for concussion. The 8- to 13-year-old group accounted for ∼35% of these visits. Approximately half of all ED visits for concussion were SRC. The 8- to 13-year-old group sustained 40% of these, which represents 58% of all concussions in this group. Approximately 25% of all SRC visits in the 8- to 13-year-old group occurred during organized team sport (OTS). During the study period, ∼4 in 1000 children aged 8 to 13 years and 6 in 1000 children aged 14 to 19 years had an ED visit for SRC, and 1 in 1000 children aged 8 to 13 years and 3 in 1000 children aged 14 to 19 years had an ED visit for concussion sustained during OTS. From 1997 to 2007, although participation had declined, ED visits for concussions in OTS in 8- to 13-year-old children had doubled and had increased by >200% in the 14- to 19-year-old group.

CONCLUSIONS:

The number of SRCs in young athletes is noteworthy. Additional research is required.
Child Fatality Review
Authors: Christian Cindy W. , Sege Robert D. ,   The Committee on Child Abuse and Neglect,   The Committee on Injury, Violence, and Poison Prevention,   The Council on Community Pediatrics
Published: August 2010

This Policy Statement was revised. See https://doi.org/10.1542/peds.2023-065481.

Injury remains the leading cause of pediatric mortality and requires public health approaches to reduce preventable deaths. Child fatality review teams, first established to review suspicious child deaths involving abuse or neglect, have expanded toward a public health model of prevention of child fatality through systematic review of child deaths from birth through adolescence. Approximately half of all states report reviewing child deaths from all causes, and the process of fatality review has identified effective local and state prevention strategies for reducing child deaths. This expanded approach can be a powerful tool in understanding the epidemiology and preventability of child death locally, regionally, and nationally; improving accuracy of vital statistics data; and identifying public health and legislative strategies for reducing preventable child fatalities. The American Academy of Pediatrics supports the development of federal and state legislation to enhance the child fatality review process and recommends that pediatricians become involved in local and state child death reviews.
Images of Older People in UK Magazine Advertising: Toward a Typology
Authors: Williams Angie , Wadleigh Paul Mark , Ylänne Virpi
Published: August 2010

The use of images of older people in the British advertising media has been under-researched to date. Further, previous research in any country has tended to examine such images from an a priori framework of general impressions and stereotypes of older people. This study addresses these issues with British consumers' ( n = 106) impressions, trait ascriptions, and similarity-between-images ratings of a representative sample of U.K. magazine advertisements featuring older characters. After a series of sorting task laboratory sessions, multidimensional scaling and hierarchical cluster analyses revealed four clearly defined groups representing types of portrayals. These types emerged from the advertisements and from the views of the consumers themselves. These emergent groupings are: (1) Frail and Vulnerable, (2) Happy and Affluent, (3) Mentors, (4) Active and Leisure-oriented older adults. These groupings seem to be a logical context-appropriate derivation from previous findings on generally held stereotypes of older persons. It is argued that the groupings have the potential to contribute to a reliable typology of advertising portrayals of older people, with potential heuristic leverage in social scientific research of intergenerational communication, lifespan concerns, and the aging process.
Ranking Performance Measures in Multi-Task Agencies
Authors: Christensen Peter O. , S¸abac Florin , Tian Jie (Joyce)
Published: August 2010

ABSTRACT: We derive sufficient conditions for ranking performance evaluation systems in multi-task agency models (using both optimal and linear contracts) in terms of a second-order stochastic dominance (SSD) condition on the likelihood ratios. The SSD condition can be replaced by a variance-covariance matrix of likelihood ratios (VCM) condition when the utility function is square-root, the performance measures are normally distributed, and for LEN models. We identify existing results derived under the LEN assumptions that rely on the VCM condition and, thus, also hold for optimal contracts.
The Effect of Magnitude of Audit Difference and Prior Client Concessions on Negotiations of Proposed Adjustments
Authors: Hatfield Richard C. , Houston Richard W. , Stefaniak Chad M. , Usrey Spencer
Published: August 2010

ABSTRACT: This study reports the result of an experiment examining two aspects of the audit context that auditors likely do not suspect can influence audited account balances: the magnitude of an audit difference and the presence of a prior client concession. Negotiation theory shows that negotiators’ initial positions (e.g., clients’ unaudited balances) as well as feelings of reciprocity created by prior negotiations serve to create expectations for the current negotiation and, in turn, affect the outcomes of such negotiations. Our results show that the magnitude of an audit difference involving an estimate (i.e., difference between client’s account balance and the auditor’s independent estimate) as well as the presence of a prior client concession influence auditors’ negotiation expectations. Specifically, auditors proposed smaller adjustments when the magnitude of the audit difference was high and when the client conceded on an audit issue prior to resolving the difference in estimates. These manipulations similarly influence the negotiated outcome, and this influence is fully mediated by the auditor’s initial negotiation position.
Attracting Creativity: The Initial and Aggregate Effects of Contract Selection on Creativity-Weighted Productivity
Authors: Kachelmeier Steven J. , Williamson Michael G.
Published: August 2010

ABSTRACT: Performance-based compensation contracts can affect productivity both by motivating effort and by attracting workers whose abilities align best with the offered contracts. Using an experiment in which participants design “rebus puzzles,” this study tests whether the incremental benefits of contract self-selection extend to a multi-dimensional performance environment in which participants choose between a contract that rewards both quantity and creativity versus a contract that rewards quantity only. Findings indicate that participants who choose a creativity-weighted pay scheme perceive themselves to have greater creative potential than those who choose a quantity-only scheme. This perceived creativity advantage manifests itself in the superior initial creativity ratings of such participants’ productive output. However, in the aggregate, participants paid only for quantity eventually surpass the creativity-weighted productivity scores of participants paid for creativity-weighted productivity, whether compensation contracts are self-selected or randomly assigned. Thus, the implications of contract selection on creativity-weighted productivity hinge on the importance of the initial advantage enjoyed by participants who self-select a creativity-weighted contract.
Seeking Shelter: Empirically Modeling Tax Shelters Using Financial Statement Information
Authors: Lisowsky Petro
Published: August 2010

ABSTRACT: Using confidential tax shelter and tax return data obtained from the Internal Revenue Service, this study develops and validates an expanded model for inferring the likelihood that a firm engages in a tax shelter. Results show that tax shelter likelihood is positively related to subsidiaries located in tax havens, foreign-source income, inconsistent book-tax treatment, litigation losses, use of promoters, profitability, and size, and negatively related to leverage. Supplemental tests show that total book-tax differences (BTDs) and the contingent tax liability reserve are significantly related to tax shelter usage, while discretionary permanent BTDs and long-run cash effective tax rates are not. Finally, the model is weaker, yet still significant, in the FIN 48 disclosure environment. This research provides investors and policymakers with an extended, validated measure to calculate the presence of extreme cases of corporate tax aggressiveness. Such information could also aid analysts and other tax and non-tax researchers in assessing the benefits and risks of firm behavior.