bluuebunny/crossref_metadata_2025 huggingface dataset:
Anaesthesia and post‐operative morbidity after elective groin hernia repair: a nation‐wide study
Authors: BAY‐NIELSEN M. , KEHLET H.
Published: September 2009

Background: Randomised studies suggest regional anaesthesia to have the highest morbidity and local infiltration anaesthesia to have the lowest morbidity after groin hernia repair. However, implications and results of this evidence for general practice are not known.

Methods: Prospective nation‐wide data collection in a cohort of n=29,033 elective groin hernia repairs, registered in the Danish Hernia Database in three periods, namely July 1998–June 1999, July 2000–June 2001 and July 2002–June 2003. Retrospective analysis of complications in discharge abstracts, identified from re‐admission within 30 days post‐operatively, prolonged length of stay (>2 days post‐operatively) or death.

Results: Complications after groin hernia repair were more frequent in patients 65+ years (4.5%), compared with younger patients (2.7%) (P<0.001). In patients 65+ years, medical complications were more frequent after regional anaesthesia (1.17%), compared with general anaesthesia (0.59%) (P=0.003) and urological complications were more frequent after regional anaesthesia (0.87%), compared with local infiltration anaesthesia (0.09%) (P=0.006). Seventeen prostatectomies occurred after post‐operative urinary retention, but with no case after local anaesthesia. Mortality within 30 days after elective groin hernia repair was 0.12%. Regional anaesthesia was disproportionately more often used in patients dying within 1 week post‐operatively.

Conclusion: Choice of the anaesthetic technique should be adjusted to available procedure‐specific scientific evidence and the use of regional anaesthesia in elderly patients undergoing groin hernia repair is not supported by existing evidence.
Low‐dose haloperidol prevents post‐operative nausea and vomiting after ambulatory laparoscopic surgery
Authors: WANG T. F. , LIU Y. H. , CHU C. C. , SHIEH J. P. , TZENG J. I. , WANG J. J.
Published: September 2009

Background: We evaluated the prophylactic effect of low‐dose haloperidol (1 mg) on post‐operative nausea and vomiting (PONV) in women undergoing ambulatory laparoscopic surgery. Droperidol (0.625 mg) and saline were controls.

Methods: One hundred and fifty women undergoing ambulatory laparoscopic surgery under general anaesthesia were enrolled in this randomized, double‐blind, and placebo‐controlled study. After tracheal intubation, the haloperidol group (n=50) received intravenous haloperidol (1 mg), the droperidol group (n=50) received intravenous droperidol (0.625 mg), and the saline group (n=50) received intravenous saline.

Results: Haloperidol‐ and droperidol‐group patients reported a lower incidence of PONV [24% and 23% vs. 49% (saline group); P<0.05] and requested fewer doses of rescue antiemetics [13% and 16% vs. 38% (saline group); P<0.05] during the first four post‐operative hours. During the 24‐h post‐operative period, haloperidol‐ and droperidol‐group patients also reported a lower incidence of PONV [31% and 32% vs. 62% (saline group); P<0.01]. No differences were found between the haloperidol and droperidol groups.

Conclusion: Like droperidol (0.625 mg), prophylactic intravenous haloperidol (1 mg) significantly reduced the incidence of PONV in women undergoing ambulatory laparoscopic surgery.
Use of a screening questionnaire for post‐traumatic stress disorder (PTSD) on a sample of UK ICU patients
Authors: TWIGG E. , HUMPHRIS G. , JONES C. , BRAMWELL R. , GRIFFITHS R. D.
Published: September 2009

Background: Although rates vary across studies, research in recent years shows that prevalence of post‐traumatic stress disorder (PTSD) following intensive care unit (ICU) can be high. Presently no screening tool assessing all three PTSD symptom categories has been validated in ICU patients. The aim of the study was to conduct a preliminary validation of such a measure, the UK‐ Post‐Traumatic Stress Syndrome 14‐Questions Inventory (UK‐PTSS‐14).

Methods: A case series cohort study performed at two ICUs in two UK district general hospitals. The UK‐PTSS‐14 was administered at three time‐points (4–14 days, 2 months and 3 months post‐ICU discharge). At time‐point three participants also completed the Post‐traumatic Stress Diagnostic Scale (PDS) and the Impact of Events Scale (IES).

Results: Forty‐four patients completed the 3‐month follow up. The UK‐PTSS‐14 was internally reliable at all three time‐points (Cronbach's α=0.89, 0.86 and 0.84, respectively). Test–retest reliability was highest between time‐points two and three (ICC=0.90). Concurrent validity at time‐point three was high against the PDS (r=0.86) and the IES (r=0.71). Predictive validity was highest at time‐point two (r=0.85 with the PDS and r=0.71 with the IES). Receiver operator characteristic curve analysis suggested the highest levels of sensitivity (86%) and specificity (97%) for diagnosis of PTSD were at time‐point two, with an optimum decision threshold of 45 points.

Conclusion: This preliminary validation study suggests that the UK‐PTSS‐14 could be reliably used as a screening instrument at 2 months post‐discharge from the ICU to identify those patients in need of referral to specialist psychological services.
Quality of life 2–7 years after major trauma
Authors: ULVIK A. , KVÅLE R. , WENTZEL‐LARSEN T. , FLAATTEN H.
Published: September 2009

Background: The aim of the present study was to assess potential long‐term reduction in health‐related quality of life (HRQOL) in adult trauma patients 2–7 years after discharge from an intensive care unit (ICU), and to study possible determinants of the HRQOL reduction.

Methods: Follow‐up study of a cohort of 341 trauma patients admitted to the ICU of a university hospital during 1998–2003. Of the 228 eligible patients, 210 (92%) completed the study. A telephone interview using the EuroQol 5‐D (EQ‐5D) was conducted. Patients reported their HRQOL both at present and before trauma.

Results: Before trauma 88% reported in retrospect no problem in any EQ‐5D dimension, compared with 20% at follow‐up. After trauma (median 4.0 years) 58% suffered pain/discomfort, 44% reported alterations in usual activities, 40% reduced mobility, 35% anxiety/depression, and 15% limited autonomy. A total of 74% experienced reduction in HRQOL. Severe problems were reported by 16%. Women experienced more anxiety/depression than men. Simplified Acute Physiology Score (SAPS) II and Injury Severity Score (ISS) were significantly associated with impaired HRQOL, while age was not. Patients with severe head injury reported better HRQOL than those without severe head injury.

Conclusion: More than 2 years post‐injury, 74% reported impaired HRQOL but only 16% had severe problems. The majority still suffered pain/discomfort, indicating that pain management is a key factor in improving long‐term outcome after severe trauma.
Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep
Authors: HUUPPONEN E. , MAKSIMOW A. , LAPINLAMPI P. , SÄRKELÄ M. , SAASTAMOINEN A. , SNAPIR A. , SCHEININ H. , SCHEININ M. , MERILÄINEN P. , HIMANEN S‐L. , JÄÄSKELÄINEN S.
Published: September 2009

Background: Dexmedetomidine, a selective α2‐adrenoceptor agonist, induces a unique, sleep‐like state of sedation. The objective of the present work was to study human electroencephalogram (EEG) sleep spindles during dexmedetomidine sedation and compare them with spindles during normal physiological sleep, to test the hypothesis that dexmedetomidine exerts its effects via normal sleep‐promoting pathways.

Methods: EEG was continuously recorded from a bipolar frontopolar–laterofrontal derivation with Entropy Module (GE Healthcare) during light and deep dexmedetomidine sedation (target‐controlled infusions set at 0.5 and 3.2 ng/ml) in 11 healthy subjects, and during physiological sleep in 10 healthy control subjects. Sleep spindles were visually scored and quantitatively analyzed for density, duration, amplitude (band‐pass filtering) and frequency content (matching pursuit approach), and compared between the two groups.

Results: In visual analysis, EEG activity during dexmedetomidine sedation was similar to physiological stage 2 (S2) sleep with slight to moderate amount of slow‐wave activity and abundant sleep spindle activity. In quantitative EEG analyses, sleep spindles were similar during dexmedetomidine sedation and normal sleep. No statistically significant differences were found in spindle density, amplitude or frequency content, but the spindles during dexmedetomidine sedation had longer duration (mean 1.11 s, SD 0.14 s) than spindles in normal sleep (mean 0.88 s, SD 0.14 s; P=0.0014).

Conclusions: Analysis of sleep spindles shows that dexmedetomidine produces a state closely resembling physiological S2 sleep in humans, which gives further support to earlier experimental evidence for activation of normal non‐rapid eye movement sleep‐promoting pathways by this sedative agent.
Percutaneous CT‐guided fine‐needle aspiration of pulmonary lesions: Results and complications in 409 patients
Authors: Laspas F , Roussakis A , Efthimiadou R , Papaioannou D , Papadopoulos S , Andreou J
Published: September 2009

The purpose of this study was to report our centre’s experience in the results and complications of percutaneous CT‐guided lung biopsy. A retrospective review of 409 patients who underwent percutaneous CT‐guided fine‐needle aspiration of suspicious lung lesions for more than 5 years was carried out. Nodule sizes ranged from 0.6 to 10 cm. The calibre of the needle used was 21–23 G. Specimen adequacy and patient outcome were evaluated. Each case was reviewed for complications. Sufficient diagnostic material was obtained in 369 (90%) of the 409 fine‐needle aspirations. Diagnosis was malignancy in 290 (70%) samples, four (1%) samples were suspicious for malignancy, 65 (16%) samples were negative for malignancy and definite benign findings were identified in 10 (3%) specimens. There were 25 false‐negative cases and one false‐positive case. Sensitivity was 92% and specificity 98%. Pneumothorax was the most common complication and occurred in 17 (4%) patients. Only one of them required thoracic drainage. Blood effusion around the lesion or along the needle track was detected on the post‐biopsy CT in 8 (2%) patients. However, only one of them suffered from a mild haemoptysis. Percutaneous CT‐guided biopsy is an effective and fast procedure for diagnosis of suspected pulmonary malignancy, with a low complication rate.
Construction of modern Australian first trimester ultrasound dating and growth charts
Authors: McLennan AC , Schluter PJ
Published: September 2009

Accurate pregnancy dating is vital to obstetric management. However, first trimester fetal charts commonly used in Australia rely on data reported more than three decades ago. This study reports first trimester dating and growth charts for crown‐rump length between 5 and 14 weeks of gestation and biparietal diameter between 9 and 14 weeks of gestation on an Australia population using modern real‐time ultrasound equipment. All consenting eligible women attending a large Sydney clinic for first trimester ultrasound between March 2005 and December 2006 were recruited. Measurements were carried out to Australasian Society for Ultrasound in Medicine standard protocols. Statistical analyses were undertaken using polynomial regression models and thorough diagnostic checks made. Overall 396 eligible women consented to the study, with 268 between 9 and 14 weeks of gestation. The average participant age was 34 years (range 22–45 years), 371 and all yielded valid biometry measurements. Equations, means and 90% reference intervals for crown‐rump length measurements and biparietal diameter measurements were derived using polynomial regression models. Thorough residual and diagnostic checks were made. Once validated by others, we believe they will warrant consideration for use by Australasian Society for Ultrasound in Medicine.
Predicting regional control based on pretreatment nodal size in squamous cell carcinoma of the head and neck treated with chemoradiotherapy: A clinican’s guide
Authors: Porceddu SV , Sidhom M , Foote M , Burmeister E , Stoneley A , El Hawwari B , Milross C , Kenny L , Poulsen M , Coman WB
Published: September 2009

The aim of this study was to determine the regional control rate with concurrent chemoradiotherapy (CRT) based on pretreatment nodal size in mucosal head and neck squamous cell carcinoma (HNSCC) in patients who achieved a complete response (CR) at the primary site by 12 weeks post‐treatment. Between December 1997 and November 2003, 117 patients with node‐positive HNSCC were treated with concurrent CRT, with 108 (92%) achieving a CR at the primary site by 12 weeks. There were 93 males (86%), median age 55 (37–79) years and the most common primary site was the oropharynx (65%). Patients were divided into three subgroups: ≤3.0 cm 70 (65%), 3.1–6.0 cm 30 (28%) and ≥6.1 cm 8 (7%). All patients received concurrent platinum‐based chemotherapy and the median radiation dose was 70 Gy (60–72 Gy). The 3‐year regional control rate based on pretreatment nodal size was ≤3.0 cm 88% (95% confidence interval (CI) 78–94%), 3.1–6.0 cm 72% (95%CI 49–86%) and ≥6.1 cm 50% (95%CI 15–77%) (P = 0.001). The 3‐year regional control rate based on pre‐treatment nodal size was ≤3.0cm 88% (95%CI 78–94%), 3.1–6.0 cm 72% (95%CI 49–86%) and ≥6.1 cm 50% (95%CI 15–77%) (P = 0.001). These results provide a quantitative guide for the clinician as to the likelihood of regional control based on pretreatment nodal size following CRT in patients who achieve a CR at the primary site by 12 weeks post‐treatment.
Patients’ preference for radiotherapy fractionation schedule in the palliation of symptomatic unresectable lung cancer†
Authors: Tang JI , Shakespeare TP , Lu JJ , Chan YH , Lee KM , Wong LC , Mukherjee RK , Back MF
Published: September 2009

The palliative radiotherapeutic management of unresectable non‐small‐cell lung cancer is controversial, with various fractionation (Fx) schedules available. We aimed to determine patient’s choice of Fx schedule after involvement in a decision‐making process using a decision board. A decision board outlining the various advantages and disadvantages apparent in the Medical Research Council study of Fx schedules (17 Gy in two fractions vs 39 Gy in 13 fractions) was discussed with patients who met Medical Research Council eligibility criteria. Patients were then asked to indicate their preferred Fx schedules, reasons and their level of satisfaction with being involved in the decision‐making process. Radiation oncologists (RO) could prescribe radiotherapy schedules irrespective of patients’ preferences. Of 92 patients enrolled, 55% chose the longer schedule. English‐speaking patients were significantly more likely to choose the longer schedule (P = 0.02, 95% confidence interval: 1.2–7.6). Longer Fx was chosen because of longer survival (90%) and better local control (12%). Shorter Fx was chosen for shorter overall treatment duration (80%), cost (61%) and better symptom control (20%). In all, 56% of patients choosing the shorter schedule had their treatment altered by the treating RO, whereas only 4% of patients choosing longer Fx had their treatment altered (P < 0.001). Despite this, all (100%) patients were satisfied with being involved in the decision‐making process. The decision board was useful in aiding decision‐making, with both Fx schedules being acceptable to patients. Interestingly, despite the longer average survival associated with longer Fx, nearly half of the patients believed that this was not as important as a shorter duration of treatment and lower cost. Despite patients’ preferences, there were significant alterations of preferred schedules because of RO’s own biases.
Randomized study of percutaneous endoscopic gastrostomy versus nasogastric tubes for enteral feeding in head and neck cancer patients treated with (chemo)radiation
Authors: Corry J , Poon W , McPhee N , Milner AD , Cruickshank D , Porceddu SV , Rischin D , Peters LJ
Published: September 2009

Percutaneous endoscopic gastrostomy (PEG) tubes have largely replaced nasogastric tubes (NGT) for nutritional support of patients with head and neck cancer undergoing curative (chemo)radiotherapy without any good scientific basis. A randomized trial was conducted to compare PEG tubes and NGT in terms of nutritional outcomes, complications, patient satisfaction and cost. The study was closed early because of poor accrual, predominantly due to patients’ reluctance to be randomized. There were 33 patients eligible for analysis. Nutritional support with both tubes was good. There were no significant differences in overall complication rates, chest infection rates or in patients’ assessment of their overall quality of life. The cost of a PEG tube was 10 times that of an NGT. The duration of use of PEG tubes was significantly longer, a median 139 days compared with a median 66 days for NGT. We found no evidence to support the routine use of PEG tubes over NGT in this patient group.
Comparison of prostate set‐up accuracy and margins with off‐line bony anatomy corrections and online implanted fiducial‐based corrections
Authors: Greer PB , Dahl K , Ebert MA , Wratten C , White M , Denham JW
Published: September 2009

The aim of the study was to determine prostate set‐up accuracy and set‐up margins with off‐line bony anatomy‐based imaging protocols, compared with online implanted fiducial marker‐based imaging with daily corrections. Eleven patients were treated with implanted prostate fiducial markers and online set‐up corrections. Pretreatment orthogonal electronic portal images were acquired to determine couch shifts and verification images were acquired during treatment to measure residual set‐up error. The prostate set‐up errors that would result from skin marker set‐up, off‐line bony anatomy‐based protocols and online fiducial marker‐based corrections were determined. Set‐up margins were calculated for each set‐up technique using the percentage of encompassed isocentres and a margin recipe. The prostate systematic set‐up errors in the medial–lateral, superior–inferior and anterior–posterior directions for skin marker set‐up were 2.2, 3.6 and 4.5 mm (1 standard deviation). For our bony anatomy‐based off‐line protocol the prostate systematic set‐up errors were 1.6, 2.5 and 4.4 mm. For the online fiducial based set‐up the results were 0.5, 1.4 and 1.4 mm. A prostate systematic error of 10.2 mm was uncorrected by the off‐line bone protocol in one patient. Set‐up margins calculated to encompass 98% of prostate set‐up shifts were 11–14 mm with bone off‐line set‐up and 4–7 mm with online fiducial markers. Margins from the van Herk margin recipe were generally 1–2 mm smaller. Bony anatomy‐based set‐up protocols improve the group prostate set‐up error compared with skin marks; however, large prostate systematic errors can remain undetected or systematic errors increased for individual patients. The margin required for set‐up errors was found to be 10–15 mm unless implanted fiducial markers are available for treatment guidance.
Measurement‐specific bioavailable testosterone using concanavalin A precipitation: Comparison of calculated and assayed bioavailable testosterone
Authors: Yamamoto Kenrou , Koh Eitetsu , Matsui Futoshi , Sugimoto Kazuhiro , Sin Ho‐Su , Maeda Yuji , Namiki Mikio
Published: September 2009

Objective:  To assess the value of calculated bioavailable testosterone (cBT) and assayed BT (aBT) for the diagnosis of late‐onset hypogonadism (LOH) in middle‐aged and elderly subjects.

Methods:  In order to assay serum BT, sex hormone‐binding globulin was precipitated with concanavalin‐A and then testosterone was measured using liquid chromatography‐tandem mass spectrometry. To validate the non‐sex‐hormone‐binding‐globulin‐bound testosterone, gel filtration chromatography and concanavalin‐A sepharose were used. Following this validation, the usefulness between aBT and cBT was evaluated in clinical samples.

Results:  Eighty‐eight healthy male volunteers (mean age 65.6 years, range: 50–86) were recruited for this study. A significant correlation was found between cBT and aBT (R2 = 0.53, P < 0.01). Mean value ratio (cBT/aBT) was 2.48. Both cBT (R2 = 0.122) and aBT (R2 = 0.251) decreased with age. Variations in aBT were less marked than those for cBT, suggesting that aBT can be used to determine age‐related reduced testosterone levels.

Conclusion:  aBT levels are more reliable than cBT levels for the diagnosis of LOH in middle‐aged and elderly subjects.
Predicting creep crack initiation in austenitic and ferritic steels using the creep toughness parameter and time‐dependent failure assessment diagram
Authors: DAVIES C. M.
Published: September 2009

Methods for evaluating the creep toughness parameter, Kmatc, are reviewed and Kmatc data are determined for a ferritic P22 steel from creep crack growth tests on compact tension, C(T), specimens of homogenous parent material (PM) and heterogeneous specimen weldments at 565 °C and compared to similar tests on austenitic type 316H stainless steel at 550 °C. Appropriate relations describing the time dependency of Kmatc are determined accounting for data scatter. Considerable differences are observed in the form of the Kmatc data and the time‐dependent failure assessment diagrams (TDFADs) for both the 316H and P22 steel. The TDFAD for P22 shows a strong time dependency, but is insensitive to time for 316H. Creep crack initiation (CCI) time predictions are obtained using the TDFAD approach and compared to experimental results from C(T) specimens and feature components. The TDFAD based on parent material properties can be used to obtain conservative predictions of CCI on weldments. Conservative predictions are almost always obtained when lower bound Kmatc values are employed. Long‐term test are generally more relevant to industrial component lifetimes. The different trends between long‐ and short‐term CCI time and growth data indicate that additional long‐term test are required to further validate the procedure to predict the lifetimes of high temperature components.
Critical crack size that causes retardation of short fatigue crack by single overload
Authors: KONDO Y. , SUDO T. , KUBOTA M.
Published: September 2009

The effect of crack length on the retardation of fatigue crack propagation caused by single overload was investigated using carbon steels S25C and S45C. The retardation and crack arrest occurred even in short cracks ranging from 50 to several hundred microns. In case retardation occurs, it is caused by the increase of crack closure stress as in a long crack. The occurrence of retardation, however, showed a complex dependency on crack length, yield strength of material and the value of baseline stress ratio R. At stress ratio R =−1, retardation did not occur for very short crack as short as 50 μm in the case of low yield strength material. This was because the increase of crack closure stress was prevented by the compressive stress component of baseline load. The plastically deformed layer near the crack tip was collapsed by the compressive stress of baseline load, which prevented the development of crack closure. In the case of high yield strength material, however, retardation occurred even in 50 μm crack. On the contrary at R = 0, retardation in the low yield strength material occurred even in 50 μm crack. The prevention of increase of crack closure did not occur in the case of R = 0. As a consequence, retardation basically occurs even in short crack as short as 50 μm unless the development of crack closure is impeded.
Six‐month outcomes on A1C and cardiovascular risk factors in patients with type 2 diabetes treated with exenatide in an ambulatory care setting
Authors: Brixner D. I. , McAdam‐Marx C. , Ye X. , Boye K. S. , Nielsen L. L. , Wintle M. , Misurski D. , Fabunmi R.
Published: September 2009

Aim: This study evaluated changes in clinical effectiveness measures of patients with type 2 diabetes initiating exenatide therapy in a real‐world setting.

Methods: Eligible patients identified in the General Electric (GE) electronic medical record (EMR) research database from 1 January 2000 through 31 December 2007 were ≥18 years old with type 2 diabetes. Patients had prescription orders in the previous 395 days for metformin, a sulfonylurea, or a thiazolidinedione as monotherapy or in combination, and had at least 6 months of follow‐up activity. Baseline clinical measures were documented from 45 days prior up to 15 days after exenatide initiation and follow‐up measures documented at 6 months ± 45 days.

Results: A total of 1709 patients were identified for study inclusion. The overall mean A1C reduction (s.e.m.) at 6 months was −0.8% (0.05) (p<0.001), weight loss was −3.2 kg (0.14) (p<0.001), blood pressure (BP) lowering was −1.9 mmHg (0.46) systolic blood pressure (SBP) (p<0.001) and −0.5 mmHg (0.27) diastolic blood pressure (DBP) (p = 0.078). Changes in low‐density lipoprotein (LDL), triglycerides and HDL were −7.4 mg/dl (1.7) (p<0.001), −23.2 mg/dl (6.7) (p = 0.001) and −0.8 mg/dl (0.33) (p = 0.012) respectively. In a quartile analysis by weight loss, mean A1C reduction ranged from −1.1 to −0.65% in the highest to lowest weight loss quartiles respectively.

Conclusions: In a real‐world setting, exenatide initiation is associated with significant improvements in the measures of clinical effectiveness for type 2 diabetes. These reductions were comparable to those reported in randomized, controlled registration trials after 6 months of therapy.
Shift‐contagion Vulnerability in the MENA Stock Markets
Authors: Lagoarde‐Segot Thomas , Lucey Brian M.
Published: September 2009

As part of a broader financial development reform agenda, the Middle East and North Africa (MENA) countries have successfully expanded and revitalised their stock markets over the last decade. Whereas previous contributions have investigated efficiency, international integration and portfolio diversification opportunities, very little is known about these markets’ vulnerability to external financial crises. In this paper, we investigate shift‐contagion to the MENA region using a comprehensive battery of econometric tests for a number of different crises episodes: the 1997 Asian crisis, the 1998 Russian virus and its Brazilian sequel, the 2000 Turkish collapse, the 9/11 turmoil, the 2001 Argentinean crisis, the 2002 Enron/WorldCom scandal and the 2007–09 global financial crisis. We found that Turkey, Israel and Jordan were the most vulnerable markets over the 1997–2009 period, followed by Tunisia, Morocco, Egypt and Lebanon. Our results also highlight heterogeneous but increasing levels of sensitivity to external financial shocks, especially during the recent global financial crisis. From a financial point of view, this suggests that MENA‐based diversification strategies may be relatively inefficient during periods of global turmoil. From an economic point of view, our results suggest that stock market development also involves potential destabilisation costs. This issue should be acknowledged and addressed by policymakers if these countries are to ensure a smooth transition towards international financial integration.
Source Country Characteristics and the Inflow of Foreign Direct Investment into Saudi Arabia
Authors: Roberts Barbara M. , Almahmood Abdulaziz
Published: September 2009

The paper examines the impact of source country characteristics on the inflow of FDI into Saudi Arabia using a gravity‐type model including economic, distance and socio‐political variables. A unique database listing all new investments involving foreign ownership is used to construct a panel of 33 countries in the period 1980–2005. To account for many country–year observations with zero FDI, the negative binomial regression, the Tobit regression and the Heckman selection procedure are used. The conclusions drawn from the analysis employing panel‐based techniques differ from the results obtained from pooled regression models. Also, the determinants of FDI differ depending on whether foreign investment is measured in terms of investment expenditure or the number of individual foreign projects. The Heckman selection results reveal that there are a large number of factors affecting the decision to invest in Saudi Arabia, compared with relatively few determinants of the actual size of investment. Traditional size and distance characteristics hold to a great extent but the relationship between FDI and bilateral trade is unclear and there is some evidence that the countries that export to Saudi Arabia do not invest there. In terms of scope for possible spillovers, there is mixed evidence on whether the investment comes from more technologically advanced economies but volume‐wise important investments originate from countries characterised by high income per capita.
An alternative response to “The best interests of the child thesis: some thoughts from Australia”
Authors: Barth Richard P.
Published: September 2009

Many of the concerns about recent changes in child welfare services practice in Australia have also been raised in the USA. Although it certainly may be the case that mandatory reporting is causing a broadening of child welfare services in Australia, close data‐informed scrutiny suggests that this is not the case in the USA. Further, there are positive alternatives to overly intrusive child welfare service interventions that are arising in the USA. There is reasonable evidence to suggest that too little protection rather than too much intrusion remains the more significant problem in the USA; this may also be true elsewhere. The quality and range of services certainly determines whether intrusion is helpful to children and families. In some cases, for example life‐threatening health problems that parents will not or cannot treat, engaging the assistance of child welfare services should not be ruled out for ideological reasons.
Union and Communion: Calvin's Theology of Word and Sacrament
Authors: HORTON MICHAEL S.
Published: September 2009

Some scholars consider Calvin's teaching on the sacraments to be an integral part of his theology. Others have challenged the Reformer's consistency in this area, regarding Calvin's eucharistic teaching in particular as a ‘foreign, uncongenial element’ in his work. My argument in this article is that Calvin's eucharistic teaching, particularly in its ‘more nearly patristic’ emphases, is neither inimical nor secondary to his system but is in fact an essential and promising outworking of his theology. As with other perspectives, Calvin's understanding of Word and sacrament generates a particular kind of ecclesiology with emphases that remain ecumenically significant and vital for the life and mission of the church.
‘Deny Yourself and Take up Your Cross’: John Calvin on the Christian Life
Authors: ZACHMAN RANDALL C.
Published: September 2009

John Calvin's vision of the Christian life is guided by the fundamental insight that what distorts our lives more than anything else is our blind self‐love. This self‐love is the reason why we love to hear things that flatter us, and hate to hear things that truly reveal who we are. Our self‐love also provides the driving engine behind our pride, ambition and arrogance, whereby we seek the meaning of our lives in power, wealth and honor, so that we may despise those we consider to be inferior to us. If we are to be transformed more and more into the image and likeness of God, so that we may at the end be united with God in eternal life, we must eradicate this blind self‐love from our hearts. Although there is much in Calvin's vision of the Christian life that may strike us as odd or even as alien, it is hard to disagree with his insight that blind self‐love is the primary reason our lives do not express the image and likeness of God.
John Calvin's Soteriology: On the Multifaceted ‘Sum’ of the Gospel
Authors: BILLINGS J. TODD
Published: September 2009

This article explores John Calvin's soteriology through examining his multivalent and yet succinct ‘sum’ of the gospel: the double grace of justification and sanctification received in union with Christ. The essay begins with a description of the scope and range of this teaching in Calvin, its biblical, patristic and Reformational sources, and its application to a wide range of doctrinal loci. After this, particular features of Calvin's account are highlighted as promising for contemporary retrieval. The essay concludes with historiographic reflections that intersect with ongoing disputes in interpreting Calvin's teaching on union with Christ and the double grace.
From Calvin to Gillespie on Covenant: Mythological Excess or an Exercise in Doctrinal Development?
Authors: TRUEMAN CARL
Published: September 2009

Much of the discussion about the development of Reformed theology in the sixteenth and seventeenth centuries has focused on the elaboration of the covenantal understanding of theology. While the covenant of works has received much attention, the covenant of redemption, a term which emerges in the middle of the seventeenth century, has been comparatively neglected and, when referenced at all, has tended to be dismissed as a highly speculative addition to Reformed theology, a piece of mythology, as Barth famously quipped. In fact, a close examination of the concerns underlying the doctrine, particularly those touching on the Reformed emphasis on Christ as Mediator according to his person (and thus both natures) indicates that this later development stands in positive relation to the earlier work of Calvin and company; and a close examination of the work of its major exponent, Patrick Gillespie, also indicates that it is a great example of how later Reformed theology did not abandon the earlier Protestant concern for connecting exegesis to doctrinal synthesis.
CBT for childhood anxiety disorders: differential changes in selective attention between treatment responders and non‐responders
Authors: Legerstee Jeroen S. , Tulen Joke H.M. , Dierckx Bram , Treffers Philip D.A. , Verhulst Frank C. , Utens Elisabeth M.W.J.
Published: September 2009

Background:  This study examined whether treatment response to stepped‐care cognitive‐behavioural treatment (CBT) is associated with changes in threat‐related selective attention and its specific components in a large clinical sample of anxiety‐disordered children.

Methods:  Ninety‐one children with an anxiety disorder were included in the present study. Children received a standardized stepped‐care CBT. Three treatment response groups were distinguished: initial responders (anxiety disorder free after phase one: child‐focused CBT), secondary responders (anxiety disorder free after phase two: child–parent‐focused CBT), and treatment non‐responders. Treatment response was determined using a semi‐structured clinical interview. Children performed a pictorial dot‐probe task before and after stepped‐care CBT (i.e., before phase one and after phase two CBT).

Results:  Changes in selective attention to severely threatening pictures, but not to mildly threatening pictures, were significantly associated with treatment success. At pre‐treatment assessment, initial responders selectively attended away from severely threatening pictures, whereas secondary responders selectively attended toward severely threatening pictures. After stepped‐care CBT, initial and secondary responders did not show any selectivity in the attentional processing of severely threatening pictures. Treatment non‐responders did not show any changes in selective attention due to CBT.

Conclusions:  Initial and secondary treatment responders showed a reduction of their predisposition to selectively attend away or toward severely threatening pictures, respectively. Treatment non‐responders did not show any changes in selective attention. The pictorial dot‐probe task can be considered a potentially valuable tool in assigning children to appropriate treatment formats as well as for monitoring changes in selective attention during the course of CBT.
The effect of Lallemantia royleana (Balangu) seed, palmate‐tuber salep and carboxymethylcellulose gums on the physicochemical and sensory properties of typical soft ice cream
Authors: BAHRAMPARVAR MARYAM , HADDAD KHODAPARAST MOHAMMAD H , RAZAVI SEYED M A
Published: September 2009

This study was aimed primarily at determining the suitability of two Iranian sources of hydrocolloid, Balangu seed and palmate‐tuber salep (PTS), for the production of ice cream mix. For this purpose, the effect of these gums and carboxymethylcellulose (CMC) on some physicochemical and sensory characteristics of a typical soft ice cream was investigated. In comparison with carboxymethylcellulose, Balangu seed did not make a significant difference (P > 0.05) to most characteristics and could be used as a suitable stabiliser. Although products prepared using only the palmate‐tuber salep showed more differences from the corresponding ones with carboxymethylcellulose, the variations were not significant.
CHICAGO, PERISCOPE and PROactive: CV risk modification in diabetes with pioglitazone
Authors: John Betteridge D.
Published: September 2009

Recent trials of intensive glycaemic control in patients with type 2 diabetes and its impact on cardiovascular disease have led to confusion and speculation amongst physicians. The Action to Control Cardiovascular Risk in Diabetes Study was terminated early because of a significant excess all‐cause mortality in the intensively‐treated group. Furthermore the ADVANCE and VADT trials did not demonstrate cardiovascular benefit with more intensive glycaemic control. Against this background, it is pertinent to re‐visit and critically appraise the results of the PROactive study which examined the effects of the thiazolidinedione, pioglitazone, on cardiovascular end‐points in a large, randomized, placebo‐controlled clinical trial in type 2 diabetic patients with symptomatic disease. PROactive has been rightly criticized in the choice of its composite primary end‐point which included a physician‐driven as opposed to a disease‐driven outcome, namely peripheral vascular re‐vascularization. This was primarily responsible for the primary composite end‐point not being achieved; whereas there was a significant beneficial impact on the major secondary end‐point of death, non‐fatal myocardial infarction and stroke. The results of PROactive have been supported by two subsequent studies examining the impact of pioglitazone on important surrogates of atherosclerosis, namely carotid intima/medial thickness (IMT) and coronary atheroma volume as delineated with intravascular ultrasound. The CHICAGO study demonstrated that IMT in type 2 diabetic patients treated with pioglitazone did not progress whereas those treated with glimepiride showed progression. In PERISCOPE atheroma volume progressed with glimepiride but did not with pioglitazone. This is exciting data pointing to the cardiovascular benefits of pioglitazone. In PROactive, CHICAGO and PERISCOPE there was a sustained effect of pioglitazone on glycaemic control and, in addition, beneficial effects in reducing triglycerides and increasing HDL‐cholesterol beyond that seen with concomitant statin therapy. These findings strongly suggest that pioglitazone has an important place in the management of type 2 diabetes.
Relevance of vitamins C and E in cutaneous photoprotection
Authors: Eberlein‐König B , Ring J
Published: September 2009

Ultraviolet (UV) radiation‐induced oxidative stress may result in acute and chronic photodamage. Based on the endogenous antioxidant system, the administration of antioxidants for scavenging reactive oxygen species might be a promising strategy in the prevention of UV‐induced skin reactions. The relevance of the most common antioxidants, vitamins E and C, is reviewed focusing on topical and systemic photoprotective effects in animals and humans.

 Topically applied vitamin C induced significant photoprotective effects at concentrations of at least 10% in animals and humans, whereas a photoprotective effect has not been demonstrated by oral administration even at high doses in humans. Topical vitamin E reduced erythema, sunburn cells, chronic UV‐B–induced skin damage, and photocarcinogenesis in the majority of the published studies, whereas only high doses of oral vitamin E may affect the response to UV‐B in humans. Combination of vitamins C and E, partly with other photoprotective compounds, did increase the photoprotective effects dramatically compared to monotherapies.

 This synergistic interplay of several antioxidants should be taken into consideration in future research on cutaneous photoprotection.
Effective treatment of Futcher's lines with Q‐switched alexandrite laser
Authors: Bukhari I A
Published: September 2009

This is a case report of a young female patient who presented with pigmentary demarcation lines type A on the anterolateral aspect of both arms, which were satisfactorily treated with a Q‐switched alexandrite laser with no adverse effects.
The natural history of androgenetic alopecia
Authors: Tosti A , Piraccini B M , Iorizzo M , Voudouris S
Published: September 2009

Androgenetic alopecia (AGA) is the most common cause of hair loss, affecting up to 80% of men and 50% of women in their lifetime.

 Genetic predisposition to the disease is well known but the responsible genes have not been identified. Polymorphism in the androgen receptor gene has been recently detected in AGA.1

 Although the role of androgens, and particularly dihydrotestosterone (DHT), in causing the disease has been established for a long time, the natural history of AGA is still not completely understood.

 This paper reviews recent data about natural progression of the disease, as well as factors that may interfere with its course and long‐term prognosis.
Adaptative or maladaptative hypertrophy, different spatial distribution of myocardial contraction
Authors: Cappelli Francesco , Toncelli Loira , Cappelli Brunello , De Luca Alessio , Stefani Laura , Maffulli Nicola , Galanti Giorgio
Published: September 2009

Background:  Left ventricular hypertrophy (LVH) may be an adaptative remodelling process induced by physical training, or result from pathological stimuli. We hypothesized that different LVH aetiology could lead to dissimilar spatial distribution left ventricular (LV) contraction, and compared different components of LV contraction using 2‐dimensional (2‐D) speckle tracking derived strain in subjects with adaptative hypertrophy (endurance athletes), maladaptative hypertrophy (hypertensive patients) and healthy controls.

Method:  We enrolled 22 patients with essential hypertension, 50 endurance athletes and 24 healthy controls. All subjects underwent traditional echocardiography and 2‐D strain evaluation of LV longitudinal, circumferential and radial function. LV basal and apical rotation and their net difference, defined as LV torsion, were evaluated.

Results:  LV wall thicknesses, LV mass and left atrium diameter were comparable between hypertensive group and athletes. LV longitudinal strain was reduced only in hypertensive patients (P < 0·05). LV apex circumferential strain was higher in hypertensive patients than in other groups (P < 0·001), LV basal circumferential strain, although slightly increased, did not reach significant difference. Hypertensive patients showed significantly increased rotation and torsion (P < 0·001), while no differences were observed between athletes and control.

Conclusion:  In patients with pathological LVH, LV longitudinal strain was reduced, while circumferential deformation and torsion were increased. No differences were observed in LV contractile function between subjects with adaptative LVH and controls. In pathological LVH, increasing torsion could be considered a compensatory mechanism to counterbalance contraction and relaxation abnormalities to maintain a normal LV output.
IAS Versus U.S. GAAP: Information Asymmetry–Based Evidence from Germany's New Market
Authors: LEUZ CHRISTIAN
Published: September 2009

abstract

Motivated by the debate about globally uniform accounting standards, this study investigates whether firms using U.S. generally accepted accounting principles (GAAP) vis‐à‐vis international accounting standards (IAS) exhibit differences in several proxies for information asymmetry. It exploits a unique setting in which the two sets of standards are put on a level playing field. Firms trading in Germany's New Market must choose between IAS and U.S. GAAP for financial reporting, but face the same regulatory environment otherwise. Thus, institutional factors such as listing requirements, market microstructure, and standards enforcement are held constant. In this setting, differences in the bid‐ask spread and share turnover between IAS and U.S. GAAP firms are statistically insignificant and economically small. Subsequent analyses of analysts' forecast dispersion, initial public offering underpricing, and firms' standard choices corroborate these findings. Thus, at least for New Market firms, the choice between IAS and U.S. GAAP appears to be of little consequence for information asymmetry and market liquidity. These findings do not support widespread claims that U.S. GAAP produce financial statements of higher informational quality than IAS.
Assessing the completeness of the deglacial‐marine stratigraphic record on west Spitsbergen by accelerator mass spectrometry radiocarbon dating
Authors: FORMAN STEVEN L. , LEHMAN SCOTT J. , BRIGGS WILLIAM M.
Published: September 2009

The record of Quaternary glaciations of coastal areas is frequently preserved as a raised deglacial‐emergence sequence. Detailed radiocarbon dating of foraminifera and marine macrofossils from a representative deglacial sequence on west Spitsbergen document two periods of sedimentation at c. 11,400 BP and at 9500 BP that together span < 500 years. The incompleteness of this record (< 25%), the highly episodic nature of sedimentation, the dominance of local glacial and environmental effects and the presence of allochthonous foraminifera inhibits ascertaining the relation between deglaciation of Svalbard/Barents Sea and changes in thermohaline circulation in the Norwegian Sea. The Late Weichselian and older deglacial sequences on west Spitsbergen have a similar sedimentologic succession. Thus, one possibility is that older raised‐marine deglacial sequences on Svalbard and other Arctic areas may represent similar brief intervals, potentially confounding correlations across the Arctic and with well established events (i.e. the Eemian Interglacial) at lower latitudes.
Holocene water‐level fluctuations of a subarctic lake at the tree line in northern Québec
Authors: PAYETTE SERGE , FILION LOUISE
Published: September 2009

Water‐level changes of a small subarctic lake, located near the tree line in northern Québec, were inferred from stratigraphic analysis of buried peat and minerogenic sediments deposited over the last 6000 14C years, i.e. the time lapse since the final withdrawal of the postglacial Tyrrell Sea waters. Two major periods of water‐level fluctuations were recorded: a generally low level of the lake from 5400‐5300 BP to 3600 3500 BP and a predominantly high water level from 3500 BP to present. The most important lowering occurred between 4600 and 4100 BP, when the water level was at least 60–100 cm lower than present. Three brief lowerings also occurred around 2600‐2400, 2100‐2000 and 1300 BP. An important lowering at 300‐250 BP coincided with the Little Ice Age period. At that time the lake level was at least 45–50 cm lower than present, and this facilitated tree growth in the shore zone. The generally low lake level before 3500 BP was probably caused by dry and warm conditions (with high evaporation), whereas the 300‐250 BP lowering was most likely due to a decrease in the annual snow fall. The formation of permafrost mounds in the shore zone after 2100‐2000 BP was associated with a lower lake level. The absence of any pedogenic development in sandy deposits at the top of the mounds suggests a rather recent origin, possibly during the Little Ice Age. The overall chronology of predominantly high and low water levels is partly similar to that of other lakes from temperate North America and northern Europe.