bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes in 2748 patients referred to a colorectal two‐week rule clinic
Authors: Smith R. A. , Oshin O. , McCallum J. , Randles J. , Kennedy S. , Delamere S. , Rooney P. S. , Carter P. S.
Published: September 2006

Objective  To assess the 3‐year outcomes of a nurse‐led, one‐stop, 2‐week rule (TWR) clinic for suspected colorectal cancer (CRC) in a large teaching hospital.

Method  Data were collected prospectively from January 2002 to December 2004. In total, 2748 patients were seen over the 3‐year period. The ratio of male:female subjects was 1190:1558 (43%:57%). Median age at presentation was 66 years (range 17–96).

Results  A total of 1363 (49.6%) nonconforming referrals were made; 1300 patients (47.3%) underwent flexible sigmoidoscopy during their initial assessment in clinic; 1439 patients (52.4%) underwent a barium enema during the course of their investigation; 2503 patients (91.1%) were seen within 14 working days. The median overall wait for the initial clinic appointment was 10 days. The annual number of patients seen was similar over the 3‐year period. A total of 174 cancers (6.3%) were identified which accounted for 36.4% of all CRCs diagnosed during the study period. Nineteen cancers presented in the nonconforming group (1.6% of all non‐conforming patients). Rectal tumours accounted for 59.8% (n = 104) of all cancers diagnosed while right‐sided tumours accounted for only 10.9% (n = 19). Advanced tumours accounted for 73.0% (n = 127) of the total; 133 (76.4%) cancer patients underwent some form of surgical intervention.

Conclusion  A specialist nurse‐led, one‐stop TWR clinic for suspected colorectal cancer is sustainable and can be run successfully with over 90% of referrals seen within the targeted time period. The proportion of non‐conforming referrals was high and a large number of advanced and unstaged tumours was observed. Low numbers of proximal tumours were detected.
Meta‐analysis of short‐term and long‐term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy
Authors: Lovegrove R. E. , Heriot A. G. , Constantinides V. , Tilney H. S. , Darzi A. W. , Fazio V. W. , Nicholls R. J. , Tekkis P. P.
Published: September 2006

Objective  The choice of ileal pouch reservoir has been a contentious subject with no consensus as to which technique provides better function. This study aimed to compare short‐ and long‐term outcomes of three ileal reservoir designs.

Method  Comparative studies published between 1985 and 2000 of J, W and S ileal pouch reservoirs were included. Meta‐analytical techniques were employed to compare postoperative complications, pouch failure, and functional and physiological outcomes. Quality of life following surgery was also assessed.

Results  Eighteen studies, comprising 1519 patients (689 J pouch, 306 W pouch and 524 S pouch) were included. There was no significant difference in the incidence of early postoperative complications between the three groups. The frequency of defecation over 24 h favoured the use of either a W or S pouch [J vs S: weighted mean difference (WMD) 1.48, P < 0.001; J vs W: WMD 0.97, P = 0.01]. The S pouch was associated with an increased need for pouch intubation (S vs J: OR 6.19, P = 0.04). The use of a J pouch was associated with a significantly higher prevalence of use of anti‐diarrhoeal medication (J vs S: OR 2.80, P = 0.01; J vs W: OR 3.55, P < 0.001).

Conclusion  All three reservoirs had similar perioperative complication rates. The S pouch was associated with the need for anal intubation. There was less frequency and less need for antidiarrhoeal agents with the W rather than the J pouch.
Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 1: short‐term outcome
Authors: Iversen L. H. , Harling H. , Laurberg S. , Wille‐Jørgensen P.
Published: September 2006

Objective  An association between caseload and outcome has been reported for complex surgical procedures. We systematically reviewed recent literature to determine whether caseload and surgical speciality are associated with short‐term outcome following colorectal cancer surgery.

Method  We searched the MEDLINE and Cochrane Library databases for relevant publications starting in 1992. We selected hospital caseload and type, and surgeon's caseload, education and experience as variables of interest. Measures of outcome were postoperative morbidity, in‐hospital and 30‐day mortality, and for rectal cancer anastomotic leak. We stratified the 35 reviewed studies by tumor location: colonic cancer, rectal cancer, or colorectal cancer and described the studies individually. A meta‐analysis was performed only when it was considered appropriate.

Results  For colonic cancer, postoperative morbidity was associated with surgeon's caseload and education. Postoperative mortality was strongly associated with hospital caseload (OR 0.64, 95% CI 0.55–0.73), and surgeon's caseload (OR 0.50, 95% CI 0.39–0.64). It was also influenced by surgeon's education and experience. For rectal cancer, we found no evidence of an association between the selected variables and short‐term outcome, including frequency of anastomotic leak. For colorectal cancer, there was evidence for an association between postoperative morbidity and hospital caseload.

Conclusion  Our review offers evidence for a positive association between high hospital caseload, surgeon's caseload, sub‐speciality and experience and improved short‐term outcome in colonic cancer surgery. We failed to find evidence of a relationship for rectal cancer surgery, possibly owing to methodological artifacts. No study reported an inverse relation.
Time‐action profile of insulin detemir and NPH insulin in patients with type 2 diabetes from different ethnic groups*
Authors: Hompesch M. , Troupin B. , Heise T. , Elbroend B. , Endahl L. , Haahr H. , Heinemann L.
Published: September 2006

Aim:  To evaluate the time‐action profiles and the dose–response relationship of the long‐acting insulin analogues insulin detemir (IDet) and NPH insulin (NPH) in type 2 diabetic patients belonging to different ethnic groups.

Methods:  Forty‐eight type 2 diabetic patients belonging to different ethnic groups (three groups of 16 African Americans (AA), 16 Hispanics/Latinos (HL) and 16 Caucasians) participated in this double‐blind crossover trial. Each patient took part in six 16‐h isoglycaemic glucose clamps (clamp target 7.2 mmol/l) and was randomly allocated to three doses (0.3, 0.6 and 1.2 (I)U/kg) of IDet and NPH, respectively.

Results:  IDet and NPH showed comparable pharmacodynamic effects [the area under the glucose infusion rate curve (AUCGIR 0‐16 h) (mg/kg)] in the investigated dose range: IDet, 0.3 U/kg, 207 AA, 535 HL, 285 Caucasians; 0.6 U/kg, 1203 AA, 824 HL and 1126 Caucasians; 1.2 U/kg, 1502 AA, 1977 HL and 2269 Caucasians; NPH, 0.3 IU/kg, 733 AA, 1148 HL and 1148 Caucasians; 0.6 IU/kg, 1395 AA, 1976 HL and 1077 Caucasians; 1.2 IU/kg, 2452 AA, 3296 HL and 2455 Caucasians. Both IDet and NPH showed a linear dose–response relationship in all three groups (p = 0.31), without any significant differences in slope (p = 0.71) or intercept (p = 0.51). Comparable results were obtained for pharmacokinetics.

Conclusions:  These results confirm a linear dose–response relationship of IDet, without any relevant differences between ethnic groups. This suggests that similar dosing recommendation can be used for IDet in type 2 diabetic patients belonging to different ethnic group.
Inhaled insulin as adjunctive therapy in subjects with type 2 diabetes failing oral agents: a controlled proof‐of‐concept study
Authors: Hausmann M. , Dellweg S. , Osborn C. , Heinemann L. , Buchwald A. , Rosskamp R. , Genova P. , Heise T.
Published: September 2006

Aim:  This controlled proof‐of‐concept study investigated inhaled insulin (INH) as adjunctive therapy to existing oral antidiabetic agents in subjects with type 2 diabetes.

Methods:  Twenty‐four subjects with type 2 diabetes [19 men and 5 women, 56.1 ± 6.6 years, body mass index 32.7 ± 4.2 kg/m2, glycosylated haemoglobin (HbA1c) 8.4 ± 0.8% (mean ± s.d.)] inadequately controlled by metformin and/or sulfonylureas were randomized to receive additional therapy with either INH administered preprandially using a metered‐dose inhaler (MDI), or insulin glargine (GLA) injected subcutaneously at bedtime for 4 weeks. Both inhaled and injected insulin doses were titrated to predefined blood glucose (BG) targets.

Results:  INH and GLA improved metabolic control to a similar extent. Mean daily BG decreased by 2.8 mmol/l in the INH group (p < 0.001) and by 2.4 mmol/l in the GLA group (p < 0.001). Accordingly, fasting BG (−2.7 vs. −3.6 mmol/l for INH vs. GLA), preprandial‐ and 2‐h postprandial BG, HbA1c (−1.23 vs. −1.05%), body weight (−1.9 vs. −2.3 kg) and serum fructosamine were similarly and significantly reduced in both groups (p < 0.05). Triglycerides decreased significantly with INH (−1.15 μmol/l; p < 0.001) but not with GLA [−0.52 μmol/l; not significant (NS)]. Incidence rates of adverse events did not differ significantly, and there were no indications of respiratory tract irritation.

Conclusions:  In subjects with type 2 diabetes inadequately controlled by oral agents, preprandial administration of INH delivered by a MDI provided a comparable metabolic control to bedtime GLA and did not show any safety concerns during a 4‐week treatment. These results warrant a more extensive investigation of preprandial treatment with INH in longer term studies.
Personality and Self‐Regulation: Trait and Information‐Processing Perspectives
Authors: Hoyle Rick H.
Published: September 2006

ABSTRACT
This article introduces the special issue of Journal of Personality on personality and self‐regulation. The goal of the issue is to illustrate and inspire research that integrates personality and process‐oriented accounts of self‐regulation. The article begins by discussing the trait perspective on self‐regulation—distinguishing between temperament and personality accounts—and the information‐processing perspective. Three approaches to integrating these perspectives are then presented. These range from methodological approaches, in which constructs representing the two perspectives are examined in integrated statistical models, to conceptual approaches, in which the two perspectives are unified in a holistic theoretical model of self‐regulation. The article concludes with an overview of the special issue contributions, which are organized in four sections: broad, integrative models of personality and self‐regulation; models that examine the developmental origins of self‐regulation and self‐regulatory styles; focused programs of research that concern specific aspects or applications of self‐regulation; and strategies for increasing the efficiency and effectiveness of self‐regulation.
Self‐Regulation and the Problem of Human Autonomy: Does Psychology Need Choice, Self‐Determination, and Will?
Authors: Ryan Richard M. , Deci Edward L.
Published: September 2006

ABSTRACTThe termautonomyliterally refers to regulation by the self. Its opposite,heteronomy, refers to controlled regulation, or regulation that occurs without self‐endorsement. At a time when philosophers and economists are increasingly detailing the nature of autonomy and recognizing its social and practical significance, many psychologists are questioning the reality and import of autonomy and closely related phenomena such as will, choice, and freedom. Using the framework of self‐determination theory (Ryan & Deci, 2000), we review research concerning the benefits of autonomous versus controlled regulation for goal performance, persistence, affective experience, quality of relationships, and well‐being across domains and cultures. We also address some of the controversies and terminological issues surrounding the construct of autonomy, including critiques of autonomy by biological reductionists, cultural relativists, and behaviorists. We conclude that there is a universal and cross‐developmental value to autonomous regulation when the construct is understood in an exacting way.
Phronesis and Creativity: Knowledge Work in Video Game Development
Authors: Zackariasson Peter , Styhre Alexander , Wilson Timothy L.
Published: September 2006

This article presents a study of the knowledge work involved in the development of video games. The success of these games is based on the ability to create a sense of immersion for the gamers. In the case presented here, dedicated gamers were also preferred when hiring personnel to develop the games. Speaking about the know‐how of this specific group in terms of phronesis, the detailed and practical understanding of a particular field, enables an understanding of the idiosyncratic competence of this group and its importance for the development process. The video game development process is also structured to enable an open‐ended process under the continuous influence of the gamers. The article concludes that innovative and creative work needs to be able to exploit a variety of competencies and that the notion of phronesis has to date been relatively under‐theorized and therefore deserves more detailed attention.
Graphical Models for Composable Finite Markov Processes
Authors: DIDELEZ VANESSA
Published: September 2006

Abstract. Composable Markov processes were introduced by Schweder (1970) in order to capture the idea that a process can be composed of different components where some of these only depend on a subset of the other components. Here we propose a graphical representation of this kind of dependence which has been called ‘local dependence’. It is shown that the graph allows to read off further independencies characterizing the underlying Markov process. Also, some standard methods for inference are adapted to exploit the graphical representation, e.g. for testing local independence.
Development and data for UK versions of an author and title recognition test for adults
Authors: Masterson Jackie , Hayes Maureen
Published: September 2006

Author and book title recognition tests have been used extensively in reading‐related research with both children and adults. The present paper reports the development of a book title and author recognition test and data from a UK sample of adults. Higher scores were obtained on the Author test than on the Title test. It is suggested that the tests are suitable for use with the United Kingdom adult population.
Evaluating the Lyapounov Exponent and Existence of Moments for Threshold AR‐ARCH Models
Authors: Cline Daren B. H.
Published: September 2006

Abstract. We demonstrate a reliable and computationally feasible method for determining whether a given threshold autoregression autoregressive conditional heteroscedastic (AR‐ARCH) model is ergodic, and for determining which moments exist when it is ergodic. This method may be used to delineate the parameter space of the model. We show (for an order 2 model) that the parameter space is much less constrained than commonly is assumed.
Long‐Term Performance Following Rights Issues and Open Offers in the UK
Authors: Ngatuni Proches , Capstaff John , Marshall Andrew
Published: September 2006

Abstract:  This study finds evidence of significant long‐term underperformance following rights issues made during 1986‐95 in the UK. The findings are resilient to a number of methodological controls. In contrast, our results for a smaller sample of open offers made during 1991‐95 show strong positive performance over a 5‐year post‐issue period, implying that firms making open offers had better growth prospects than firms making rights issues. During 1986‐90, a period when open offers were rarely used, firms appeared to be making rights issues to exploit overvaluation. However, this was not evident for rights issues made during 1991‐95, a period when open offers were more commonly used.
Attentional capacity for processing concurrent stimuli is larger across sensory modalities than within a modality
Authors: Talsma Durk , Doty Tracy J. , Strowd Roy , Woldorff Marty G.
Published: September 2006

One finding in attention research is that visual and auditory attention mechanisms are linked together. Such a link would predict a central, amodal capacity limit in processing visual and auditory stimuli. Here we show that this is not the case. Letter streams were accompanied by asynchronously presented streams of auditory, visual, and audiovisual objects. Either the letter streams or the visual, auditory, or audiovisual parts of the object streams were attended. Attending to various aspects of the objects resulted in modulations of the letter‐stream‐elicited steady‐state evoked potentials (SSVEPs). SSVEPs were larger when auditory objects were attended than when either visual objects alone or when auditory and visual object stimuli were attended together. SSVEP amplitudes were the same in the latter conditions, indicating that attentional capacity between modalities is larger than attentional capacity within one and the same modality.
The impact of emotions on the perception of dyspnea in pediatric asthma
Authors: Von Leupoldt Andreas , Riedel Frank , Dahme Bernhard
Published: September 2006

Inadequate symptom perception is increasingly recognized as a contributing factor in asthma morbidity. Recent research has shown that psychological factors can influence the perception of asthmatic symptoms such as dyspnea, but little is known, about the impact of emotions on the perception of dyspnea in pediatric asthma. Therefore, we examined the impact of viewing affective film clips of positive, neutral, and negative valence on perceived dyspnea during resistive load breathing in children with stable mild asthma. Perceived dyspnea decreased during the positive film compared to baseline and neutral film whereas the level of respiratory loading and respiratory resistance (R5) remained unchanged across conditions. The results underline the potential impact of psychological factors such as emotions on the perception of dyspnea in children with asthma.
Long‐term streptozotocin‐induced diabetes alters prostanoid production in rat aorta and mesenteric bed
Authors: Peredo H. A. , Rodríguez R. , Susemihl M. C. , Villarreal I. , Filinger E.
Published: September 2006

1 Vascular disease is a major cause of mortality and morbidity in chronic diabetes mellitus.

2 Prostanoids, metabolites of arachidonic acid, include vasoactive substances produced and released from the vascular wall. Alterations in prostanoid production have been reported in the vasculature of diabetic humans and experimental animals.

3 The aim of the present work was to study the influence of three different periods of long‐term streptozotocin‐induced diabetes, 30, 120 and 180 days in the production of prostanoids in the thoracic aorta and in the mesenteric vascular bed of the rat. The prostanoids released to the incubation medium by the tissues were extracted and measured by reversed‐phase HPLC.

4 In the diabetic groups, body weight was reduced and glycaemia was increased when compared with the corresponding non‐diabetic controls.

5 In the aorta, 30 days of diabetes did not modify the prostanoid release pattern, meanwhile 120 and 180 days of incubation decreased prostacyclin (PGI2) production. In the mesenteric bed, at 30 days the release of the vasodilators PGI2 and prostaglandin (PGE2) and the vasoconstrictor thromboxane (TXA2) was reduced. At 120 days the vasodilators were reduced and at 180 days such reduction was joined by an increase of the release of vasoconstrictor metabolites.

6 Thirty days of diabetes did not modify the PGI2/TXA2 ratio in the aorta or mesenteric bed. On the other hand, 120 and 180 days of diabetes reduced significantly the ratio when compared with the corresponding controls.

7 In conclusion, the mesenteric bed, a resistance vascular bed, seems to be more sensitive than the aorta, a conductance vessel, to the effects of diabetes on prostanoid production. The observed effects contribute to a displacement of the balance of prostanoid release in favour of the vasoconstrictor metabolites, a phenomenon that could be related to the vascular complications of diabetes mellitus.
Selective agonists revealα1A‐ andα1B‐adrenoceptor subtypes in caudal artery of the young rat
Authors: Parés‐Hipólito J. , Gómez‐Zamudio J. H. , Gallardo‐Ortiz I. A. , López‐Guerrero J. J. , Santamaría‐Ortiz J. , Ibarra M. , Villalobos‐Molina R.
Published: September 2006

1 Multipleα1‐adrenoceptors were evaluated in caudal artery of the young Wistar rat using selective agonists and antagonists.

2 Arteries were exposed to the selectiveα1A‐adrenoceptor agonist, A‐61603 (N‐[5‐(4,5‐dihydro‐1H‐imidazol‐2‐yl)‐2‐hydroxy‐5,6,7,8‐tetrahydronaphthalen‐1‐yl] methanesulfonamide) or to phenylephrine and to prazosin (α1‐adrenoceptor antagonist), or the selectiveα1A‐adrenoceptor antagonists 5‐methylurapidil, RS 100329 (5‐methyl‐3‐[3‐[4‐[2‐(2,2,2,‐trifluoroethoxy)phenyl]‐1‐piperazinyl]propyl]‐2,4‐(1H)‐pyrimidinedione), RS 17053 (N‐[2(2‐cyclopropylmethoxy) ethyl]‐5‐chloro‐α,α‐dimethyl‐1H‐indole‐3‐ethanamide), and the selectiveα1D‐adrenoceptor antagonist BMY 7378 (8‐[2‐[4‐(2‐methoxyphenyl)‐1‐piperazinyl]ethyl]‐8‐azaspiro[4.5] decane‐7,9‐dione).

3 Results showed a 100‐fold higher potency of A‐61603 for theα1‐adrenoceptor present in the artery, compared with phenylephrine. Prazosin displaced both agonists with high affinity, whereas 5‐methylurapidil, RS 100329 and RS 17053 displaced A‐61603 with high affinity, indicating the presence ofα1A‐adrenoceptors.

4 The selectiveα1A‐adrenoceptor antagonists blocked phenylephrine responses with low affinity, suggesting that phenylephrine activated a second receptor population in caudal artery.

5 BMY 7378 antagonized with low affinity both A‐61603 and phenylephrine‐induced contractions, indicating absence ofα1D‐adrenoceptors in the vessel.

6 The results suggest that functionalα1B‐adrenoceptors are present in caudal arteries of the young Wistar rat.
Pulmonary blood volume and transit time in cirrhosis: relation to lung function
Authors: Møller Søren , Burchardt Hans , Øgard Christina G. , Schiødt Frank V. , Lund Jens O.
Published: September 2006

Abstract: Background/Aims: In cirrhosis a systemic vasodilatation leads to an abnormal distribution of the blood volume with a contracted central blood volume. In addition, the patients have a ventilation/perfusion imbalance with a low diffusing capacity. As the size of the pulmonary blood volume (PBV) has not been determined separately we assessed PBV and pulmonary transit time (PTT) in relation to lung function in patients with cirrhosis and in controls.

Methods: Pulmonary and cardiac haemodynamics and transit times were determined by radionuclide techniques in 22 patients with alcoholic cirrhosis and in 12 controls. The lung function including diffusing capacity for carbon monoxide (DL, CO) was determined by conventional single breath technique.

Results: In the patients, PTT was shorter, 3.9±1.2 vs 5.7±1.0 s in the controls, P<0.001, and the PBV was lower, 362±151 vs 587±263 ml, in the controls, P<0.005. Both PTT and PBV were lowest in patients with advanced disease. DL, CO was reduced in the patients and correlated significantly with PTT (r=0.58, P=0.007) and PBV (r=0.49, P<0.03).

Conclusions: The results suggest that the reduced PBV contributes to the reduced effective blood volume in cirrhosis. The relation between PBV and PTT and the low diffusing capacity suggests the pulmonary vascular compartment as an important element in the pathophysiology of the lung dysfunction in cirrhosis.
Reviews: Altered Laboratory Findings Associated with End‐Stage Renal Disease
Authors: Robitaille Robert , Lafrance Jean‐Philippe , Leblanc Martine
Published: September 2006

Several laboratory parameters can be altered in advanced renal failure. Results may be difficult to interpret and may become misleading and unreliable in such a context. On the other hand, some of the alterations may reflect real abnormalities. Thus sufficient knowledge and careful judgment are required by the clinician. We reviewed different publications related to biochemical anomalies in renal failure and report some of the main findings. The sections are divided as follows: cardiovascular risk factors and markers, inflammation markers, pancreatic and liver function tests, hormones, bone turnover indices and parathyroid hormone assays, tumor markers, carbohydrate metabolism indicators, and others. The information provided should be useful to clinicians involved in the care of renal failure patients.
The Role of Continuous Renal Replacement Therapy in the Treatment of Poisoning
Authors: Goodman Jeffrey W. , Goldfarb David S.
Published: September 2006

Extracorporeal elimination of drugs and toxins is a critical component in the management of poisonings, though specific techniques and indications remain a matter of debate. Conventional hemodialysis is frequently the treatment of choice because of its widespread availability and proven effectiveness for certain drugs and toxins. With the increased availability of continuous renal replacement therapy (CRRT) modalities, there is yet another therapeutic option, but one that has yet to find a definitive role in this field. The continuous nature of these therapies is attractive for the management of acute renal failure, but the relatively slower clearance rates as compared to conventional hemodialysis is a distinct drawback in patients with acute xenobiotic‐induced toxicity. There are abundant case reports as well as a few small case series in the medical literature documenting the use of CRRT, but specific techniques and the clinical outcomes vary considerably. Therefore one cannot draw definitive conclusions regarding benefit. Some patients, particularly those who are hemodynamically unstable and are not candidates for conventional hemodialysis, may warrant a trial of CRRT. However, at the present time, routine use for the treatment of poisoning is not supported. Controlled trials to better clarify its role would be beneficial, though such studies would be extremely difficult to conduct in this field. We believe that the intelligent application of extracorporeal modalities requires a thorough knowledge of drug pharmacokinetics, of the techniques utilized, and a skeptical analysis of the available literature.
Interventional Nephrology in a Federal Hospital: Economics of Health Care
Authors: Vachharajani Tushar J. , Atray Naveen K.
Published: September 2006

Interventional nephrology is now an accepted subspecialty of nephrology that is revolutionizing the standard of care for renal failure patients. Interventional nephrology deals with the placement of tunneled cuffed catheters (TCCs) and maintenance of permanent vascular accesses, thus assisting in timely care. Prior to 2000 most end‐stage renal disease (ESRD) patients from the Overton Brooks Veterans Affairs Medical Center (OBVAMC) were referred to an outlying hospital for TCC placement and endovascular procedures (EVPs) of permanent dialysis access. The referral process was cumbersome for the patients and expensive to the Medicine Service. OBVAMC started an interventional nephrology service in 2000. The current study reports the financial benefits of starting an interventional nephrology service at our institution. All procedures performed during the period from April 2000 to April 2004 were analyzed. The procedures were performed in the cardiac catheterization laboratory. The total payment (physician's and hospital fees) to the referral hospital for procedures prior to April 2000 was used to estimate the average savings to the Medicine Service over the last 4 years. A total of 129 TCCs and 43 EVPs were performed during this period. The estimated expense to OBVAMC would have been $603,978 for TCCs and $288,100 for EVPs based on charges prior to April 2000. The actual expense to the hospital, including facility fees and disposables, was $156,013. The net savings to OBVAMC over the last 4 years was $736,065. Interventional nephrology provided to a small population of renal failure patients in a tertiary federal health care facility has resulted in huge savings for the hospital. Increasing awareness of this procedural aspect of nephrology benefits not only the patients, but also helps ease the financial burden of ever‐escalating health care costs.
ASDIN Clinical Case Focus: Optimal Timing for Secondary Arteriovenous Fistula Creation: Devastating Effects of Delaying Conversion
Authors: Asif Arif , Leon Carlos , Merrill Donna , Ellis Renee , Bhimani Bhagwan , Pennell Phillip
Published: September 2006

A chronic hemodialysis patient was referred to interventional nephrology for evaluation of arteriovenous access dysfunction. The patient had been receiving hemodialysis using a left forearm brachiobasilic loop graft for the past 3 years. Physical examination revealed a hyperpulsatile graft. Angiography documented a critical stenosis at the vein–graft anastomosis and a well‐developed basilic vein from the elbow to the axillary region. Central veins were patent all the way to the right atrium. All attempts to navigate the wire across the stenosis failed. The patient was educated and counseled regarding the possibility of surgical creation of a secondary arteriovenous fistula (AVF). The images obtained were shared and discussed with the surgeon. A plan to create a secondary AVF using the basilic vein in the arm was made. A few months later the patient was referred to interventional nephrology, this time for thrombectomy of the same left arm loop graft. Thrombectomy could not be performed and a right internal jugular tunneled catheter was inserted. The patient again was referred to the surgeon for AVF creation. Six weeks later the patient was seen in the interventional laboratory for removal of the right internal jugular tunneled catheter. It was noted that instead of a fistula, the patient had received a right forearm brachiocephalic loop graft. Devastating consequences, such as the lost opportunity to create a fistula, insertion of a tunneled dialysis catheter, arteriovenous graft placement, exhaustion of available sites for fistula creation, and exposure to increased morbidity and mortality associated with grafts and catheters, can result if the opportunity to create a secondary AVF is not availed in a timely manner. This concept must be understood by every member of the vascular access team.
Decision‐Making Deficits in Alcohol‐Dependent Patients With and Without Comorbid Personality Disorder
Authors: Dom Geert , De Wilde Bieke , Hulstijn Wouter , Van Den Brink Wim , Sabbe Bernard
Published: September 2006

Background: Impairments in decision making are a consistent finding in substance use disorder (SUD) populations. However, decision‐making deficits are not specific for SUDs and are also reported in the context of other psychiatric disorders such as antisocial and borderline personality disorders (PDs). Given the frequent comorbidity between SUD and cluster B PD, it might be questioned whether the decision‐making impairments typically reported in SUD populations reflect the addictive disorder, the cluster B PD, or a combination of the 2.

Methods: In the current study, we compare the decision‐making performance of non–substance‐abusing controls (n=53) on the Iowa Gambling Task (IGT) with the decision‐making performance of 3 abstinent alcohol‐dependent samples, i.e., alcoholic patients without any PD (n=38), alcoholic patients with a cluster A or C PD (n=19), and alcoholic patients with a cluster B PD (n=23).

Results: Overall, all 3 alcohol‐dependent subsamples performed inferior compared with controls. Between alcoholic subsamples, the alcoholic patients with a cluster A or C PD had the highest IGT score, followed by the alcoholic patients without a PD, while the cluster B alcoholic patients were the most impaired.

Conclusion: These findings suggest that impairments in decision making underlie both alcohol dependence and cluster B PD, and alcoholic patients with a comorbid cluster B PD are particularly impaired in their decision making. These deficits may underlie the severe problems that characterize cluster B alcoholic patients specifically in inappropriate behaviors (e.g., poly substance abuse, legal, and professional dysfunction).
Individual Differences in Ethanol Self‐Administration Following Withdrawal Are Associated With Asymmetric Changes in Dopamine and Serotonin in the Medial Prefrontal Cortex and Amygdala
Authors: Carlson Jeffrey N. , Drew Stevens K.
Published: September 2006

Background: Ethanol withdrawal alters brain neurochemistry, causes asymmetric activation of neurons in the medial prefrontal cortex (mPFC) and amygdala (AMY), and increases ethanol craving and drinking. Rats with intrinsic rightward‐turning preferences drink more ethanol than those with left or no preferences; they also exhibit an ethanol‐induced neurochemical activation that favors the right side of the mPFC. Our experiments used rats with different turning preferences to assess differences in withdrawal effects on mPFC and AMY neurochemistry as well as ethanol self‐administration.

Methods and Results: Rats with left‐turning, right‐turning, and nonturning preferences were fed a 6% ethanol‐containing liquid diet (WD) or a pair‐fed control diet for 14 days. Differences in dopamine (DA), serotonin (5HT), norepinephrine (NE), and metabolite [3,4‐dihydroxphenylacetic acid, homovanillic acid (HVA), and 5‐hydroxyindoleacetic acid) concentrations were assessed in each side of the mPFC and AMY during acute withdrawal. Similar groups were fed the same diets and tested for consumption of 10% ethanol versus water and 1% sucrose versus water. WD increased HVA/DA in the mPFC and caused depletions of DA and 5HT in the mPFC and 5HT in the AMY. These effects were greater in the right than in the left side of these structures in rats with right‐turning preferences. WD reduced ethanol drinking but right turners drank significantly more than left turners on day 2 of testing and drank more on days 2 and 3 than on day 1. No effects were observed on sucrose drinking. Similar groups were also trained to self‐administer ethanol using a sucrose‐fade sipper tube procedure that separated measures of ethanol seeking (bar pressing) and consumption. Following 14 days of vapor chamber exposure to ethanol, rats of all turning preferences had a lower rate of bar pressing on the first postwithdrawal day and shorter latencies to begin bar pressing on the third withdrawal day versus prewithdrawal baseline. Only right‐turning‐preference rats consumed more ethanol following withdrawal.

Conclusions: These studies show that individual rats differ in postwithdrawal brain neurochemistry and ethanol consumption and that these differences are associated with differences in functional brain asymmetry.
Predictors of 16‐Year Mortality Among Individuals Initiating Help‐Seeking for an Alcoholic Use Disorder
Authors: Timko Christine , DeBenedetti Anna , Moos Bernice S. , Moos Rudolf H.
Published: September 2006

Background and Methods: We examined rates and predictors of mortality in individuals (47% women) who had just initiated help‐seeking for their alcohol use disorders (AUDs) at the start of the study (n=628) and were followed for 16 years.

Results: For both women and men, the observed‐to‐expected mortality ratio (1.4) was lower than rates found in samples of treated individuals with AUDs, suggesting that those initiating help‐seeking careers have better chances of long‐term survival. Of the individuals for whom cause of death was known, 68% died of alcohol‐related causes. Men were more likely to die than were women. When gender was controlled, individuals who were older and unmarried and had more alcohol dependence symptoms at baseline were more likely to die over the 16‐year period. When these baseline characteristics were controlled, better drinking outcomes at 1 year were associated with a lower likelihood of subsequent death. The combination of a shorter duration of inpatient/residential care and better drinking outcomes at 1 year was related to a lower probability of death, as was the combination of a longer duration of outpatient care or Alcoholics Anonymous attendance and better drinking outcomes at 1 year.

Conclusions: Efforts should be made to help providers identify individuals who are not responding positively to inpatient or residential treatment and intervene to motivate participation in continuing outpatient care and community 12‐step self‐help groups to reduce the likelihood of a chronic and fatal AUD course.
Transthoracic Tissue Doppler Imaging of the Atria: A Novel Method to Determine the Atrial Fibrillation Cycle Length
Authors: DUYTSCHAEVER MATTIAS , HEYSE ALEX , DE SUTTER JOHAN , CRIJNS HARRY , GILLEBERT THIERRY , TAVERNIER RENE , TIELEMAN ROBERT
Published: September 2006

Background: The atrial fibrillation cycle length (AFCL) is a critical parameter for the perpetuation and termination of AF. In the present study, we evaluated a new method to measure the AFCL based on transthoracic tissue Doppler imaging (TDI) of the right atrium (RA) and left atrium (LA).

Methods: Twenty patients with AF (6 acute AF, 14 persistent or permanent AF) were studied. A quadripolar catheter was positioned at RA or LA to measure AFCL (AFCLEGM, gold standard). Transthoracic echocardiography (apical 4‐chamber view) was used to perform pulsed wave TDI at the free wall of RA or LA. AFCLTDI was defined as the time interval between two consecutive positive to negative crossings of the baseline of the atrial time velocity curves. AFCLEGM and AFCLTDI were measured at baseline and during a 10‐minute infusion of flecainide (1.5 mg/kg).

Results: Measurement of AFCLTDI was feasible in all but one patient. At baseline, AFCLEGM was 170 ± 22 ms, AFCLTDI 172 ± 22 ms (difference 2 ± 5 ms). AFCLTDI correlated significantly with AFCLEGM (R = 0.91, P < 0.0001). Bland‐Altman analysis showed a bias of −2 ms with a 95% limit of agreement between −26 ms and +22 ms. During flecainide, the AFCLTDI method yielded an AFCL prolongation from 176 ± 23 ms at baseline to 279 ± 68 ms (P < 0.01) after 10 minutes of infusion (57 ± 26%).

Conclusions: (1) Tissue Doppler imaging of the atria during transthoracic echocardiography can be used to reliably determine the AFCL during both acute and persistent or permanent AF. (2) Continuous measurement of AFCL with TDI can be used to monitor the effect of antiarrhythmic drugs on atrial rate during AF. (3) This novel method is attractive because of the ease of acquiring the data and its noninvasive character.
Idiopathic Ventricular Tachycardia Originating from the Posteroseptal Mitral Annulus: A Case Report
Authors: ASHIKAGA KEIICHI , TSUCHIYA TAKESHI , TASHIRO HIDEKI , YAMAMOTO KUNIHIKO
Published: September 2006

We describe a 71‐year‐old man with a ventricular tachycardia (VT) originating from the mitral annulus. A sustained VT was induced by exercise or an isoproterenol administration, but not by pacing. Frequent premature ventricular contractions (PVCs) with the same QRS as the VT were transiently suppressed by an adenosine triphosphate injection, suggesting that it was due to cyclic‐AMP mediated triggered activity. The PVCs and VT were all abolished by radiofrequency catheter ablation guided by the earliest activation and a perfect pace map, which was located at the posteroseptal mitral annulus. The patient has been free from any symptoms for 2 years.
Ghettos in Canada's cities? Racial segregation, ethnic enclaves and poverty concentration in Canadian urban areas
Authors: WALKS R. ALAN , BOURNE LARRY S.
Published: September 2006

Recent literature suggests a growing relationship between the clustering of certain visible minority groups in urban neighbourhoods and the spatial concentration of poverty in Canadian cities, raising the spectre of ghettoization. This paper examines whether urban ghettos along the U.S. model are forming in Canadian cities, using census data for 1991 and 2001 and borrowing a neighbourhood classification system specifically designed for comparing neighbourhoods in other countries to the U.S. situation. Ecological analysis is then performed in order to compare the importance of minority concentration, neighbourhood classification and housing stock attributes in improving our understanding of the spatial patterning of low‐income populations in Canadian cities in 2001. The findings suggest that ghettoization along U.S. lines is not a factor in Canadian cities and that a high degree of racial concentration is not necessarily associated with greater neighbourhood poverty. On the other hand, the concentration of apartment housing, of visible minorities in general, and of a high level of racial diversity in particular, do help in accounting for the neighbourhood patterning of low income. We suggest that these findings result as much from growing income inequality within as between each visible minority group. This increases the odds of poor visible minorities of each group ending up in the lowest‐cost, least‐desirable neighbourhoods from which they cannot afford to escape (including social housing in the inner suburbs). By contrast, wealthier members of minority groups are more mobile and able to self‐select into higher‐status ‘ethnic communities’. This research thus reinforces pleas for a more nuanced interpretation of segregation, ghettoization and neighbourhood dynamics.
Situating design in the Canadian household furniture industry
Authors: LESLIE DEBORAH , REIMER SUZANNE
Published: September 2006

This paper traces the process of design across the furniture commodity chain and argues that Canadian household furniture producers have been historically reluctant to designate resources that improve the styling of their products. They have emphasized commerce at the expense of art, and relied primarily on the United States for design inspiration. However, in recent years, a series of smaller, more innovative firms have adopted an aggressive design‐led strategy. These firms have been more likely to forge tighter relationships with retailers and designers and to exploit place‐based signifiers in the marketing and styling of their products.
Entre intégration économique et cohésion sociale: les coopératives forestières et le développement régional au Québec
Authors: GINGRAS PATRICK , CARRIER MARIO
Published: September 2006

Cet article porte sur la relation entre la mondialisation, l'innovation économique et la cohésion sociale au sein des coopératives forestières du Québec dans une perspective de développement régional. Depuis une quinzaine d'années, certaines coopératives forestières au Québec tentent d'innover dans leurs façons de gérer et de produire. Pour innover, ces coopératives s'inscrivent dans un processus de gouvernance avec l'ensemble des acteurs de l'industrie forestière dont l'État, la grande entreprise forestière et les communautés forestières. Cette nouvelle gouvernance semble non seulement permettre aux coopératives forestières d'innover, mais aussi de dynamiser leur capacitéà assurer la cohésion sociale au sein de leurs communautés d'appartenance. La gouvernance forestière apparaît donc comme une stratégie de développement régional pertinente pour les régions qui, comme les régions forestières, sont situées en périphérie et souvent économiquement dévitalisées.
Health hazards and socio‐economic status: a neighbourhood cohort approach, Vancouver, 1976–2001
Authors: BUZZELLI MICHAEL , SU JASON , LE NHU , BACHE TENNY
Published: September 2006

This paper lays the foundation for a research program concerned with the geographical patterning of environmental and population health at the urban neighbourhood scale. Based on the Vancouver metropolitan region, the aim is to better understand the role of neighbourhoods as epidemiological spaces where environmental and social characteristics combine as health processes and outcomes at the community and individual levels. With respect to procedure, this paper builds a cohort of commensurate neighbourhoods across all six census periods from 1976 to 2001, assembles neighbourhood air pollution (total particles) data, and provides an initial analysis to demonstrate how air pollution systematically and consistently maps onto neighbourhood socio‐economic markers, specifically education and family status. We conclude with a discussion of how the neighbourhood cohort can be further developed to address emergent priorities in the population and environmental health literatures, namely the need for temporally matched data, a life‐course approach and analyses that control for spatial scale effects.
Urban brownfields redevelopment in Canada: the role of local government
Authors: DE SOUSA CHRISTOPHER A.
Published: September 2006

As in many U.S. and European cities, the legacy of a negligent past has left scars on Canada's urban landscape in the form of numerous under‐used industrial and commercial brownfield sites. While governments in the U.S. and Europe have implemented a variety of policies and programs to help developers overcome the costs and risks associated with redeveloping these sites, there continues to be apprehension among stakeholders in Canada that efforts implemented by the different levels of government here have been deficient, fragmented and piecemeal in comparison. This paper examines the nature of the brownfields problem in Canadian cities and investigates the role of local governments in managing these problems ‘on the ground’. Survey data from 24 cities, coupled with information gathered from four site visitations, reveal that brownfields are indeed a problem for many cities. The data suggest that even though perceptions of what is needed to better manage the problem locally are relatively similar throughout the country, managerial efforts remain disparate and somewhat limited because of diverse provincial policies and variable property markets.
Adverse effects of fluorescein angiography in hypertensive and elderly patients
Authors: Musa Fayyaz , Muen Wisam. J. , Hancock Richard , Clark David
Published: September 2006

Purpose:  To evaluate adverse effects in patients undergoing fundus fluorescein angiography (FA), and to assess the level of these adverse effects in hypertensive and elderly patients.

Method:  We carried out a retrospective study of 358 patients undergoing FA. They were assessed for adverse effects and their relationship to medical history, pre‐ and post‐FA blood pressure and age.

Results:  The overall adverse reaction rate (AR) was 11.2%, the majority (80%) of which involved nausea. There were no mortalities and no cases of anaphylaxis or cardiac arrest. Hypertension (systolic or diastolic) did not increase the AR. Interestingly, raised initial systolic blood pressure (BP) ≥ 160 showed a statistically significant decreased AR compared with that for BP < 160 (7% versus 15%, respectively; p = 0.04). There was no statistical correlation between AR and age.

Conclusions:  FA is a relatively safe procedure, but serious side‐effects have been reported in the past and therefore adequate measures need to be in place to cope with such emergencies. In our study, there was no increase in the incidence of adverse effects in patients who were hypertensive or elderly. Therefore, these patients should not be denied an important diagnostic procedure that may improve their quality of life purely because of hypertension or age.