bluuebunny/crossref_metadata_2025 huggingface dataset:
2. PRESENCE ACHIEVED IN LANGUAGE (WITH SPECIAL ATTENTION GIVEN TO THE PRESENCE OF THE PAST)
Authors: GUMBRECHT HANS ULRICH
Published: September 2006

The aim of this essay is to ask whether what it calls the “presence” of things, including things of the past, can be rendered in language, including the language of historians. In Part I the essay adumbrates what it means by presence (the spatio‐temporally located existence of physical objects and events). It also proposes two ideal types: meaning‐cultures (in which the interpretation of meaning is of paramount concern, so much so that the thinghood of things is often obscured), and presence‐cultures (in which capturing the tangibility of things is of utmost importance). In the modern period, linguistic utterance has typically come to be used for, and to be interpreted as, the way by which meaning rather than presence is expressed, thereby creating a gap between language and presence. Thus, in Part II the essay explores ways that this gap might be bridged, examining seven instances in which presence can be “amalgamated” with language. These range from instances in which the physical dimensions of language itself are made manifest, to those through which the physicality of the things to which language refers is supposed to be made evident. Of particular note for theorists of history are those instances in which things can be made present by employing the deictic, poetic, and incantatory potential of linguistic expression. The essay concludes in Part III with a reflection on Heidegger's idea that language is the “house of being,” now interpreted as the idea that language can be the medium through which the separation of humans and the (physical) things of their environment may be overcome. The hope of achieving presence in language is no less than a reconciliation of humans with their world, including—and of most interest to historians—the things and events of their past.
3. “PRESENCE” AND MYTH
Authors: ANKERSMIT F. R.
Published: September 2006

There are no dictionary meanings or authoritative discussions of “presence” that fix the significance of this word in a way that ought to be accepted by anybody using it. So we are in the welcome possession of great freedom to maneuver when using the term. In fact, the only feasible requirement for its use is that it should maximally contribute to our understanding of the humanities. When trying to satisfy this requirement I shall relate “presence” to representation. Then I focus on a variant of representation in which the past is allowed to travel to the present as a kind of “stowaway” (Runia), so that the past is literally “present” in historical representation. I appeal to Runia's notion of so‐called “parallel processes” for an analysis of this variant of historical representation.
4. THE MATERIAL PRESENCE OF THE PAST
Authors: DOMANSKA EWA
Published: September 2006

This article deals with the material presence of the past and the recent call in the human sciences for a “return to things.” This renewed interest in things signals a rejection of constructivism and textualism and the longing for what is “real,” where “regaining” the object is conceived as a means for re‐establishing contact with reality. In the context of this turn, we might wish to reconsider the (ontological) status of relics of the past and their function in mediating relations between the organic and the inorganic, between people and things, and among various kinds of things themselves for reconceptualizing the study of the past. I argue that the future will depend on whether and how various scholars interested in the past manage to modify their understanding of the material remnants of the past, that is, things as well as human, animal, and plant remains. In discussing this problem I will refer to Martin heidegger's distinction between an object and a thing, to bruno latour's idea of the agency of things and object‐oriented democracy, and to Don Ihde's material hermeneutics.

To illustrate my argument I will focus on some examples of the ambivalent status of the disappeared person (dead or alive) in argentina, which resists the oppositional structure of present versus absent. In this context, the disappeared body is a paradigm of the past itself, which is both continuous with the present and discontinuous from it, which simultaneously is and is not. Since there are no adequate terms to analyze the “contradictory” or anomalous status of the present‐absent dichotomy, I look for them outside the binary oppositions conventionally used to conceptualize the present‐absent relationship in our thinking about the past. for this purpose I employ Algirdas Julien Greimas's semiotic square.
6. ACTES DE PRÉSENCE: PRESENCE IN FASCIST POLITICAL CULTURE1
Authors: PETERS RIK
Published: September 2006

In order to discuss the notion of presence, I explore Fascist Italy as an example of a presence‐based culture. In the first part of this paper, I focus on the doctrines of “the philosopher of fascism,” Giovanni Gentile (1875–1944), in order to show that his programme of cultural awakening revolves around the notion of the “presentification of the past.” This notion formed the basis of Gentile's dialectic of the act of thought, which is the kernel of his actual idealism, or actualism. I argue that actualism should primarily be interpreted as an ontology of a historical reality; it expresses the view that reality is history. In his 1914 inaugural “L'esperienza pura e la realtà storica” (Pure Experience and Historical Reality), Gentile drew this view to its ultimate consequence by developing a view of experience that has some striking parallels with the contemporary views of presence as expounded by Gumbrecht, Runia, and Ankermit. In the second part of my paper, I discuss how Gentile and his collaborators put presence into practice in school reforms, the Enciclopedia Italiana, and in hundreds of monuments, memorials, and exhibitions. Finally, I discuss the 1932 Mostra della rivoluzione fascista, which was not only the apex of fascist culture politics, but also of the practice of presence. In this context, I argue that this practice should not be seen as a politics of historical interpretation, as Hayden White once held, but as a politics of sublime historical experience, or presence. The presence of presence in fascist political culture raises some difficult questions for all who embrace the new paradigm, questions that can only be answered if the notion of presence is somehow balanced by the critical historical method, which is the basis for a true dialogue with the past.
EMPATHY IN HISTORY, EMPATHIZING WITH HUMANITY
Authors: Moyn Samuel
Published: September 2006

The Fragility of Empathy After the Holocaust. By Carolyn J. Dean.

History in Transit: Experience, Identity, and Critical Theory. By Dominick LaCapra.
TOCQUEVILLE AND THE FRENCH REVOLUTION
Authors: Kahan Alan S.
Published: September 2006

Tocqueville Unveiled: The Historian and His Sources for The Old Regime and the Revolution. By Robert T. Gannett Jr.
HISTORY VS. (EPISTEMOLOGICAL) THEORY
Authors: Eldridge Richard
Published: September 2006

Interpretive Reasoning. By Laurent Stern.
The Diffusion of Calculative and Collaborative HRM Practices in European Firms
Authors: POUTSMA ERIK , LIGTHART PAUL E. M. , VEERSMA ULKE
Published: September 2006

The aim of this paper is to trace and explain variations in calculative and collaborative human resource management (HRM) practices between companies and across national borders. Variations and similarities are explained in terms of the convergence and divergence of HRM practices determined by national institutions, and the increasing influence of multinational companies (MNCs). We explore the diffusion of HRM practices in Europe over time, using data sets from two surveys conducted in several European countries in 1995 and 2000. We use institutional explanations for the development of three selected bundles of HRM practices: individual, calculative performance‐oriented practices; collective incentive schemes for the alignment of interests; and collaborative practices that seek to enhance the commitment of employees. We found substantial effects of country‐specific institutions and of the country of origin of MNCs, which clearly support the institutional duality thesis. Foreign‐owned MNCs, especially those that are US‐based, appear to moderate country‐specific institutional effects on the diffusion of the three HRM bundles.
U.S. High‐Performance Work Practices at Century's End
Authors: BLASI JOSEPH R. , KRUSE DOUGLAS L.
Published: September 2006

This study examines the incidence, industry differences, and economic environment of work practices in the United States in 1994 and 1997 using census data from a nationally representative random sample of establishments. Self‐managed work teams were used by a majority of workers in some sites. Work‐related meetings had higher incidence. A high‐performance work organization is used in about 1 percent of establishments. There were significant industry differences associated with globalization, namely, imports and exports.
Twin Tracks—Employee Representation at Eurotunnel Revisited
Authors: GOLLAN PAUL J.
Published: September 2006

The introduction of the European Directive on Information and Consultation and the recent implementation of the Information and Consultation of Employees (ICE) Regulations into United Kingdom (UK) law have increased the focus on workplace representation arrangements. This paper examines the interplay between nonunion and union representative arrangements at Eurotunnel (UK) and assesses their effectiveness in representing the needs of employees over a 5‐year period. Importantly, the paper also examines the opportunities and challenges of both nonunion representation (NER) and union voice arrangements. The findings show that the effectiveness of nonunion structures as bodies representing the interests of employees in filling the lack of representation is questionable. However, union recognition through an employer–union partnership agreement has also raised important issues regarding the effectiveness, impact, and legitimacy of unions at Eurotunnel. The main implication of this research is that the existence of a mechanism—union or nonunion—for communication between management and employees at the workplace may not be a sufficient condition for effective representation of employee interests. In addition, while trade unions may provide greater voice than nonunion arrangements (thus the reluctance of management to accept such voice arrangements), the strength of voice is dependent on the legitimacy and effectiveness of trade unions in representing employees’ interests at the workplace. And that in turn depends on the union being perceived by the workforce as both representative and able to act independently. If the union cannot, it will not meet the needs of either employees or management—and could run the risk of being supplanted under the provisions of the new EU Directive on Information and Consultation with tougher requirements for compliance in terms of procedures for consultation and information disclosure.
The Performance of European Works Councils in Engineering: Perspectives of the Employee Representatives
Authors: WADDINGTON JEREMY
Published: September 2006

Drawing on a structured survey of European works council representatives within the engineering industry, this paper identifies a number of shortfalls in the performance of European works councils. In particular, it shows that European works council representatives retain a national rather than a European point of reference and are critical of the integration of European works councils with other aspects of trade union organization and activity. In contrast, European works council representatives welcome the transparency within multinational companies introduced by the directive. The paper concludes in terms of a range of revisions that might usefully be introduced to improve the performance of the directive.
Intellectual Capital, Monitoring, and Risk: What Predicts the Adoption of Employee Stock Options?
Authors: KROUMOVA MAYA K. , SESIL JAMES C.
Published: September 2006

We use empirical analysis to analyze company characteristics associated with the adoption and maintenance of broad‐based stock option plans. First, a cross‐sectional analysis evaluates what company characteristics are now associated the incidence of such plans. Second, a longitudinal analysis examines the company characteristics that predict the adoption of such plans. Our results show that firms with higher levels of intellectual capital and capital intensity are more likely to adopt and maintain employee stock option plans.
Ecology of a coastal population of the critically endangered Darwin's fox (Pseudalopex fulvipes) on Chiloé Island, southern Chile
Authors: Jiménez J. E.
Published: September 2006

The behavioral ecology of the critically endangered Darwin's fox Pseudalopex fulvipes was examined during the reproductive season of 2001/2002 on a coastal population, on Chiloé Island in southern Chile. Foxes were radio‐tracked and their diet and feeding behavior, activity patterns, home range sizes and spatial organization, habitat use and selection, social organization and abundance were studied. Foxes were solitary hunters and showed a generalist and opportunistic feeding behavior. Insects were the most abundant prey, followed by crustaceans, rodents, birds, amphibians, ungulates, reptiles, and marsupials. As marine organisms were frequently eaten, the ocean subsidy was important. Plant seeds were dispersed up to +650 m from their sources. Prey were hunted in all habitat types recognized, throughout the daily cycle, and were consumed as they were available along the season. All foxes were active throughout the day, but more so at night. Morphologically, aside from males having broader muzzles, they did not show external sexual dimorphism or differences in weight. The tail and feet of Darwin's foxes were relatively shorter than in other congeneric species. Individual home ranges and core areas ranged from 103 to 488 ha and from 30 to 130 ha, respectively, were similar between males and females, and larger than expected for foxes of that size. All home ranges were elongated (2930 m on average) following the shoreline. Foxes overlapped their home ranges extensively – and core areas less so – with individuals of the same or different gender, showing no apparent territorial behavior. They appear to be monogamous, allowing subordinates in their home ranges. The ecological density was 0.92 foxes km−2, which may be higher than in inland populations. Old‐growth forest was consistently avoided by all individuals, second‐growth forest and shrubland were used as available, and the use of dunes and other lands (mainly shores) was mixed.
Using scissors to quantify hardness of insects: do bats select for size or hardness?
Authors: Freeman P. W. , Lemen C. A.
Published: September 2006

Scissors are used to determine the hardness of fresh insects of different size and taxa. Our results indicate a strong relationship between the size of an insect and its hardness, which can be expressed as log(Fmax)=0.65 × log(V)+α.Fmaxis the maximal force needed to cut the insect and is our measure of insect hardness.Vis the volume of the insect andαis a constant that can be derived for different insect taxa. The value of 0.65 was found as an average of beetle and moth samples, and this number appears consistent across insect taxa. We found that beetles averaged about 3.2 times harder than moths of the same size. Beetles were also more variable in hardness than moths, with the softest beetles about equal in hardness to an average moth of the same size. Using our data on insect hardness coupled with data on the diets of bats and their bite forces from the literature, we attempt to determine whether the upper size limit of insects taken by a bat is limited by the insect's dimensions or its hardness. Our results indicate that both these factors may be important.
Migration patterns in a population of cottonmouths (Agkistrodon piscivorus) inhabiting an isolated wetland
Authors: Glaudas X. , Andrews K. M. , Willson J. D. , Gibbons J. W.
Published: September 2006

Few studies have examined the spatial and temporal migration patterns of snakes to and from active‐season habitats. We conducted a year‐long population‐level analysis of cottonmouth Agkistrodon piscivorus migration patterns by monitoring snakes entering and leaving a Carolina bay wetland that was encircled by a continuous terrestrial drift fence. Cottonmouths used the wetland during the active season and left the bay in the fall to overwinter in other habitats. Adults and juveniles did not differ in time of arrival at the bay but juveniles left the bay earlier than adults. Spatially, captures of adult cottonmouths entering and leaving the bay were distributed non‐randomly, with capture peaks corresponding to the directions to the nearest permanent aquatic habitats. Juveniles' immigration patterns in the spring were biased in the same directions as those of the adults, but they left non‐directionally in the fall. This suggests that neonates do not rely on adult scent trailing to locate hibernacula, and that in a region with moderate winter temperatures, suitable overwintering sites may not be a limited resource. Additionally, our study demonstrates that cottonmouths make extensive use of upland habitats and underscores the importance of both critical upland habitat and forested corridors between wetlands and hibernacula for the conservation of wetlands herpetofauna.
Morphological evolution in a hyperdiverse clade: the ant genus Pheidole
Authors: Pie M. R. , Traniello J. F. A.
Published: September 2006

Understanding patterns of morphological variation and their evolutionary causes is among the main goals of evolutionary biology. In this paper we analyse the pattern of morphological variation in the hyperdiverse ant genus Pheidole (Hymenoptera: Formicidae). We describe the morphospace defined by 231 Pheidole species in the New World using 18 linear quantitative characters. The first ordination axis of the morphospace was found to mainly reflect differences in body size, which explained 83.2 and 78.6% of all morphological variation in minor and major worker subcastes, respectively. Therefore, despite considerable morphological divergence among Pheidole species, most of this variation can be attributed to allometric changes along a size axis, leaving little opportunity for ecological specialization that might be reflected in the studied morphological traits. Simulations suggest that this degree of concentration of variance on the first principal component is unlikely to be due solely to shared phylogenetic history. The second ordination axis reflected mostly variation in head characters, most notably antennal scape length. The third ordination axis described aspects of alitrunk and petiole shape. Although generally concordant, the loading patterns in the second and third axes differed between minors and majors, suggesting different selective pressures affecting the evolution of each subcaste. These general trends in shape were confirmed by additional analyses that corrected for body size. Ordination analyses were complemented by comparing patterns of interspecific morphological covariation in minors and majors of Pheidole using newly developed analyses based on the statistical concept of conditional independence of Magwene. A comparison between worker subcastes indicated substantial reorganization in the pattern of character covariation, particularly through a decrease in character‐correlation levels (dissociation). Moreover, graphical modelling indicated correlations between characters in widely different parts of the body, suggesting that the opportunity for morphological evolution in Pheidole appears to be surprisingly limited. This result might explain why morphological evolution in Pheidole has been highly conservative in spite of substantial ecological diversification.
Factors affecting juvenile survival in African wild dogs (Lycaon pictus) in Kruger National Park, South Africa
Authors: Buettner U. K. , Davies‐Mostert H. T. , Du Toit J. T. , Mills M. G. L.
Published: September 2006

African wild dog Lycaon pictus populations are declining due to persecution as well as habitat destruction and fragmentation. Understanding the natural mechanisms driving population dynamics is important for conservation management as it clarifies natural from human‐induced factors. Therefore, this understanding is essential to compensate for disadvantaging ecological factors and successfully apply conservation actions. Juvenile survival is important in driving wild dog population dynamics, and therefore this study investigated the influence of rainfall and pack size on the survival of juveniles up to the age of 12 months. We found that past rainfall significantly influenced pup survival up to 9 months of age, such that pups benefited from preceding dry periods. The positive effects of pack size on juvenile survival only became evident for pups older than 9 months and, despite this delayed Allee effect, we found no evidence of reproductive failure in small packs as compared with larger ones.
Geophagy and nutrient supplementation in the Ngorongoro Conservation Area, Tanzania, with particular reference to selenium, cobalt and molybdenum
Authors: Mills A. , Milewski A.
Published: September 2006

Wildlife and livestock in the Ngorongoro Conservation Area (NCA), Tanzania, commonly practise geophagy. We investigated the nutrient content of nine earth licks and adjacent topsoils in the NCA, and for comparative purposes, two salt pans in north‐eastern Tanzania, licks in central Tanzania and a lick near Puerto Maldonado, Peru. The licks had no consistent pattern of nutrient enrichment relative to unutilized topsoils, although the Na content of licks was greater than that of the adjacent topsoils at all but one site. The three largest licks in the NCA (Gibbs Farm, Seneto and Ascent Road) were enriched relative to topsoils and global averages in Se (maximum of 4.7 mg kg−1), Co (maximum of 107 mg kg−1) and/or Mo (maximum of 7.4 mg kg−1). We suggest that licks do provide supplemental Na, but that Se, Co and/or Mo at the largest licks provide easily overlooked nutritional benefits and are perhaps the primary target for geophagy at these sites. Subsoil zones of clay deposition are likely to be enriched in various elements through illuviation or mineral precipitation from solution. Animals may use the taste of NaCl as a clue for locating such zones where they are likely to find a greater quantity of micronutrients relative to other soils. These findings have consequences for conservation and pastoralism in that these large licks may be key resources, providing micronutrients that are essential for maintaining the health and fecundity of animal as well as human populations in the region.
Multicentre, parallel group, randomised, single‐blind study of the safety and efficacy of atosiban versus ritodrine in the treatment of acute preterm labour in Korean women
Authors: Shim J‐Y , Park YW , Yoon BH , Cho YK , Yang J‐H , Lee Y , Kim A
Published: September 2006

Objective  To compare the efficacy and safety of atosiban with those of ritodrine in preterm labour.

Design  Multicentre, single‐blind, randomised, controlled trial.

Setting  Obstetric units in six referral centres in Korea.

Population  Women with singleton pregnancies with preterm labour, between 24 and 33 + 6 weeks of gestation.

Methods  One hundred and twenty‐eight women were randomised to receive intravenous atosiban (n= 63) or ritodrine (n= 65) and were stratified by gestational age (<28 weeks and ≥28 weeks). Atosiban or ritodrine was administered for up to 48 hours. Progression of labour was assessed by the frequency of contractions and cervical dilatation and effacement. Alternative tocolysis could be given as rescue therapy.

Main outcome measure  Efficacy was assessed as the proportion of women in each group who did not deliver and did not need alternative tocolytic therapy at 48 hours and 7 days after therapy initiation. Safety was assessed as the numbers of maternal adverse events and neonatal morbidity.

Results  Tocolytic efficacy after 7 days was significantly better in the atosiban group than in the ritodrine group (60.3 versus 34.9%), but not at 48 hours (68.3 versus 58.7%). Maternal adverse events related to therapy were reported less frequently in the atosiban group (7.9 vs 70.8%; P= 0.0001), resulting in fewer early drug terminations due to adverse events (0 versus 20.0%; P= 0.0001). This, however, was not accompanied by a concurrent improvement in perinatal outcomes.

Conclusion  The efficacy and safety of atosiban in the treatment of preterm labour were superior to those of ritodrine.
A comparison of perinatal mortality in Korea on holidays and working days
Authors: Hong JS , Kang HC , Yi S‐W , Han YJ , Nam CM , Gombojav B , Ohrr H
Published: September 2006

Objective  To examine whether the perinatal mortality of infants born during holidays differs from that of infants born on workdays, and to elucidate its cause.

Design  Cross‐sectional study.

Setting  Vital statistics linked to the National Infant Mortality Survey data for 1999 births in Korea.

Population  In all, 628 485 births in 1999 in Korea.

Methods  Number of births and perinatal mortality were classified according to the day of the week using the occurrence index. After adjusting for confounding factors, the odds ratios (ORs) for increased holiday mortality were estimated using logistic regression.

Main outcome measure  Birthweight‐adjusted perinatal mortality.

Results  Births on holidays were 33% fewer and perinatal deaths 24% higher than expected (PMR, Perinatal Mortality Rate, 16.4 versus 12.8; OR, 1.3; 95% CI, 1.2–1.4). After the adjustment of birthweight, gender, plurality and congenital anomalies, the odds ratio for death of infants born during holidays was 1.2 (95% CI, 1.1–1.3).

Conclusions  The higher perinatal mortality during holidays in Korea appears to be due to different qualities of perinatal care, rather than difference in case‐mix.
Seasonal patterns and preterm birth: a systematic review of the literature and an analysis in a London‐based cohort
Authors: Lee SJ , Steer PJ , Filippi V
Published: September 2006

Objective  The objectives of this study included a systematic review of the countries in which a seasonal pattern of preterm birth has been reported and an analysis on the seasonal variability of preterm birth in a London‐based cohort.

Design  Cross‐sectional study.

Setting  Eighteen maternity units in a London health region from 1988 to 2000.

Population  The study population comprised 482 765, live singleton births born after 24 weeks of gestation and weighing more than 200 g.

Methods  Systematic review and secondary analysis of seasonality over 13 years of births from the St Mary’s Maternity Information System (SMMIS).

Main outcome measure  Annual patterns of preterm birth and a comparison of risk by seasons.

Results  Three studies from developing countries and three from developed countries reported a seasonal pattern of preterm birth. One study from the USA reported no seasonal pattern of preterm birth. No British studies were located. Rates of preterm birth in developed countries were highest twice a year (once in winter and again in summer). In London (SMMIS data set), however, preterm births peaked only once a year, in winter. Babies born in winter were 10% more likely to be preterm compared with those born in spring (OR 1.10, 95% CI 1.07–1.14).

Conclusion  Establishing a seasonal pattern of birth can have important implications for the delivery of healthcare services. Most studies from both developed and developing countries support the existence of preterm birth seasonality. This study has shown that the seasonality of preterm births in this London‐based cohort differs from other developed countries that have previously reported a seasonal pattern of preterm birth.
The advent of international ‘mail‐order’ egg donation
Authors: Heng BC
Published: September 2006

The rising demand and increasing scarcity of donor oocytes in developed countries have led to some fertility clinics sourcing oocyte donors from abroad, particularly from poorer countries, in what is referred to as ‘transnational’ or ‘international’ oocyte donation. In a further new ‘twist’ to this scheme, frozen sperm of the recipient’s male partner is exported abroad through courier mail and is used to fertilise donor oocytes in a foreign clinic to produce embryos, which are then cryopreserved and imported back by mail for transfer to the woman. There are numerous ethical concerns with regards to such means of procuring donor oocytes. First, there is an issue of exploiting economically underprivileged women in poorer countries and disproportionate gains on the part of medical doctors and fertility clinics. Second, there is a question of abdication of responsibility for the donor’s welfare on the part of the fertility doctor who takes charge of the recipient’s treatment abroad if oocyte donors were to develop severe ovarian hyperstimulation syndrome. Third, the issue of responsibility and accountability becomes even more contentious if congenital defects were to appear in offsprings born from transnational oocyte donation or in the case of transmission of communicable diseases such as hepatitis B, syphilis and AIDS to the recipient. Last, cost savings from the lower prescription price of fertility drugs in economically less‐developed countries may not be passed down to the oocyte recipient but instead be exploited to boost the already substantial profit margin of fertility clinics and doctors.
The effect of learning curve on the outcome of caesarean section
Authors: Fok WY , Chan LYS , Chung TKH
Published: September 2006

Objective  To evaluate the operative outcomes when trainees first perform caesarean sections independently.

Design  A retrospective study in a tertiary obstetric unit.

Population  Five hundred caesarean sections, which represented the first 50 caesarean sections performed independently by each of ten trainees, were studied.

Methods  The effect of learning curve on outcome was analysed.

Main outcome measures  Total operative time, incision‐to‐delivery interval, operative blood loss, Apgar score, cord arterial pH, incidence of neonatal intensive care unit admission, postoperative complication rates and duration of hospitalisation.

Results  The mean operative time for the first five cases by trainees was 52.2 ± 11.4 minutes. It progressively decreased and reached 39.6 ± 8.4 minutes for the 46th to 50th cases. The operative time was significantly longer in the first 15 caesarean sections (P < 0.05). Moreover, the incision‐to‐delivery interval was also longer during the first five cases (P= 0.02). Besides the time of the operation, the trend for operative blood loss stabilised after the first ten caesarean sections (P < 0.05). Otherwise, there were no significant differences among other outcome variables.

Conclusion  This study shows that trainees need to perform 10–15 caesarean sections before their skills become more proficient. Senior obstetricians may need to provide guidance to the trainees during their first independent 15 caesarean sections.
Prediction of recurrence after treatment for high‐grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation
Authors: Verguts J , Bronselaer B , Donders G , Arbyn M , Van Eldere J , Drijkoningen M , Poppe W
Published: September 2006

Objectives  The aim of this study was to examine the accuracy of the presence of high‐risk human papillomavirus (HR‐HPV) DNA (HR‐HPV DNA test) postconisation as prediction of recurrent or residual cervical intraepithelial neoplasia (CIN) after treatment of high‐grade cervical intraepithelial lesions (CIN2+) in a prospective study and to compare this with follow‐up cytology and the marginal status of the excised tissue.

Design  Prospective follow‐up study.

Setting  Unselected women presenting at colposcopy clinic of University Hospital Gasthuisberg, Leuven.

Population  Seventy‐two women treated with conisation for CIN2 or CIN3.

Methods  Women were followed by HR‐HPV DNA test (Hybrid Capture II test of Digene®) every 3 to 6 months. The same vial was used for cytology and the HR‐HPV DNA test (SurePath™). All women were further followed by colposcopy and cytology for 24 months at 6‐month intervals. The outcome of the study was presence of >CIN2, proven with colposcopy‐directed biopsy occurring within 24 months after treatment. HR‐HPV status was correlated with recurrent or residual CIN2+.

Main outcome measures  Sensitivity, specificity, predictive values and diagnostic odds ratios to predict treatment failure or cure were computed for HR‐HPV testing, marginal status and follow‐up cytology. HR‐HPV status was also correlated with section margins postconisation and with the first cervical smear.

Results  In 6 of the 72 treated women (8%), residual or recurrent CIN occurred. Women with recurrence were significantly older than women without a recurrence (51.5 ± 9.6 versus 39.8 ± 12.2 years, P= 0.007). All six women with recurrence were HR‐HPV positive, four had a positive follow‐up smear (≥atypical squamous cells of uncertain significance = ASCUS+) and only two had involved section margins. Among the 66 cured women, 15 were HR‐HPV positive, 6 had an abnormal smear and 12 had positive section margins. Sensitivity of cytology, positive section margins and HR‐HPV DNA positivity was 66.7, 33.3 and 100% to predict treatment failure. Specificity of the three tests was, respectively, 90.9, 81.8 and 77.3%. Women with HR‐HPV DNA at 3 to 6 months showed recurrent or residual CIN in 15% (2/13) if they had normal follow‐up Pap smears and in 50% (4/8) if they had abnormal Pap smears. Margin status was not statistically significantly associated with human papillomavirus status.

Conclusion  Persistence or clearance of HR‐HPV DNA is an early valid prognostic marker of failure or cure after treatment for CIN2+ and is more accurate than cytology or section margin status at the time of conisation. The absence of HR‐HPV DNA has a 100% negative predictive value. Higher age at conisation may be a previously unrecognised risk factor for recurrence.
Polypharmacy and Prescribing Quality in Older People
Authors: Steinman Michael A. , Seth Landefeld C. , Rosenthal Gary E. , Berthenthal Daniel , Sen Saunak , Kaboli Peter J.
Published: September 2006

OBJECTIVES: To evaluate the relationship between inappropriate prescribing, medication underuse, and the total number of medications used by patients.

DESIGN: Cross‐sectional study.

SETTING: Veterans Affairs Medical Center.

PARTICIPANTS: One hundred ninety‐six outpatients aged 65 and older who were taking five or more medications.

MEASUREMENTS: Inappropriate prescribing was assessed using a combination of the Beers drugs‐to‐avoid criteria (2003 update) and subscales of the Medication Appropriateness Index that assess whether a drug is ineffective, not indicated, or unnecessary duplication of therapy. Underuse was assessed using the Assessment of Underutilization of Medications instrument. All vitamins and minerals, topical and herbal medications, and medications taken as needed were excluded from the analyses.

RESULTS: Mean age was 74.6, and patients used a mean±standard deviation of 8.1±2.5 medications (range 5–17). Use of one or more inappropriate medications was documented in 128 patients (65%), including 73 (37%) taking a medication in violation of the Beers drugs‐to‐avoid criteria and 112 (57%) taking a medication that was ineffective, not indicated, or duplicative. Medication underuse was observed in 125 patients (64%). Together, inappropriate use and underuse were simultaneously present in 82 patients (42%), whereas 25 (13%) had neither inappropriate use nor underuse. When assessed by the total number of medications taken, the frequency of inappropriate medication use rose sharply from a mean of 0.4 inappropriate medications in patients taking five to six drugs, to 1.1 inappropriate medications in patients taking seven to nine drugs, to 1.9 inappropriate medications in patients taking 10 or more drugs (P<.001). In contrast, the frequency of underuse averaged 1.0 underused medications per patient and did not vary with the total number of medications taken (P=.26). Overall, patients using fewer than eight medications were more likely to be missing a potentially beneficial drug than to be taking a medication considered inappropriate.

CONCLUSION: Inappropriate medication use and underuse were common in older people taking five or more medications, with both simultaneously present in more than 40% of patients. Inappropriate medication use is most frequent in patients taking many medications, but underuse is also common and merits attention regardless of the total number of medications taken.
The Epidemiology of Bathing Disability in Older Persons
Authors: Gill Thomas M. , Guo Zhenchao , Allore Heather G.
Published: September 2006

OBJECTIVES: To quantify the burden of bathing disability over time; to determine whether the burden of bathing disability differs according to age, sex, and physical frailty; and to evaluate the relationship between disability in bathing and disability in other essential activities of daily living (ADLs).

DESIGN: Prospective cohort study.

SETTING: General community in greater New Haven, Connecticut.

PARTICIPANTS: Seven hundred fifty‐four community‐living older persons aged 70 and older who were nondisabled (required no personal assistance) in four essential ADLs: bathing, dressing, transferring from a chair, and walking inside the house.

MEASUREMENTS: Bathing disability, defined as the inability to wash and dry one's whole body without personal assistance, was assessed every month for up to 6 years, along with disability in dressing, transferring, and walking.

RESULTS: Over the course of 6 years, 440 participants (58.4%) had at least one episode of bathing disability, and 266 (34.0%) had multiple episodes, with the duration of each episode averaging about 6 months. Whether assessed as number of episodes, duration of episodes, incidence rates, or number of months per 100 months, the burden of bathing disability was greatest in participants who were physically frail and was consistently higher in women than men and in participants who were aged 80 and older than those who were aged 70 to 79. Most episodes of bathing disability (86.1%) were not preceded in the prior month by disability in dressing, transferring, or walking, and nearly half (48.3%) were not accompanied at onset by disability in one or more of these other ADLs. In a multivariable model that included age, sex, and physical frailty, the onset of bathing disability increased the likelihood of developing disability in the other essential ADLs the following month fivefold (hazard ratio=5.1, 95% confidence interval=4.1–6.4).

CONCLUSION: Disability in bathing may serve as a sentinel event in the disabling process. Given the recurrent nature of bathing disability, programs designed to enhance independent bathing will need to focus not only on the prevention of bathing disability, but also on the restoration and maintenance of independent bathing in older persons who become disabled.
Diagnosis and Characteristics of Syncope in Older Patients Referred to Geriatric Departments
Authors: Ungar Andrea , Mussi Chiara , Del Rosso Attilio , Noro Gabriele , Abete Pasquale , Ghirelli Loredana , Cellai Tommaso , Landi Annalisa , Salvioli Gianfranco , Rengo Franco , Marchionni Niccolò , Masotti Giulio ,   for the Italian Group for the Study of Syncope in the Elderly
Published: September 2006

OBJECTIVES: To test the applicability and safety of a standardized diagnostic algorithm in geriatric departments and to define the prevalence of different causes of syncope in older patients.

DESIGN: Multicenter cross‐sectional observational study.

SETTING: In‐hospital geriatric acute care departments and outpatient clinics.

PARTICIPANTS: Two hundred forty‐two patients (aged ≥65, mean±standard deviation =79±7, range 65–98) consecutively referred for evaluation of transient loss of consciousness to any of six clinical centers participating in the study. Of these, 11 had a syncope‐like condition (5 transient ischemic attack; 6 seizures), and 231 had syncope (aged 65–74, n=71; aged ≥75, n=160).

MEASUREMENTS: Protocol designed to define etiology and clinical characteristics of syncope derived from European Society of Cardiology Guidelines on syncope.

RESULTS: No major complication occurred with use of the protocol. Neurally mediated was the more prevalent form of syncope in this population (66.6%). Cardiac causes accounted for 14.7% of all cases. The neuroreflex form of syncope (vasovagal, situational, and carotid sinus syndrome) was more common in younger than in older patients (62.3% vs 36.2%; P=.001), whereas orthostatic syncope was more frequent in the older than in the younger group (30.5% vs 4.2%; P<.001). In only 10.4% of cases, syncope remained of unexplained origin. After initial evaluation, a definite diagnosis was possible in 40.1% of the cases, and a suspected diagnosis was obtained in 57.9%. Syncope of suspected cardiac origin after initial evaluation was confirmed in 43.7% of cases, and neuromediated causes were confirmed in 83.5% of the cases.

CONCLUSION: The protocol is applicable even beyond the age of 90 in geriatric departments. The standardized protocol is associated with a reduction in the frequency of unexplained syncope to about 10%.
Are Internal Medicine Residency Programs Adequately Preparing Physicians to Care for the Baby Boomers? A National Survey from the Association of Directors of Geriatric Academic Programs Status of Geriatrics Workforce Study
Authors: Warshaw Gregg A. , Bragg Elizabeth J. , Thomas David C. , Ho Mona L. , Brewer David E.
Published: September 2006

Patients aged 65 and older account for 39% of ambulatory visits to internal medicine physicians. This article describes the progress made in training internal medicine residents to care for older Americans. Program directors in internal medicine residency programs accredited by the Accreditation Council for Graduate Medical Education were surveyed in the spring of 2005. Findings from this survey were compared with those from a similar 2002 survey to determine whether any changes had occurred. A 60% response rate was achieved (n=235). In these 3‐year residency training programs, 20 programs (9%) required less than 2 weeks of clinical instruction that was specifically structured to teach geriatric care principles, 48 (21%) at least 2 weeks but less than 4 weeks, 144 (62%) at least 4 weeks but less than 6 weeks, and 21 (9%) required 6 or more weeks. As in 2002, internal medicine residency programs continue to depend on nursing home facilities, geriatric preceptors in nongeriatric clinical ambulatory settings, and outpatient geriatric assessment centers for their geriatrics training. Training was most often offered in a block format. The mean number of physician faculty per residency program dedicated to teaching geriatric medicine was 3.5 full‐time equivalents (FTEs) (range 0–50), compared with a mean of 2.2 FTE faculty in 2002 (P≤.001). Internal medicine educators are continuing to improve the training of residents so that, as they become practicing physicians, they will have the knowledge and skills in geriatric medicine to care for older adults.
Novel Robotic Catheter Remote Control System: Feasibility and Safety of Transseptal Puncture and Endocardial Catheter Navigation
Authors: SALIBA WALID , CUMMINGS JENNIFER E. , OH SEIL , ZHANG YOUHUA , MAZGALEV TODOR N. , SCHWEIKERT ROBERT A. , BURKHARDT J. DAVID , NATALE ANDREA
Published: September 2006

Objectives: The aims of this study were to demonstrate the safety and the feasibility of the robotic catheter remote control system (CCS) in endocardial navigation in all cardiac chambers, as well as facilitation of the transseptal puncture.

Background: CCS has been developed to facilitate control and precise positioning of catheters within the cardiovascular system.

Methods: CCS consists of a remote catheter manipulator, a set up joint, a physician workstation, and a steerable guide catheter (SGC) and sheath. A conventional 4‐mm tip catheter was inserted through the SGC to perform mapping of five predefined targets in each cardiac chamber. Seven mongrel dogs were used in this study. Intracardiac echocardiography and three‐dimensional (3‐D) electroanatomical mapping were integrated with CCS to facilitate catheter manipulation and to guide transseptal puncture. The time to complete the transseptal puncture and the time to complete access to the predefined targets in each cardiac chamber were measured. Gross and microscopic examinations of the accessed and ablation sites were performed to evaluate safety.

Results: Transseptal puncture was performed successfully in all animals with a mean time of 7 ± 3 minutes. Procedure times to access the five targets in the right atrium, right ventricle, left atrium, and left ventricle were 5.6 ± 1.7, 4.6 ± 1.5, 13.5 ± 11.0, 7.0 ± 2.9 minutes, respectively. There were no intracardiac damages associated with catheter manipulation noted in the excised hearts.

Conclusions: Endocardial catheter navigation and mapping using the robotic catheter remote control is safe and feasible. Moreover, the CCS could be used to perform transseptal puncture and left atrial instrumentation.
Ventricular Fibrillation During No‐Flow Global Ischemia in Isolated Rabbit Hearts
Authors: WU TSU‐JUEY , LIN SHIEN‐FONG , HSIEH YU‐CHENG , TING CHIH‐TAI , CHEN PENG‐SHENG
Published: September 2006

Introduction: The dominant frequency (DF) during ventricular fibrillation (VF) in Langendorff‐perfused guinea pig hearts is higher in left ventricle (LV) than in right ventricle (RV). However, the onset of VF invariably leads to global ischemia. Whether or not a high DF source exists in LV during global ischemia is unknown.

Methods and Results: By using a two‐camera optical mapping system, epicardial activation patterns of VF were studied in 12 isolated rabbit hearts during baseline, no‐flow global ischemia, and reperfusion. Simultaneous endocardial electrode recording was performed in 4 of the 12 hearts. Optical mapping showed type 1 VF at baseline, with multiple wandering and short‐lived wavelets. After the onset of global ischemia, VF showed progressively increased spatiotemporal periodicity. The majority (65%) of VF recorded after 7 minutes of global ischemia showed type 2 VF, containing a single epicardial site with stable (≥3.85 seconds in duration) repetitive activities. Among the 33 sites with these activities, 24 were located near the interventricular septum, and 27 showed an epicardial breakthrough pattern with centrifugal propagation and wavebreaks distant from the focal site. After 10 minutes of global ischemia, the DF was lower on LV epicardium (5.0 ± 1.4 Hz) than on RV epicardium (8.6 ± 2.5 Hz, P < 0.001). However, there was no DF gradient between RV and LV endocardium (9.7 ± 1.0 vs 9.6 ± 0.9 Hz).

Conclusions: VF during prolonged global ischemia is consistent with type 2 VF with a single subepicardial source of rapid activation, mostly near the interventricular septum. The DF in LV is not higher than in RV.