bluuebunny/crossref_metadata_2025 huggingface dataset:
The Spiritual Rule
Authors: Marques Joan F.
Published: September 2008

Purpose

The purpose of this paper is to review the phenomenon of moral principles as they have been adopted over time. The paper specifically reviews the Golden Rule, and the subsequently formulated Platinum Rule. While the value of both these rules is underscored, the paper also reviews their weaknesses in light of our new millennium awareness of increased globality and ensuing interconnectedness. The paper makes a statement that even moral principles that have been around for centuries, may have to be reevaluated in light of changed circumstances, and conclusively presents “The Spiritual Rule,” a principle that eliminates the risk of excessive arbitrariness, and calls for consideration of all life on earth in every decision we make.

Design/methodology/approach

This paper is a conceptual paper, reflecting on two existing principles that influence the way human beings, and therefore managers as well, make their decisions in general. The author first briefly reviews both principles (or “rules”), subsequently analyzes their weaknesses in light of contemporary developments, and ultimately introduces a new principle, the spiritual rule, thereby drawing on supporting statements various researchers and authors with in‐depth consideration of modern days' developments in human interaction.

Findings

When one wants to engage in “good business” in these and future days, one can no longer merely focus on a one‐on‐one perspective, or limit ourselves to the stakes of only two parties. There are greater interests at stake and there are larger groups of people involved in our decisions. Individualism has proven its merit, but so has collectivism. The awareness that is dawning upon us these days is that no extreme is of lasting benefit to all of us. A well‐considered blend of various strategies, resulting from openness to other ways of thinking, is the enlightened behavioral paradigm in and outside of the workplace.

Practical implications

There are many complicated theories out there about how leaders should make their decisions. However, what works best is a simple guideline that can be used in all situations and environments and that is based on the realization that human beings are first and foremost interconnected spiritual entities. This paper addresses this need and identifies the important practical considerations that leaders will need to include in their decisions.

Originality/value

The paper's unique contribution is to offer a moral principle that incorporates the spiritual dimension in every area of decision‐making. The three considerations presented in this paper, reduction of selfish reflections, reduction of unjust assessments of other's wishes, and reduction of harm to the welfare of our planet, are on target with the trends toward global interconnectedness and encourage leaders to consider the value of implementing and maintaining the spiritual rule.
From smart and corporate to urban and edgy
Authors: Burke Maria
Published: September 2008

Purpose

This paper aims to address issues surrounding the revitalising of organisations in turbulent environments.

Design/methodology/approach

The paper contains a discussion of relevant issues and presentation of research which considers how leaders today are choosing to function in a very uncertain environment, that of higher education.

Findings

The characteristics of urban and edgy organisations were all found to be evident in the leaders style in higher education. However, it was identified that this type of leadership rests on two critical axis–Knowledge management (shared and open) and the overarching style of leadership (empowerment and encouragement).

Research limitations/implications

This work is introductory and used a small sample as a pilot–further more extensive work is needed in this area.

Practical implications

This paper has introduced the idea of a new label for organisations which find themselves to be so full of diversity and differences that they can be characterised as being “on the edge” of danger–yet these organisations have found a way to be something which is separate from that of the urban character–important, flexible, dynamic, and playing a central role in development of new ideas.

Originality/value

The contribution made to the discipline of leadership is the introduction of a new way of looking at organisation–the work offers new ways of looking at established ideas, through new lenses which may assist leaders and all who work in large organisations.
Integration and knowledge sharing: transforming to long‐term competitive advantage
Authors: Lin Ming‐Ji James , Chen Chih‐Jou
Published: September 2008

Purpose

The purpose of the study is to examine the influence of internal integration and external integration on three types of shared knowledge (shared knowledge of internal capabilities, customers, and suppliers) and whether more leads to superior firm innovation capability and product competitive advantage.

Design/methodology/approach

The paper draws on results from a large‐scale survey. The empirical data used in the study comprises of 245 high technology firms in Taiwan. This study applies the confirmatory factor analysis to examine the reliability and validity of the measurement model, and the structural equation modeling (SEM) to investigate the hypotheses and research model.

Findings

The results show that internal integration and external integration significantly influence shared knowledge of internal capabilities, customers and suppliers among new product development (NPD) team members. The results also indicate that team members' shared knowledge enable the firm to improve innovation capability and new product competitive advantage.

Research limitations/implications

As the data used in the study was cross‐sectional, the causal relationships and the sustainability of firm and product innovative performance cannot be easily captured. Future research can examine how factors of individual traits, organizational characteristics, and external environmental factors may influence the shared knowledge and product competitive advantage.

Practical implications

This study emphasizes the importance of the firm's integration to utilize and share knowledge of internal capabilities, customers and suppliers effectively. Besides, the relationships among internal/external integration, shared knowledge, firm innovation capability and product competitive advantage may provide a clue regarding how firms can manage integrations and promote knowledge‐sharing culture to sustain their firm innovation capability and product competitive advantage.

Originality/value

As only little empirical research has been conducted on the impact of internal/external integration on the firm's innovative capability and product competitive advantage through shared knowledge, the empirical evidence reported here makes a valuable contribution in this highly important area.
The managing director and the development of dynamic capabilities
Authors: Schlemmer Frank , Webb Brian
Published: September 2008

Purpose

This research aims at examining the role of the managing director in the development of dynamic capabilities at SMEs.

Design/methodology/approach

The paper used a mixed‐methods approach and conducted case studies at 13 SMEs. The primary sources of data were semi‐structured interviews, which were supplemented by quantitative data from a postal survey and content analysis of the companies' websites.

Findings

The paper suggests that managing directors “enact” in the development of dynamic capabilities, if they believe that dynamic capabilities are a source of competitive advantage. If they do not appreciate the importance of dynamic capabilities they can get trapped in a vicious circle.

Research limitations/implications

This research focuses especially on small firms, and it is unlikely that the findings can be applied to large firms.

Practical implications

The key managerial implication is the threat of a vicious circle if the development of dynamic capabilities is neglected.

Originality/value

This paper draws the dynamic capabilities framework and the enactment concept together, suggesting that managerial decisions and behavior affect dynamic capabilities at an organizational level, which then drives firm performance.
Asymmetry, heterogeneity and inter‐firm relationships
Authors: Papadopoulos Andrew , Cimon Yan , Hébert Louis
Published: September 2008

Purpose

The purpose of this paper is to organize the theoretical landscape surrounding explanations of the impact asymmetry and heterogeneity on inter‐firm relationships, especially alliances.

Design/methodology/approach

A conceptual framework integrating the resource‐based view, transaction cost economics and industrial organization is put forth to better understand asymmetry and heterogeneity in alliances.

Findings

It is argued that low asymmetry and low heterogeneity are best addressed from an industrial organization perspective. Transaction cost economics best explains alliances in high asymmetry and low heterogeneity situations while the resource‐based view is most appropriate for high heterogeneity and low asymmetry alliances. In the case of high asymmetry and high heterogeneity, the tension between the resource‐based view and transaction costs economics is reconciled.

Research limitations/implications

Researchers gain an original re‐framing of the theoretical landscape that will assist in generating new insights for future theory development.

Practical implications

The paper lays the ground for new research directions while leaving practitioners with a better understanding of the lenses through which they should examine their firms' cooperative endeavours.

Originality/value

Previous literature seldom addressed the categorization of various theoretical approaches along the notions of asymmetry and heterogeneity in inter‐firm relationships.
Identification of prognostic biomarkers in gastric cancer using endoscopic biopsy samples
Authors: Yamada Yasuhide , Arao Tokuzo , Gotoda Takuji , Taniguchi Hirokazu , Oda Ichiro , Shirao Kuniaki , Shimada Yasuhiro , Hamaguchi Tetsuya , Kato Ken , Hamano Tetsutaro , Koizumi Fumiaki , Tamura Tomohide , Saito Daizo , Shimoda Tadakazu , Saka Makoto , Fukagawa Takeo , Katai Hitoshi , Sano Takeshi , Sasako Mitsuru , Nishio Kazuto
Published: September 2008

Endoscopic biopsy prior to chemotherapy provides an opportunity for studying biomarkers to predict the overall survival in gastric cancer patients. This prospective study was performed to identify prognostic biomarkers in patients with unresected gastric cancer. Fifty‐nine cases of chemotherapy‐naive metastatic gastric cancer were enrolled in this study. A microarray analysis was performed using 40 biopsy samples to identify candidate genes whose expressions might be correlated with the overall survival. After adjusting for clinical covariates based on a multivariate analysis, the identified genes were validated using real‐time reverse transcription polymerase chain reaction (RT‐PCR) analysis in 19 independent validation samples. Ninety‐eight candidate genes whose expression levels were significantly correlated with the overall survival were identified using a microarray analysis based on a proportional hazards model (P < 0.005). Multivariate analysis was performed to assess 10 of these genes, and the results yielded a statistical significance level for DACH1 and PDCD6. We further evaluated these two genes in independent samples using real‐time RT‐PCR and found that lower mRNA expression levels of PDCD6 were correlated significantly with a poor overall survival. We identified PDCD6 as a prognostic biomarker in patients with unresected gastric cancer using endoscopic biopsy samples. Our PCR‐based single gene prediction strategy successfully predicted the overall survival and may lead to a better understanding of this disease subgroup. (Cancer Sci 2008; 99: 2193–2199)
Competitor‐free space mediates non‐target impact of an introduced biological control agent
Authors: MESSING RUSSELL H. , WANG XIN‐GENG
Published: September 2008

Abstract 1. Enemy‐free space has been shown to mediate host shifts in herbivores, but this has not previously been documented in parasitoids. Also, natural enemies shown to maintain host shifts have always been from higher trophic levels, rather than competitors.

2. In Hawaii, an Australian parasitoid (Diachasmimorpha tryoni) of medflies that loses competition contests to a subsequently introduced Asian parasitoid (Fopius arisanus) has shifted its realised host range to attack non‐target gall flies on lantana.

3. The present study demonstrates experimentally that D. tryoni reproduction is: (i) lower on medflies in coffee when F. arisanus is present than when it is absent; (ii) higher in gall flies on lantana than on medflies in coffee, when F. arisanus is present; and (iii) higher in medflies on coffee than in gall flies on lantana, when F. arisanus is absent. This meets Berdegue et al.’s (Ecological Entomology, 21, 203–217, 1996) three conditions to confirm the importance of enemy‐free space.

4. In the field, F. arisanus is abundant on medflies, whereas D. tryoni is rare on medflies, but is the dominant parasitoid of lantana gall flies.

5. Competitor‐free space is thus shown to be a key mechanism maintaining an apparent host shift by an introduced biocontrol agent onto a non‐target species.
Prevention of arthropathy in haemophilia – intensive on‐demand treatment, UK perspective
Authors: LEE C. A.
Published: September 2008

Summary.  In the past, there were only minimal studies aimed at establishing the dose of concentrate required for treating an acute joint bleed in patients without inhibitors. The cost of treatment with bypassing agents consumes huge economic resources and therefore it is important to have rigorous studies to establish rational dosing. Both the FEIBA NovoSeven Comparative study and the comparative dosing study have been bold attempts to clarify treatment regimens for managing joint bleeds in patients with inhibitors. As a very challenging situation in which to conduct research, it is important that such endeavour continues.
Prevention of arthropathy: may it be extrapolated from patients without inhibitors to patients with inhibitors?
Authors: HEDNER U.
Published: September 2008

Summary.  Although no consensus on the exact dosing schedule of prophylaxis in non‐inhibitor haemophilia patients has been achieved, regular administration of factor VIII (FVIII) or factor IX (FIX) concentrates is currently accepted as the most effective treatment model in order to prevent sick days, hospital stays and the development of arthropathy in patients with severe haemophilia. The basis for prophylaxis has been the idea to increase the plasma levels of FVIII or FIX above 1% thereby improving the haemostasis in severe haemophilia. Current treatment in haemophilia patients with inhibitors includes the use of activated prothrombin complex concentrates and recombinant FVIIa (rFVIIa). Regular administration of such agents has recently repeatedly been reported to decrease the number of joint and muscle bleeds in these patients. Regarding rFVIIa, such an effect was confirmed in a controlled study published in 2007. Although the exact mechanism of action of rFVIIa in this setting is still not clear, it seems reasonable to assume that prophylaxis with rFVIIa will be able to prevent or minimize the development of haemophilic arthropathy. As arthropathy is a long‐term complication in haemophilia and the result of repeated joint bleeds, a longer follow‐up of patients on regular prophylaxis including measurements of the joint scores, as has been performed in FVIII/FIX prophylaxis in non‐inhibitor patients, will be required for a definite conclusion.
Climate change drives speciation in the southern rock agama (Agama atra) in the Cape Floristic Region, South Africa
Authors: Swart Belinda L. , Tolley Krystal A. , Matthee Conrad A.
Published: September 2008

Aim  Vicariance has played a major role in the evolution of the southern rock agama, Agama atra (Reptilia: Agamidae), and it is hypothesized that habitat shifts will affect small‐scale patterns of gene flow. The Cape Floristic Region (CFR) is known for high levels of diversity and endemism; thus we set out to investigate whether genetic structuring of CFR populations of A. atra corresponds to regional environmental shifts.

Location  Cape Fold Mountains and the Cape Floristic Region of South Africa.

Methods  The phylogeographical structure of 116 individuals of A. atra was determined by making use of 988 characters derived from two mitochondrial DNA fragments (control region and the NADH dehydrogenase subunit 2 coding region, ND2). Most animals originated from the CFR, but to gain a better understanding of the processes and patterns of dispersal within the species, 17 additional specimens from outside the CFR were also included and analysed in a phylogenetic context.

Results  Parsimony and Bayesian analyses revealed four distinct CFR clades (Cape clades) associated with geography. Phylogenetic analyses suggest that populations of A. atra in the CFR region are not entirely isolated from other populations, because some individuals from outside the CFR were nested within the four main Cape clades. The combined mitochondrial DNA data set revealed 59 distinct haplotypes in the CFR. Analysis of molecular variance (amova) confirmed the high degree of genetic structure among the Cape clades, with more than 75% of the genetic variation found among the geographical areas. A spatial amova suggested that a ‘central clade’ originally defined as one of the four Cape clades may contain several additional populations. The main cladogenesis of A. atra within the CFR is estimated to have taken place c. 0.64–2.36 Ma.

Main conclusions  Agama atra shows at least four distinct genetic provinces within the CFR region, which highlights the conservation importance of this biologically diverse area. The dates of separation among the clades coincide well with the documented Pleistocene climate fluctuations, which might have contributed towards the isolation among lineages; the congruent genetic structure of A. atra with other CFR taxa further supports vicariance as a main isolating factor.
The Five Dimensions of Pay Satisfaction in a Maquiladora Plant in Mexico
Authors: García María Fernanda , Posthuma Richard A. , Mumford Troy , Quiñones Manuel
Published: September 2008

We examined the dimensionality of pay satisfaction using a Spanish language questionnaire and a sample of 236 maquiladora workers in Mexico. A confirmatory factor analysis indicated that a five‐factor solution has the best fit compared to alternative models. Thus, blue‐collar Mexican workers were able to distinguish five distinct facets of pay satisfaction: pay level, pay raises, benefits, pay structure/administration, and bonuses. This study replicates the five‐factor structure of pay satisfaction in a Spanish‐speaking sample of production workers in a maquiladora plant in Mexico.

Nous avons examiné la satisfaction relative au salaire en utilisant un questionnaire en langue espagnole sur un échantillon de 236 travailleurs d’une industrie maquiladora au Mexique. Une analyse factorielle confirmatoire a indiqué qu’une solution à cinq facteurs semble être le meilleur ajustement comparé aux alternatives possibles. Ainsi, les cols bleus mexicains sont capables de distinguer cing facettes de satisfaction relative au salaire: le niveau de salaire, son augmentation, sa gestion/son administration et les primes. Cette étude reproduit la structure en cinq facteurs de la satisfaction relative au salaire sur un échantillon hispanophone de travailleurs à la production d’une usine maquiladora au Mexique.
Physically‐based Dye Advection for Flow Visualization
Authors: Li Guo‐Shi , Tricoche Xavier , Hansen Charles
Published: September 2008

Dye advection is widely used in experimental flow analysis but has seen less use for visualization in computational fluid dynamics. One possible reason for this disconnect is the inaccuracy of the texture‐based approach, which is prone to artifacts caused by numeric diffusion and mass fluctuation. In this paper, we introduce a novel 2D dye advection scheme for flow visualization based on the concept of control volume analysis typically used in computational fluid dynamics. The evolution of dye patterns in the flow field is achieved by advecting individual control volumes, which collectively cover the entire spatial domain. The local variation of dye material, represented as a piecewise quasi‐parabolic function, is integrated within each control volume resulting in mass conserving transport without excessive numerical diffusion. Due to its physically based formulation, this approach is capable of conveying intricate flow structures not shown in the traditional dye advection schemes while avoiding visual artifacts.
TimeRadarTrees: Visualizing Dynamic Compound Digraphs
Authors: Burch M. , Diehl S.
Published: September 2008

The evolution of dependencies in information hierarchies can be modeled by sequences of compound digraphs with edge weights. In this paper we present a novel approach to visualize such sequences of graphs. It uses radial tree layout to draw the hierarchy, and circle sectors to represent the temporal change of edges in the digraphs. We have developed several interaction techniques that allow the users to explore the structural and temporal data. Smooth animations help them to track the transitions between views. The usefulness of the approach is illustrated by examples from very different application domains.
G2 Tensor Product Splines over Extraordinary Vertices
Authors: Loop Charles , Schaefer Scott
Published: September 2008

We present a second order smooth filling of an n‐valent Catmull‐Clark spline ring with n biseptic patches. While an underdetermined biseptic solution to this problem has appeared previously, we make several advances in this paper. Most notably, we cast the problem as a constrained minimization and introduce a novel quadratic energy functional whose absolute minimum of zero is achieved for bicubic polynomials. This means that for the regular 4‐valent case, we reproduce the bicubic B‐splines. In other cases, the resulting surfaces are aesthetically well behaved. We extend our constrained minimization framework to handle the case of input mesh with boundary.
DIAGNOSING FROUDE'S DISEASE: BOUNDARY WORK AND THE DISCIPLINE OF HISTORY IN LATE‐VICTORIAN BRITAIN
Authors: HESKETH IAN
Published: September 2008

Historians looking to make history a professional discipline of study in Victorian Britain believed they had to establish firm boundaries demarcating history from other literary disciplines. James Anthony Froude ignored such boundaries. The popularity of his historical narratives was a constant reminder of the continued existence of a supposedly overturned phase of historiography in which the historian was also a man of letters, transcending the boundary separating fact from fiction and literature from history. Just as professionalizing historians were constructing a methodology that called on historians to be inductive empirical workers, Froude refused to accept the new science of history, and suggested instead that history was an individual enterprise, one more concerned with drama and art than with science. E. A. Freeman warned the historical community that they “cannot welcome [Froude] as a partner in their labors, as a fellow‐worker in the cause of historic truth.”

This article examines the boundary work of a professionalizing history by considering the attempt to exclude Froude from the historian's discourse, an attempt that involved a communal campaign that sought to represent Froude as “constitutionally inaccurate.” Froude suffered from “an inborn and incurable twist,” argued Freeman, thereby diagnosing “Froude's disease” as the inability to “make an accurate statement about any matter.” By unpacking the construction of “Froude's disease,” the article exposes the disciplinary techniques at work in the professionalization of history, techniques that sought to exclude non‐scientific modes of thought such as that offered by Froude.
Neurophysiologic abnormalities in children with Charcot‐Marie‐Tooth disease type 1A
Authors: Yiu Eppie M. , Burns Joshua , Ryan Monique M. , Ouvrier Robert A.
Published: September 2008

Abstract  Although Charcot‐Marie‐Tooth disease type 1A (CMT1A) initially manifests in the first decade, there are no large studies describing its neurophysiologic features in childhood. We report neurophysiologic findings in 80 children aged 2–16 years with CMT1A who underwent median motor and sensory nerve conduction studies. Neurophysiologic abnormalities were present in all children. Median motor nerve conduction velocity was invariably less than 33 m/s (mean 18.7 m/s, range 9.0–32.9 m/s), with conduction velocities significantly slower in children aged 7–16 years compared with children aged 6 years and below. All children had prolonged distal motor latencies (mean 7.3 ms, range 4.0–12.3 ms). The compound muscle action potential (CMAP) amplitude was reduced from an early age (mean 7.1 mV, range 2.1–13.5 mV), and its normal increase with age was attenuated. Median sensory responses were present in only seven children, all aged less than 9 years and with slowed sensory conduction. Neurophysiologic abnormalities are present in all children with CMT1A from the age of 2 years. Motor conduction slowing progresses through the first 6 years of life and thereafter remains stable. CMAP amplitude is reduced from an early age, and the normal physiologic increase with age is attenuated. Median sensory responses may be recorded in younger children, and their presence does not exclude the diagnosis of CMT1A.
What Is Resource Consumption and How Can It Be Measured?
Authors: Gößling‐Reisemann Stefan
Published: September 2008

In the first part of this series of two articles, an approach was presented that takes the entropy production associated with any process as a measure of the resource consumption of that process. Entropy production is thereby used to approximate the intuitive notion of consumption, which can best be described by the term “loss of potential utility.” This article presents an application example from the metallurgical sector. The related concept of exergy analysis is discussed and compared against the entropy approach. It was found that the production of 1 ton of refined copper generates 90.2 megajoules per Kelvin of entropy. A comparison with exergy analyses of copper production processes from the literature shows agreement at least on the order of magnitude. While results in one case deviate from the entropy analysis by about 40%, in another case the deviation is about 160%. One can only speculate on the reasons for this discrepancy, without knowing the exact process specifications of the processes analyzed. For entropy production as a measure for resource consumption, a baseline for comparison and interpretation of the results based on natural entropy disposal and reduction mechanisms is suggested.
Agreement without Peace? International Mediation and Time Inconsistency Problems
Authors: Beardsley Kyle
Published: September 2008

Mediation has competing short‐ and long‐term effects. In the short run, the actors are better able to identify and settle on a mutually satisfying outcome. In the long run, mediation can create artificial incentives that, as the mediator's influence wanes and the combatants' demands change, leave the actors with an agreement less durable than one that would have been achieved without mediation. This article tests the observable implications from this logic using a set of international crises from 1918 to 2001. The results reconcile findings in the previous literature that inconsistently portray the effectiveness of mediation.
The Campaign Value of Incumbency: A New Solution to the Puzzle of Less Effective Incumbent Spending
Authors: Benoit Kenneth , Marsh Michael
Published: September 2008

A puzzle in research on campaign spending is that while expenditure is positively related to votes won, this effect is far more strongly, or even exclusively, enjoyed by challengers rather than by incumbents. We unearth a new explanation for the puzzle, focusing on the hidden, yet variable, campaign value of office perquisites which incumbents deploy in their campaigns to win votes. When these variable office benefits are unobserved, then the effect is to make observed incumbent spending less effective than spending by challengers. Using data from the 2002 Irish general election, where incumbency was assigned a variable campaign value and included in declared campaign spending, we are able to demonstrate this hidden incumbency effect and estimate its relationship to electoral success, in terms of overall votes, share of votes, and probability of winning a seat. Contrary to previous research showing ineffective incumbent spending, we find that when the campaign value of office is also measured, public office value “spending” is not only very effective in winning votes, but also seems to be more effective than regular incumbent spending.
What Triggers Public Opposition to Immigration? Anxiety, Group Cues, and Immigration Threat
Authors: Brader Ted , Valentino Nicholas A. , Suhay Elizabeth
Published: September 2008

We examine whether and how elite discourse shapes mass opinion and action on immigration policy. One popular but untested suspicion is that reactions to news about the costs of immigration depend uponwho the immigrants are.We confirm this suspicion in a nationally representative experiment: news about the costs of immigration boosts white opposition far more when Latino immigrants, rather than European immigrants, are featured. We find these group cues influence opinion and political action by triggering emotions—in particular, anxiety—not simply by changing beliefs about the severity of the immigration problem. A second experiment replicates these findings but also confirms their sensitivity to the stereotypic consistency of group cues and their context. While these results echo recent insights about the power of anxiety, they also suggest the public is susceptible to error and manipulation when group cues trigger anxiety independently of the actual threat posed by the group.
Identifying Subjects Who Benefit from Additional Information for Better Prediction of the Outcome Variables
Authors: Tian L. , Cai T. , Wei L. J.
Published: September 2008

SummarySuppose that we are interested in using new bio‐ or clinical markers, in addition to the conventional markers, to improve prediction or diagnosis of the patient's clinical outcome. The incremental value from the new markers is typically assessed by averaging across patients in the entire study population. However, when measuring the new markers is costly or invasive, an overall improvement does not justify measuring the new markers in all patients. A more practical strategy is to utilize the patient's conventional markers to decide whether the new markers are needed for improving prediction of his/her health outcomes. In this article, we propose inference procedures for the incremental values of new markers across various subgroups of patients classified by the conventional markers. The resulting point and interval estimates can be quite useful for medical decision makers seeking to balance the predictive or diagnostic value of new markers against their associated cost and risk. Our proposals are theoretically justified and illustrated empirically with two real examples.
C5‐6 Cervical Dislocation Resulting from Improper Seat Belt Use
Authors: Frank Edmund H. , Pennington Steven E. , Keenen Timothy L. , Frankel Pamela
Published: September 2008

Motorists may improperly use the diagonal shoulder belt of newer passive restraint systems by failing to use the lap belt. An unusual case of a patient who did not wear a lap belt and who sustained a cervical C5–6 distraction injury resulting in quadriplegia is reported. Emergency physicians should be aware of this injury mechanism and should reinforce proper passive restraint use.
Lung Compliance Following Cardiac Arrest
Authors: Davis Kenneth , Johannigman Jay A. , Johnson Robert C. , Branson Richard D.
Published: September 2008

Objective: To determine lung compliance in patients who had out‐of‐hospital cardiac arrests.

Methods: A prospective, observational study of patients suffering nontraumatic cardiopulmonary arrest and requiring CPR at one university hospital ED. Following termination of resuscitation efforts, lung compliance was measured. Measurements were made while inflating the lung from 250 mL to 2.000 mL (in 250‐mL increments) using a calibrated supersyringe. Airway flow and pressure were measured at the endotracheal tube with a pneumotachograph and a pressure transducer. Flow and pressure signals were recorded by a respiratory monitor and used to construct pressure‐volume curves for calculation of lung compliance.

Results: The 25 cardiac arrest patients (17 men, eight women) had a mean (± SD) age of 65 ± 7 years. Mean lung compliance was 0.051 ± 0.011 L/cm H2O. Lung compliance was smaller at low lung volumes, suggesting the presence of alveolar collapse. Compliance values from 500 mL to 1,500 mL were similar. Compliance also diminished with increasing duration of CPR.

Conclusions: One previous publication suggested that lung compliance following resuscitation is 0.022 L/cm H2O. The results of this study, using the accepted standard measurements of static lung compliance, suggest that true compliance is twice this value. This finding has important ramifications for future research on ventilation during resuscitation and current ventilation standards.
Directing an Emergency Medicine Residency: The Problems and Their Potential Solutions
Authors: Weigand John , Kuhn Gloria , Gerson Lowell W.
Published: September 2008

Objective: To characterize the problems facing emergency medicine residency directors (EMRDs), to describe potential solutions, and to associate perceptions with anticipated duration in the position of EMRD.

Methods: A confidential questionnaire was mailed to the EMRDs at all Accreditation Council for Graduate Medical Education‐approved programs. The survey included a problem and solution list constructed by a panel of EMRDs. The respondents were asked to rate problems using a Likert‐like scale and were asked to indicate which of the listed solutions they had used and had found useful, or thought would be useful. Associations of these features and demographic variables with the intention to leave the position of EMRD within S years were sought.

Results: Eighty‐seven of 93 EMRDs (93.5%) completed the survey. Their mean age was 40 years; 50% had been EMRDs for <3 years. Most of the EMRDs (62%) had an associate EMRD, and 77% had at least one secretary. The EMRDs worked a median of 220 hours per month. Major problems included: insufficient time for the job (57%). career interfering with family needs (44%). and lack of adequate faculty help (38%). The most frequently cited and useful solutions included: attending education courses, self‐reading on education and management techniques. and discussing problems with and seeking advice from others. Most (68%) of the EMRDs anticipated continuing as program director for ≤5 years. Neither age, gender, previous amount of time in the position, number of hours worked, nor nature of the problems faced on the job was a significant predictor of which of the EMRDs anticipated leaving.

Conclusions: Half the responding EMRDs were <40 years of age. half had been EMRDs for ≤3 years, and 68% anticipated continuing in their position for ≤5 years. Major frustrations included lack of knowledge and time. Family and career conflicts were frequent. These problems are similar to those of program directors in other specialties. Some recommendations are made to assist EMRDs.
Disaster Medicine: Current Assessment and Blueprint for the Future
Authors:   SAEM Disaster Medicine White Paper Subcomminee
Published: September 2008

Emergency services for disaster‐affected populations require the application of out‐of‐hospital planning, curative acute medical skills, and public health principles. SAEM can play an important role in promoting the research and educational agendas for disaster medicine through its network of EM educators at academic health centers. Testing of disaster medicine principles as part of the EM certification process will emphasize the importance of disaster medicine in the overall training of EPs. Postgraduate fellowships in disaster medicine also should be promoted and closely linked to disaster response organizations. Overall professional training must encompass the many facets described in this paper to prepare physicians to meet the challenges of disaster medicine.
Survey of Emergency Medical Services Curricula in U.S. Emergency Medicine Residencies
Authors: Cone David C. , Dawdson Steven J.
Published: September 2008

Some areas of EMS instruction are more consistently offered in residency programs than in the past. Formal (structured) preparation for the provision of OLMC has become almost universal, while involvement in quality‐related activities and training in the areas of risk management and EMS administration appear to have increased. However, resident involvement in disaster activities has decreased in recent years, and there is still much variability between programs in the extent and scope of EMS teaching. Field experiences still vary widely, for both ground and air services.
Successful Treatment of Amoxapine‐induced Refractory Status Epilepticus with Propofol (Diprivan)
Authors: Merigian Kevin S. , Browning Randall G. , Leeper Kenneth V.
Published: September 2008

Tonic‐clonic seizure activity is a recognized complication of amoxapine overdose. Refractory drug‐induced status epilepticus is associated with significant morbidity and mortality. Standard regimens for controlling status epilepticus may be ineffective for aborting drug‐induced seizures. The authors report the case of a 30‐year‐old woman who presented with an amoxapine overdose that deteriorated into status epilepticus refractory to conventional therapy. Propofol given by intravenous bolus and maintenance infusion successfully halted the patient's seizure activity. This case suggests that propofol may be effective as an anticonvulsant in refractory drug‐induced status epilepticus.
Ophthalmologic Procedures in the Emergency Department— Part II: Routine Evaluation Procedures
Authors: Knoop Kevin , Trott Alexander
Published: September 2008

The emergency physician (EP) must be familiar with performance of ophthalmologic procedures for evaluation and treatment of a multitude of eye complaints. This article is the second of three articles addressing ophthalmologic procedures potentially of use by the EP. This article reviews the indications and the techniques for the following routine procedures: visual acuity testing, pupil dilatation, topical anesthesia use, and tonometry. Criteria for consultation also are addressed.
Smoking Habits of Emergency Department Patients: An Opportunity for Disease Prevention
Authors: Lowenstein Steven R. , Tomlinson David , Koziol‐McLain Jane , Prochazka Allan
Published: September 2008

Objective: To determine smoking habits, levels of addiction, readiness to quit, and access to primary care among ED patients.

Methods: A questionnaire was administered prospectively to all non‐critical adult patients who presented to one university hospital ED during 23 randomly selected four‐hour time blocks; 336 (89%) of 376 eligible patients responded. Self‐reported smoking was validated by carbon monoxide breath testing in a pilot sample of 49 patients.

Results: The study patients were mostly young (mean age = 35 ± 15 years), female (59%), white (62%), and high school‐educated (73%). Of the 336 ED patients, 41% were current smokers (95% CI = 0.36–0.46); 42% of these were “moderately” to “very highly” dependent on nicotine (Fagerstrom Test for Nicotine Dependence > 4). Of those who smoked, 68% stated they wanted to quit, and 49% wanted to quit within the month. Fifty‐six percent of all those who smoked stated that they had never been told to quit smoking by any physician. Thirty‐five percent of the ED sample (118 patients) relied upon EDs for most or all of their routine, primary health care; 55% (95% CI = 0.46–0.64) of these patients were current smokers.

Conclusions: The prevalence rates of smoking and nicotine addiction among ED patients are high. Almost half of ED smokers are ready to quit, but most state they have never been told by a physician to do so. Finally, a large proportion of ED smokers receive their primary care in EDs. Therefore, the ED may be an underused setting for smoking cessation intervention.
Ethanol‐associated Hypoglycemia Is Uncommon
Authors: Sucov Andrew , Woolard Robert H.
Published: September 2008

Objective: To determine the association of ethanol intoxication with hypoglycemia in ED patients.

Methods: Retrospective, laboratory log review of 953 consecutive patients who were evaluated for ethanol intoxication in an urban university hospital ED over a three‐month period. Simultaneous serum glucose determination was carried out for each patient and associations between ethanol level and glucose were sought.

Results: Glucose concentrations were unavailable for 16 patients (1.7%). Of the remaining patients, 584 patients had detectable ethanol concentrations (ethanol‐positive), and 353 had no detectable ethanol (ethanol‐negative). Ethanol concentrations (mean ± SD) in the ethanol‐positive group were 50.11 ± 24.08 mmol/L (231 ± 111 mg/dL), and glucose concentrations were 5.83 ± 1.94 mmol/L (105 ± 35 mg/dL). Hypoglycemia [glucose <3.72 mmol/L (67 mg/dL)] was observed for five (0.9%) ethanol‐positive patients. It was classified as mild‐moderate [2.78–3.66 mmol/L (50–66 mg/dL)] for four patients (0.7%) and severe [<2.78 mmol/L (50 mg/dL)] for one (0.2%). Ethanol concentrations ranged from 25.60 to 68.33 mmol/L (118 to 315 mg/ dL). There was no correlation between ethanol and glucose concentrations in any subset of the ethanol‐positive patient population. In the ethanol‐positive group, patients who had several ethanol‐positive visits (56 patients, mean 3.6 visits/patient) accounted for four of the five episodes of hypoglycemia, including the one episode of severe hypoglycemia. The frequency of hypoglycemia in repeat visitors (2.0%) was higher than that in the group of patients without repeat visits (0.2%). In the ethanol‐negative group, there were four (1.1%) episodes of mild‐moderate hypoglycemia and no severely hypoglycemic patient. Hypoglycemia was not more likely to occur among ethanol‐positive patients than it was among ethanol‐negative patients.

Conclusion: Hypoglycemia was uncommonly associated with ethanol intoxication, and was found almost exclusively among patients with several ethanol‐positive visits. Glucose and ethanol concentrations do not show any linear correlation; patients with higher ethanol concentrations are not at higher risk of hypoglycemia. Hypoglycemia is not more likely to occur in ethanol‐positive than in ethanol‐negative patients. Initial glucose screening does not appear to be necessary for all patients suspected of intoxication; selective screening may be more appropriate.
Smoking Cessation Counseling by Emergency Physicians: Opinions, Knowledge, and Training Needs
Authors: Prochazka Allan , Koziol‐McLain Jane , Tomlinson David , Lowenstein Steven R.
Published: September 2008

Objectives: To determine: 1) the extent of emergency physicians' (EPs') training in smoking cessation counseling; 2) their understanding of counseling and pharmacologic treatment techniques; 3) their current practices in screening, counseling, and referring patients who smoke; and 4) perceived barriers to routine smoking cessation counseling in emergency medical practice.

Methods: A 26‐item questionnaire addressing the above issues was mailed to all 256 members of the Colorado Chapter of the American College of Emergency Physicians.

Results: Completed questionnaires were returned by 196 physicians (77% response rate). The majority of respondents were men (80%), practiced in urban settings (87%), and were board‐certified in emergency medicine (82%). Most EPs lacked formal smoking cessation training (55%) and felt poorly prepared to counsel patients about smoking cessation (65%). A minority (27%) of the physicians reported routinely asking patients to quit smoking. The physicians with formal smoking cessation training were more likely to counsel and refer patients routinely (34% vs 20%, p = 0.03). The physicians cited the following barriers to routine smoking cessation counseling: a lack of time; a perception that patients are not interested; a belief that the ED setting is inappropriate for counseling; and a sense that counseling is ineffective. Lack of reimbursement was cited by only 13% of the respondents. The physicians who had formal smoking cessation training perceived fewer barriers to ED‐based counseling.

Conclusions: Emergency physicians have received little training in smoking cessation and perceive many barriers to ED‐based smoking cessation interventions. Not surprisingly, they infrequently take action to encourage or assist their patients to quit smoking.
When Public Health Competes with Individual Needs
Authors: Schmidt Terri A.
Published: September 2008

A case of a homeless, alcoholic man with tuberculosis is presented. This case is used to illustrate the ethical dilemmas health care providers must face when the needs of society and the actions of the patient come into conflict. In addition to discussing historical cases of conflicts between individual rights and the needs of society, two models for solving the dilemma in the current case are considered.
Ophthalmologic Procedures in the Emergency Department—Part III: Slit Lamp Use and Foreign Bodies
Authors: Knoop Kevin , Trott Alexander
Published: September 2008

The emergency physician (EP) must be familiar with carrrying out ophthalmologic procedures for evaluation and treatment of a multitude of eye complaints. This article is the last of three articles addressing ophthalmologic procedures of use by the EP. This article reviews the indications and the techniques for slit lamp examination of the eye and techniques of foreign body removal. Criteria for consultation also are addressed.
Urban Trauma Transport of Assaulted Patients Using Nonmedical Personnel
Authors: Branas Charles C. , Sing Ronald F. , Davidson Steven J.
Published: September 2008

Objective: To describe one urban trauma transport system to clarify the impact of transport by nonmedical personnel on patient outcome.

Methods: Retrospective data were assembled over a six–year period through the use of the state trauma registry for an urban county served by seven state–accredited trauma centers. A subset of 4,767 consecutive assaulted patients was analyzed using the TRISS method to estimate survival probability. An unexpected death index (UDI), calculated as the difference between expected (TRISS method) and observed death rates, also was determined. Outcomes for patients transported by fire medics (FMs) vs nonmedical, police personnel (NPs) were compared.

Results: FMs transported 2,108 (44%) and NPs transported 1,356 (29%) of the injured assault victims. The FM–transported patients had a lower expected probability of survival than had the NP–trans–ported patients (p < 0.001). This also was true within the penetrating–injury subgroup (p < 0.001), but not the blunt–injury subgroup. The observed death rate was higher for all the FM–transported patients than it was for the NP–transported patients (15% vs 11%; p < 0.01). The UDIs were not different overall, although the NP–transported patients who had blunt trauma had a significantly lower UDI (p < 0.01).

Conclusions: NP transport of assaulted patients is generally associated with equivalent outcomes in comparison with FM transport in this urban environment. However, these data also provide evidence of an on–scene implicit triage with more severely injured patients generally transported by FMs.