bluuebunny/crossref_metadata_2025 huggingface dataset:
Induction of spermatogenic cell apoptosis in prepubertal rat testes irrespective of testicular steroidogenesis: a possible estrogenic effect of di(n-butyl) phthalate
Authors: Alam Mohammad Shah , Ohsako Seiichiroh , Matsuwaki Takashi , Zhu Xiao Bo , Tsunekawa Naoki , Kanai Yoshiakira , Sone Hideko , Tohyama Chiharu , Kurohmaru Masamichi
Published: November 2009

Although di(n-butyl) phthalate (DBP), a suspected endocrine disruptor, induces testicular atrophy in prepubertal male rats, whether it exerts estrogenic activity in vivo remains a matter of debate. In the present study, we explored the estrogenic potency of DBP using 3-week-old male rats, and then examined the relationship between estrogen-induced spermatogenic cell apoptosis and testicular steroidogenesis. Daily exposure to DBP for 7 days caused testicular atrophy due to loss of spermatogenic cells, whereas testicular steroidogenesis was almost the same with the control values. A single exposure of DBP decreased testicular steroidogenesis in addition to decreasing the level of serum LH at 3 h after DBP treatment, with an extremely high incidence of apoptotic spermatogenic cells at 6 h after administration. To elucidate the estrogenic activity of DBP, we carried out an inhibition study using pure antiestrogen ICI 182,780 (ICI) in a model of spermatogenic cell apoptosis induced by DBP or estradial-3-benzoate (EB). Although both the DBP- and EB-treated groups showed a significant increase in spermatogenic cell apoptosis, ICI pretreatment significantly decreased the number of apoptotic spermatogenic cells in these two groups. In contrast, testicular steroidogenesis and serum FSH were significantly reduced in all the treated groups, even in the DBP+ICI and EB+ICI groups. Taken together, these findings led us to conclude that estrogenic compounds such as DBP and EB induce spermatogenic cell apoptosis in prepubertal rats, probably by activating estrogen receptors in testis, and that reduction in testicular steroidogenic function induced by estrogenic compounds is not associated with spermatogenic cell apoptosis.
Introduction
Authors: Crowdy Denis , Evans Mark
Published: November 2009

-
Sonic psychogeography
Authors: Mitchell Tony
Published: November 2009

This article explores aspects of the relationship between music, place, locality and identity in Aotearoa/New Zealand. While there have been numerous attempts to construct a national identity for New Zealand music (often referred to as ‘Kiwi’ music), I will argue that there is far more comprehensive evidence of a range of regional musics, which go beyond examples such as the Flying Nun-Dunedin Christchurch and roots-reggae-dub-Wellington nexus, and suggest rather a local-transnational nexus, which combines strong global influences with evocations of particular localities. This transnational orientation suggests a liminal or ‘in-between’ situatedness for much music produced in New Zealand, in which landscape and ‘sonic geography’, whether urban or rural, is not related to expressions of national identity, but to a more locally- grounded poetics of home, belonging, and also alienation. In exploring ‘psychogeographical’ aspects of a range of popular music in Aotearoa, I will examine remixes of taonga puoro music (pre-European Maori musical instruments) by Richard Nunns and Hirini Melbourne by various dub and electronica musicians, music by Neil Finn, Don McGlashan, Bachelorette, Roy Montgomery, and music inspired by places in the South island, especially the ‘landscape of trauma’ of the Aramoana massacre of 1990.
Imagining Okinawa
Authors: Gillan Matt
Published: November 2009

Since the early 1970s, Okinawan styles have become popular throughout Japan and, to some extent, the rest of the world. This music has been performed both by native Okinawan musicians, and also by musicians from the Japanese mainland, drawn partly by the exoticness of this ‘Japanese other’. While modern-day Okinawan music has been considered from the perspective of Okinawan identity within a Japanese framework, the role of Japanese musicians in the recent Okinawan music boom has been overlooked. In this paper I present an overview of the activities of Japanese mainland musicians in their use of Okinawan musical material and, through an analysis of published interviews and writings by these musicians, I examine the cultural meanings that these musical expropriations have held. In addition, I argue that the activities of Okinawan musicians themselves have been greatly affected by mainland Japanese musicians, and that modern Okinawan music must be seen within a national musical context.
Music as territory
Authors: Suwa Junichiro
Published: November 2009

This paper discusses sociocultural changes in music in post war Papua New Guinea, by presenting examples of under-researched early stringband activities in the Madang area. The musicians as social actors are seen to be undertaking an act of what the author calls ‘territorialization’, a means of cultural survival through music-making in an era of transition from traditional local chiefdom to modern independent state. The case of Aksim Siming of Kranket, a key figure in the early phases of Madang stringband music, will be presented, along with details of others who participated in guitar and bambooband activities.
The clusterin paradigm in prostate and breast carcinogenesis
Authors: Rizzi Federica , Bettuzzi Saverio
Published: November 2009

The biological functions of clusterin (CLU, also known as ApoJ, SGP2, TRPM-2, CLI) have been puzzling the researchers since its first discovery in the early 80's. We know that CLU is a single 9-exons gene expressing three protein forms with different sub-cellular localisations and diverse biological functions. Despite the many reports from many research teams on CLU action and its relation to tumourigenesis, contradictions in the data and alternative hypothesis still exist. Understanding the role of CLU in tumourigenesis is complicated not only by the existence of different protein forms but also by the changes of tumours over time and the selection pressures imposed by treatments such as hormone ablation or chemotherapy. This review focuses on recent discoveries concerning the role of CLU in prostate and breast cancer onset and progression. Although CLU acts primarily as a tumour suppressor in the early stages of carcinogenesis, consistent with its role in the involution of the prostate following castration, late stage cancer may overexpress CLU following chemotherapeutic drugs or hormonal ablation therapy. High expression of secreted or cytoplasmic CLU may represent a pro-survival stimulus because it confers increased resistance to killing by anti-cancer drugs or enhances tumour cell survival in specific niches.
MicroRNAs in ovarian carcinomas
Authors: Dahiya Neetu , Morin Patrice J
Published: November 2009

The molecular mechanisms involved in epithelial ovarian cancer initiation and progression are just beginning to be elucidated. In particular, it has become evident that microRNAs (miRNAs or miRs), a class of molecules that post-transcriptionally regulate gene expression, play a major role in ovarian tumorigenesis. Several microRNA profiling studies have identified changes in microRNA patterns that take place during ovarian cancer development. While most deregulated microRNAs are down-regulated in cancer, and may therefore act as tumor suppressors, others are elevated and may represent novel oncogenes in this disease. A number of microRNAs identified as aberrantly expressed in ovarian carcinoma have been shown to have important functional roles in cancer development and may therefore represent targets for therapy. In addition, some of the microRNA patterns may have prognostic significance. The identification of functional targets represents a major hurdle in our understanding of microRNA function in ovarian carcinoma, but significant progress is being made. It is hoped that a better understanding of the microRNA expression and roles in ovarian cancer may provide new avenues for the detection, diagnosis, and therapy of this deadly disease.
Plasma sex hormone concentrations and breast cancer risk in an ethnically diverse population of postmenopausal women: the Multiethnic Cohort Study
Authors: Woolcott Christy G , Shvetsov Yurii B , Stanczyk Frank Z , Wilkens Lynne R , White Kami K , Caberto Christian , Henderson Brian E , Le Marchand Loïc , Kolonel Laurence N , Goodman Marc T
Published: November 2009

To add to the existing evidence that comes mostly from White populations, we conducted a nested case–control study to examine the association between sex hormones and breast cancer risk within the Multiethnic Cohort that includes Japanese American, White, Native Hawaiian, African American, and Latina women. Of the postmenopausal women for whom we had a plasma sample, 132 developed breast cancer during follow-up. Two controls per case, matched on study area (Hawaii, Los Angeles), ethnicity/race, birth year, date and time of blood draw and time fasting, were randomly selected from the women who had not developed breast cancer. Levels of estradiol (E2), estrone (E1), androstenedione, dehydroepiandrosterone (DHEA), and testosterone were quantified by RIA after organic extraction and Celite column partition chromatography. E1 sulfate, DHEA sulfate (DHEAS), and sex hormone-binding globulin (SHBG) were quantified by direct immunoassays. Based on conditional logistic regression, the sex hormones were positively associated and SHBG was negatively associated with breast cancer risk. All associations, except those with DHEAS and testosterone showed a significant linear trend. The odds ratio (OR) associated with a doubling of E2 levels was 2.26 (95% confidence interval (CI) 1.58–3.25), and the OR associated with a doubling of testosterone levels was 1.34 (95% CI 0.98–1.82). The associations in Japanese American women, who constituted 54% of our sample, were similar to or nonsignificantly stronger than in the overall group. This study provides the best evidence to date that the association between sex hormones and breast cancer risk is generalizable to an ethnically diverse population.
The Ca2+–calmodulin-dependent kinase II is activated in papillary thyroid carcinoma (PTC) and mediates cell proliferation stimulated by RET/PTC
Authors: Rusciano Maria Rosaria , Salzano Marcella , Monaco Sara , Sapio Maria Rosaria , Illario Maddalena , De Falco Valentina , Santoro Massimo , Campiglia Pietro , Pastore Lucio , Fenzi Gianfranco , Rossi Guido , Vitale Mario
Published: November 2009

RET/papillary thyroid carcinoma (PTC), TRK-T, or activating mutations of Ras and BRaf are frequent genetic alterations in PTC, all leading to the activation of the extracellular-regulated kinase (Erk) cascade. The aim of this study was to investigate the role of calmodulin-dependent kinase II (CaMKII) in the signal transduction leading to Erk activation in PTC cells. In normal thyroid cells, CaMKII and Erk were in the inactive form in the absence of stimulation. In primary PTC cultures and in PTC cell lines harboring the oncogenes RET/PTC-1 or BRafV600E, CaMKII was active also in the absence of any stimulation. Inhibition of calmodulin or phospholipase C (PLC) attenuated the level of CaMKII activation. Expression of recombinant RET/PTC-3, BRafV600E, or RasV12 induced CaMKII activation. Inhibition of CaMKII attenuated Erk activation and DNA synthesis in thyroid papillary carcinoma (TPC-1), a cell line harboring RET/PTC-1, suggesting that CaMKII is a component of the Erk signal cascade in this cell line. In conclusion, PTCs contain an active PLC/Ca2+/calmodulin-dependent signal inducing constitutive activation of CaMKII. This kinase is activated by BRafV600E, oncogenic Ras, and by RET/PTC. CaMKII participates to the activation of the Erk pathway by oncogenic Ras and RET/PTC and contributes to their signal output, thus modulating tumor cell proliferation.
THE BEARING CAPACITY OF SCREW PILES AND SCREWCRETE CYLINDERS.
Authors: WILSON G
Published: November 2009

Summary

This Paper describes an investigation which included model-experiments and full-scale loading tests on screw piles and cylinders, observations on the settlement of piles in actual structures, the derivation of a theory of bearing capacity, a check on the relationship between the driving torque and the bearing capacity of the pile, and the formulation of design rules.

Two important factors, the first of which does not appear to have been appreciated previously, emerge from this investigation: they are that the value of the coefficient of earth-pressure at rest is a critical factor in the bearing capacity of structures founded in a frictional medium, and that the effect of screwing a cylinder with a closed nose into dense sand is to raise the horizontal earth-pressure considerably and so to effect a very large increase in the bearing capacity.
THE THERMAL EXPANSION OF CONCRETE. ENGINEERING RESEARCH. (SUMMARY OF A REPORT TO BE PUBLISHED BY THE BUILDING RESEARCH STATION).
Authors: BONNELL D G R , HARPER F C
Published: November 2009

Synopsis

Measurements of the coefficient of thermal expansion of different aggregates, and of concretes prepared from them with different cements, have been made over the temperature range 32°F. to 104°F.

The values for aggregates have been found to range from 2.1 to 6.5 × l0-6 per °F. Siliceous materials have the highest coefficients, limestones the lowest, and igneous materials intermediate.

Concretes have values in the range 3.4 to 7.3 × 10-6 per °F. The magnitude of the coefficient of expansion of concrete depends largely on the aggregate used; concretes with siliceous aggregate have the highest values and those with limestone aggregate the lowest, whilst concretes with igneous aggregate have intermediate values.

The coefficient of thermal expansion of neat hydrated cement is higher than that of any aggregate measured. The richer mixes tend to have the higher thermal expansion but the order of difference is not high; the age of concrete has little effect on its thermal expansion.

The method of curing and the water content have only a small influence on the thermal expansion. Desiccated and water-saturated concretes have similar coefficients of expansion but the values are lower than that of partly-dry concrete.
A Game Theoretic Approach to Conflicting and Evolving Stakeholder Preferences in the E&P Industry
Authors: Willigers B. J. A. , Bratvold R. B. , Hausken K.
Published: November 2009

In the high-risk E&P industry, the profit of each stakeholder depends on the strategies of all. The optimal choice for one player may not be optimal for other players, who may opt to prevent it. These characteristics suggest using game theory to model decision situations in the E&P industry. In a business dominated by joint ventures and tight governmental regulation, an understanding of the interests and influence of all stakeholders is particularly important. Although the E&P industry is accustomed to developing complex economic models to obtain insight into the commercial attractiveness of joint ventures, the influence of other stakeholders is often ignored. Each stakeholder must decide how much to invest, in which sequence to make decisions, whether to make decisions before or after the other stakeholders, which decisions to make before vs. after technological and organizational uncertainty is resolved, whether to accept or block the designation of one stakeholder as dominant, and whether to accept or block hub placement within one of multiple oil fields. A joint development program of a portfolio of gas fields and its gas processing and export facility has been analyzed using tools from game theory. The focus is on which infrastructure to develop and when. Players' preferences are functions of equity stakes and expected reserve sizes of the prospects. The analysis provides insight into the preferred development options of the individual players, how preferences change as uncertainty gets resolved, and how much individual players are to gain or lose if certain investment decisions are made. The analysis allows a player (1) to identify under what conditions its objectives are aligned with fellow players, and (2) to quantify the maximum amount it can pay to gain support from its fellow players.
Prediction of longitudinal dispersion coefficients in natural rivers using genetic algorithm
Authors: Sahay Rajeev Ranjan , Dutta Som
Published: November 2009

A new expression for the prediction of longitudinal dispersion coefficient in natural rivers, using genetic algorithms, is proposed. The expression uses hydraulic and geometric characteristics of rivers, which are readily available. For performance evaluation, using published field data, results of coefficient prediction by the new expression and by the other reported expressions are compared. According to various performance indices, it is concluded that the new formula predicts the longitudinal dispersion coefficient more accurately. Sensitive analysis performed on input parameters indicates the ratio of the cross-sectional mean velocity to the bottom shear velocity to be the most influencing parameter for accurate prediction of the longitudinal dispersion coefficient.
Effect of watershed delineation and areal rainfall distribution on runoff prediction using the SWAT model
Authors: Rouhani Hamed , Willems Patrick , Feyen Jan
Published: November 2009

The effect of the division in number of subcatchments and the spatial distribution of areal rainfall on the prediction of streamflow was evaluated using the SWAT model and data from the Grote Nete River catchment (Flanders, Belgium). A multi-automatic calibration scheme (MACS), using the Shuffled Complex Evolution (SCE) optimization algorithm, was applied. A total of 6 delineations were examined. The performance of each model set-up was assessed with respect to the outlet measured daily total, quick and slow flow component. The highest Nash–Sutcliffe Efficiency (EF) value for daily total flow was obtained by a delineation of 21 subcatchments. The EF of daily slow flows are high (>0.7) and comparatively stable for all analyzed delineations. Although quick flows are systematically underestimated, for larger number of subcatchments a relative good agreement exists between observed and simulated extreme flows with medium to high return period, expect for the 65 subdivision. The effect of the spatial density of rainfall input was evaluated running the model with uniform and non-uniform areal distribution of rainfall. A modified definition of Nash–Sutcliffe Efficiency (NSEref) was introduced to measure the performance of the simulated runoff versus the reference flow, derived with the Thiessen-based areal rainfall as input. The analysis revealed that: (a) the NSEref decreases with the number of subcatchments in which the basin is divided, and (b) simulations using a uniform rainfall distribution equal to the rainfall recorded in a rainfall station situated centrally in the catchment underperform as input.
Analysis of hourly precipitation characteristics in Kraków, southern Poland, using a classification of circulation types
Authors: Twardosz Robert
Published: November 2009

This paper investigates the relationship between maximum precipitation in Kraków and types of atmospheric circulation in southern Poland, as classified by Niedźwiedź. Three characteristics were used to define this relationship: maximum precipitation (Pmax), its duration (d) and probability of exceedance (p). The input data came from Kraków's uniquely long and homogenous pluviographic record spanning the period 1886–2007. Hourly precipitation values for the maximum precipitation events were identified and arranged in 1–24 hour intervals. They were then processed using the generalized extreme value (GEV) distribution to produce quantiles of maximum precipitation totals in each of the intervals and broken down by the corresponding circulation type. Differences between the development mechanisms are manifested in relationships between precipitation characteristics and their measure of randomness, i.e. exceedance probability. This paper demonstrates that maximum precipitation events depend on their duration d and atmospheric circulation. The maximum short-duration (one-hour) events occur primarily in either of two circulation types: (i) cyclonic with advection from the east and from the southeast or (ii) low-pressure centre and cyclonic trough. Maximum long-duration precipitation events (24 hour), on the other hand, occur in the cyclonic type of circulation with advection from the north and from the northeast.
An assessment of long-term trends in hydrologic components and implications for water levels in Lake Superior
Authors: Motiee Homayoun , McBean Edward
Published: November 2009

The combination of climate change and natural periodicities in meteorological variables are demonstrating significant impacts on the water resources of Lake Superior within the Laurentian Great Lakes system of North America. Statistical analyses of long-term records are used to demonstrate how changes over time may be interpreted very differently, depending upon the timeframe over which the analyses are made. Non-linear regression modelling shows that, while increasing trends in overland and overlake precipitation, flows and runoff occurred during the first decades of the twentieth century, very different trends are apparent for the period 1970–2005. For this latter period, increasing rates of air overlake temperature and lake evaporation are occurring but all other parameters are demonstrating decreasing trends. The result is a decline in water levels in Lake Superior at the rate of approximately 1 cm per year over the last 35 years. The results are used to show that to avoid decreasing water levels in Lake Superior, the discharge through St Mary's River must be decreased to approximately one-half the long-term annual average, the results of which will have dramatic implications for ships' cargo levels and hydroelectric energy generation.
Seasonally varying highway de-icing agent contamination in a groundwater plume from an infiltration basin
Authors: Ostendorf David W. , Palmer Richard N. , Hinlein Erich S.
Published: November 2009

This research documents the seasonal variation of de-icing agent contamination by measuring the specific conductivity of runoff and groundwater from an infiltration basin that serves a highway drainage system in southeast Massachusetts. The order of magnitude of the winter maxima of the runoff and groundwater specific conductivities over a 9 year period of record is 10 mS cm−1. The groundwater specific conductivity decreases by 1–2 orders of magnitude to its fall minimum, which is an order of magnitude higher than the fall minimum of the runoff. This warm weather source behaviour implies slow, seasonal dissolution of de-icing agent solids deposited in the infiltration basin during the winter. A completely mixed reactor idealization of the basin models this postulate as a coupled balance of dissolved and solid de-icing agents. The data suggest that 13% of the de-icing agent solids applied to the highway deposits in the basin, where it dissolves into the infiltrating groundwater with a first order decay rate of 0.0035 day−1.
Can Regression Discontinuity Help Answer an Age-Old Question in Education? The Effect of Age on Elementary and Secondary School Achievement
Authors: Smith Justin
Published: November 2009

Single-date school entry systems create large age differences between children in the same grade. Older students have been shown in the literature to outperform younger students along many elementary school outcomes, and some post-schooling outcomes. Little evidence exists about the size of these advantages in high school. Data from British Columbia, Canada are used to estimate the effect of age on test scores in grades 4, 7, and 10. I estimate that older students still have a sizable skill advantage in grade 10 across numeracy, reading, and writing tests. The advantage is strongest for girls and low-income students. The results suggest a certain degree of permanence to age related skill differences, which may spill over and affect adult outcomes.
Brain Drain and Brain Return: Theory and Application to Eastern-Western Europe
Authors: Mayr Karin , Peri Giovanni
Published: November 2009

This paper develops a novel model of optimal education, migration and return by heterogeneous, forward-looking agents. The model is parameterized and simulated to analyze the effects of immigration policies, identifying the brain-drain, brain-gain and brain-return effects when barriers to migration are reduced. We use parameters from the literature to inform our model and simulate migration and return from middle-income to industrialized countries. In particular, we apply the model to study migration and return between Eastern and Western Europe. We find that, for plausible degrees of openness, the possibility of return migration combined with the education incentive channel turns the brain drain into a brain gain for Eastern Europe.
Health System Reconstruction in Iraq ‐ The Way Ahead: A Report from the Iraq Health Symposium, May 20‐21, 2008
Authors: Tarantino David A , Morton Melinda J. , Kosaraju Akhila , Jawad Shakir , Casscells S. Ward
Published: November 2009

Health system stabilization and reconstruction support is a vital component of post‐conflict and disaster assistance efforts, and has been an essential component of overall reconstruction efforts in Iraq. However, decades of conflict, deprivation of key resources, mismanagement, sanctions, and a massive exodus of health care providers have exacted a grave toll on Iraq's health care capacity; furthermore, the health system continues to suffer from the impact of the ongoing insurgency and sectarian violence. Iraq's key public health indicators are among the worst in the region. In light of these pressing concerns, the humanitarian situation in Iraq presents a unique and ongoing challenge to the international community, aid agencies, and other key stakeholders. This symposium served as a forum for international leaders to review reconstruction efforts thus far and collaboratively plan future steps in Iraq's health system reconstruction.
U.S.A. Tobacco Control: Six Lessons in Public Policy for Medical and Science Professionals
Authors: Rudder Catherine E. , Fritschler A. Lee
Published: November 2009

The expertise of medical and science professionals is needed in public policy debates in the U.S. and around the world. As societies mature, questions in public policy become increasingly complex and should be informed by science. However, too often public agendas are advanced without the benefit of science and those trained in how to interpret it. Similarly, those trained in the sciences often do not have requisite knowledge, training or an interest in politics and policymaking. Yet, it is clear that optimal policy results in those cases when scientists and policy elites work together in meaningful partnerships. Because the worlds of science and politics—their cultures, assumptions, and methods—are largely separate and different, cooperation between these two cultures is difficult. The authors of this paper hope that their work interpreting one major issue of scientific importance as it has wound its way through public policy processes will be instructive to those in science who are enlisted to bring scientific discovery to public policy making (Fritschler and Rudder 2007). The 60‐year political struggle to move the issue of tobacco control from the agenda of a small group of medical researchers to the public agenda offers insights about public policymaking that are transferable to other issues which rest on science.
Current Global Trends in Medical Professionalism
Authors: Blackmer Jeff
Published: November 2009

Medical professionalism is a complex topic which must include a consideration of both individual and collective physicians, societal and patient rights and obligations. While attempting to propose a definition which might capture the various aspects of this issue, this paper also examines current global trends in medical professionalism such as care during a pandemic, professionally‐led regulation, conflict of interest, and conscientious objection. All of these are issues that are often dealt with on a systemic level as a medical collective but they also have a real and lasting impact at the individual physician level. While much of the attention in medical professionalism is paid to the individual practitioner, there is also an important role to be played in policy development, and national and international advocacy efforts by physician organizations such as the World Medical Association and others.
Training and Supply of Japanese Physicians: An Impending Crisis?
Authors: Yajima Kazuyoshi
Published: November 2009

Recent shortages of physicians are forcing many Japanese city hospitals to close. These shortages are also affecting university hospitals. Medical graduates migrate to major hospitals in larger cities, rather than working at their local university hospitals or in smaller towns. Even larger in‐hospital units such as internal medicine or surgery tend to have very few, if any, doctors on staff. These units at one time had at least 10 doctors on their staff. Many university hospitals that employed at least ten full time specialists on different wards are now faced with the sad prospect of closing specialty departments. It is important to address the underlying roots of the problem and remediate this crisis affecting the Japanese health sector.
Comparative Analysis of Health Insurance Systems in the United States and South Korea
Authors: Doh Soogwan , Cole Benjamin R.
Published: November 2009

This paper uses a case study design to compare the U.S. health insurance system with that of South Korea, analyzing the effects of the two countries' cultural value systems, political institutions, and stakeholders on the historical development and current status of national health insurance policy. The authors find that in the United States, a value system characterized by anti‐statism, anti‐elitism, individualism, liberalism, and a laissez‐faire philosophy has acted, in combination with a decentralized democratic political system and strong, well‐organized interest groups opposed to publicly‐funded healthcare, to significantly limit the possibility of national health insurance reform on anything but an incremental basis. In contrast, South Korea's value system has been characterized by statism, elitism, groupism, and a philosophy of nobles oblige, which has interacted with autocratic but health insurance reform‐minded regimes, in a weak civil society (with particularly weak organizations representing anti‐health reform interests) where formal lobbying activities were illegal, to produce a policy environment particularly favorable to comprehensive health insurance reform from the 1960s through the 1980s. The study demonstrates that each country has not only different political institutions and laws governing interest groups, but also significantly different cultures and medical traditions, which must be considered if policy reforms in either country, or indeed for any country considering health insurance reform, are to be implemented successfully. The paper concludes with a brief discussion of implications of these findings on health insurance reforms in both countries, with particular consideration of the reform plans of the Obama administration in the United States.
A Community Health System Response to the Pandemic of Novel H1N1
Authors: Cormier Scott , Septimus Edward J. , Moody Julia , Perlin Jonathan B.
Published: November 2009

On Tuesday, April 21, 2009, the Centers for Disease Control and Prevention (CDC) announced the first U.S. cases of novel H1N1 virus in the United States. Within the next few days, the number of cases would grow, and hospitals saw increasing flu cases as well as a number of “worried well.” This article reviews the immediate response of the Hospital Corporation of America (HCA) system to the novel H1N1 pandemic within the first month after CDC announced confirmation of the first case.
A Review of David Watts' Bedside Manners
Authors: Mayer Jeremy D , Koizumi Naoru
Published: November 2009

A review of David Watts' Bedside Manners critiquing writing style, content, and lack of overt statements about policy.
Creeping Punji Sticks: A Review of Six‐Legged Soldiers
Authors: Hallock Kevin
Published: November 2009

A review of Jeffrey Lockwood's Six‐Legged Soldiers: Using Insects as Weapons of War, suggesting that there is a need to identify what infrastructure should be strengthened in the event of such unconventional warfare.
Professional Governance and the Practice of Medicine: A Matter of Civil Engagement and Social Responsibility
Authors: Kloiber Otmar
Published: November 2009

For more than 60 years the World Medical Association has continued to serve as a platform to develop global medical policy on ethical and socio‐medical issues. Many of the WMA policies have become landmarks in policy development reaching far beyond the community of physicians, as they have inspired or even become part of legal regulations and international action. Yet this work is not seen as a self‐serving privilege, but as a service to the patients, the profession and society in general. It provides the basis for regulation and self‐governance based on the aim to serve the individual person's and the populations' health and well‐being.
Reflections on Public Policy and Medicine
Authors: Haynes Kingsley E.
Published: November 2009

The author comments on the importance of the World Medical & Health Policy journal in light of current medical policy needs. It is suggested that we need to share knowledge and different health management innovation more quickly and effectively, and that health communications is key.
Commentary for the Inaugural Issue
Authors: Rich Paul J.
Published: November 2009

Dr. Paul Rich, President of the Policy Studies Organization, introduces the editors of World Medical & Health Policy, and underscores the much‐needed aim of this journal, “to help all of us be informed and participate in the forging of medical and health policies so we can make informed decisions.” Dr. Rich continues that “this is a journal for the leaders in world medicine and health affairs. There never was a time when health decisions needed more well‐founded information and well crafted scholarship. That is a large task. It is not flattery but simply the truth to say that seldom has a new journal gone out into the world with better captains or more promise, and with prospects we trust not for great fatigue but for great achievement.”
Personalized Medicine and Its Ethical Challenges
Authors: Wolpe Paul Root
Published: November 2009

Personalized medicine is an emerging term for a medical philosophy that uses a person's individual clinical, genetic, genomic, and environmental information to tailor a treatment plan that will maximize efficacy and safety for that individual. While the technology offers much promise, it also is also challenged by some ethical and social questions in both its clinical application and in its research enterprise. Questions about privacy, safety, phenotypical expression, drug interactions, and genetic vs. social group identities will challenge clinical pharmacogenetics. Research studies raise some similar issues, as well as fairness in subject selection. Finally, personalized medicine will change the economics of drug production and distribution. Issues such as these and other complications of the coming focus on personalized medicine are discussed.
Book Reviews
Authors: Nicogossian Arnauld
Published: November 2009

Book reviews of Koenig's 2008 Medicine, Religion, and Health: Where Science and Spirituality Meet, and Fosarelli's 2008 Prayers & Rituals at a Time of Illness and Dying, investigating the impact of religion and spirituality on public health and medical practices.
In The News
Authors: Kloc Michelle , Nicogossian Arnauld , Jacobs William
Published: November 2009

The Editors of the Journal are bringing to the readership's attention the most recent medical news and issues deserving consideration for developing medical and health policies, standards or use, and knowledge in counseling patients in preventive care. The readers might wish to visit additional medical news websites which are readily accessible, some free of charge, such as MedScape, Stone Heart, American College of Physicians and the World Medical Association news websites.
Urinary PSA level and relative tumor volume after prostate biopsy
Authors: Pejcic T. , Hadzi-Djokic J. , Markovic B. , Dragicevic D. , Glisic B. , Lalic N. , Acimovic M. , Dzamic Z. , Radosavljevic R.
Published: November 2009

Objectives: To estimate the ratio between urinary prostate specific antigen (uPSA) and tumor volume after prostate biopsy. Methods: From 2000 to July 2008, uPSA concentration was determined in 60 patients with clinically organ-confined prostate cancer (PCa). All patients underwent six-area transrectal ultrasound (TRUS) - guided biopsy, with at least 12 biopsy cores. Single pathologist determined tumor grade (G), Gleason score (GS), the percentage of tumor infiltration (% TI) and the percentage of positive cores (% PC) in all biopsy cores. Additionally, relative tumor-biopsy volume (RTV) was calculated by multiplying % PC, % TI and prostate ultrasound- derived volume (Vol). Forty-one patients underwent retropubic radical prostatectomy (RRP), while 19 patients underwent radiation therapy. Results: Average uPSA was 308.6+311.9 ng/ml (range 0.06-988 ng/ml), average PSA was 9.7+ 5.5 ng/ml (range 1.2-24.3 ng/ml), tumor grade 1.7+ 0.8, Gleason score 5.2 + 1.3, the percentage of tumor infiltration 27.6+21.8 %, and the percentage of positive cores, 52.2+30.7 %. Average RTV was 6.3+ 8.4 ml (0.29-56 ml). All patients were divided in two groups: I, with RTV 4 ml and II, with RTV = 4 ml. The patients with RTV 4 ml had lower G (1.4 0.6 vs. 2.1+0.8, p=0.0002), lower GS (4.5+1 vs. 5.8+1.3, p=0.003) and higher uPSA (389.4+340.8 vs. 193.1 +229.7, p=0.014). There were no differences in serum PSA levels between the groups. Conclusion: Relative tumor-biopsy volume (RTV) is useful parameter in the preoperative assessment of tumor volume. Patients with higher RTV had significantly higher G and GS. However, these patients had significantly lower uPSA. This phenomenon could be the consequence of compromised PSA drainage from the peripheral zone of the prostate, caused by the tumor.
The effect of smoking and forced use of the voice to development of the vocal polyps
Authors: Gnjatic M. , Stankovic P. , Djukic V.
Published: November 2009

Dysphonia is often caused by polyps which are benign changes of pseudotumors With their presence they are hampering with glotis oclusion Laryngomicroscopy of general and endotracheal anaesthesia has been preformed on all of the patients. Microsurgical technique has been used to remove the polyps. Bioptic material was analyzed in pathohystlogoical laboratory of clinic of pathology in Banjaluka. All of the results were presented through tables and graphic representations. Frequency of polyps through age and sex groups, along with the examination of ethyological factors in emergence of polyps of vocal cords. Results are in accordance with the results of other authors who were involved in similar problematics. Through analysis of our data we percieve that the abuse of voice is part of ethiological factors that lead not only to emergence of vocal fold lesions but as well as other benign changes.
Anaesthesia in colorectal carcinoma surgery at the clinic for digestive surgery from 1997 to 2007.
Authors: Palibrk I. , Rankovic V. , Masirevic V. , Marcetic Lj. , Matic M. , Milenkovic M. , Pantic-Palibrk V.
Published: November 2009

BACKGROUND: Colorectal cancers are one of the most present neoplasms in human population. This pathology is one of the most frequent ones at the Clinic for Digestive Surgery in Belgrade. AIM: To investigate if there were any changes in both number and structure of patients with colorectal cancers (age, gender, co-morbidity) as well as in both type and duration of surgical procedures and in providing and maintaining anaesthesia in patients with this disease. METHODS: This is a retrospective study. Research materials were anaesthesiological cards written for patients undergoing surgery in order to treat colorectal cancers at the Clinic for Digestive surgery in both 1997 and 2007. Demographics, co-morbidity, ASA score were the parameters we followed in our survey as well as the type of the resection and duration of these surgical interventions. Besides that providing and maintaining anaesthesia and balance of circulatory volume were considered too. RESULTS: The number of the colorectal surgical interventions has been increased up to 489 (13.1% of all) in 2007 comparing to the number of 379 (13.55% of all) in 1997. The percentage has remained the same because the number of all surgical procedures has been increased. The percentage of the rectal resections is increased highly significant in 2007 (50.1% in 1997; 62.6% in 2007). During the same year the duration of the operations was shortened (mean value 176.31 minutes in 1997, 157.5 minutes in 2007). In 2007 highly statistically significant is bigger amount of colloid and crystalloid infusions that were given for supplementation of circulatory volume (mean value 3294.89 ml in 2007; 2552.22 ml in 1997) . On the other hand lower amount of blood was given in 2007 than in 1997 (mean value 102.76 opposite to 488.07) what is statistically significant. The number of the patients with co-morbidities is not statistically importantly changed in these two followed years. Anaesthesiology technique has been changed and is monitored by higher use of inhalation anesthetics. They were used more in 2007 (29.65 %) for these types of surgical procedures than in 1997 when they had been used almost never. CONCLUSION: In these two followed years there have been significant changes in surgical interventions (type and duration of the operation). Surgical teams are higher specialized for the procedures they use modern technology such as stapplers have better equipment for diagnosing the illness. The use of modern inhalation anaesthetics has been increased along with reduced amount of blood and derivates used for supplementation of circulatory volume.
Ispitivanje funkcionalnog statusa bolesnika posle hirurske revaskularizacije miokarda
Authors: Nedeljkovic U.D. , Krstic N.M. , Varagic-Markovic S.Lj. , Putnik S.M.
Published: November 2009

Determination of patient's functional status in early postoperative period is a delicate task, because of its general health status. Measures that can be used for that purpose are walk tests and functional status questionnaires. Objective: To determine correlation of different functional tests administered preoperatively and two minute walk test (2MWT) done postoperatively. To detect predictors of early functional recovery measured with two minute walk test. Method: We examined ninety eight patients hospitalized for an elective coronary artery bypass graft surgery in February and March 2008. Functional status was assessed preoperatively using Duke Activity Status Index questionnaire (DASI), generic health related quality of life questionnaire and two minute walk test. Prior to discharge from the hospital, two minute walk test was repeated along with VAS for intensity of pain. Statistical analyze was done using Pearson's correlation coefficient, T test and multivariate regression analysis. Results: Distance walked in 2 minutes decreased significantly postoperatively (p<0.001). There was significant correlation between DASI and SF -12 preoperatively (r=0.6 p<0.001) and DASI preoperatively with 2MWT postoperatively (r=0.4 p<0.001). 2MWT postoperatively showed good correlation with intensity of pain (r= -0.42 p<0.001 ) and age (r= -0.35 p<0.001). There were no significant correlation with comorbidity, number of bypasses or postoperative complications. Multivariate regression analysis showed that the age was the strongest independent predictor of functional recovery (?=-0.33 <0.05p) and that values of DASI preoperatively had moderate importance in prediction of functional status(?=0.238 p <0.06) Conclusion: 2MWT was sensitive to change postoperatively. Significant correlation of 2MWT postoperatively with DASI preoperatively , age and VAS, as well as prediction capacity of age and DASI , gives us possibility to utilize those parameters in early rehabilitation program in order to achieve maximal functional recovery of patients.
Results of epidemiological surveillance of hospital infections at the Clinic of Digestive System Surgery, CCS, in 2007
Authors: Mioljevic V. , Jovanovic B. , Mazic N. , Palibrk I. , Milicevic M.
Published: November 2009

INTRODUCTION: Nosocomial infections (NI) are significant medical problem in the countries worldwide. NI significance reflects in higher morbidity and mortality rates, and moreover, NIs add to longer stay and higher treatment costs. Based on data obtained from underdeveloped and developing countries, over 20% of hospitalized patients acquire some of NIs, while that proportion is 5% in developed countries. OBJECTIVE: a) to establish the frequency of noosocomial infections at the Clinic of Digestive System Diseases, b) determine the NI incidence in accord with anatomic localizations, c) evaluate the percentage prevalence of NI causes according to anatomic localizations, and d) review the problem of resistance of NI causative agents. MATERIAL AND METHODS: The study of NI incidence was calculated by Center for Diseases and Prevention (CDC) methodology. Sampling, cultivation, isolation, identification and sensitivity tests of cauosative agents to antimicrobial drugs, obtained from patient's material, were carried out by standard microbiological methods in Microbiological laboratory of the Emergency Center, Clinical Center of Serbia. All infections in patients hospitalized at the Clinic of Digestive System Surgery in 2007 were recorded. Data available from medical documentation as well as data obtained from interviews of medical personnel were analyzed. RESULTS: The incidence rates of patients with NI ranged from 1.7-3.4 per 1000 hospital days. Out of a total number of recorded nosocomial infections, surgical site infections accounted for 69%, blood infections 23% and urinary tract infections 6.8%. The most frequent causative agents of surgical site infections in the last year were as follows: Pseudomonas spp (19%), followed by Staphylococcus aureus and Klebsiella spp - (18%), Acinetobacter spp. (13%), and Enterococcus spp (8%). Forty percent (40%) of all blood infections verified by laboratory tests in 2007 was caused by coagulase negative Staphylococcus spp (CNS), followed by Acinetobacter spp (18%), Enterococcus spp (11%), and Staphylococcus aureus (7%). The most frequent causative agents of urinary infections were: Escherichia coli (35%) and Enterococcus spp (29%). Over 80% of Staphylococcus aureus isolates were resistant to Methicillin (MRSA) and enterobacteria produced by beta lactamase were recorded (ESBL). CONCLUSION: Enforcement of epidemiological surveillance of nosocomial infections contributes to insight of severity of NI problem, recognition of resistance of causative agents to antibiotics and recommendation of specific preventive measures related to these infections.