bluuebunny/crossref_metadata_2025 huggingface dataset:
Part of the action, or ‘going native’? Learning to cope with the ‘politics of integration’
Authors: Fuller Duncan
Published: July 2005

SummaryDespite continuing work within feminist research on issues of political commitment and critical forms of engagement, and an increasing desire within geography to effect social change through our privileged positions as academics, active collaboration with groups involved in social action continues to be fraught with ambiguity and anxiety. In this paper, I consider the potential role of the ‘researcher as activist’ through documentation of my interaction and repositioning of identities while becoming involved in credit union development in Kingston upon Hull. I hope to illustrate how the maintenance of a critical, multi‐positioned (and repositioned) identity can be seen as a beneficial, reflexive learning experience for researchers operating within ethnography, and for the research itself.
Left out? Observations on the RGS‐IBG conference on social exclusion and the city
Authors: Hague Euan , Thomas Chris , Williams Stephen
Published: July 2005

Summary
On 29 October 1998, the RGS‐IBG invited delegates to a conference entitled ‘Social exclusion and the city’, with Geoff Mulgan (founder of the think‐tank Demos and a policy advisor to Prime Minister Blair) as the keynote speaker. The event was well attended, providing much useful insight into the government policies of the 'Social Exclusion Unit’ and ongoing academic research into the processes and problems of 'social exclusion’. Here we provide some general observations on the conference and some suggestions regarding the possible directions of the debate on social exclusion and inclusion.
Power plays: reflections on the process of submitting an undergraduate dissertation
Authors: Shah Alpa
Published: July 2005

Summary
This article is based on a performance on the power plays of research. It is a self‐critical examination of the practices involved in submitting an undergraduate dissertation. The original performance was a dialogue between myself, reflecting on the specific experiences of my dissertation, and Craig Jeffrey, who punctuated it with more general aspects of the dissertation process. It was written for an audience of undergraduate geographers at the University of Cambridge to illuminate the theatre of inequalities and oscillations of power between various actors: the researcher, the researched and the agenda of the academic discipline. Later, my colleagues on the social anthropology Masters programme at the London School of Economics heard another version of the performance.
The final fifth: autobiography, reflexivity and interpretation in cross‐cultural research
Authors: Twyman Chasca , Morrison Jean , Sporton Deborah
Published: July 2005

Summary
This paper addresses concerns about the complexities of cross‐cultural field‐ work, and the importance of the positionality of researchers and translators in the research process. These concerns build upon debates within the social sciences about autobiography, reflexivity and the research process, as well as notions of validity, reliability and ‘truth’. The paper re‐examines these debates in the context of cross‐cultural research by focusing on praxis—actual experiences in the field.
Tensions in managing the suburbs: conservation versus change
Authors: Larkham Peter J
Published: July 2005

Summary
This paper rewiews the increasing trend for conservation in suburban areas. Focusing mainly on English suburban conservation areas, it explores the background to the movement, the views of residents and the range of town‐planning systems used in such attempts to retain the ‘character and appearance’ of these areas. Concepts of, and approaches to, urban landscapes that might be familiar to urban geographers are conspicuous by their absence. A range of tensions are explored, including those generated between residents and professionals, the values and attitudes of the professionals and the likely future conflict over values and attitudes in conservation versus change: the application of concepts of sustainability, including ‘densification’ and the compact city.
Doing household research: interviewing couples together and apart
Authors: Valentine Gill
Published: July 2005

Summary
The question of whether household members should be interviewed together or apart is hotly debated in ‘family’ studies. In this paper, I use my own experiences of both methods of interviewing in order to explore some of the practical problems, ethical issues and power dynamics of conducting household research, and to demonstrate how a household focus can contribute to the understanding of gender relations.
A geography of insurance exclusion: perceptions of unemployment risk and actuarial risk assessment
Authors: Cebulla Andreas
Published: July 2005

Summary
Proposed welfare reform in Great Britain advocates joint public and private provision of insurance. Using omnibus survey data, this paper projects the availability and geographical coverage of private unemployment insurance in Britain among currently employed persons, on the basis of actuarial risk assessment criteria. It compares actuarial risk assessments with the respondents' subjective job risk assessments and their declared intention to take out private unemployment insurance. The paper identifies the extent and geography of structural/self‐exclusion from insurance.
Neurohydrology: implementation options and a research agenda
Authors: Abrahart Robert J
Published: July 2005

Summary
This paper recommends further investigation into the use of artificial neural networks for tackling complex hydrological modelling tasks. Three possible modes of implementation are discussed, and a research agenda is proposed—comprising an organizational framework within which to examine and report on the potential benefits.
Environmental restoration: environmental management or environmental threat?
Authors: Eden Sally , Tunstall Sylvia M. , Tapsell Susan M.
Published: July 2005

Summary
This paper compares the ethical and political issues raised by two environmental restoration schemes in England: those of the River Skerne and the A33 near Twyford Down. Neither example fully restores a ‘natural’ condition, nor tries to, but both raise questions about how far restoration is an acceptable option for environmental management.
Evaluating qualitative research: dealing with the tension between ‘science’ and ‘creativity’
Authors: Bailey Cathy , White Catherine , Pain Rachel
Published: July 2005

Summary
This paper responds to recent calls for detailed evaluative criteria for qualitative research in human geography. It argues that the dualism between ‘science’ and ‘creativity’ is unfounded, and that while systematic methods of evaluation are required, standardization is inappropriate. Furthermore, it seeks to demonstrate that grounded theory provides an alternative framework that demonstrates how these ideas might be put into practice.
Invisible carers: young people in Zimbabwe's home‐based healthcare
Authors: Robson Elsbeth
Published: July 2005

Summary
Women and young people are disproportionately burdened by the restructuring of healthcare services. Home‐based healthcare provision by children in Zimbabwe is investigated through qualitative interviews with young carers and key informants. The study suggests that young people (especially girls) become carers according to varied personal and household factors in the context of the AIDS pandemic, macro‐economic decline and ESAP‐weakened formal health services.
The Short cut to international development: representing Africa in ‘New Britain’
Authors: Power Marcus
Published: July 2005

Summary
Under New Labour, the British Department for International Development (DFID) promises a radical and alternative new ‘development agenda’ and, more specifically, an end to ‘development handouts’. The short cut to international development envisioned by Secretary of State Clare Short is explored in this paper, as is the ‘messy’ contextuality of writing about development in ‘New Britain’. This paper raises questions about New Labour's discussion of the ‘moral authority’ for international development in ‘post‐colonial’ Britain, particularly in light of the recent ‘arms‐to‐Africa’ affair involving Britain and Sierra Leone. The paper argues that Britannia's neoliberal vision of development is not so ‘cool’ and that, in ethical terms, the development of foreign policy toward Africa has not been consistent. In conclusion, the paper raises doubts about the likelihood of world poverty being halved by 2015 (as the DFID has confidently predicted).
Constituency election campaigning under the alternative vote: the New South Wales Legislative Assembly election 1995
Authors: Johnston Ron , Forrest James
Published: July 2005

Summary
Most studies of the impact of local campaigning on the geography of election results in single‐member constituency electoral systems have been conducted in countries where the ‘first‐past‐the‐post’ system is employed. Australia uses the ‘alternative vote’ (AV) system for elections to the federal and some state Lower Houses, with parties competing for both first‐ and lower‐preference votes. This paper analyses the relationship between spending and success in the contests for both types of votes at the 1995 New South Wales State Legislative Assembly election, with significant findings: the more intense a party's campaign, ceteris paribus, the more first‐preference votes it obtained and the more lower‐preference votess when these were reallocated. The AV system was recommended for adoption in the UK by a government‐commissioned report in 1998, and the paper draws some implications for the UK situation.
Gender differences in space‐time constraints
Authors: Kwan Mei‐Po
Published: July 2005

SummaryThis study explores gender differences in space‐time constraints and their impact on women's and men's activity‐travel patterns from a time‐geographic perspective. Using a travel diary data set collected in Columbus, Ohio (USA), the time‐budget and fixity constraints of three population subgroups are examined. This paper concludes that space‐time constraints have a significant impact on individual's activity‐travel patterns.
Knowledge‐complexes and the locus of technological change: the biotechnology sector in Oxfordshire
Authors: Smith Helen Lawton , Mihell David , Kingham David
Published: July 2005

Summary
The case of the biotechnology industry in Oxfordshire is used to examine localism as a means of underpinning the technological trajectory of an industry (Storper 1992). Oxfordshire has a rapidly developing cluster of biotechnology firms. Its position as a focal point of technological change derives from the combination of world‐class scientific research in its research institutions and its firms, a scientific labour market and an emerging infrastructure, including a soft infrastructure: networks, culture and innovation centres, which together are shaping this particular development path.
Betweenness at work
Authors: Tooke Jane
Published: July 2005

Summary
This paper engages with current debates concerning reflexive research processes. It applies a relational concept of difference—recently envisaged as ‘betweenness’—to highlight how gender and class difference can be used to reflect other differences. It concludes that ‘betweenness’ can help identify geographies of identity and culture.
From rags to riches? Migration and intergenerational change in London's housing market, 1971–91
Authors: Lyons Michal , Simister John
Published: July 2005

Summary
In 1971 under half of London's young people, then living with their parents, lived in households that owned their homes, while well over half lived in rented housing. By 1991, now no longer living with their parents, less than a quarter of these young people were tenants. This paper identifies the components of that intergenerational tenure mobility, distinguishing between home ownership in more, and less, ‘desirable’ wards, and quantifies the role of migration in mediating the overall changes in Londoner's housing market status between 1971 and 1991. It analyses the moderating factors contributing to housing status mobility, such as labour market mobility and household type, and assesses the differential impact of these processes on men and women. ONS Longitudinal Study data for the period 1971–91 are analysed. Findings are that the aggregate changes concealed a range of housing careers. In particular, in‐migrants fared less well in the London housing market than in its labour market.
Professionalization and displacement in Greater London
Authors: Atkinson Rowland
Published: July 2005

Summary
This article presents results from research that has looked at the process of displacement induced by gentrification. The approach uses census data to measure social change to examine the interaction between proxy indicators of gentrification and displacement. Data is presented indicating that links exist between these processes. The paper concludes that while these links do not conclusively demonstrate the existence of displacement it is unlikely that such a strongly observed effect is unrelated to processes of professionalization and that other approaches to the study of displacement are also needed to achieve a more rounded view of the process.
Pulling out of landed property: the Oxford colleges and the Church Commissioners
Authors: Spencer David
Published: July 2005

SummaryThis paper assesses the extent to which the Oxford colleges—like the Church Commissioners—have transferred capital out of landed property as part of a broader project of asset re‐structuring. It argues that explanation lies in changes to the rules of accumulation, which were the outcome of a series of political and ideological conflicts between the colleges and the central state.
Changing home, changing school: towards a research agenda on child migration
Authors: Dobson Janet , Stillwell John
Published: July 2005

Summary
The purpose of this contribution is to draw attention to a particular sub‐group of the population whose migration behaviour has been largely neglected by population geographers but whose activities are of sufficient extent and consequence to require closer investigation. The paper outlines some evidence of the magnitude and geography of internal and international child migration in Britain in the 1990s and argues that research might usefully focus on the relationship between child migration and the school system, and the implications of this interdependence for public policy.
Fear of crime, cultural threat and the countryside
Authors: Yarwood Richard , Gardner Graham
Published: July 2005

SummaryThis paper argues that the study of crime and the fear of crime in rural areas reveals much about the geography of crime, policing and rural society. Drawing upon a crime and safety survey conducted with residents of a rural parish in Worcestershire it establishes a link between fear of crime and ‘cultural threats’ to residents' dominant constructions of rurality. It concludes by considering the 1998 Crime and Disorder Act and its implications for rural policing and society.
Rural Self‐Reliance in Bondolfi, Zimbabwe: the role of beekeeping
Authors: NEL ETIENNE , ILLGNER PETER M. , WlLKlNS K. , ROBERTSON M.P.
Published: July 2005

Community‐based economic self‐reliance has become critical in many African countries because of the severity of prevailing soci‐economic and environmental constraints. Concerns over food security have encouraged a re‐evaluation of the importance of indigenous technical knowledge. This study examines a rural area in Zimbabwe where members of the local community have established a successful beekeeping association to improve their livelihoods. The history of the initiative, its broader impact on the community and the role played by external facilitation feature in the study.
The Climate and Hydrology of the Upper Blue Nile River
Authors: CONWAY DECLAN
Published: July 2005

The Upper Blue Nile river basin is the largest in Ethiopia in terms of volume of discharge, second largest in terms of area, and contributes over 50 per cent of the long‐term river flow of the Main Nile. This paper provides a review of the nature and variability of the climate and hydrology in the source region of the Blue Nile‐the central Ethiopian Highlands. Annual rainfall over the basin decreases from the south‐west (>2000 mm) to the north‐east (around 1000 mm), with about 70 per cent occurring between June and September. A basin‐wide time series of annual rainfall constructed from 11 gauges for the period 1900 to 1998 has a mean of 1421millimetres, minimum in 1913 (1148 mm) and maximum in 1903 (1757 mm). Rainfall over the basin showed a marked decrease between the mid‐1960s and the late 1980s and dry years show a degree of association with low values of the Southern Oscillation Index (Sol). The October to February dry season in 1997/98 was the wettest on record and responsible for widespread flooding across Ethiopia and also parts of Somalia and Kenya. Available river flow records, which are sparse and of limited duration, are presented for the Blue Nile and its tributaries upstream of the border with Sudan. Runoff over the basin amounts to 45.9 cubic kilometres (equivalent to 1456 m3s−1) discharge, or 261 millimetre depth (1961–1990), a runoff ratio of 18 per cent. Between 1900 and 1997 annual river flow has ranged from 20.6 cubic kilometres (1913) to 79.0 cubic kilometres (1909), and the lowest decade‐mean flow was 37.9 cubic kilometres from 1978 to 1987. Annual river flow, like rainfall, shows a strong association with the SOI
Historical Constraints on Slope Movement Age: a Case Study at Broadway, United Kingdom
Authors: WHITWORTH MALCOLM , MURPHY WILLIAM , GLLES DAVID , PETLEY DAVID
Published: July 2005

The Broadway area of the Cotswolds has been extensively investigated in an attempt to delineate areas of slope instability, including‘relict’landslides, which may have been initiated under periglacial climatic conditions. It is, therefore, useful both in terms of the geomorphology and of the understanding of the evolution of the area, to investigate the rates and timing of any reactivation and subsequent movements of landslides in this area. The remains of ridge and furrow cultivation can be seen extensively throughout the Cotswolds. This particular agricultural practice, which documentary evidence suggests dates back to Anglo‐Saxon times (approximately 10th century AD), has been disturbed in many places by slope movements. A detailed study of Parish Records and other local his‐torical sources has revealed that ridge and furrow cultivation ceased on Parliamentary Enclosure, which in this area, occurred in 1771. Therefore, it is possible to identify patterms of slope movement between these dates. Landslides have been identified by ground mapping and aerial photography, and can be divided into three categories. Firstly, active landslides which are those which have shown evidence of movement during the study period. Secondly, suspended landslides, which show evidence of movement, but have not been observed to move during the study period. In this context, this has been taken to mean landslides, which have shown evidence of movement since 1771. Thirdly, relict landslides which have shown no evidence of movement since 1771 and thus were probably active under a different climatic regime. By incorporating historical data with the geomorphological survey it has been possible to identify areas of potentially difficult ground for engineering geomorphological purposes.
Fishing and Farming at Lake Chad: Responses to Lake‐level Fluctuations
Authors: SARCH MARIE‐THÉRÈSE , BIRKETT CHARON
Published: July 2005

Lake Chad lies at the southern extreme of the Sahara Desert and is well known for large fluctuations in its surface area this century. Seasonal fluctuations, however, have received much less attention. This paper presents the results of two complimentary research efforts on the south‐west shore of the lake. These illustrate how important both inter and intra‐annual fluctuations in the level of the lake are, both in terms of their impact on the environment and in the response of the communities living on the lake shore. The paper compares a time series of the fluctuations in the level of Lake Chad as monitored by the TOPEX/POSEIDON satellite with findings from participatory research with the communities of the south‐west lake shore. It shows how the communities of the lake have responded to lake‐level fluctuations with their livelihood choices. These results are used to show that although vastly different in scope, a high degree of complimentarity exists between remotely‐sensed information and community‐based research and that they are of potentially great value to development initiatives on the shores of Lake Chad.
The Thames Embankment and the disciplining of nature in modernity
Authors: OLIVER STUART
Published: July 2005

The embanking of the Thames was an emblematic stage in the construction of modernity's discourse of ‘the natural’, re‐engineering the river as a concrete framing of nature between the embankment walls and a representational framing of the natural within an engineering ideology. The legitimacy of embanking's control was, therefore, about both physical mechanisms and a particular discourse of the natural, but the Thames embankments did not merely reflect modernity's discourse ‐ they actively helped mould it. The creation of a discourse of embanking was slow and hesitant, the product of the interplay between the subsidiary discourses of urban improvement and sanitarianism, and an opposing discourse of tradition. When built, the embankments acted as a fixed, ordered boundary between the cultured nature of the drained, commodified land, and the regulated liveliness of the river. They acted literally and figuratively to sever culture from a nature that was enclosed and tamed by embankment walls.
Views and Visions of Land Use in the United Kingdom
Authors: ROBERTSON MARGARET , WALFORD REX
Published: July 2005

As part of a national study aimed at surveying the land use and landscape of the United Kingdom, 1287 surveyors recorded their views and visions of one‐kilometre grid squares in which they conducted fieldwork. This study, which took place in 1996, has links to previous national land‐use surveys by L. Dudley Stamp (1950) and Alice Coleman (1976, 1977). Of the total sample, 1037 reports are from the observations of school children. Their views relate to six key questions which have been analysed using qualitative research techniques to identify categories of shared responses. Reported in frequency counts, the results highlight a degree of communality in the perceptions of the majority of young people and adults involved. They show their hopes and dreams for a cleaner and varied landscape in the future with more green space, greater provision for well‐planned low density housing, and recreation facilities. At the same time their expressed concerns for the management of the environment, housing development, green space provision, recreation and leisure activities indicate a disquiet about the future. This apparent pessimism is most notable in the views for urban locations. For rural locations there is a higher expectation that things will remain more‐or‐less the same in 20 years time.
Current shortcomings of global mapping and the creation of a new geographical framework for the world
Authors: RHIND DAVID
Published: July 2005

The vast bulk of topographic mapping ‐ the geographical framework used to underpin many activities of the state and of business ‐ has been created and is maintained to national standards. As a consequence, what is available differs greatly from country to country. Yet there is a range of needs for globally‐consistent map information. Such needs have long been recognized: the International Map of the World was an attempt to meet them. A multiplicity of factors has constrained the National Mapping Organizations from meeting this aim. However, new technologies have enhanced our capacity to create a geographical framework almost anywhere in the world. Using such technologies, commercial and other non‐commercial bodies (e.g. the US military and its counterparts within NATO) have begun to produce wide‐area geographical information. This paper describes the nature of the need for global mapping, the players involved and the drivers and obstacles to progress. It proposes a rapid way to enhance the current situation through public/private sector partnerships based on a combination of skills, information assets and resources. If implemented, this could lead to global coverage of a framework derived from 1:25000 scale mapping within about two years.
Mapping Systems and GIS: A Case Study using the Ghana National Grid
Authors: THOMAS GRAHAM , SANNIER CRISTOPHE A.D. , TAYLOR JOHN C.
Published: July 2005

The problem of incompatible projections and conversion between mapping systems is of general concern to those involved in the collection of natural resources data. The Ghana National Grid (GNG) is an example of a mapping system that is not defined in image processing and GIS software and for which the transformation parameters are not readily available in the literature. Consequently, integrating GNG topographic map data within a GIS with data derived from other sources can be problematic. In this paper a practical solution for deriving the required transformation parameters to convert from the World Geodetic System of 1984 (WGS84) to the GNG system is demonstrated. The method uses a single geodetic control point, available 1:50 000 topographic maps and a SPOT satellite panchromatic image geo‐referenced to GNG. The resultant parameters are applied to road survey data in Universal Transverse Mercator (UTM) format for overlay with the SPOT image. Despite the approximations made in applying the method, when compared against official estimates of the datum transformation parameters, this relatively simple procedure resulted in estimates that appear acceptable in regard to combining data sets at a nominal scale of 1:50000.
A disappearing biome? Reconsidering land‐cover change in the Brazilian savanna
Authors: JEPSON WENDY
Published: July 2005

The Cerrado, the tropical savanna covering 22% of Brazil's territory, or approximately 1.783 million km2, has suffered significant human impacts during the past three decades. This paper re‐examines estimates of Cerrado vegetation change dynamics using high‐resolution satellite remote sensing data from an area of interest extracted from eastern Mato Grosso State. This region has undergone a high degree of typical agricultural development since the early 1970s. Results indicate significant loss of original vegetation as well as high levels of regeneration, suggesting Cerrado vegetation may be more resilient to human impacts than catastrophic estimations suggest. The paper concludes with a critical review of Cerrado land‐cover change studies and the implications of evidence for vegetation regeneration, land‐cover dynamism and land‐use intensification, paying particular attention to spatial scale and research methods. The discussion concludes that Cerrado land‐cover change studied at a higher resolution and larger scales (smaller area) is required to represent more effectively the complexity of land conversion for better assessment of human impacts and environmental policy.
The Effects of Price Competition and Reduced Subsidies for Uncompensated Care on Hospital Mortality
Authors: Volpp Kevin G. M. , Ketcham Jonathan D. , Epstein Andrew J. , Williams Sankey V.
Published: July 2005

Objective. To determine whether hospital mortality rates changed in New Jersey after implementation of a law that changed hospital payment from a regulated system based on hospital cost to price competition with reduced subsidies for uncompensated care and whether changes in mortality rates were affected by hospital market conditions.

Data Sources/Study Setting. State discharge data for New Jersey and New York from 1990 to 1996.

Study Design. We used an interrupted time series design to compare risk‐adjusted in‐hospital mortality rates between states over time. We compared the effect sizes in markets with different levels of health maintenance organization penetration and hospital market concentration and tested the sensitivity of our results to different approaches to defining hospital markets.

Data Collection/Extraction Methods. The study sample included all patients under age 65 admitted to New Jersey or New York hospitals with stroke, hip fracture, pneumonia, pulmonary embolism, congestive heart failure, hip fracture, or acute myocardial infarction (AMI).

Principal Findings. Mortality among patients in New Jersey improved less than in New York by 0.4 percentage points among the insured (p=.07) and 0.5 percentage points among the uninsured (p=.37). There was a relative increase in mortality for patients with AMI, congestive heart failure, and stroke, especially for uninsured patients with these conditions, but not for patients with the other four conditions we studied. Less competitive hospital markets were significantly associated with a relative decrease in mortality among insured patients.

Conclusions. Market‐based reforms may adversely affect mortality for some conditions but it appears the effects are not universal. Insured patients in less competitive markets fared better in the transition to price competition.
Neighborhood Effects on Posthospitalization Mortality: A Population‐based Cohort Study of the Elderly in Chicago
Authors: Wen Ming , Christakis Nicholas A.
Published: July 2005

Context. Place of residence is associated with health outcomes.

Objective. To examine neighborhood effects on mortality after the onset of serious disease and to assess whether these effects vary for different sociodemographic or diagnostic subgroups.

Design, Setting, Patients. Our sample consists of a complete cohort of 10,557 elderly Medicare beneficiaries throughout the city of Chicago newly diagnosed and hospitalized for the first time with one of five common serious diseases in 1993 (stroke, myocardial infarction, congestive heart failure, hip fracture, and lung cancer) followed until 1999. Attributes of 51 zip code neighborhoods were obtained both from census data (1990) and from a comprehensive social survey of neighborhood residents (1994–1995). Cox proportional hazards models with robust standard errors were specified.

Main Outcome Measure. Survival after hospitalization.

Results. People who lived in neighborhoods with higher socioeconomic status (SES) or with a better social environment had significantly longer survival after disease onset. We evaluated the differential impact of neighborhood attributes on survival depending on gender, race, and poverty using interaction terms. Only the interaction terms between neighborhood social‐structural factors and individual poverty were significant, suggesting that neighborhood SES and social environment were especially helpful for people with higher income. Neighborhood attributes did not differ in their impact depending on the race or sex of the subjects. Analyses of cause‐specific mortality showed that myocardial infarction was the primary force driving the associations between neighborhood attributes and mortality.

Conclusions. Where people live matters with respect to posthospitalization mortality, but how neighborhoods affect this outcome depends on individual demographic and diagnostic characteristics. Myocardial infarction in particular may be a “neighborhood sensitive” condition. Individuals' health may depend not just on individuals' characteristics but also on their neighborhoods'.
New York's Statistical Model Accurately Predicts Mortality Risk for Veterans Who Obtain Private Sector CABG
Authors: Weeks William B. , Bazos Dorothy A. , Bott David M. , Lombardo Rosemary , Racz Michael J. , Hannan Edward L. , Fisher Elliott S.
Published: July 2005

Objective.To determine whether patients' use of the Veterans Health Administration health care system (VHA) is an independent risk factor for mortality following coronary artery bypass grafting (CABG) in the private sector in New York.

Data Sources.VHA administrative and New York Department of Health Cardiac Surgery Reporting System (CSRS) databases for surgeries performed in 1999 and 2000.

Study Design.Prospective cohort study comparing observed, expected, and risk‐adjusted mortality rates following private sector CABG for 2,326 male New York State residents aged 45 years and older who used the VHA (VHA users) and 21,607 who did not (non‐VHA users).

Data Collection Methods.We linked VHA administrative databases to New York's CSRS to identify VHA users who obtained CABG in the private sector in New York in 1999 and 2000. Using CSRS risk factors and previously validated risk‐adjustment model, we compared patient characteristics and expected and risk‐adjusted mortality rates of VHA users to non‐VHA users.

Principal Findings.Compared with non‐VHA users, patients undergoing private sector CABG who had used the VHA were older, had more severe cardiac disease, and were more likely to have the following comorbidities associated with increased risk of mortality: diabetes, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, and history of stroke (p<.001 for all); a calcified aorta (p=.009); and a high creatinine level (p=.003). Observed (2.28 versus 1.80 percent) and expected (2.48 versus 1.78 percent) mortality rates were higher for VHA users than for non‐VHA users. The risk‐adjusted mortality rate for VHA users (1.70 percent; 95 percent confidence interval [CI]: 1.27–2.22) was not statistically different than that for the non‐VHA users (1.87 percent; 95 percent CI: 1.69–2.06). Use of the VHA was not an independent risk factor for mortality in the risk‐adjustment model.

Conclusions.Although VHA users had a greater illness burden, use of the VHA was not found to be an independent risk factor for mortality following private sector CABG in New York. The New York Department of Health risk adjustment model adequately applies to veterans who obtain CABG in the private sector in New York.
Predicting Mortality and Healthcare Utilization with a Single Question
Authors: DeSalvo Karen B. , Fan Vincent S. , McDonell Mary B. , Fihn Stephan D.
Published: July 2005

Objective. We compared single‐ and multi‐item measures of general self‐rated health (GSRH) to predict mortality and clinical events a large population of veteran patients.

Data Source/Study Setting. We analyzed prospective cohort data collected from 21,732 patients as part of the Veterans Affairs Ambulatory Care Quality Improvement Project (ACQUIP), a randomized controlled trial investigating quality‐of‐care interventions.

Study Design. We created an age‐adjusted, logistic regression model for each predictor and outcome combination, and estimated the odds of events by response category of the GSRH question and compared the discriminative ability of the predictors by developing receiver operator characteristic curves and comparing the associated area under the curve (AUC)/c‐statistic for the single‐ and multi‐item measures.

Data Collection/Extraction Methods. All patients were sent a baseline assessment that included a multi‐item measure of general health, the 36‐item Medical Outcomes Study Short Form (SF‐36), and an inventory of comorbid conditions. We compared the predictive and discriminative ability of the GSRH to the SF‐36 physical component score (PCS), the mental component score (MCS), and the Seattle index of comorbidity (SIC). The GSRH is an item included in the SF‐36, with the wording: “In general, would you say your health is: Excellent, Very Good, Good, Fair, Poor?”

Principal Findings. The GSRH, PCS, and SIC had comparable AUC for predicting mortality (AUC 0.74, 0.73, and 0.73, respectively); hospitalization (AUC 0.63, 0.64, and 0.60, respectively); and high outpatient use (AUC 0.61, 0.61, and 0.60, respectively). The MCS had statistically poorer discriminatory performance for mortality and hospitalization than any other other predictors (p<.001).

Conclusions. The GSRH response categories can be used to stratify patients with varying risks for adverse outcomes. Patients reporting “poor” health are at significantly greater odds of dying or requiring health care resources compared with their peers. The GSRH, collectable at the point of care, is comparable with longer instruments.
The Effect of Expanded Mental Health Benefits on Treatment Initiation and Specialist Utilization
Authors: Lindrooth Richard C. , Lo Sasso Anthony T. , Lurie Ithai Z.
Published: July 2005

Objective. To measure the effects of a mental health benefit design change on treatment initiation for psychiatric disorders of employees of a large U.S.‐based company.

Data Sources. Mental health treatment administrative claims data plus eligibility information provided by the company for the years 1995–1998.

Study Design. We measure the effect of a change in mental health benefits consisting of three major elements: a company‐wide effort to destigmatize mental illness; reduced copayments for mental health treatment; and an effort to increase access to specialty mental health providers.

Data Extraction Methods. We identified the subsample of employees that were continuously enrolled in the company's health plan over the period 1995–1998, were between the ages of 18 and 65, and were actively employed.

Principal Findings. Our results suggest that the combined effect of destigmatization and reduced copayments led to an 18 percent increase (p<.01) in the probability of initiating mental health treatment. The results suggest that the effort to increase access to specialty providers was effective, but only for nonphysician providers: initiation at nonphysician mental health providers increased nearly 90 percent (p<.01) relative to nonspecialty providers, while use of psychiatrists declined by nearly 40 percent (p<.01).

Conclusions. Our results suggest that the benefit change increased initiation for mental health treatment overall and encouraged the use of nonphysician specialty mental health providers.
Lower incidence of hepatic failure than hepatocellular carcinoma in Japanese patients with chronic Hepatitis C
Authors: Imazeki Fumio , Yokosuka Osamu , Fukai Kenichi , Kawai Shigenobu , Kanda Tatsuo , Kojima Hiroshige , Saisho Hiromitsu
Published: July 2005

Abstract: Background: Previous studies have shown that the development of hepatic failure was found more frequently than that of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C in the United States and European countries. We investigated the status in Japan in a retrospective cohort study.

Methods: The incidences of HCC and hepatic failure were accessed in 459 patients with biopsy‐proven C‐viral chronic liver disease with a mean follow‐up period of 8.9±3.2 years and the cause of death was also analyzed in the cohort.

Results: HCC developed in 63 patients, 46 of 355 interferon (IFN)‐treated and 17 of 104 untreated patients. In contrast, the development of hepatic failure was found in 18 patients, 12 of 355 IFN‐treated and six of 104 untreated patients. HCC developed in four of 116 with sustained virological response (SVR), and hepatic failure developed in one of them. Thirty‐two of 63 patients developing HCC and eight of 18 patients developing hepatic failure died.

Conclusions: Development of hepatic failure was less frequent than that of HCC in Japan. It is important for a favorable prognosis of patients with C viral chronic liver disease to achieve a higher SVR and thus inhibit the development of HCC in Japan.
Hyaluronic acid, an accurate serum marker for severe hepatic fibrosis in patients with non‐alcoholic fatty liver disease
Authors: Suzuki Ayako , Angulo Paul , Lymp James , Li Dave , Satomura Shinji , Lindor Keith
Published: July 2005

Abstract: Aim: To determine whether serum hyaluronic acid reliably predicts the severity of hepatic fibrosis in patients with non‐alcoholic fatty liver disease (NAFLD).

Methods: We studied 79 patients with histologically confirmed NAFLD. Hyaluronic acid was measured in serum obtained at the time of liver biopsy. Severity of fibrosis was staged based on Brunt's classification. The prediction levels for fibrosis were determined by area under the receiver operating characteristic curve (AUC).

Results: The logarithm of serum hyaluronic acid was significantly different among the stages of fibrosis (P<0.0001, analysis of variance) and had a significant positive correlation with the degrees of fibrosis after adjusting for age and serum albumin (partial r=0.44, P<0.0001). AUCs were 0.67, 0.87, 0.89, and 0.92 for any levels of fibrosis, ≥moderate fibrosis, ≥severe fibrosis, and cirrhosis, all of which were significantly higher than 0.5 (P<0.05). The cut‐off value of serum hyaluronic acid of 46.1 μg/l was associated with the highest AUC for severe fibrosis, yielding a sensitivity of 85% and a specificity of 80%. The corresponding positive and negative predictive values were 51% and 96%, when assuming prevalence of severe fibrosis in NAFLD patients of 20% at referral centers.

Conclusions: Measurement of serum hyaluronic acid is useful to identify NAFLD patients with severe fibrosis.
Correlation of nitric oxide and atrial natriuretic peptide changes with altered cGMP homeostasis in liver cirrhosis
Authors: Montoliu Carmina , Kosenko Elena , Del Olmo Juan A. , Serra Miguel A. , Rodrigo José M. , Felipo Vicente
Published: July 2005

Background: Cyclic GMP (cGMP) concentration is increased in plasma of patients with liver cirrhosis. Three possible mechanisms may contribute: increased cGMP synthesis by soluble (activated by nitric oxide), or particulate (activated by atrial natriuretic peptide (ANP)) guanylate cyclase or increased release from cells.

Aim: The aim of this work was to analyze the possible contributors to increased plasma cGMP and to assess whether changes in the parameters of the system vary with the degree of liver disease (Child Pugh score) or by the presence of ascites.

Methods: We measured cGMP in plasma and lymphocytes, soluble guanylate cyclase activation by nitric oxide in lymphocytes, nitrates and nitrites and ANPs (activator of particulate guanylate cyclase) in plasma. We analyzed the correlation between changes in different parameters to discern which parameters contribute to increased plasma cGMP.

Results: The plasma content of nitrates+nitrites, ANP and cGMP are increased. Activation of soluble guanylate cyclase by nitric oxide is increased in patients while basal cGMP in lymphocytes is decreased.

Conclusions: Both increased ANP and increased activation of soluble guanylate cyclase by nitric oxide contribute to increased plasma cGMP in patients. The concentrations of ANP and cGMP in plasma increase with the degree of disease and are higher in patients with ascites.
Zonation of alanine metabolism in the bivascularly perfused rat liver
Authors: Botini Fernanda Fonseca , Suzuki‐Kemmelmeier Fumie , Nascimento Écio Alves , Ide Luci Tiemi , Bracht Adelar
Published: July 2005

Abstract: Aims/Background: Zonation of alanine metabolism was investigated in the bivascularly perfused rat liver, a technique in which a selective area of the periportal region can be reached via the hepatic artery.

Methods: Bivascular liver perfusion was done in both the antegrade and retrograde modes. Predominance of a given metabolic parameter in the periportal or perivenous area was deduced from comparisons of the changes caused by alanine infusion into the hepatic artery in antegrade and retrograde perfusion.

Results: Confirming previous notions, glutamine synthesis predominated in the perivenous area, however, the contribution of the periportal area was significant. Gluconeogenesis and the associated extra oxygen consumption were more pronounced in the periportal region. The capacity of urea synthesis in the periportal region was relatively small as indicated by the ratios of urea to glucose production, which were lower in this region. Ammonia in the periportal region was considerably above the mean ammonia production of whole the liver parenchyma. The overflows of pyruvate and lactate were considerably smaller in the periportal region.

Conclusion: The distribution of alanine metabolism seems to reflect mainly zonation of the fates of the carbon skeleton (mainly gluconeogenesis). The production of glutamine in the periportal area is in agreement with recent reports about the presence of glutamine synthetase in Kupffer and endothelial cells.
Mechanism of protective action of bicyclol against CCl4‐induced liver injury in mice
Authors: Liu Geng Tao , Li Yan , Wei Huai Ling , Zhang Hui , Xu Ji Yan , Yu Ling Hong
Published: July 2005

Abstract: Bicyclol is a novel synthetic drug for the treatment of chronic viral hepatitis in China. This paper reports the protective action of bicyclol against experimental liver injury in mice and its mechanism of action. Oral administration of bicyclol markedly reduced the elevated serum transaminases (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)) and the hepatic morphologic changes induced by CCl4 in mice. Mechanistic studies demonstrated that bicyclol significantly inhibited CCl4‐induced lipid peroxidation of liver microsomes and 14CCl4 covalent binding to microsomal lipids and proteins in vitro, and decreased the level of the trichloromethyl free radical (•CCl3) generated from CCl4 metabolism by NADPH‐reduced liver microsomes. On the other hand, bicyclol neither directly inhibited the activity of ALT or AST in vitro nor affected hepatic ALT protein content in mice. These results suggest that bicyclol has remarkable hepatoprotective effects and its mechanism of action may be related to a decrease in free radical‐induced damage to hepatocytes.
Increased expression of uncoupling protein 2 in HepG2 cells attenuates oxidative damage and apoptosis
Authors: Collins Peter , Jones Catherine , Choudhury Sarah , Damelin Leonard , Hodgson Humphrey
Published: July 2005

Abstract: Introduction: Oxidative damage plays a major part in the pathogenesis of liver disease. Uncoupling proteins (UCPs) may be able to limit the generation of reactive oxygen species (ROS) and be cytoprotective.

Methods: We investigated the effect of up‐regulation of UCP2 in a hepatoblastoma cell line exposed to menadione or hypoxia/re‐oxygenation.

Results: Lipid and protein oxidation was increased in HepG2 cells exposed to ROS but this increase was significantly lower in cells over‐expressing UCP2 under identical conditions. LDH release increased 2.5‐fold in response to hypoxia/re‐oxygenation in control HepG2 cells with no significant increase in UCP2 transfected cells. Hypoxia/re‐oxygenation resulted in a reduction in liver‐specific protein secretion that was attenuated in transfected cells and UCP2 over‐expression also resulted in a 66% reduction in apoptosis compared with non‐transfected controls.

Conclusions: These data suggest that UCP2 can limit oxidative damage in HepG2 cells in response to oxidative stress resulting in improved cell function and resistance to apoptosis.