bluuebunny/crossref_metadata_2025 huggingface dataset:
Framing issues in the public debate: the case of human rights
Authors: Meriläinen Niina , Vos Marita
Published: January 2013

Purpose

The purpose of this paper is to better understand how issues may be framed in public debate. The outcomes of this debate affect organizations. The study is based on the seven types of framing identified by Hallahan and scrutinizes which of these types is utilized, and how this is done, in the case of human rights issues.

Design/methodology/approach

For this study a secondary analysis of academic papers on human rights issues was conducted. After a literature search, 40 papers originating from 23 different journals were further analyzed. Where the researchers described the framing of human rights issues, the type of framing was identified according to the typology and mode of utilization.

Findings

In the case of human rights, all seven framing types were found; however, the most common were the framing of attributes in which the economic or cultural context was emphasized and the framing of situations pointing out power differences between the actors.

Research limitations/implications

The study underlines the complexity of framing and the importance of awareness of framing processes. It shows that the framing typology provides valuable insights into the debate on social issues, inspiring further research.

Practical implications

This study provides a better understanding of the processes of issue framing, an important part of corporate communication strategies.

Social implications

The study adds to actor and audience awareness of framing.

Originality/value

Insights from framing theory are applied to the debate on social issues, thereby offering a fresh perspective on research in this field and relevant to corporate social responsibility.
Energy resources: trajectories for supply chain management
Authors: Halldórsson Árni , Svanberg Martin
Published: January 2013

Purpose

The aim of this research paper is to explain how principles of supply chain management (SCM) provide important conditions for the production, accessibility and use of energy, from the point of origin to the point of consumption.

Design/methodology/approach

The paper identifies three distinct trajectories in which the interplay between energy and SCM can release potential for research and practice.

Findings

Energy resources are vital to power industrial processes in manufacturing and logistics, while their use is also a major contributor to carbon emissions. The integrative nature of SCM provides conditions for improvement in use and accessibility of energy, and can facilitate the transition in which fossil fuels are replaced with a system of supply and conversion of renewable energy. These opportunities are highlighted by developing a set of three trajectories, which range from a true supply chain perspective on the energy sector, to an up‐stream and down‐stream perspective, respectively.

Research limitations/implications

The impact of energy resources on carbon emissions makes them important units of analysis in further SCM research. Future research must acknowledge the variety in the nature of energy resources, and provide frameworks that are able to address the particular features of these.

Practical implications

Supply chain strategists must assess how energy use, efficiency, dependency and accessibility influence operations, both internally and externally in the supply chain. Logistics flows are powered by energy. As a considerable portion of carbon emissions created by supply chain operations is energy related, energy must be seen as a means towards achievement of environmental sustainability.

Social implications

Understanding the relationship between energy and SCM will help managers to address environmental sustainability.

Originality/value

This is a timely topic of a cross‐disciplinary nature that has only been addressed to a limited extent by SCM so far. The topic is relevant to a large group of problem owners: supply chain strategists of companies where energy use, efficiency, dependency and security is an issue, and where operations processes have an impact on carbon emissions; for the energy sector, that needs to sustain a steady supply of energy, and increase accessibility to renewable energy sources that can replace fossil fuel; for policy makers, where energy dependency and security at a national level is an issue.
Broadband deployment and the bandwagon effect in the UK
Authors: Deshpande Advait
Published: January 2013

Purpose

The aim of this paper is to look at the extent to which the bandwagon effect played a part in digital subscriber line (DSL) broadband adoption combined with the regulatory measures, the slowdown in the cable industry and the changes within the telecommunications industry in the United Kingdom (UK). The dynamics of broadband deployment, broadband adoption against a real‐world supply‐demand equation and the factors that influenced the outcome in the UK are examined in detail.

Design/methodology/approach

This paper combines historic facts and socio‐economic analysis done from archival research and interview material to examine the outcome in which the less‐heralded copper DSL technology outpaced cable broadband adoption. The analysis delves into the influence of the bandwagon effect and the two types of outcome associated with it i.e. network externalities and the complementary bandwagon effects.

Findings

The paper argues that the deployment of broadband technologies in the UK has not taken place solely on the merits of the technology or factors such as speed, end‐user demand and costs. A combination of factors related to regulatory decisions, status of industry finances, commercial expediency, short‐term technical benefits and the bandwagon effect are argued to be at work.

Originality/value

The paper is useful for historians, policy makers, regulators and communications industry analysts given its focus on broadband deployment in the UK in correlation to the bandwagon economics.
Pricing strategies and innovations in the Thai mobile communications market
Authors: Srinuan Chalita , Srinuan Pratompong , Bohlin Erik
Published: January 2013

Purpose

The aim of this paper is to explore the price plans offered by Thai mobile operators and analyse the role of demand characteristics in the development of new price plans. The paper also shows how demand affects a firm's degree of innovativeness in terms of the number of new price plans.

Design/methodology/approach

The empirical qualitative analysis is based on an original data set from several secondary data sources and includes all the price plans offered in the history of the Thai mobile communications market between 2002 and 2010.

Findings

The results show that mobile operators have introduced several innovative price plans to attract and retain their consumers. Although a greater number of price plans can increase competition among operators, some have complex combinations that may lead to confusion for consumers.

Practical implications

A price comparison programme should therefore be implemented by the telecom regulator to ensure that consumers receive correct and complete information about the price plans.

Originality/value

Most studies, by far, have not extensively discussed this mobile communications market in detail and the effect of innovation on competition between firms in the mobile communications industry, in particular the development of innovation in developing countries.
Empirical relationship between foreign direct investment and economic growth
Authors: Iqbal Chaudhry Naveed , Mehmood Asif , Saqib Mehmood Mian
Published: January 2013

Purpose

The purpose of this paper is to find out empirically the relationship between foreign direct investment (FDI) and economic growth and it will also highlight the relationship status between the variables included in the model, either long‐ or short‐run in case of China.

Design/methodology/approach

This study uses secondary data obtained from World Development Indicators over the period 1985‐2009, whose viability has also been checked through the World Bank and IFS. An Augmented Dickey‐Fuller (ADF) unit root test is used to estimate an autoregressive distributive lag (ARDL) approach to co‐integration as the variables in the model are in I(1) and I(0) form and the Schwarz Bayesian Criterion (SBC) is used in this study to find out the estimated lags of the model, which are ultimately used to find out the short‐ and long‐run relationship of the variables included in the model. The error correction model (ECM) was also applied which basically provides information about the causal factors that may affect the variables included in the model.

Findings

The results provide evidence that there is an empirical relationship among FDI and economic growth. The computed value of F‐statistics is greater than the upper bond value described by Pesaran, M.H. et al., which depicts evidence against the null hypothesis of no effect and hence long‐run relationship among the variables is concluded at bottom line. Empirical evidence reveals that FDI has a positive effect on economic growth. An error correction model (ECM) is applied and the error correction term was negative and significant. This indicates that there exists a relationship between the variables. Diagnostic tests showed a lack of heteroscedisticity, confirming the validity of the model; CUSUM and CUSUMSQ tests were used to reveal the model's stability.

Practical implications

The Government of China should keep keen emphasis on the ingredients of this study so that China could reap maximum share of FDI through the achievement of positive spillovers of foreign investment, which ultimately results in its economic growth. However, the ingredients of this study depict the expenditures on security status, growth options as well as on infrastructure. This study also gives better impending in decision making about FDI in case of China.

Originality/value

This study bridges the gap between theory and practice and proves empirically the relationship between FDI and economic growth through auto regressive distributive lag approach (ARDL) to co‐integration in case of China. This research includes most dominating factors in the model which differentiate it from all previous empirical researches related to FDI's relationship with economic growth. However, this study not only pin points the new dominating factors related to this kind of relationship, but also set up a new horizon in the field of research to get groundbreaking results – in case of other countries – by following the footings set by this research.
Ecological processes and the ecology of stress: the impacts of abiotic environmental factors
Authors: Wingfield John C.
Published: January 2013

Rapid, effective and enduring responses of physiology and behaviour to perturbations of the environment are key to robustness of an organism (ability to resist perturbations) and resilience (ability to resist and recover quickly from perturbations) so that the normal life cycle can be resumed quickly.

Perturbations of the environment can be labile (i.e. eventually subside) or permanent such as when human activity changes the environment in the long term, for example, deforestation, urbanization, etc.

Hormonal responses to labile perturbation factors (LPFs) allow organisms to cope during the perturbation and then return to the normal life cycle. These hormonal responses are called stress responses especially in cases when major changes in physiology and behaviour occur (emergency life‐history stage).

Permanent perturbations require more than just temporary acclimation resulting in changes in range, adaptation or in some cases local extinction. Perturbations can be abiotic, biotic and social, but these are not mutually exclusive.

Here I focus on the effects of abiotic perturbation factors and their effects on the hypothalamo‐pituitary–adrenal/interrenal axis in vertebrates. There is a great need for more field investigations of responses of free‐living populations to perturbations of the environment, especially now that it appears the frequency and intensity of these events is increasing. However, such studies will require a high degree of opportunism on the part of the investigators to take advantage of unpredictable events when they occur.
Evaluation of the analgesic efficacy and psychoactive effects of AZD1940, a novel peripherally acting cannabinoid agonist, in human capsaicin‐induced pain and hyperalgesia
Authors: Kalliomäki Jarkko , Annas Peter , Huizar Karin , Clarke Cyril , Zettergren Annika , Karlsten Rolf , Segerdahl Märta
Published: January 2013

The aim of the present study was to investigate the effects of AZD1940, a novel peripherally acting cannabinoid CB1/CB2 receptor agonist, on capsaicin‐induced pain and hyperalgesia, as well as on biomarkers of cannabinoid central nervous system (CNS) effects.

The present study was a randomized, double‐blind, placebo‐controlled, four‐sequence, two‐period, cross‐over study in 44 male healthy volunteers aged 20–45 years. The effects of two single oral doses of AZD1940 (400 and 800 μg) were compared with placebo. Pain intensity after intradermal capsaicin injections in the forearm was assessed on a continuous visual analogue scale (VAS; 0–100 mm). Primary and secondary hyperalgesia induced by application of capsaicin cream on the calf were assessed by measuring heat pain thresholds and the area of mechanical allodynia, respectively. The CNS effects were assessed at baseline and up to 24 h after dosing using a visual analogue mood scales (VAMS) for feeling ‘stimulated’, ‘high’, ‘anxious’, ‘sedated’ or ‘down’.

AZD1940 did not significantly attenuate ongoing pain or primary or secondary hyperalgesia compared with placebo. Mild CNS effects for AZD1940were observed on the VAMS for ‘high’ and ‘sedated’. Dose‐dependent mild‐to‐moderate CNS‐related and gastrointestinal adverse events were reported following treatment with AZD1940.

No evidence of analgesic efficacy was found for a peripherally acting CB1/CB2 receptor agonist in the human capsaicin pain model. The emergence of mild dose‐dependent CNS effects suggests that the dose range predicted from preclinical data had been attained.
Pharmacokinetics, safety, and tolerability of single‐ and multiple‐dose exenatide once weekly in Chinese patients with type 2 diabetes mellitus (对中国2型糖尿病患者单次和多次给予艾塞那肽周制剂的药代动力学、安全性和耐受性研究)
Authors: Cui Yi Min , Guo Xiao Hui , Zhang Dong Mei , Tham Lai San , Tang Cheng Cai , Mace Kenneth , Linnebjerg Helle
Published: January 2013

Background

This open‐label, single‐period study assessed the pharmacokinetics, safety, tolerability, and pharmacodynamics of exenatide once weekly (q.w.), following single and multiple weekly subcutaneous (s.c.) injections in native Chinese patients with type 2 diabetes (T2D).

Methods

Patients (n = 25; mean [±SD] age 51.3 ± 8.2 years; body mass index 25.6 ± 2.4 kg/m2; HbA1c 7.4 ± 1.2%; duration of diabetes 3.1 ± 3.1 years) previously treated with diet modification and exercise alone or incombination with stable metformin doses were enrolled in the study. Twenty‐five patients received weekly doses of 2 mg, s.c., exenatide q.w. for 10 weeks, followed by 10 weeks observation. Pharmacokinetic parameters of exenatide, fasting plasma glucose (FPG), HbA1c, and body weight were summarized using descriptive statistics.

Results

Steady state plasma exenatide concentrations (299 pg/mL) were attained within 8 weeks. Exenatide q.w. was generally well tolerated, and the majority of adverse events reported were mild in severity. The most frequent study drug‐related adverse events were diarrhea and vomiting. Decreases were observed from baseline to 10 weeks in FPG (~3.0 mmol/L), HbA1c (~1.0%), and body weight (~3.8 kg).

Conclusions

This is the first clinical trial of exenatide q.w. in native Chinese patients with T2D. The results suggest that exenatide q.w. has a pharmacokinetic profile in this patient population similar to that observed in other ethnic and racial populations, and appears to be safe and generally well tolerated, with the potential to improve glycemic control and decrease body weight without increasing the risk of hypoglycemia.
Ellagitannins: defences of Betula nana against Epirrita autumnata folivory?
Authors: Ruuhola Teija , Salminen Paula , Salminen Juha‐Pekka , Ossipov Vladimir
Published: January 2013

The induced resistance of the subarctic mountain birch Betula pubescens ssp. czerepanovii is a well‐characterized phenomenon, whereas the induced responses of Betula nana L., one of the parental species of mountain birch, have not yet been characterized. Betula nana is more resistant to several classes of insectivorous herbivores than the mountain birch, although the mechanisms responsible for the better ability to resist herbivores are not known.

The present study aimed to determine the metabolic changes that are induced by early season herbivory in B. nana leaves and to study the effects of rapidly induced resistance on the growth of Epirrita autumnata larvae.

Defoliation of B. nana was accomplished by E. autumnata larvae and leaf samples for chemical analyses were collected when the defoliating larvae were at their third and fifth instar. At the same time, laboratory assays for the growth and consumption rates of E. autumnata larvae were conducted.

The wounding of leaves by E. autumna larvae induced the production of ellagitannins (ETs) in B. nana. Intriguingly, the concentrations of protein‐bound amino acids were also induced by herbivory; however, an increase in proteins was not mirrored in the growth rate of larvae, which was less on the induced foliage. The decreased growth rate of larvae was apparently linked to the increased concentrations of oxidatively‐active ETs and the high concentration of ETs may explain the better resistance of this parental species compared with the hybrid mountain birch with its lower levels of ETs.
Expressive drawing ability in children with autism
Authors: Jolley Richard P. , O'Kelly Rachael , Barlow Claire M. , Jarrold Christopher
Published: January 2013

The autistic impairments in emotional and social competence, imagination and generating ideas predict qualitative differences in expressive drawings by children with autism beyond that accounted by any general learning difficulties. In a sample of 60 5–19‐year‐olds, happy and sad drawings were requested from 15 participants with non‐savant autism and compared with those drawn by three control groups matched on either degree of learning difficulty (MLD), mental age (MA) or chronological age (CA). All drawings were rated by two artists on a 7‐point quality of expression scale. Contrary to our predictions, the drawings from the autistic group were rated similar to those of theMAandMLDgroups. Analysis of the people and social content of the drawings revealed that although children with autism did not draw fewer people, they did draw more immature forms than mental age controls. Furthermore, there was tentative evidence that fewer social scenes were produced by the autism sample. We conclude that the overall merit of expressive drawing in autism is commensurate with their general learning difficulties, but the social/emotional impairment in autism affects their drawings of people and social scenes.
Quartz OSL chronology and dust accumulation rate changes since the Last Glacial at Weinan on the southeastern Chinese Loess Plateau
Authors: Kang Shugang , Wang Xulong , Lu Yanchou
Published: January 2013

The fine‐grained (4–11 μm) quartz Optically Stimulated Luminescence (OSL) dating technique was applied to the Weinan section on the southeastern Chinese Loess Plateau (CLP) with a high luminescence sampling resolution (10‐ and 20‐cm intervals). Fifty‐eight OSL ages, spanning c. 1–74 ka, were obtained for the 10‐m loess–palaeosol sequences. The reliability of the OSL dating and the constructed chronology was confirmed by comparing the OSL ages with independent dates from other studies and by correlation with palaeoclimatic time series. The closely spaced OSL ages at Weinan indicate that the mean dust accumulation rate (DAR) of L1–1 (MIS 2, 7.0±0.9 cm ka−1) is lower than those of L1–3 (MIS 4, 19.1±6.1 cm ka−1) and L1–2 (MIS 3, 16.0±0.7 cm ka−1) and that the mean DAR c. 30–20 ka ago (11.4±2.4 cm ka−1) is higher than that c. 20–10 ka ago (3.0±0.1 cm ka−1) in L1–1. The subsequent calculation of the mass accumulation rate (MAR) indicates that the MAR of L1–1 (107 g m−2 a−1) is much lower than those of L1–2 (247 g m−2 a−1) and L1–3 (307 g m−2 a−1). By comparing the mean DAR results during the Last Glacial at Weinan with those at a further six sites from other studies, we observed that the mean DAR of L1–2 is higher (lower) than that of L1–1 on the eastern (western) CLP, and that the mean DAR during MIS 2 has an evident transition from high to low at c. 20 ka on the entire CLP. Possible mechanisms for the above mean DAR changes at orbital and sub‐orbital time scales are presented.
Meta‐analysis of epoetin beta and darbepoetin alfa treatment for chemotherapy‐induced anemia and mortality: Individual patient data from Japanese randomized, placebo‐controlled trials
Authors: Ohashi Yasuo , Uemura Yukari , Fujisaka Yasuhito , Sugiyama Toru , Ohmatsu Hironobu , Katsumata Noriyuki , Okamoto Rumiko , Saijo Nagahiro , Hotta Tomomitsu
Published: January 2013

Erythropoiesis‐stimulating agents (ESA) reduce the need for transfusions and improve the quality of life in patients receiving chemotherapy, but several clinical trials have suggested that ESA might have a negative impact on survival. To evaluate the efficacy and safety of ESA, epoetin beta and darbepoetin alfa, including their impact on overall survival and thromboembolic events, we conducted an individual data‐based meta‐analysis of three randomized, placebo‐controlled trials studying Japanese patients with chemotherapy‐induced anemia. All trials were conducted in compliance with Good Clinical Practice. A total of 511 patients with solid tumor or lymphoma (epoetin beta or darbepoetin alfa, n = 273; placebo, n = 238) were included. The ESA significantly reduced the risk of transfusion (relative risk, 0.47; 95% confidence interval, 0.29–0.76). No significant effect of the ESA on overall survival was observed (unadjusted hazard ratio, 1.00; 95% confidence interval, 0.75–1.34). A prespecified subgroup analysis showed no strong interaction between the baseline hemoglobin concentration and the effect of ESA on overall survival. Among the ESA‐treated patients, the highest hemoglobin achieved during the treatment period in each patient had no impact on mortality. No increase in thromboembolic events was observed in the ESA‐treated patients (0.7% vs 1.7% placebo). The ESA reduced the risk of transfusion without a negative impact on the survival of patients with chemotherapy‐induced anemia.
Development of an evidence‐informed in‐home family services model for families and children at risk of abuse and neglect
Authors: Ingram Stephanie D. , Cash Scottye J. , Oats Robert G. , Simpson Amy , Thompson Ronald W.
Published: January 2013

This paper describes the components of a programme designed to prevent child maltreatment which includes the promising practices of a continuous engagement process, cognitive‐behavioural parent and skill teaching, and development of formal and informal supports for families. The programme was also designed to be implemented wide scale. Methods for assessment of strengths and needs, individualization of goals and intervention strategies, and assessment of goal achievement are also described. Finally, preliminary results of a programme implementation fidelity and outcome evaluation are summarized. The authors conclude that this programme is ready for a more rigorous efficacy trial to continue to build the evidence base for this promising intervention addressing a prevalent social problem.
Associations of Grassland Bird Communities with Black‐Tailed Prairie Dogs in the North American Great Plains
Authors: AUGUSTINE DAVID J. , BAKER BRUCE W.
Published: January 2013

Colonial burrowing herbivores can modify vegetation structure, create belowground refugia, and generate landscape heterogeneity, thereby affecting the distribution and abundance of associated species. Black‐tailed prairie dogs (Cynomys ludovicianus) are such a species, and they may strongly affect the abundance and composition of grassland bird communities. We examined how prairie dog colonies in the North American Great Plains affect bird species and community composition. Areas occupied by prairie dogs, characterized by low percent cover of grass, high percent cover of bare soil, and low vegetation height and density, supported a breeding bird community that differed substantially from surrounding areas that lacked prairie dogs. Bird communities on colony sites had significantly greater densities of large‐bodied carnivores (Burrowing Owls [Athene cunicularia], Mountain Plovers, [Charadrius montanus], and Killdeer [Charadrius vociferus]) and omnivores consisting of Horned Larks (Eremophila alpestris) and McCown's Longspurs (Rhynchophanes mccownii) than bird communities off colony sites. Bird communities off colony sites were dominated by small‐bodied insectivorous sparrows (Ammodramus spp.) and omnivorous Lark Buntings (Calamospiza melanocorys), Vesper Sparrows (Pooecetes gramineus), and Lark Sparrows (Chondestes grammacus). Densities of 3 species of conservation concern and 1 game species were significantly higher on colony sites than off colony sites, and the strength of prairie dog effects was consistent across the northern Great Plains. Vegetation modification by prairie dogs sustains a diverse suite of bird species in these grasslands. Collectively, our findings and those from previous studies show that areas in the North American Great Plains with prairie dog colonies support higher densities of at least 9 vertebrate species than sites without colonies. Prairie dogs affect habitat for these species through multiple pathways, including creation of belowground refugia, supply of prey for specialized predators, modification of vegetation structure within colonies, and increased landscape heterogeneity.

Asociaciones de Comunidades de Aves de Pastizales con Perros de la Pradera en la Gran Llanura de Norte América
The transcription factor activating enhancer‐binding protein epsilon (AP–2ε) regulates the core promoter of type II collagen (COL2A1)
Authors: Niebler Stephan , Bosserhoff Anja K.
Published: January 2013

The transcription factor activating enhancer‐binding protein epsilon (AP–2ε) was recently shown to be expressed during late chondrocyte differentiation, especially in hypertrophic chondrocytes. In this study, we were able to reveal that the promoter of the type II collagen (COL2A1) gene, encoding the extracellular matrix protein type II collagen, is specifically regulated by AP–2ε. Expression of COL2A1 is downregulated at the transition of chondroblasts into hypertrophic chondrocytes and our data provide evidence that AP–2ε is involved in this process. In reporter gene assays, overexpression of AP–2ε in cartilaginous cell lines resulted in a significant reduction in COL2A1 core promoter activity of ~ 45%. Furthermore, we found that this process is dose‐dependent and highly specific for the epsilon isoform. Computational analysis offered only a single putative AP–2‐binding motif within the chosen promoter fragment but site‐directed mutagenesis revealed this motif to be regulatory inactive. After expanding our screening to motifs containing minor differences from the classical AP–2 consensus sequence (5′–GCCN3GGC–3′), we determined the sequence 5′–GCCCAGGC–3′ ranging from position −128 to −135 bp as an important regulatory site and responsible for COL2A1 downregulation through AP–2ε. Interaction of AP–2ε with the COL2A1 promoter at this site was confirmed by chromatin immunoprecipitation and electromobility shift assay. Further, our experiments suggest that at least one additional factor is involved in this process. This is the first study to prove regulation of COL2A1 by AP–2ε highlighting the role of the transcription factor as a modulator of cartilage development.
Preliminary assessment of the environmental and selective effects of a captive breeding and rearing programme for endangered Atlantic salmon, Salmo salar
Authors: de Mestral L. G. , O'Reilly P. T. , Jones R. , Flanagan J. , Herbinger C. M.
Published: January 2013

The selective and environmental effects of captivity on several fitness‐correlated traits were assessed in smolts of endangered Atlantic salmon, Salmo salar L., from the inner Bay of Fundy, produced via artificial spawning and released into the wild as juveniles. Smolts were sampled as they migrated downstream and identified through microsatellite‐based parentage analysis as offspring of either wild‐spawning adults or adults that were spawned in captivity. Overall, captive‐origin smolts exhibited a significantly later run timing and smaller body size than wild smolts. Significant differences in run timing and body size were also found between captive‐origin smolts that had experienced rearing environments that differed in duration of captivity and thermal regime. Significant differences in run timing, fork length and weight were found between first and second generation captive‐origin smolts, although the expression of these differences depended on the rearing environment experienced, suggesting a possible genotype by environment effect. The ratio of effective‐to‐census number of breeders that produced the captive‐origin smolts was higher than that of the wild‐origin smolts due to successful captive breeding management practices. These results have direct implications for captive breeding and rearing programmes for salmonids and wider implications for understanding the rates of evolutionary and environmentally induced change that can occur in captivity.
Selective use of the insulin tolerance test to diagnose hypopituitarism
Authors: Sarlos S. , Inder W. J.
Published: January 2013

The insulin tolerance test is considered the gold standard for assessing the hypothalamic‐pituitary‐adrenal and growth hormone (GH) axes, but its use varies considerably among different endocrine units. We recommend using the insulin tolerance test to assess the hypothalamic‐pituitary‐adrenal axis within 3 months of pituitary surgery, where adrenocorticotropic hormone 1–24 testing is equivocal, and to assess for GH deficiency where the patient is being considered for GH replacement therapy. We also discuss safety issues, how to ensure adequate hypoglycaemia and possible alternative tests, such as the overnight metyrapone test and glucagon test.
Junior doctor training in pleural procedures: a quality survey
Authors: Aiyappan V. , Munawar A. , Thien F.
Published: January 2013

Pleural effusion is a common medical condition encountered by doctors. This study was conducted to ascertain the level of junior doctor (physician‐in‐training) training, knowledge and supervision in the management of pleural effusion. The information was collected with the help of a proforma, from 49 junior medical doctors working in a metropolitan health service. All the doctors who participated in the survey had come across pleural effusion in their practice, but only 67% of doctors had any experience with the procedure of diagnostic thoracentesis. Sixty‐seven percent of doctors conveyed that they will refer the majority of cases (75–100%) for radiological‐guided thoracentesis. The main reasons for referral for radiologically guided procedure were lack of experience (65%), fear of complications (61%), lack of supervision and guidance (49%), and lack of time (38%). A significant proportion of doctors interviewed (47%) was unaware of the major indications for intercostal tube drainage of parapneumonic effusions. This survey highlights deficiencies in junior doctor knowledge and procedural skills. Junior doctor training should be tailored to increase the ‘hands‐on’ training time and increased patient contact. Senior clinicians should be given sufficient ‘protected time’ for teaching and training.
Two cases of meningococcal purpura fulminans: the ‘less is more’ approach
Authors: Ahmad Zeeshan , Jordan Robert , Das‐Gupta Rana , Srivastava Shekhar
Published: January 2013

This study presents a case series of patients with meningococcal purpura fulminans who were treated at a tertiary referral centre within a few days of each other. Presenting with signs and symptoms of florid meningococcal sepsis, they were managed initially by physicians and intensivists, whereas the development of large purpuric areas and tissue necrosis was managed expectantly by plastic surgeons. When the patients were deemed to have recovered clinically and the necrosis delineated, surgical management was implemented with subsequent involvement of various rehabilitation services. This article highlights the cases of two patients, and their clinical presentation, management and rehabilitation together with a current literature review on this area.
A novel tool to assess the risk of urinary incontinence after nerve‐sparing radical prostatectomy
Authors: Abdollah Firas , Sun Maxine , Suardi Nazareno , Gallina Andrea , Tutolo Manuela , Passoni Niccolò , Bianchi Marco , Salonia Andrea , Colombo Renzo , Rigatti Patrizio , Karakiewicz Pierre I. , Montorsi Francesco , Briganti Alberto
Published: January 2013

What's known on the subject? and What does the study add?

Urinary incontinence is one of the most important morbidities after radical prostatectomy that has detrimental effect on the postoperative quality of life.

The present study provides an accurate and dynamic multivariable risk stratification tool that predicts the postoperative urinary incontinence risk after radical prostatectomy based on patient‐related as well as surgeon‐related variables.

Objective

To develop a multivariable risk classification tool to estimate postoperative urinary incontinence (UI) risk as UI represents one of the most disabling surgical sequelae after radical prostatectomy (RP).

Patients and Methods

We evaluated 1311 patients treated with nerve‐sparing RP between 2006 and 2010 at our institution.

Regression tree analysis was used to stratify patients according to their postoperative UI risk. Kaplan–Meier curve estimates were used to assess the UI rate in the novel UI‐risk groups. The discrimination of the novel tool was measured with the area under the curve method.

Results

At 3, 6 and 12 months, the UI rates were 44%, 26% and 12%, respectively.

Regression tree analysis stratified patients into high risk (International Index of Erectile Function – Erectile Function domain [IIEF‐EF] = 1–10), intermediate risk (IIEF‐EF > 10 and age ≥ 65 years), low risk (IIEF‐EF > 10, age < 65 years and body mass index [BMI] ≥ 25 kg/m2) and very low risk (IIEF‐EF > 10, age < 65 years and BMI < 25 kg/m2) groups.

The 3‐month UI rates in these groups were 37%, 43%, 45% and 48%, respectively. The 6‐month UI rates were 19%, 23%, 29% and 34%, respectively. The 12‐month UI rates were 7%, 13%, 14% and 15%, respectively (log‐rank P < 0.001).

The area under the curve was 71%, 70% and 68% at 3, 6 and 12 months, respectively.

Conclusions

We developed the first risk classification tool that predicts patients at high risk of UI after RP. These consisted mainly of individuals who were impotent before RP, elderly and/or overweight.

This tool can be used for patient counselling.
Differing risk of cancer death among patients with lymph node metastasis after radical prostatectomy and pelvic lymph node dissection: identification of risk categories according to number of positive nodes and Gleason score
Authors: Schiavina Riccardo , Borghesi Marco , Brunocilla Eugenio , Manferrari Fabio , Fiorentino Michelangelo , Vagnoni Valerio , Baccos Alessandro , Pultrone Cristian Vincenzo , Rocca Giovanni Christian , Rizzi Simona , Martorana Giuseppe
Published: January 2013

What's known on the subject? and What does the study add?

Lymph node (LN) status is one of the most important prognostic variables in patients undergoing radical prostatectomy, but not all patients with node‐positive PCa are at the same risk of recurrence and cancer‐specific death.

In this study we evaluated the role of pathological variables in stratifying the risk of cancer death in patients with prostate cancer. Patients with 1–3 positive LNs and Gleason score (GS) ≤7 experienced better CSS and OS than those with >3 metastatic LNs and/or GS >7. This evidence could allow urologists to better predict oncological outcomes of patients and select more appropriate therapeutic management.

Objectives

To evaluate the outcomes in patients with node‐positive prostate cancer (PCa) after radical prostatectomy (RP) and pelvic lymph node dissection (PLND) according to the number of positive lymph nodes (LNs).

To identify different risk groups among patients with node‐positive PCa.

Patients and Methods

We evaluated 98 consecutive patients with pN1M0 PCa who underwent RP between November 1995 and May 2011.

Kaplan–Meier and Cox proportional univariable and multivariable regression models were used to analyse the survival rates.

Patients were divided into two groups according to number of positive LNs using the most informative positive LN theshold for predicting survival, then into three different risk groups according to number of positive LNs and pathological Gleason score (GS).

Results

Mean (range) follow‐up was 68.4 (10–192) months.

Patients with 1–3 positive LNs (n = 75; 76.5%) had significantly better cancer‐specific survival (CSS) and overall survival (OS) compared with those with >3 positive nodes (n = 23; 23.4%; P < 0.01).

Patients with 1–3 positive LNs and pathological GS ≤7 (Group 1) had significantly better CSS than those with >3 positive LNs or GS 8–10 (Group 2 [P = 0.015]). Group 2 patients, moreover, had significantly better CSS (P = 0.019) and OS (P = 0.021) than those with >3 positive LNs and GS 8–10 (Group 3).

Conclusions

Patients with 1–3 positive LNs have higher CSS and OS rates than those with >3 metastatic LNs.

Taking into account the pathological GS, as well as the number of positive nodes, three risk group categories with considerable differences in terms of survival can be found. Patients with LN‐positive PCa should be stratified into different groups according to these two measures, to obtain a better prediction of oncological outcomes.
Fracture after androgen deprivation therapy among men with a high baseline risk of skeletal complications
Authors: Shao Yu‐Hsuan , Moore Dirk F. , Shih Weichung , Lin Yong , Jang Thomas L. , Lu‐Yao Grace L.
Published: January 2013

What's known on the subject? and What does the study add?

Receipt of androgen deprivation therapy (ADT) has been associated with an increased risk of skeletal‐associated complications, such as a decrease in bone mineral density and an increase in fracture risk. Many men with pre‐existing health conditions receive ADT as their primary treatment because they are considered to be inappropriate candidates for attempted curative treatments. However, several chronic health conditions, such as diabetes, rheumatoid disease and chronic liver disease, are strong predictors for osteoporosis and fractures.

We undertook the present study aiming to quantify the impact of treating men with ADT who carry known risk factors for skeletal complications. Among these high‐risk men, more than 58% develop at least one fracture after ADT within the 12 years of follow‐up. Men who sustained a fracture within 48 months experienced an almost 40% higher risk of mortality than those who did not. Our findings suggest that treating men with a high fracture risk at baseline with long‐term ADT may have serious adverse consequences.

Objective

To quantify the impact of androgen deprivation therapy (ADT) in men with a high baseline risk of skeletal complications and evaluate the risk of mortality after a fracture.

Patients and Methods

We studied 75 994 men, aged ≥66 years, with localized prostate cancer from the Surveillance, Epidemiology and End Results–Medicare linked data.

Cox proportional hazard models were employed to evaluate the risk.

Results

Men with a high baseline risk of skeletal complications have a higher probability of receiving ADT than those with a low risk (52.1% vs 38.2%, P < 0.001).

During the 12‐year follow‐up, more than 58% of men with a high risk and 38% of men with a low risk developed at least one fracture after ADT.

The dose effect of ADT is stronger among men who received ADT only compared to those who received ADT with other treatments.

In the high‐risk group, the fracture rate increased by 19.9 per 1000 person‐years (from 52.9 to 73.0 person‐years) for men who did not receive ADT compared to those who received 18 or more doses of gonadotropin‐releasing hormone agonist among men who received ADT only, and by 14.2 per 1000 person‐years (from 45.2 to 59.4 person‐years) among men who received ADT and other treatments.

Men experiencing a fracture had a 1.38‐fold higher overall mortality risk than those who did not (95% CI, 1.34–1.43).

Conclusions

Men with a high baseline risk of skeletal complications developed more fractures after ADT.

The mortality risk is 40% higher after experiencing a fracture.

Consideration of patient risk before prescribing ADT for long‐term use may reduce both fracture risk and fracture‐associated mortality.
Factor Selection and Structural Identification in the Interaction ANOVA Model
Authors: Post Justin B. , Bondell Howard D.
Published: January 2013

When faced with categorical predictors and a continuous response, the objective of an analysis often consists of two tasks: finding which factors are important and determining which levels of the factors differ significantly from one another. Often times, these tasks are done separately using Analysis of Variance (ANOVA) followed by a post hoc hypothesis testing procedure such as Tukey's Honestly Significant Difference test. When interactions between factors are included in the model the collapsing of levels of a factor becomes a more difficult problem. When testing for differences between two levels of a factor, claiming no difference would refer not only to equality of main effects, but also to equality of each interaction involving those levels. This structure between the main effects and interactions in a model is similar to the idea of heredity used in regression models. This article introduces a new method for accomplishing both of the common analysis tasks simultaneously in an interaction model while also adhering to the heredity‐type constraint on the model. An appropriate penalization is constructed that encourages levels of factors to collapse and entire factors to be set to zero. It is shown that the procedure has the oracle property implying that asymptotically it performs as well as if the exact structure were known beforehand. We also discuss the application to estimating interactions in the unreplicated case. Simulation studies show the procedure outperforms post hoc hypothesis testing procedures as well as similar methods that do not include a structural constraint. The method is also illustrated using a real data example.
The more polluted the environment, the more important biodiversity is for food web stability
Authors: Garay‐Narváez Leslie , Arim Matías , Flores José D. , Ramos‐Jiliberto Rodrigo
Published: January 2013

Human activities have led to massive influxes of pollutants, degrading the habitat of species and simplifying their biodiversity. However, the interaction between food web complexity, pollution and stability is still poorly understood. In this study we evaluate the effect exerted by accumulable pollutants on the relationship between complexity and stability of food webs. We built model food webs with different levels of richness and connectance, and used a bioenergetic model to project the dynamics of species biomasses. Further, we developed appropriate expressions for the dynamics of bioaccumulated and environmental pollutants. We additionally analyzed attributes of organisms’ and communities as determinants of species persistence (stability). We found that the positive effect of complexity on stability was enhanced as pollutant stress increased. Additionally we showed that the number of basal species and the maximum trophic level shape the complexity–stability relationship in polluted systems, and that in‐degree of consumers determines species extinction in polluted environments. Our study indicates that the form of biodiversity and the complexity of interaction networks are essential to understand and project the effects of pollution and other ecosystem threats.
Are Offshore RMB Arrangements the Basis for a Long‐term Exchange Rate System without Convertibility?
Authors: Whalley John , Chen Hejing
Published: January 2013

This paper discusses China's relatively new structure of dual onshore and offshore RMB markets. Its distinguishing feature is both offshore trading at exchange rates that are market determined and onshore trading at exchange rates anchored at the official spot rate with capital account inconvertibility. We note that thus far the CNH and CNY spot rates have largely tracked each other, suggesting that the shadow price on the convertibility constraint onshore and also the offshore diversification benefit is close to zero. However, this could change in the future. We discuss the potential for the offshore RMB market to grow with trade settlement and bilateral swap arrangements in RMB, which would provide a big enough pool of liquidity for the RMB to become a vehicle currency and reserve currency. These potential developments will be restrained by onshore inconvertibility, but moving to convertibility seemingly implies major change in China's financial structure and the offshore RMB arrangements are only a small first step along this path. Crucial in this evolution of arrangements will be future Chinese growth performance and the relative attractiveness of onshore inconvertible but offshore marketable RMB relative to the debt laden and slow growth currencies of the USA, the EU and Japan.
Income and Price Elasticities of China's Exports
Authors: Yao Zhizhong , Tian Feng , Su Qingyi
Published: January 2013

The appearance of new product varieties and improvements in the quality of goods have both played key roles in the rapid growth of China's exports. However, these two important elements have not been formally integrated into the demand equations for China's exports. As we demonstrate in this paper, income elasticity will be underestimated if new varieties of goods and quality improvements are omitted in price index and quantity index calculations, which are necessary for estimating the export demand function. Moreover, the faster new product varieties enter export markets, the greater the underestimation will be. In this paper, we develop an export demand equation that takes into account new product varieties and improvements in quality, and then calculate the demand function for China's exports using the data from 1992 to 2006. According to our estimation, the short‐term income elasticity of demand for China's exports is approximately 2.34, and the short‐term price elasticity is approximately –0.65. Our estimation predicts an increase in China's export value in the case of an RMB appreciation or export rebate rates reduction in the short term, due to the low price elasticity of China's exports, whose absolute value is less than 1. Our findings are novel and could have significant policy implications.
From Deprivation to Distribution: Is Global Poverty Becoming A Matter of National Inequality?
Authors: Sumner Andy
Published: January 2013

This paper asks the following question: does the shift in global poverty towards middle‐income countries (MICs) mean that global poverty is becoming a matter of national inequality? This paper argues that many of the world's extreme poor already live in countries where the total cost of ending extreme poverty is not prohibitively high as a percentage of GDP. And in the not‐too‐distant future, most of the world's poor will live in countries that do have the domestic financial scope to end at least extreme poverty and, in time, moderate poverty. This will likely pave the way for addressing poverty reduction as primarily a domestic issue rather than primarily an aid and international issue; and thus a (re)framing of poverty as a matter of national distribution and national social contracts and political settlements between elites, middle classes and the poor.