bluuebunny/crossref_metadata_2025 huggingface dataset:
An Empirical Investigation into the Segmentation of the Labour Supply
Authors: Burchell Brendan , Rubery Jill
Published: September 2003

This paper explores the empirical evidence for segmentation in the labour supply using survey data from a local labour market. Employees were clustered using variables relating to their work histories, current job attributes, employment expectations and personal attributes. Five clusters of employees were identified, which differed markedly in their past, present and expected future labour market behaviour. The main theoretical tenets of segmentation theorists were supported, in as much as the labour market was found to foster and perpetuate the advantages and disadvantages of identifiable groups of workers. The analyses presented in the paper suggest that this structuring of the labour supply is both complex and varied, giving rise, for example to several markedly different types of secondary workers. Examples are given of how this segmentation approach to analyzing labour markets can further our understanding of related phenomena, such as the position of women in the labour market and work values.
Italian `Cassa Integrazione' and Post Redundancy
Authors: Bonazzi Giuseppe
Published: September 2003

After explaining how Cassa Integrazione (CIG) copes with redundancies in Italian industry, the paper presents research carried out in Turin on a sample of 70 former Fiat and 20 former Ceat workers. It argues that the making of the factory populations and the politics pursued by the companies are important factors in making the CIG experience more or less dramatic. Some features of former Fiat workers who spent a short, a medium and a long period on CIG are then examined. It turns out that those with stronger family support were abler to use CIG for a longer period, until they had the best chance for a new job. The hypothesis suggested is that this strategic behaviour is to be related to the different stage reached by the workers in the cycle of urban integration.
A Perfunctory Sort of Post-Fordism: Economic Restructuring and Labour Market Segmentation in Britain in the 1980s
Authors: Lovering John
Published: September 2003

It has been claimed that the changes of the last decade represent a transition from a `Fordist' towards a `post-Fordist' pattern of economic organisation. A review of aspects of economic change in Britain in the last decade suggests that popular versions of this theory are misleading. Despite the international importance of some sectors, the British economy as a whole continued its relative decline. The labour market is being restructured through the contraction and truncation of internal labour markets, alongside the dualistic development of external labour markets. These trends are redrafting the map of labour market `places' and altering the balance of selection criteria governing access to them. The effect is to heighten employers ability to differentiate between workers according to the different terms under which they are available. In Britain's idiosyncratic version of `post-Fordism' long-established status inequalities associated with gender, race, age and class, are mobilised as key axes of segmentation in the labour market.
British Trade Unionism 1979-89: Change, Continuity and Contradictions
Authors: Kelly John
Published: September 2003

The paper begins by briefly documenting many of the changes that have occurred in the 1980s in union membership, occupational structure, strikes, etc. and sets out to compare two interpretations: (i) that these represent a secular transformation towards a new industrial relations, (ii) that they constitute a largely cyclical phenomenon. Whilst there are clearly elements of both modes of change, it is argued that in terms of core elements of industrial relations - the power, interests and relations between the parties - the cyclical hypothesis is much nearer the truth. The paper uses Batstone's (1988) model of power resources to analyse the impact of changes and trends in labour markets, product markets, employer and union strategies, production systems and worker attitudes. In some cases, e.g. worker attitudes, there has been little basic change; in others, e.g. production systems, the effects have been variable; in others again, e.g. state and employer strategies, the effects have sometimes been the opposite of those intended. The paper ends by looking at several explanations for these results.
Technical Innovation and Work Reorganisation in British Manufacturing in the 1980s: Continuity, Intensification or Transformation?
Authors: Elger Tony
Published: September 2003

This article discusses the implications of technical change and flexibility initiatives for the character of work reorganisation in British manufacturing during the last decade. It assesses rival interpretations, some of which discern major transformations and others which emphasise considerable continuity. It argues, against both these interpretations, that work reorganisation has often been piecemeal, bargained, contradictory and incremental, but has nevertheless tended to involve enhanced managerial prerogatives and diminished worker and union leverage. Despite appreciable diversity, involving a spectrum of relatively modest and more radical innovations, the dominant pattern of change has involved task enlargement and reductions in the porosity of labour, with a bias towards work intensification.
Rethinking Economic Structure: Exploring the Role of the Small Firm and Self-Employment in the British Economy
Authors: Curran James
Published: September 2003

Dominant sociological interpretations of the economic structures of industrial societies have long neglected the role of small scale economic activities. However, current rethinking, stimulated by attempts to explain economic restructuring in the 1980s, appears to offer petty capitalism and self-employment a more important role in the economy. Several versions of economic restructuring theory are examined critically and argued to continue to offer an inadequate account of the role of small scale enterprise in the economy and especially of the social reality of small scale enterprise ownership, organisational patterns and employment. Conceptual and theoretical issues relevant to a more direct focus on small scale economic activities are explored together with a review of studies of a wide range of aspects of such activities. The paper ends by arguing for the continuing importance of small scale economic activities in industrial societies and the need for analyses of economic restructuring and, more fundamentally economic sociology generally, to incorporate a proper recognition of small scale economic activities and self-employment.
Labouring at School: Work-Experience in the Technical and Vocational Education Initiative
Authors: Shilling Chris
Published: September 2003

The Technical and Vocational Education Initiative (TVEI) is a four year programme of study for 14-18 year olds which aims to provide vocational and general education broadly related to employment trends. It was announced by the Prime Minister in 1982 and in 1986 the government signalled its intention to extend TVEI to all local education authorities (LEAs) in England and Wales. Although it is not yet clear how much of TVEI will be retained within or alongside the National Curriculum, elements of the Initiative will undoubtedly affect the future education of school students. The central curricular feature of TVEI has been work-experience and in 1988 the Department of Education and Science (DES) announced that this activity was to be extended to all secondary students in England and Wales. This paper analyses the recent development of work-experience, locates it within broader shifts which have taken place in the school-society relationship and uses data from eight LEAs to examine its organization and effects on participating students.
Gendering Jobs: Corporate Strategy, Managerial Control and the Dynamics of Job Segregation
Authors: Morgan Glenn , Knights David
Published: September 2003

The paper argues that the understanding of gender relations at work necessitates an explicit consideration of corporate strategy and managerial practices. Through the detailed examination of relations within a financial services company, we show how certain important issues of corporate strategy revolve around the gendered nature of particular jobs. The struggle within senior management to develop a corporate strategy was reflected in the lower levels of the organization in a struggle between particular groups over the maintenance of gendered identities and the control of particular work settings. The struggle between different groups of men, as well as between men and women, was conducted in terms of who was best able to contribute to the success of the company's corporate strategy. The paper argues that an important dimension of the gendered order in work settings is to be located in the dynamics of corporate strategy formation and development in organizations. Analyses of gender at work, it is argued, need to take into account some of the issues of management control and corporate strategy.
The Decline and Rise of Self-Employment
Authors: Bögenhold Dieter , Staber Udo
Published: September 2003

Indications are that the long-term decline of self-employment has come to a halt in the 1970s in the advanced industrialized economies. In this paper, we challenge the currently popular argument that the recent revival of self-employment represents an effective answer to the problems of slow economic growth and unemployment. Our time-series regression analysis of aggregate self-employment rates in eight major OECD countries from the early 1950s to 1987 suggests that rising self-employment may be a response to deficiencies in labour markets rather than a sign of economic vitality.
The Barriers to Flexibility: Flexible Rostering on the Railways
Authors: Pendleton Andrew
Published: September 2003

This paper reports a case study investigation of the implementation of flexible rostering in British Rail. It is found that this initiative did not secure readily identifiable improvements in flexibility or efficiency and indeed resulted in some new rigidities in work organisation. The national agreement introducing flexible rostering took a skeletal form, reflecting the priority in the public sector of reducing rather than adding to national level work regulation, and left potential conflicts with other agreements and practices to be resolved at the workplace. Workplace representatives were able to stamp their interests onto outcomes because local managers needed their expertise and consent to implement the scheme.
Japanization at Work: The Case of Engineering Plants in Leeds
Authors: Bratton John
Published: September 2003

This paper draws on case studies undertaken between 1985 and 1988. The research analysed the effects of Computer Numerically Controlled machine tools and Japanese manufacturing techniques such as cellular technology, just-in-time and total-quality-control in `concrete' and unionized environments. It is argued that such changes enhanced manual engineering skills and shopfloor autonomy, partly through CNC technology, but also by functional flexibility associated with cellular arrangements. The evidence is in contention with labour process theorists who either posit a view that deskilling is a central dynamic of technological change or consider that Japanese-style methods are bound to reverse the deskilling process. Exploring the hypothesis that cellular and just-in-time methods increases managerial control, the paper provides evidence of enhanced managerial control through the use of microprocessor-based manufacturing technology and worker-generated forms of control, a process described as computer-controlled-autonomy.
How do you Manage a Flexible Firm? The Total Quality Model
Authors: Hill Stephen
Published: September 2003

The introduction of modern principles of quality management among American and British companies in response to changing product markets and Japanese competition has significant implications for labour, management and the firm. Investigation of different applications of these principles shows that the `flexibilization' of management and company organization in order to increase entrepreneurial behaviour is a vital and hitherto neglected component of economic restructuring. Quality management also has a workforce dimension, but this is less important for the analysis of contemporary developments.
Young Workers and the Job-Swapping Phenomenon
Authors: Cregan Christina
Published: September 2003

This paper suggests that the job-swapping phenomenon associated with new entrants to the workforce marks part of a social adjustment process in the transition to adult working life in which young people, by virtue of their age and inexperience and the jobs in which they work, embark on a series of separations. The data-set under investigation consists of a survey of a single cohort of 1922 early school-leavers from manual backgrounds in London, 1979-1981. Job-swapping as an adjustment process was identified for a minority; non-whites were more separation-prone than whites, but there were no gender differences. The effect of the process on change in income over the period of the survey was evident for males but not for females; this seemed to be the result of the different characteristics of gender-based markets.
Patterns of Working Hours in Large-Scale Grocery Retailing in Britain and France: Convergence after 1992?
Authors: Gregory Abigail
Published: September 2003

As 1992 approaches, a major question being raised is to what extent the development of the Single European Market will allow the integration of societies and economies with different structures, laws and traditions, and encourage the convergence of organisational and institutional patterns across member states. This article explores this question by examining patterns of working hours in large-scale grocery retailing in two member states - Britain and France. Based on comparative fieldwork carried out in 1986 and 1987 it shows that patterns of working hours currently differ in terms of patterns of part-time hours (levels of use, length of contracts, shift lengths and patterns) and the types of flexibility in working hours, and seeks to explain these differences in terms of the differing social policies and industrial relations frameworks relating to part-time work and to working hours more generally in the two countries.

The article speculates on the possible effect of the Single European Market on large-scale grocery retailing as part of a wider assessment of factors likely to influence patterns of working hours in this sector after 1992. It finds that there are indeed pressures towards convergence, particularly affecting Britain, as a result of commercial, technological and European social policy measures with major implications for employers and for women's patterns of employment. It suggests, however, that in the short to medium term past national specificities will continue to maintain the differences found.
The Community, The Multinational, its Workers and their Charter: A Modern Tale of Industrial Democracy?
Authors: Ramsay Harvie
Published: September 2003

The advent of the Single Market is seen as central to the interests and development of multi-national capital based in Europe. Indeed, much of the motivation for the change involved an attempt to strengthen European multinationals in relation to those based in Japan and America. This strategy and its outcomes are reviewed critically. In this perspective, what is referred to as the `social dimension' of 1992 becomes a matter of which approach to the labour market and to employees in the workplace is the most appropriate. The Social Charter, which has aroused much controversy in the United Kingdom, is based on the goal of obtaining labour's consent for, and co-operation in achieving, the necessary adjustments to competitive pressures by granting forms of employment protection and channels of influence. The contrary argument, advanced by the Bruges Group and orthodox economists, is that this, too, is an interference compromising the free workings of the market and so sapping the gains of removing non-tariff trade barriers. The paper considers the possibilities open to European trade unions in this situation and concludes that there appears little hope of controlling or moderating the restructuring processes which 1992 seeks to unleash. There remain limits, however, on the power of multi-nationals and the conclusion is that neither convergence nor divergence are very appropriate descriptions of what is likely to happen in Europe after 1992.
Control and Autonomy in Small Firms: The Case of the West Midlands Clothing Industry
Authors: Ram Monder
Published: September 2003

This paper explores the dynamics of workplace relations in small firms. Case study evidence from three clothing firms in the West Midlands is used to demonstrate that workplace relations in small firms are not necessarily harmonious nor autocratic. Rather, they are complex, informal and often contradictory. Even in this most competitive of industries, it is not simply a question of management autocracy. There is always a negotiation of order which, in the context of the clothing firms in the West Midlands, includes the further dimension of ethnicity. Conventional views of the clothing industry which stress the prevalence of tight managerial control, intensive pace of work and strict discipline, are questioned in the light of the findings.
Air embolism as a cause of the systemic inflammatory response syndrome: a case report
Authors: Kapoor Tarun , Gutierrez Guillermo
Published: September 2003

We describe a case of systemic inflammatory response syndrome associated with air embolism following the removal of a central line catheter, coupled with a deep inspiratory maneuver. The presence of a patent foramen ovale allowed the passage of a clinically significant amount of air from the venous circulation to the systemic circulation. The interaction of air with the systemic arterial endothelium may have triggered the release of endothelium-derived cytokines, resulting in the physiologic response of systemic inflammatory response syndrome.
Adenosine A1 Antagonism Attenuates Atropine‐resistant Hypoxic Bradycardia in Rats
Authors: Kaplan Justin L. , Gao Erhe , De Garavilla Lawrence , Victain Michelle , Minczak Bohdan , Dalsey William C.
Published: September 2003

Objectives: To test the following hypotheses: Hypoxia induces bradycardia and hemodynamic compromise that are resistant to atropine but responsive to selective antagonism of the adenosine A1 receptor (A1AdoR). The mechanism for such attenuation is independent of the vagus nerve. Methods: Ten minutes after sham or actual bilateral cervical vagotomy, paralyzed ventilated rats were made hypoxic (5% fractional inspired oxygen, continued until death). Five minutes after beginning hypoxia, intravenous treatment with BG‐9719, a selective A1AdoR antagonist (0.1 mg/kg); atropine (0.1 mg/kg); BG‐9719 vehicle; or saline was initiated. These drug doses were based on pilot studies. Of the eight treatment groups (eight possible combinations of vagotomy status and drug/vehicle treatment), n= 8 in all except nonvagotomized, vehicle‐treated rats (where n= 7). Results: Heart rate and left ventricular contractility decreased rapidly with hypoxia. Atropine had minimal effects in prolonging survival (from mean ± SEM of 15.5 ± 2.1 minutes to 20.2 ± 2.5 minutes, p = 0.94) and attenuating posthypoxic decreases in heart rate (p = 0.89) and contractility (p = 0.83) compared with saline. BG‐9719 prolonged survival, however, from 14.4 ± 1.9 minutes (with vehicle treatment) to 37.2 ± 6.8 minutes (p < 0.001). Survival, heart rate, and contractility were preserved with BG‐9719 compared with atropine and vehicle (p < 0.05, all comparisons). Vagotomy prevented the effects of BG‐9719 on survival prolongation (p = 0.003), heart rate (p = 0.01), and contractility (p < 0.001) but did not affect those outcomes in saline‐treated rats. Conclusions: Survival, heart rate, and contractility were better preserved with BG‐9719 than atropine. A1AdoR selective antagonism, possibly because of its multiple mechanisms for attenuating hypoxic cardiac insufficiency, resulted in better hemodynamic and clinical outcomes. That attenuation seems to have a component of vagal mediation.
Randomized Clinical Trial of Propofol versus Methohexital for Procedural Sedation during Fracture and Dislocation Reduction in the Emergency Department
Authors: Miner James R. , Biros Michelle , Krieg Susan , Johnson Christopher , Heegaard William , Plummer David
Published: September 2003

Although methohexital has been well studied for use in emergency department (ED) procedural sedation (PS), propofol has been evaluated less extensively for ED use. Objective: The authors hypothesized that there is no difference in the depth of sedation and the rate of respiratory depression (RD) between propofol and methohexital in PS during the reduction of fractures and dislocations in the ED. Methods: This was a randomized prospective study of nonintoxicated adult patients undergoing PS for fracture or dislocation reduction in the ED between July 2001 and March 2002. Patients were randomized to receive either propofol or methohexital, 1 mg/kg intravenously, followed by repeat boluses of 0.5 mg/kg every 2 minutes until adequate sedation was achieved. Doses, vital signs, end‐tidal CO 2 (ETCO 2) by nasal cannulae, pulse oximetry, and bispectral electroencephalogram analysis (BIS) scores were recorded. RD was defined as an ETCO 2 greater than 50 torr, an oxygen saturation less than 90% at any time, or an absent ETCO 2 waveform. After returning to baseline mental status, patients completed three 100‐mm visual analog scales (VASs) regarding pain associated with the procedure, recall of the procedure, and satisfaction. RD rates and VAS outcomes were compared with chi‐square tests. Results: There were 109 patients enrolled; six were excluded for study protocol violations. Of the remaining 103 patients, 52 received methohexital (reduction successful in 94%) and 51 received propofol (98% successful). No cardiac rhythm abnormalities or significant decline in systolic blood pressure (>20%) was detected. Six patients required bag‐valve‐mask‐assisted ventilations during the procedure, all for less than 1 minute; four of these patients received methohexital, and two received propofol. By the authors' definition, RD was seen in 25 of 52 (48%) patients receiving methohexital and 25 of 51 (49%) patients receiving propofol (p = 0.88). The mean minimum recorded BIS score was 66.2 (95% confidence interval [CI] = 62 to 70) for methohexital and 66 (95% CI = 60 to 71) for propofol. VAS results showed similar rates of reported pain, recall, and satisfaction for the two agents. Conclusions: The authors were unable to detect a significant difference in the level of subclinical RD or the level of sedation by BIS between the two agents. The use of either agent seems to be safe in the ED.
Development and Validation of a New Index to Measure Emergency Department Crowding
Authors: Bernstein Steven L. , Verghese Vinu , Leung Winifred , Lunney Anne T. , Perez Ivelisse
Published: September 2003

Objectives: To develop a quantitative measure of emergency department (ED) crowding and busyness. Methods: A five‐week study in spring 2002 in an urban teaching ED compared a new index (the Emergency Department Work Index [EDWIN]) with attending physician and nurse ratings of crowding. EDWIN is defined as ∑n it i/N a(B T−B A), where n i = number of patients in the ED in triage category i, t i = triage category, N a = number of attending physicians on duty, B T = number of treatment bays, and B A = number of admitted patients in the ED. The triage system used is the Emergency Severity Index (ESI), which was modified by reversing the ranking of triage categories; that is, an ESI score of 1 represented the least acute patient and 5 the sickest. EDWIN was calculated every two hours in a convenience sample of 60 eight‐hour shifts. With each measurement, the charge attending physician and nurse estimated how busy/crowded the ED was, using a Likert scale. Nurse and physician assessments were averaged and compared with EDWIN scores. Data were analyzed with SPSS 10.0 (SPSS Inc., Chicago, IL). Results: A total of 2,647 patients aged 18 years and older were assessed at 225 time points over 35 consecutive days. Nurses and physicians showed good interrater agreement of crowding assessment (weighted κ 0.61, 95% confidence interval = 0.53 to 0.69). Median EDWIN scores and interquartile ranges (IQRs) when the ED was rated as not busy, average, and very busy were 1.07 (IQR = 0.80 to 1.55), 1.55 (IQR = 1.16 to 1.93), and 1.83 (IQR = 1.42 to 2.45) (p < 0.001). The ED was on diversion for 17 time blocks (6.5% of all blocks), with a median EDWIN of 2.77 (IQR = 1.83 to 3.63), compared with an EDWIN of 1.45 (IQR = 1.05 to 2.00) when not on diversion (p < 0.001). EDWIN scores correlated weakly with various process‐of‐care measures chosen as secondary end points. Conclusions: EDWIN correlated well with staff assessment of ED crowding and diversion. The index can be programmed into tracking software for use as a “dashboard” to alert staff when the ED is approaching crisis. If validated across other sites, EDWIN may provide a tool to compare crowding levels among different EDs.
Incomplete Data Reporting in Studies of Emergency Department Patients with Potential Acute Coronary Syndromes Using Troponins
Authors: Glavan Bradford , Shewakramani Sanjay , Hollander Judd E.
Published: September 2003

Objectives: A multidisciplinary panel of experts is developing standardized reporting criteria for risk stratification studies of emergency department (ED) patients with potential acute coronary syndromes (ACS). The authors assessed the need for such criteria by reviewing published studies to determine whether these core criteria currently are being reported. Methods: Studies published during 2000–2001 in eight journals representing emergency medicine, cardiology, and general medicine that evaluated the cardiac troponins for risk stratification of ED patients with chest pain were identified by a systematic MEDLINE review. Two raters independently analyzed each study with a structured tool. The presence or absence of 47 core criteria in eight major reporting categories, which were determined by expert consensus, was abstracted from the articles. When the two raters disagreed, discrepancies were resolved by consensus. Data are presented as percent frequency of occurrence with 95% confidence intervals. Results: Twenty‐two articles met inclusion criteria. The two reviewers had a median of 7.5 initial discrepancies per article (interquartile range = 6 to 10) but achieved consensus on all.Conclusions: Many of the 47 items considered core criteria by the expert committee writing standardized reporting guidelines for risk stratification studies of potential ACS patients were not reported often in major cardiology and emergency medicine journals. There seems to be a need for standardized reporting guidelines because important information is not currently being reported.
Is Total Out‐of‐hospital Time a Significant Predictor of Trauma Patient Mortality?
Authors: Lerner E. Brooke , Billittier Anthony J. , Dorn Joan M. , Wu Yow‐Wu B.
Published: September 2003

Objective: To determine if there is an association between total out‐of‐hospital time and trauma patient mortality. Methods: A retrospective review was performed of a convenience sample of consecutive medical records for all admitted patients transported by helicopter or ambulance from the scene of injury to the regional trauma center. Descriptive and univariate analyses were conducted to determine which variables were associated with patient mortality and total out‐of‐hospital time. Multiple predictors logistic regression was used to determine if total out‐of‐hospital time was associated with trauma patient outcome, while controlling for the variables associated with trauma patient mortality. Results: Of the 2,925 patients who were transported from the scene, 1,877 met the inclusion criteria. Six percent (116) did not survive. The multiple predictors model included CUPS (critical, unstable, potentially unstable, stable) status, patient age, Injury Severity Score, Revised Trauma Score, and total out‐of‐hospital time as predictors of mortality. Total out‐of‐hospital time (odds ratio 0.987; p = 0.092) was the only variable not found to be a significant predictor of mortality. Conclusions: Provider‐assigned CUPS status, patient age, Injury Severity Score, and Revised Trauma Score all were significant predictors of trauma patient mortality. Total out‐of‐hospital time was not associated with mortality.
Unrecognized Misplacement of Endotracheal Tubes in a Mixed Urban to Rural Emergency Medical Services Setting
Authors: Jemmett Michael E. , Kendal Kevin M. , Fourre Mark W. , Burton John H.
Published: September 2003

Objective: To determine the rate of unrecognized endotracheal tube misplacement when performed by emergency medical services (EMS) personnel in a mixed urban and rural setting. Methods: The authors conducted a prospective, observational analysis of out‐of‐hospital endotracheal intubations (EIs) performed by EMS personnel serving a mixed urban, suburban, and rural population. From July 1, 1998, to August 30, 1999, emergency physicians assessed and recorded the position of out‐of‐hospital EIs using auscultation, direct laryngoscopy, infrared CO 2 detectors, esophageal detector devices, and chest x‐ray. The state EMS database also was reviewed to determine the number of EIs involving patients transported to the authors' medical center and paramedic assessment of success for these encounters. Results: A total of 167 out‐of‐hospital EIs were recorded, of which 136 (81%) were deemed successful by EMS personnel. Observational forms were completed for 109 of the 136 patients who arrived intubated to the emergency department. Of the studied patients, 12% (13 of 109) were found to have misplaced endotracheal tubes. For the patients with unrecognized improperly placed tubes, 9% (10 of 109) were in the esophagus, 2% (2 of 109) were in the right main stem, and 1% (1 of 109) were above the cords. Paramedics serving urban and suburban areas did not perform significantly better (p < 0.05) than intermediate‐level providers serving areas that are more rural. Conclusions: The incidence of unrecognized misplacement of endotracheal tubes by EMS personnel may be higher than most previous studies, making regular EMS evaluation and the out‐of‐hospital use of devices to confirm placement imperative. The authors were unable to show a difference in misplacement rates based on provider experience or level of training.
Cost–Effectiveness of Helicopter Transport of Stroke Patients for Thrombolysis
Authors: Silbergleit Robert , Scott Phillip A. , Lowell Mark J. , Silbergleit Richard
Published: September 2003

Objectives: Treatment with intravenous (IV) or intra‐arterial (IA) thrombolysis in patients with acute ischemic stroke demands careful patient selection and specialized institutional capabilities. Physicians at hospitals without these resources may prefer patient transfer for acute treatment. Helicopter transport for these patients has been described but without analysis of the effects of its additional cost. The authors examined the cost–effectiveness of helicopter transport for patients with acute stroke. Methods: Costs per additional good outcome and per quality‐adjusted life‐year (QALY) were calculated using a computer model. Input variables included flight, thrombolytic agent, and angiography costs; annual cost per patient for long‐term care of symptomatic stroke; percentage of transported patients treated; percentage of patients receiving IV versus IA therapy; discount rate; absolute probability of good outcome; annual mortality with and without treatment; and quality‐of‐life modifier. Sensitivity analysis was performed. Results: Helicopter transport of acute stroke patients to tertiary care centers for thrombolytic therapy costs $35,000 per additional good outcome and $3,700 per QALY for the reference case. Cost–effectiveness was sensitive to the effectiveness of thrombolysis but minimally sensitive to most other input values. Cost per QALY ranged from $0 to $50,000, as the absolute increase in good outcomes (minimal or no deficit) ranged from 20% to 5%. Cost–effectiveness was not sensitive to ranges of helicopter flight costs or the proportion of flown patients undergoing treatment. Conclusions: This model indicates helicopter transfer of patients with suspected acute ischemic stroke for potential thrombolysis is cost‐effective for a wide range of system variables.
Bench to Bedside: The Role of Mitochondrial Medicine in the Pathogenesis and Treatment of Cellular Injury
Authors: Watts John A. , Kline Jeffrey A.
Published: September 2003

Interest in the study of mitochondria has undergone a revival. The term mitochondrial medicine developed around evidence pointing to the mitochondria as a logical target for therapy. This article reviews the normal functions of mitochondria and integration of mitochondrial processes in cells. Changes in mitochondria that occur in ischemia and reperfusion, production of reactive oxygen species by mitochondria, stimulation of apoptosis, and roles of mitochondria in sepsis also are reviewed. The authors also review therapies that are based on targeting drugs to mitochondria, regulating calcium availability, substrate preferences, and activation of poly (ADP‐ribose) polymerase and apoptosis. The purpose of this article is to provide a framework for emergency medicine academicians to understand the roles of mitochondria in pathology and to facilitate the transition of this information into therapeutic strategies based on mitochondrial medicine. For individuals interested in the biochemistry of mitochondria, knowledge of this fundamental organelle is expanding at a rapid rate.
Resolution of Delayed Altered Mental Status Associated with Hydrogen Peroxide Ingestion Following Hyperbaric Oxygen Therapy
Authors: Heide Stuart J. Vander , Seamon Jason P.
Published: September 2003

Case Report: An 82‐year‐old women presented with altered mental status, seizure, and apnea after an accidental ingestion of concentrated hydrogen peroxide. Ingestion of concentrated peroxide can result in gas embolism of the cerebral vasculature. After hyperbaric treatment, the patient had prompt and full neurologic recovery. To the best of the authors' knowledge, this is the first reported case of reversal of significant altered mental status associated with hydrogen peroxide ingestion in temporal relation with hyperbaric oxygen therapy. Emergency physicians need to be aware of the dangers of peroxide ingestion and may wish to consider hyperbaric oxygen as a potential additional treatment for severe cases.
Adolescent Foley Catheter Technique for Visualizing Hymenal Injuries in Adolescent Sexual Assault
Authors: Jones Jeffrey S. , Dunnuck Chris , Rossman Linda , Wynn Barbara N. , Genco Michael
Published: September 2003

Objectives: To determine the usefulness of the Foley catheter balloon technique for visualizing injuries of the estrogenized hymen in adolescent sexual assault victims compared with supine labial traction. Methods: A prospective clinical trial of 20 adolescent (age 13–16 years old) victims of sexual assault evaluated at a free‐standing Nurse Examiner Clinic was conducted over a four‐month study period. The clinic, affiliated with an emergency medicine residency program, is staffed by registered nurses who have been specially trained to perform medicolegal examinations using colposcopy with digital imaging. The Foley catheter technique uses an inflated balloon in the distal vaginal vault to expand the estrogenized hymen to its full capacity so that the edge may be readily visualized for signs of trauma. The Foley technique was compared with gross inspection, using supine labial traction, to photodocument hymenal abnormalities. Photographs of the hymen were obtained using the labial traction technique and then with the Foley technique. Three emergency physicians independently examined each pair of photographs with high interrater agreement for the presence of injury (κ= 0.88). Results: Twenty adolescent sexual assault victims volunteered for the study; mean age was 14.8 years. Gross inspection of the hymen using supine labial traction identified hymenal injuries in three patients (15%). Use of the Foley catheter balloon technique allowed identification of hymenal abnormalities in nine additional cases (60%). The common injuries to the hymen included lacerations (30%), followed by ecchymosis and abrasions. One patient (5%) voiced discomfort (mild pressure sensation) during inflation of the balloon. Conclusions: The Foley catheter balloon technique is a simple method allowing improved photodocumentation of hymenal trauma in adolescent sexual assault victims compared with supine labial traction.
Heart Rate Response to Intravenous Catheter Placement
Authors: Bartfield Joel M. , Janikas John S. , Lee Ryan S.
Published: September 2003

Objective: To investigate the relationship between change in heart rate and pain and anxiety caused by intravenous catheter (IV) placement. Methods: An observational study was performed in a university‐based tertiary care emergency department. Patients who required IV placement as part of their management were considered as possible subjects. Heart rates were recorded at the following times: baseline, tourniquet placement, and IV placement. Immediately after IV placement, subjects recorded pain and anxiety scores using 100‐mm visual analog scales. Percentage change in heart rate (compared with baseline) was calculated at time of tourniquet placement (anxiety) and IV placement (pain). Simple linear regression analyses were performed comparing pain scores with percent change in heart rate at the time of IV and tourniquet placement. Significance was defined as p < 0.05. Results: Ninety subjects were enrolled. Subjects had a mean age of 48 years, and 54% were women. There was a normal distribution of heart rate changes, with greater than 80% of all subjects having a 10% or less change in heart rates. The results of the analysis of pain scores versus percentage change in heart rate at IV placement yielded a Pearson correlation coefficient of 0.13 (p = 0.2). The results of the analysis of anxiety scores versus percentage change in heart rate at tourniquet placement yielded a Pearson correlation coefficient of 0.014 (p = 0.9). Conclusions: Changes in heart rate do not correlate with pain and anxiety associated with IV placement.
Predictors of Academic Productivity in Emergency Medicine
Authors: Henderson Sean O. , Brestky Philip
Published: September 2003

Objectives: Emergency medicine (EM), as a young specialty, has few measures of academic productivity beyond the traditional National Institutes of Medicine ranking, which is not applicable to most academic EM programs. This study was undertaken to identify factors associated with number of publications per academic institution in an attempt to predict keys to success. Methods: Retrospective study for a seven‐year period using a MEDLINE search with Emergency in the Institution field. All publications were included except Letters and Abstracts. The Society for Academic Emergency Medicine (SAEM) website was queried for program descriptors that were analyzed as independent predictors of publication success. A multivariate predictive model was constructed to evaluate the independent variables found to be significant univariate modifiers. Results: Although total emergency department census, postgraduate years, fellowship opportunities, residency research requirement, hospital census, the year the program was established, and SAEM region were not associated with increased publications, faculty size and program location (region) were statistically associated with increased publications. The Western United States had the highest number of total publications per program (mean 39.6 [95% confidence interval = 25.8 to 53.5]). Faculty size was an independent predictor of publication, with each additional faculty member adding 0.58 publications for the entire seven‐year period under review. No other demographic descriptors were significantly associated with publications. Conclusions: Only program location and faculty size were associated with the number of publications for a specific institution. Factors such as patient care load did not seem to influence such productivity.
The effect of laminate lay-up on the flutter speed of composite wings
Authors: Guo S J , Bannerjee J R , Cheung C W
Published: September 2003

This paper presents an analytical study on optimization of a laminated composite wing structure for achieving a maximum flutter speed and a minimum weight without strength penalty. The investigation is carried out within the range of incompressible airflow and subsonic speed. In the first stage of the optimization, attention has been paid mainly to the effect on flutter speed of the bending, torsion and, more importantly, the bending-torsional coupling rigidity, which is usually associated with asymmetric laminate lay-up. The study has shown that the torsional rigidity plays a dominant role, while the coupling rigidity has also quite a significant effect on the flutter speed. In the second stage of the optimization, attention has been paid to the weight and laminate strength of the wing structure, which is affected by the variation in laminate lay-up in the first stage. Results from a thin-walled wing box made of laminated composite material show that up to 18 per cent increase in flutter speed and 13 per cent reduction in weight can be achieved without compromising the strength. The investigation has shown that a careful choice of initial lay-up and design variables leads to a desirable bending, torsional and coupling rigidities, with the provision of an efficient approach when achieving a maximum flutter speed with a minimum mass of a composite wing.
Auxiliary power system technology using a hydrodynamic clutch
Authors: Hirtz N , Althaus J
Published: September 2003

A hydraulic clutch used for Auxiliary Power Unit (APU) drives provides a flexibility in adapting its characteristic to the requirements of the typical application. In comparison to a mechanical clutch, the hydrodynamic clutch is able to engage dynamically both unloaded and loaded. In particular, the dynamic engagement can be varied very easily by controlling the oil flow into the clutch.

This paper describes the general function of the APU system and explains the advantages of the hydrodynamic clutch with respect to the system requirements. The clutch working principle and its design for the special application are presented. Measurement results illustrate the clutch performance in engaged and disengaged mode. The optimization of the APU starting procedure, which benefits significantly from the smooth clutch behaviour, is explained in detail.
The ‘tumble’ departure mode in weightshift-controlled microlight aircraft
Authors: Gratton G , Newman S
Published: September 2003

The cost of private or recreational flying is high for most conventional aircraft types. During the last 25 years, however, an alternative has become available in the form of the microlight aircraft. It has a relatively low cost of ownership and has opened up flying to a greater audience.

However, there have been a number of accidents, usually fatal, to this class of aircraft, which could not be explained through any conventional understanding. The reason for these accidents, which involve a departure from controlled flight followed by aircraft structural failure (generally including mechanical failure of the basebar, wingtips and leading edge), has become known as the “tumble”, owing to the basic motion of the aircraft. This paper analyses the tumble mode, from its initiation through to the steady rotation condition. History has shown that the tumble mode has always resulted in the destruction of an aircraft. In consequence, it is the authors' opinion that consideration of the tumble during the approval of new designs should concentrate upon avoidance, since there is no identifiable recovery mechanism from the established mode without the use of an external safety device.

A programme of research into this phenomenon was initiated in 1997. The peculiar nature of the tumble motion has required the aerodynamic modelling to address the effects of a high pitch rate, which has led to the introduction of unsteady aerodynamic effects.

This paper sets out to describe and explain the mode, leading to a model that might reasonably be developed to produce relatively tumble resistant aircraft. Finally, the methods of possible entry are explained; it is intended that this information may be used in pilot training to ensure the avoidance of the tumble instability.
Dye-sensitized Solar Cell with Polysaccharide Solid Electrolyte
Authors: Kaneko Masao , Hoshi Takayuki
Published: September 2003

A solid state dye-sensitized solar cell was successfully fabricated using inexpensive polysaccharide solid involving redox electrolyte and organic medium with the incident photon-to-electricity conversion efficiency over 7%.
Gender Differences in NSAID Use among Older Adults with Osteoarthritis
Authors: Dominick Kelli L , Ahern Frank M , Gold Carol H , Heller Debra A
Published: September 2003

BACKGROUND:

Nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly prescribed medications for the treatment of osteoarthritis (OA). Little is known about whether there are important gender differences in NSAID use among patients with OA.

OBJECTIVE:

To examine gender differences in patterns of NSAID use among older adults (≥65 y) with OA.

METHODS:

Subjects (n = 11 298) were members of a statewide prescription drug plan who responded to a health-related quality-of-life (HRQOL) survey in 1997 and had a physician diagnosis of OA. Gender differences in patterns of NSAID use were examined over a 2-year period.

RESULTS:

Approximately one-third of the participants filled at least 1 NSAID prescription during the study. Women were significantly more likely to be prescribed an NSAID than men (37% vs. 30%), had a greater total days' supply of NSAIDs, and were more frequently prescribed NSAIDs with greater degrees of cyclooxygenase-2 selectivity. These gender differences persisted in statistical analyses controlling for demographic factors, HRQOL, and gastrointestinal (GI) risk factors.

CONCLUSIONS:

Results of this study showed significant gender differences in patterns of NSAID use, and these differences were independent of the risk for GI adverse effects and self-reported symptoms. Further research is needed to examine reasons for these gender variations, as well as their impact on the quality of symptom management.